Endocrine system – Herbal Reality

Metabolic syndrome

Jessika Thiele — Sat, 25 Apr 2026 15:04:55 +0000

Metabolic syndrome affects one in four UK adults. This article examines its pathophysiology, clinical presentation, and evidence-based herbal and lifestyle interventions.

Understanding metabolic syndrome

Metabolic syndrome is not a single condition but rather a cluster of risk factors that when present at same time, they significantly increase the risk of type 2 diabetes, heart attacks and strokes (1). It is diagnosed when three or more of these risk factors are present in an individual: abdominal obesity, insulin resistance, hypertension and dyslipidaemia (high triglycerides and/or low HDL cholesterol) (2). Metabolic syndrome is preventable and reversible, and its primary treatment focuses on intensive lifestyle changes (3).

In the UK, approximately one in four adults meets the criteria for metabolic syndrome, making it a highly prevalent condition (4). Though often asymptomatic in early stages, metabolic syndrome reflects underlying metabolic dysfunction that, if unaddressed, can progress to chronic diseases with high morbidity and mortality (5,6).

Metabolic syndrome contributes to cardiovascular disease through cardiometabolic dysfunction, such as inflammation, oxidative stress, endothelial dysfunction and atherosclerosis (6,7). Cardiovascular disease represents the second cause of death in the UK, accounting for around 170,000 deaths each year, roughly one in four deaths nationally (8).

Metabolic syndrome is on the rise, and it is driven by sedentary lifestyles, highly processed diets, aging populations and environmental stressors (9).

How does metabolic syndrome work?

Metabolic syndrome’s pathophysiology is complex, as genetics, diet and lifestyle factors all interact to drive metabolic dysfunction (1,10). Insulin resistance and chronic low-grade inflammation are at the core metabolic syndrome (10). However, the exact mechanisms behind it are not completely understood. Some researchers emphasise insulin resistance as the main and primary causal factor, and others suggest oxidative stress, inflammation and mitochondrial dysfunction as the key drivers (10,11).

Insulin resistance and high glucose levels

Insulin resistance is a state in which the normal ability of insulin to promote glucose uptake into peripheral tissues is impaired. This means that muscles, the liver and adipose tissue respond less effectively to insulin. To compensate, the pancreas produces more insulin, leading initially to hyperinsulinemia and high glucose levels. Both insulin and glucose are pro-inflammatory. Sustained high levels of insulin and glucose in the blood, eventually lead to type 2 diabetes (12).

Adipose tissue dysfunction

Excess visceral fat, particularly around the abdomen, secretes inflammatory adipokines/cytokines and free fatty acids that exacerbate insulin resistance and promote chronic low-grade inflammation (13).

Dyslipidaemia

Elevated triglycerides and low HDL (good) cholesterol arise from disturbed lipid metabolism associated with insulin resistance. These lipid abnormalities promote inflammation of the arteries which lead to atherosclerosis (14).

Hypertension

Altered insulin signalling affects blood vessel function and sodium retention, contributing to elevated blood pressure (15). Under normal conditions, insulin promotes vasodilation by stimulating nitric oxide production in the inside of vessels (endothelium). However, when there is insulin resistance, nitric oxide production is impaired, blood vessels lose their ability to dilate effectively, and vascular stiffness increases (15).

Chronic inflammation and oxidative stress

Persistent low-grade inflammation is a key pathogenic component, linking metabolic syndrome with endothelial dysfunction and cardiovascular disease. Oxidative stress reduces nitric oxide availability, making vessels tighter, it damages endothelial cells, and promotes vascular inflammation. All of this contributes to arterial damage and atherosclerosis (11).

As the underlying mechanisms of metabolic syndrome are complex and multifactorial, treatment needs to be holistic and multidimensional, an approach to which herbal medicine is particularly well suited.

Understanding the root causes

Metabolic syndrome arises from the interaction of genetic susceptibility and lifestyle factors. Ethnicity, family history, and inherited genetic variation significantly shape an individual’s risk. For example, studies show that variants in the APOC3 gene, which encodes apolipoprotein C3, a component of triglyceride-rich lipoproteins, such as very low-density lipoproteins (VLDL), have been associated with elevated triglycerides and increased likelihood of developing metabolic syndrome (16).

However, genetic predisposition alone is rarely sufficient. Environmental triggers and lifestyle factors strongly influence whether this susceptibility is expressed. Central or visceral adiposity is one of the most influential causes. Visceral fat is metabolically active and releases adipokines and inflammatory mediators that promote insulin resistance, endothelial dysfunction, and dyslipidaemia (17).

Physical inactivity also reduces insulin sensitivity and contributes to weight gain and adverse lipid profiles. Diet plays a role in the development of some of the risk factors that constitute metabolic syndrome (17). A diet high in refined carbohydrates and added sugars increase the likelihood of developing insulin resistance and visceral fat. A diet high in saturated fats also increased the chances of developing visceral fat as well as dyslipidaemia, contributing to high triglycerides and high LDL (bad) cholesterol (18). Excess salt and sodium is linked to hypertension which is another key component of metabolic syndrome (15).

Chronic psychological stress and inadequate or disrupted sleep alter cortisol regulation, appetite signalling, and insulin pathways, contributing to the mechanisms of metabolic dysfunction and endothelial inflammation (19). Persistent systemic inflammation, as seen in long-standing conditions, such as HIV, Chagas disease and autoimmune disorders, are associated with increased chances of developing metabolic syndrome (20,21,22).

Advancing age is another risk factor that increases the susceptibility of developing it, as metabolic flexibility declines and insulin resistance becomes more common (23).

Signs and symptoms

Metabolic syndrome is often a silent condition as many people with it are asymptomatic. Metabolic syndrome is identified by a cluster of measurable cardiometabolic risk factors rather than by a distinct set of symptoms (24).

Primary clinical signs for its diagnosis

Abdominal adiposity: Increased waist circumference, men > 94 cm (> 37 inches), women > 80 cm (> 32 inches) (24). For South Asian and Chinese men >= 90 cm and women >= 80 cm. This often the most visible clinical sign (25).
Raised blood pressure: blood pressure above ≥130/85 mmHg, or current treatment for hypertension (2,23).
Elevated fasting plasma glucose: fasting glucose ≥5.6 mmol/L, or established type 2 diabetes (2,23).
Elevated triglycerides: ≥1.7 mmol/L, or treatment for raised triglycerides (2,23).
Reduced HDL cholesterol: <1.0 mmol/L in men, <1.3 mmol/L in women (2,23).

Symptoms

Tiredness
Reduced exercise tolerance
Brain fog or difficulty concentrating
Increased thirst or increased urination if persistent high glucose levels
Headaches, if high blood pressure present
Visible central weight gain (26)

Herbs for metabolic syndrome

The herbal approach should be comprehensive to address all aspects of metabolic syndrome. Herbalists focus on reducing abdominal fat tissue, improving blood pressure, improving the lipid profile by reducing triglycerides and increasing HDL, and improving insulin resistance (27).

Liquorice (Glycyrrhiza glabra)

Reducing abdominal and visceral adiposity is central to improving the overall metabolic picture. Coleus (Coleus forskohlii) is traditionally used to support weight and fat loss, with actions linked to modulation of cyclic AMP and lipolysis (27). Liquorice (Glycyrrhiza glabra) can also play a supportive role in body fat reduction, though caution is required with long term use in individuals with hypertension (28).

The constituent berberine from Berberis species has strong clinical support for metabolic syndrome. A recent systematic review and meta-analysis of randomized placebo-controlled trials concluded that berberine improves components of metabolic syndrome, including glucose metabolism, triglycerides, lipid profiles and waist circumference, while improving insulin signalling and reducing inflammation (29). Berberine has also been shown to have antihypertensive properties and endothelial protection, being able to relax blood vessels (30). Examples of berberine containing plants include barberry (Berberis vulgaris) and Oregon grape (Mahonia aquifolium).

Improving insulin sensitivity and glycaemic control is another fundamental aspect of the treatment strategy. Gymnema (Gymnema sylvestre) is particularly suited where sugar cravings and diabetes are present, helping to regulate glucose metabolism and reduce sweet taste perception (27,31,32). Goat’s rue (Galega officinalis), the plant from which metformin was synthesised, can also be used alongside gymnema as it has glucose lowering actions and it lowers insulin resistance (33). Fenugreek (Trigonella foenum-graecum) and ginseng (Panax ginseng) offer additional support for glycaemic control and insulin sensitivity (33,34).

Berberine again has a central role here due to its insulin-sensitising and anti-inflammatory effects (35,36). Curcumin from turmeric (Curcuma longa) is supported by randomized clinical evidence and systematic reviews showing improvements in insulin sensitivity and dyslipidaemia particularly in metabolic syndrome (37,38). Its ability to modulate inflammatory cytokines and improve endothelial function is especially relevant given the inflammatory component of insulin resistance and metabolic syndrome.

Hepatic support is often required, especially where fatty liver or elevated gamma-glutamyl transferase (GGT) are present. Milk thistle (Silybum marianum) has hepatoprotective properties, which makes it beneficial in cases of non-alcoholic fatty liver disease and raised liver enzymes, particularly when these coexist with metabolic syndrome (27).

A meta-analysis showed that milk thistle supplementation can reduce total cholesterol and LDL, reduce triglycerides and improve glucose metabolism (39). In a clinical trial in people with type 2 diabetes, silymarin at 140 mg three times daily for 45 days reduced triglycerides and LDL, increased HDL, lowered total cholesterol and decreased fasting blood glucose levels and serum insulin (40).

Globe artichoke (Cynara scolymus)

Addressing the lipid profile directly, by reducing triglycerides and increasing HDL, can also be supported with garlic (Allium sativum) and artichoke (Cynara scolymus) (27,41,42). Garlic has demonstrated lipid-lowering and modest antihypertensive effects in clinical studies, likely mediated through nitric oxide modulation and antioxidant activity (41,43). Both artichoke and chicory extracts have been associated with improved cholesterol and triglyceride parameters, alongside digestive support that may further benefit metabolic regulation (42).

Green tea (Camellia sinensis) can lower total cholesterol and LDL (44). Green tea contributes cardiometabolic support through antioxidant and metabolic effects. These herbs, together with Berberis species can contribute to an improvement of triglycerides and HDL balance.

Where hypertension is present, hawthorn (Crataegus spp.), yarrow (Achillea millefolium) and limeflower (Tilia spp.) can be considered to support vascular tone (27). These all have a vasodilatory effect, helping bring down blood pressure. They work best in combination. The use of hawthorn has been supported by clinical evidence. A recent meta-analysis showed that hawthorn significantly reduces blood pressure.

Hawthorn contains flavonoids that improve vascular endothelial function, reduce inflammation, and increase nitric oxide-mediated vasodilation (45). Garlic again can offer an additional benefit through modest blood pressure reduction.

Given the strong link between chronic stress, cortisol dysregulation and central fat deposition, stress management is important. The use of nervines can be relevant depending on the individual presentation.

Holistic solutions

Clinical trials consistently show that weight reduction through dietary change and physical activity significantly improves all core components of metabolic syndrome — waist circumference, blood pressure, fasting glucose and lipid profile (18, 46). A Mediterranean diet containing vegetables, legumes, whole grains, good-quality olive oil, nuts and seeds has strong evidence improving insulin sensitivity and lowering inflammation (46). A calorie restricted low glycaemic load (GL) diet with good fibres has also been proposed as beneficial to improve insulin sensitivity, glucose levels and decrease abdominal fat (27).

Regular movement is just as important (17). Regular moderate-to-vigorous exercise improves insulin sensitivity independent of weight loss and reduces visceral adiposity. This could be brisk walking, cycling, swimming or strength training, for example (17).

Stress and sleep are often underestimated drivers of metabolic imbalance. Ongoing stress and poor-quality sleep disrupt cortisol cycles, appetite regulation and glucose control, making it harder for the body to maintain metabolic stability (19). Therefore, stress reduction activities and optimal sleep hygiene are equally fundamental.

References

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Angouti F, Nourafcan H, Saeedi Sar S, Assadi A, Ebrahimi R. Optimizing antidiabetic properties of Galega officinalis extract: investigating the effects of foliar application of chitosan and salicylic acid. Food Sci Nutr. 2024;12(8):5844-5857.
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Mohammadi S, Asbaghi O, Afrisham R, et al. Impacts of supplementation with silymarin on cardiovascular risk factors: a systematic review and dose–response meta-analysis. Antioxidants (Basel). 2024;13(4):390. https//doi.org/10.3390/antiox13040390
Ebrahimpour-Koujan S, Gargari BP, Mobasseri M, Valizadeh H, Asghari-Jafarabadi M. Lower glycemic indices and lipid profile among type 2 diabetes mellitus patients who received novel dose of Silybum marianum (L.) Gaertn. (silymarin) extract supplement: a triple-blinded randomized controlled clinical trial. Phytomedicine. 2018;44:39-44. https://doi.org/10.1016/j.phymed.2018.03.050
Du Y, Zhou H, Zha W. Garlic consumption can reduce the risk of dyslipidemia: a meta-analysis of randomized controlled trials. J Health Popul Nutr. 2024;43(1):113.
Shahinfar H, Bazshahi E, Amini MR, et al. Effects of artichoke leaf extract supplementation or artichoke juice consumption on lipid profile: a systematic review and dose-response meta-analysis of randomized controlled trials. Phytother Res. 2021;35(12):6607-6623.
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Xu R, Yang K, Li S, Dai M, Chen G. Effect of green tea consumption on blood lipids: a systematic review and meta-analysis of randomized controlled trials. Nutr J. 2020;19(1):48. https://doi.org/10.1186/s12937-020-00557-5
Szikora Z, Mátyus RO, Szabó BV, Csupor D, Tóth B. Hawthorn (Crataegus spp.) clinically significantly reduces blood pressure in hypertension: a meta-analysis of randomized placebo-controlled clinical trials. Pharmaceuticals (Basel). 2025;18(7):1027.
Castro-Barquero S, Ruiz-León AM, Sierra-Pérez M, Estruch R, Casas R. Dietary strategies for metabolic syndrome: a comprehensive review. Nutrients. 2020;12(10):2983. https://doi.org/10.3390/nu12102983

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Myrrh

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Dill

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Chai hu

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Self-heal

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Fu ling

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Bladderwrack

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Jasmine

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Cat’s claw

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Clary sage

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Gymnema

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Mulberry

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Codonopsis

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Black walnut

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Bugleweed

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Blackberry

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Goat’s rue

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Overactive thyroid

Jessika Thiele — Sun, 01 Dec 2024 16:32:57 +0000

Overactive thyroid, or hyperthyroidism, is a condition characterised by an increase in metabolism, affecting heart rate, weight, energy and a myriad of other symptoms.

Understanding hyperthyroidism

Hyperthyroidism, commonly known as an overactive thyroid, is a condition in which the thyroid gland produces excessive amounts of thyroid hormones (1). These hormones, primarily thyroxine (T4) and triiodothyronine (T3), play a crucial role in regulating metabolism, heart rate, energy levels, and temperature. When thyroid hormone levels are too high, it accelerates metabolic processes throughout the body, affecting various systems (1).

In the UK, hyperthyroidism has a notable prevalence, with people assigned female at birth being disproportionately affected. Approximately 2% of people assigned female at birth and 0.2% of people assigned male at birth in the UK experience hyperthyroidism at some point in their lives (2,3). The majority of cases are due to Graves’ disease, an autoimmune disorder accounting for 60–80% of cases, which predominantly affects people assigned female at birth between the ages of 30 and 60 (1,2). Other causes include toxic multinodular goitre and thyroiditis, but these are less common (1). Hyperthyroidism is also relatively rare in children, affecting only 1–2 per 10,000 (4).

How does hyperthyroidism work?

Hyperthyroidism primarily results from excessive production or release of T4 and T3 hormones from the thyroid gland, driven by dysfunction within the hypothalamic-pituitary-thyroid (HPT) axis (1). Under normal circumstances, the hypothalamus produces thyrotropin-releasing hormone (TRH), which stimulates the anterior pituitary to release thyroid-stimulating hormone (TSH). TSH then acts on the thyroid gland, promoting the production and release of T4 and T3. These hormones regulate the basal metabolic rate and impact nearly every organ system (1).

In hyperthyroidism, elevated levels of T4 and T3 override the negative feedback loop, causing TSH levels to fall, but this fails to inhibit thyroid hormone production. The imbalance results in excessive energy production, rapid metabolism, and enhanced sympathetic nervous system activity, often manifesting in symptoms such as increased heart rate, tremors, weight loss, increased sweating and anxiety (1). Thyroid-stimulating antibodies also play a role in certain cases, as seen in autoimmune conditions like Graves’ disease (4).

Understanding the root causes

Overactive thyroid can develop from several underlying causes, with the most common ones including:

Graves’ disease

This autoimmune disorder is the leading cause of hyperthyroidism. In Graves’ disease, the immune system produces thyroid-stimulating immunoglobulins (TSIs) that mimic TSH, stimulating the thyroid gland to produce excess hormones. TSIs are not regulated by the typical feedback mechanisms, which leads to sustained hyperthyroidism. Graves’ disease may also cause Graves’ ophthalmopathy, an eye-related complication seen in some patients (4).

Toxic nodular goitre and thyroid adenomas

This condition involves nodules in the thyroid that autonomously produce thyroid hormones, independent of TSH regulation. These “toxic” nodules lead to overproduction of thyroid hormones, especially in individuals with a history of iodine deficiency. This form of hyperthyroidism is more common in older adults and in regions with iodine deficiency (4,5).

Thyroiditis

Thyroiditis is an inflammation of the thyroid gland that can cause a temporary release of stored thyroid hormones, resulting in transient hyperthyroidism. This condition may follow a viral infection (subacute thyroiditis), autoimmune (Hashimoto’s thyroiditis in its initial stages) or can occur in some people after childbirth (postpartum thyroiditis) (6,7).

Excess iodine

High iodine intake can lead to an overproduction of thyroid hormones, particularly in individuals with underlying thyroid dysfunction. Sources of excess iodine may include dietary supplements, iodine-rich foods, and certain medications, such as amiodarone (used to treat heart arrhythmias) (8).

Thyroid hormone medication overuse

Excessive intake of thyroid hormone medication, typically in treating hypothyroidism, can cause hyperthyroidism if not carefully monitored (9).

Pituitary adenoma

Rarely, a benign tumour in the pituitary gland may secrete excessive TSH, overstimulating the thyroid and causing hyperthyroidism (2).

Signs and symptoms

The symptoms of overactive thyroid are varied, reflecting the hormone’s widespread influence over the body’s metabolism and organ systems (1,5). Common symptoms include:

Weight loss: Despite a normal or sometimes increased appetite, individuals often lose weight due to a high metabolic rate.
Increased heart rate and palpitations: Elevated T3 and T4 levels can lead to tachycardia, arrhythmias and palpitations. When the heart is affected, it can be dangerous and it is important to seek help.
Anxiety and irritability: Excessive thyroid hormones increase sympathetic activity, causing nervousness, restlessness, and anxiety.
Heat intolerance and excessive sweating: Increased metabolic activity raises body temperature, leading to intolerance to heat, frequent sweating and moist, warm skin.
Tremors: Fine hand tremors are common due to an overstimulation of the nervous system.
Fatigue and muscle weakness: People with an overactive thyroid can also experience fatigue. Although metabolism is high, muscles may weaken over time due to increased energy demands.
Menstrual irregularities: People with an uterus may experience changes in menstrual cycles, with lighter or less frequent periods.
Goitre: Enlargement of the thyroid gland is sometimes present in overactive thyroids, particularly in Graves’ disease.
Exophthalmos: In Graves’ disease, inflammation and swelling around the eyes can cause them to protrude, a condition known as exophthalmos.

Herbal solutions

Rehmannia (Rehmannia glutinosa)

Conventional medical treatments for hyperthyroidism include antithyroid drugs like carbimazole, radioactive iodine therapy, or surgery to remove part or the whole thyroid gland in severe cases (5,10). Herbal medicine offers support in managing hyperthyroid symptoms by addressing symptoms, modulating immune function, and helping regulate thyroid activity (11,12).

It is important to consult a professional herbalist who can advise on the most appropriate herbs to take, and how to take them. It is important not to leave an overactive thyroid untreated as it could lead to serious complications and organ damage (13). A herbalist could also advise whether herbal medicine could support you and refer you to appropriate medical care if needed.

The following herbs have shown promise in studies or traditional use for their effects on thyroid function and related symptoms:

Gypsywort (Lycopus europaeus)

Gypsywort, aslo known as bugleweed, has been traditionally used to help people with an overactive thyroid, with Grave’s disease particularly with cardiac involvement (11,12). It is one of the most widely studied herbs for hyperthyroidism. It appears to inhibit the binding of TSH to thyroid cells, reducing hormone production, as well as preventing the conversion of T4 to the more active T3. It also contains lithospermic acid, which is thought to reduce the production of thyroid-stimulating immunoglobulins, which suggests gyspywort can be helpful in Grave’s disease. Studies have shown that bugleweed can effectively alleviate mild symptoms of hyperthyroidism and may be especially helpful in cases of subclinical hyperthyroidism (14,15).

Gypsywort is contraindicated during pregnancy and lactation and also in patients with hypothyroidism (11). It is also important to avoid this herb concurrently with the drug thyroxine (11).

Motherwort (Leonurus cardiaca)

Motherwort for its calming effects on the heart, motherwort can alleviate heart palpitations and tachycardia associated with hyperthyroidism (11,16). Its anxiolytic properties also make it beneficial for the anxiety and irritability often experienced with this condition. The German Commission E recommends its use for nervous cardiac disorders and as adjuvant for hyperthyroidism (16).

Lemon balm (Melissa officinalis)

Lemon balm has been traditionally used to reduce anxiety and promote relaxation (11). This herb also has mild anti-thyroid effects, potentially by interfering with TSH receptor binding. TSH activity was inhibited through direct binding TSH hormone and also by indirect binding to TSH-receptor sites (17).

Studies have shown that lemon balm can help in reducing the anxiety, restlessness, and insomnia commonly seen in hyperthyroidism (18,19). This makes lemon balm a good therapeutic option for those with overactive thyroid symptoms.

Rehmannia (Rehmannia glutinosa)

Rehmannia is a medicinal plant used in traditional Chinese medicine It supports the adrenal glands and modulates immune function, which can be useful in autoimmune hyperthyroidism (Graves’ disease). It is generally used in combination with other herbs in formulas to manage thyroid and immune function holistically (20,21).

Reishi mushroom (Ganoderma lucidum)

Reishi is well-known as an adaptogen supporting the adrenal glands in periods of stress. Reishi helps modulate the immune system, which can be beneficial in autoimmune hyperthyroidism such as Graves’ disease. Reishi also has anti-inflammatory properties that can reduce thyroid gland inflammation and stress-related symptoms (22).

Holistic solutions

Holistic approaches are essential for managing hyperthyroidism as they target the body’s overall balance, reduce stress, and improve lifestyle factors that can exacerbate symptoms. Some beneficial lifestyle and holistic interventions include:

Diet and nutrition

A balanced diet that includes antioxidants, vitamins, and minerals can support thyroid health. Foods rich in antioxidants (such as berries and leafy greens) help with oxidative stress, and selenium- and zinc-rich foods (such as Brazil nuts and seafood) are essential for thyroid function and immune balance (23). Reducing iodine intake is also advised, if excessive iodine consumption has contributed to an overactive thyroid (25). Avoiding stimulants such as caffeine is also important, not to further stimulate the sympathetic nervous system and to reduce palpitations and anxiety.

Stress management

Chronic stress exacerbates hyperthyroid symptoms by increasing sympathetic nervous system activity. Practicing mindfulness, meditation, or yoga can reduce stress and potentially mitigate symptoms like anxiety, palpitations, and irritability.

Adequate rest

Sleep is crucial for managing the heightened metabolic demands of hyperthyroidism. Ensuring good sleep hygiene and aiming for 7–9 hours of sleep per night can help reduce fatigue and improve recovery.

Exercise

Gentle, regular exercise is beneficial for maintaining muscle tone and promoting relaxation without overstressing the cardiovascular system. Activities like walking, yoga, and swimming can help reduce stress, improve energy levels, and support cardiovascular health.

Acupuncture

Acupuncture may help in regulating the HPT axis and the body’s stress response, making it potentially helpful in managing symptoms of hyperthyroidism. Some studies suggest acupuncture may have a regulatory effect on thyroid function, which supports acupuncture’s role as an adjuvant approach to supporting people with an overactive thyroid (26).

References

Chaker L, Razvi S, Bensenor IM, Azizi F, Pearce EN, Peeters RP. Hypothyroidism (primer). Nat Rev Dis Primers. 2022;8(1).
Taylor PN, Albrecht D, Scholz A, et al. Global epidemiology of hyperthyroidism and hypothyroidism. Nat Rev Endocrinol. 2018;14(5):301-316.
Weetman AP. Graves’ disease. N Engl J Med. 2000;343(17):1236-1248.
Léger J, Carel JC. Hyperthyroidism in childhood: Causes, when and how to treat. J Clin Res Pediatr Endocrinol. 2013;5(Suppl 1):50.
Kravets I. Hyperthyroidism: Diagnosis and treatment. Am Fam Physician. 2016;93(5):363-370.
Bindra A, Braunstein GD. Thyroiditis. Am Fam Physician. 2006;73(10):1769-1776.
Sweeney LB, Stewart C, Gaitonde DY. Thyroiditis: An integrated approach. Am Fam Physician. 2014;90(6):389-396.
Roti E, Uberti ED. Iodine excess and hyperthyroidism. Thyroid. 2001;11(5):493-500.
Ross DS. Subclinical hyperthyroidism: Possible danger of overzealous thyroxine replacement therapy. Mayo Clin Proc. 1988;63(12):1223-1229.
Vasileiou M, Gilbert J, Fishburn S, Boelaert K. Thyroid disease assessment and management: Summary of NICE guidance. BMJ. 2020;368.
Fisher C. Materia Medica of Western Herbs. Aeon Books; 2018.
Bone K, Mills S. Principles and Practice of Phytotherapy: Modern Herbal Medicine. Elsevier Health Sciences; 2012.
Lee SY, Pearce EN. Hyperthyroidism: A review. JAMA. 2023;330(15):1472-1483.
Guttuso T, et al. Lycopus europaeus in hyperthyroidism management: Clinical evidence and mechanisms. J Herbal Med. 2021.
Beer AM, Wiebelitz KR, Schmidt-Gayk H. Lycopus europaeus (Gypsywort): Effects on the thyroidal parameters and symptoms associated with thyroid function. Phytomedicine. 2008;15(1-2):16-22.
Fierascu RC, Fierascu I, Ortan A, et al. Leonurus cardiaca L. as a source of bioactive compounds: An update of the European Medicines Agency assessment report (2010). Biomed Res Int. 2019;2019(1):4303215.
Santini F, Vitti P, Ceccarini G, et al. In vitro assay of thyroid disruptors affecting TSH-stimulated adenylate cyclase activity. J Endocrinol Invest. 2003;26:950-955.
Cases J, Ibarra A, Feuillère N, Roller M, Sukkar SG. Pilot trial of Melissa officinalis L. leaf extract in the treatment of volunteers suffering from mild-to-moderate anxiety disorders and sleep disturbances. Mediterr J Nutr Metab. 2011;4(3):211-218.
Ghazizadeh J, Sadigh-Eteghad S, Marx W, et al. The effects of lemon balm (Melissa officinalis L.) on depression and anxiety in clinical trials: A systematic review and meta-analysis. Phytother Res. 2021;35(12):6690-6705.
He Q, Dong H, Gong M, et al. New therapeutic horizon of Graves’ hyperthyroidism: Treatment regimens based on immunology and ingredients from traditional Chinese medicine. Front Pharmacol. 2022;13:862831.
Dharmananda S. Treatments for thyroid diseases with Chinese herbal medicine. ITM. 1996.
Bhardwaj N, Katyal P, Sharma AK. Suppression of inflammatory and allergic responses by pharmacologically potent fungus Ganoderma lucidum. Recent Pat Inflamm Allergy Drug Discov. 2014;8(2):104-117.
Aihara K, Nishi Y, Hatano S, et al. Zinc, copper, manganese, and selenium metabolism in thyroid disease. Am J Clin Nutr. 1984;40(1):26-35.
Chen Z, et al. Acupuncture and its effects on the hypothalamic-pituitary-thyroid.
Dunn JT, Semigran MJ, Delange F. The prevention and management of iodine-induced hyperthyroidism and its cardiac features. Thyroid. 1998;8(1):101-106.
Cheng FK. An overview of the contribution of acupuncture to thyroid disorders. J Integr Med. 2018;16(6):375-383.

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Underactive thyroid

Jessika Thiele — Sun, 01 Dec 2024 16:06:28 +0000

Underactive thyroid, or hypothyroidism, often manifests as sluggishness, fatigue, headaches and weight gain, owing to the decreased rate of metabolism.

Understanding underactive thyroid

Hypothyroidism, also referred to as an underactive thyroid, is a condition in which the thyroid gland does not produce adequate levels of thyroid hormones, leading to a reduction in metabolic activity (1). Thyroid hormones, primarily thyroxine (T4) and triiodothyronine (T3), play a key role in regulating various bodily processes, including metabolism, heart rate, and temperature. When these hormones are too low, physiological functions slow down, affecting various organ systems (1).

Hypothyroidism affects approximately 2–5% of the UK population, with higher prevalence in people assigned female at birth and older adults. Subclinical hypothyroidism (mild thyroid dysfunction seen in blood tests without overt symptoms) is estimated to affect 4–10% of the population, depending on the studied population and diagnostic thresholds. Incidence rates in the UK range from 2.3 to 4.1 per 1,000 individuals annually (2).

People assigned female at birth are affected significantly more, with a female-to-male ratio of approximately 5:1 (3). The risk of developing an underactive thyroid also appears to increase after menopause.

Hypothyroidism is often associated with other autoimmune disorders, including type 1 diabetes, rheumatoid arthritis, and pernicious anaemia. There is also an increased risk of cardiovascular disease and raised cholesterol in untreated hypothyroidism (1).

How does hypothyroidism work?

Thyroid hormones are regulated through the hypothalamic-pituitary-thyroid (HPT) axis. The hypothalamus releases thyrotropin-releasing hormone (TRH), which stimulates the anterior pituitary gland to produce thyroid-stimulating hormone (TSH). TSH then targets the thyroid gland, increasing the production of thyroid hormones (T3 and T4). T3 is the active form of thyroid hormone, whereas T4 is primarily a precursor (1).

Hypothyroidism occurs when the production of T3 and T4 is insufficient to meet physiological needs, usually due to inadequate TSH stimulation, a failure of the thyroid gland to produce hormones, or impaired conversion of T4 to the more active T3 (1).

When the body senses a deficiency in thyroid hormones, the hypothalamus secretes thyrotropin-releasing hormone (TRH), stimulating the pituitary gland to release more TSH. In an underactive thyroid, TSH levels often become elevated as the body attempts to stimulate the thyroid to produce more hormones. This is the first sign that can be detected in a blood test. In cases of primary hypothyroidism (e.g. Hashimoto’s, iodine deficiency) the thyroid gland fails to respond effectively, resulting in low T3 and T4 levels (1).

This hormonal deficiency leads to a decrease in basal metabolic rate, accumulation of glycosaminoglycans in tissues (causing characteristic signs such as myxoedema), and impaired thermoregulation. These changes contribute to a spectrum of clinical symptoms affecting almost every organ system (4).

Understanding the root causes

Hypothyroidism can develop from several underlying causes, with the most common ones including:

Hashimoto’s thyroiditis

Hashimoto’s thyroiditis, an autoimmune disorder, is the leading cause of hypothyroidism in middle- and high-income countries. The body’s immune system mistakenly attacks the thyroid gland, leading to inflammation of the gland and reduced hormone production (1).

Iodine deficiency

Iodine is a critical component of thyroid hormone synthesis. A deficiency, more common in regions of the world where iodine-rich foods or iodised salt are scarce, leads to impaired hormone production (1,5).

Medications and medical treatment

Certain medications, such as lithium or the antiarrhythmic amiodarone, can inhibit thyroid function. Additionally, treatments like radioactive iodine therapy or thyroid surgery for hyperthyroidism or cancer can result in hypothyroidism (1)

Congenital hypothyroidism

Some individuals are born with an underdeveloped or absent thyroid gland, leading to lifelong hormone deficiencies (5).

Stress and environmental toxins

Chronic stress and exposure to endocrine disruptors, such as heavy metals or pesticides, can impair thyroid function over time and cause underactive thyroid (6).

Signs and symptoms

The signs and symptoms of an underactive thyroid depend on the severity and duration of hormone deficiency, but they can include the following (1,4,5):

Metabolic symptoms:

Tiredness, fatigue, sleeplessness, weakness
Difficulty losing weight
Cold intolerance and lower core temperature. This happens when impaired thermoregulation leads to an increased sensitivity to cold

Nervous system symptoms:

Depression and mental sluggishness. Cognitive functions and mood are affected, leading to memory problems, poor concentration, and depression.
Difficulty concentrating, forgetfulness, brain fog
Headaches or migraines

Dermatological signs and symptoms:

Dry, flaky skin and hair loss. The skin becomes dry and coarse, and hair may thin or fall out due to slowed cellular turnover.
Myxoedema: this involves the accumulation of glycosaminoglycans causing puffiness in the face and extremities.
Slower wound healing

Cardiorespiratory signs and symptoms:

Lower respiration rate; difficulty breathing

Elimination system symptoms:

Slower gastrointestinal motility commonly results in constipation.
Sluggish liver metabolism
Sluggish lymphatic function

Gynaecological signs and symptoms:

Reduced fertility and difficulty conceiving
Menstrual irregularities and amenorrhea

Herbal solutions

Conventional treatment for underactive thyroid involves taking levothyroxine (also called thyroxine, which is synthetic T4).

The most commonly used medicinal plant is bladderwrack, also known as kelp. Other herbs that have been shown to improve thyroid activity are ashwagandha, myrrh and black cumin. Herbs and mushrooms that increase stamina and improve cognitive function and brain fog can also be useful as part of a formula, for example gotu kola, liquorice or bacopa (7,8,9).

Brahmi (Bacopa monnieri)

Ashwagandha (Withania somnifera)

Ashwagandha is an adaptogenic herb known for its ability to modulate stress and support adrenal function, which is closely linked to thyroid health. Some research suggests that ashwagandha may help normalise thyroid hormone levels, specifically by stimulating the production of thyroid hormones (10). It has been shown in some studies to increase serum levels of T3 and T4, potentially helping people with subclinical hypothyroidism (7).

Its adaptogenic properties may reduce cortisol levels, as high cortisol can negatively affect thyroid hormone conversion and production (9).

Small human studies indicate a potential improvement in TSH and T4 levels in those with mild hypothyroidism when taking ashwagandha supplements (11).

Black cumin (Nigella sativa)

Black cumin has anti-inflammatory, antibacterial and gastroprotective effects. It has also been associated with reductions in body weight, body mass index (BMI), and improvements in lipid profiles, such as increased HDL (good cholesterol) and decreased LDL (bad cholesterol) and triglycerides in patients with Hashimoto’s (12,13).

Clinical research shows that black cumin supplementation can reduce thyroid-stimulating hormone (TSH) levels while increasing T3 and T4 levels (7,14). It has also been effective in lowering anti-thyroid peroxidase (anti-TPO) antibodies, which are markers of autoimmune thyroid damage in Hashimoto’s thyroiditis (14). These changes suggest improved thyroid function and reduced autoimmunity after supplementation with black cumin.

Bladderwrack (Fucus vesiculosus)

Bladderwrack or kelp is a mucilaginous seaweed that contains a high concentration of iodine (15). Iodine is a key mineral in the synthesis of thyroid hormones, and bladderwrack supports thyroid function by supplying this mineral. Bladderwrack is, therefore, used in cases of hypothyroidism where iodine deficiency is suspected (8).

Bladderwrack also contains other minerals, polyphenols and polysaccharides (8). These compounds have anti-inflammatory properties, which can benefit those with autoimmune hypothyroidism (Hashimoto’s thyroiditis) (9). Bladderwrack has also been traditionally used to decrease inflammation and pain in rheumatoid arthritis and other types of rheumatism (8, 9).

While iodine is essential for thyroid function, excess iodine can exacerbate hypothyroidism or lead to hyperthyroidism, particularly in people with autoimmune thyroid disease (8, 16). Therefore, bladderwrack should be used cautiously and under the advice of a professional herbalist to prevent iodine overload.

This seaweed is contraindicated in hyperthyroidism and when there is sensitivity to iodine. It is also contraindicated with the drugs carbimazole (drug used in hyperthyroidism), amiodarone and lithium, and it should be used with caution when taken concomitantly with thyroxine (8, 16). Bladderwrack should be avoided during pregnancy and lactation, and it is important to get TSH levels monitored if taken long term.

Guggul or Myrrh (Commiphora mukul)

Myrrh is derived from the resin of the Commiphora mukul tree, and it is used in Ayurvedic medicine for various conditions, including to support metabolism and thyroid function (17). Guggulsterone, an active compound in myrrh, can stimulate thyroid function by increasing iodine uptake and the activity of enzymes that convert T4 to T3 (18). This resin can help alleviate symptoms associated with hypothyroidism, such as weight gain and sluggish metabolism, due to its potential effects on fat metabolism (17).

Commiphora mukul is at risk from overharvesting and habitat loss, so its use is not recommended for this reason.

Holistic solutions

Diet

Iodine is essential for thyroid hormone synthesis (1). It can be found in iodised salt or seaweed. Too much iodine is not recommended though, excessive intake can exacerbate autoimmunity in Hashimoto’s. Selenium also supports thyroid function and reduces anti-TPO antibodies (1,18). It is found in Brazil nuts, seafood, and eggs. Zinc is another micronutrient that is critical for converting T4 to active T3 (20). It is found in pumpkin seeds, nuts, and legumes. An anti-inflammatory diet rich in dark green leafy vegetables, fruits, omega-3 fats, and lean proteins can reduce systemic inflammation and help in autoimmune thyroiditis (21). Avoiding gluten can sometimes be helpful as it can mimic thyroid tissue and exacerbate autoimmune reactions in some. A trial elimination diet can help identify a sensitivity (22,23).

Stress reduction

Chronic stress impairs thyroid function by elevating cortisol, which inhibits TSH production and T4 conversion. Techniques like yoga, meditation, and mindfulness can be helpful to reduce stress levels. Low-intensity exercises like walking and swimming can invigorate the metabolism and reduce inflammation without stressing the body (24,25).

Acupuncture

A systematic review and meta-analysis found that acupuncture can alleviate clinical symptoms in patients with Hashimoto’s thyroiditis, support thyroid function regulation, and significantly improve overall quality life of people with an underactive thyroid (26).

References

Chaker L, Razvi S, Bensenor IM, Azizi F, Pearce EN, Peeters RP. Hypothyroidism. Nat Rev Dis Primers. 2022;8(1).
Thyroid UK. Hypothyroidism. Published 2024. Accessed at: https://thyroiduk.org/if-you-are-hypothyroid/about-hypothyroidism/overview-of-hypothyroidism/#:~:text=The%20prevalence%20of%20hypothyroidism%20is,is%20much%20higher%20than%20this.&text=Subclinical%20hypothyroidism%20is%20found%20in,women%20and%20increases%20with%20age.
Castello R, Caputo M. Thyroid diseases and gender. J Sex-Gender-Specif Med. 2019;5(3):136-141.
NHS. Underactive thyroid. Published 2021. Accessed at: https://www.nhs.uk/conditions/underactive-thyroid-hypothyroidism/symptoms/.
Zamwar UM, Muneshwar KN. Epidemiology, types, causes, clinical presentation, diagnosis, and treatment of hypothyroidism. Cureus. 2023;15(9).
Pearce EN, Braverman LE. Environmental pollutants and the thyroid. Best Pract Res Clin Endocrinol Metab. 2009;23(6):801-813.
Javidi N, Khorasani ZM, Salari R, Niroumand S, Yousefi M. Achievements in hypothyroidism treatment with herbal medicine: A systematic review of randomized controlled trials. Curr Drug Discov Technol. 2023;20(5):1-9.
Fisher C. Materia Medica of Western Herbs. Aeon Books; 2018.
Bone K, Mills S. Principles and Practice of Phytotherapy: Modern Herbal Medicine. Elsevier Health Sciences; 2012.
Chetheer ZS, Ibraheem AA. Effect of Withania somnifera supplement on thyroid gland hormones, body weight, body temperature, and thyroglobulin in male rabbits induced with hypothyroidism. Adv Anim Vet Sci. 2024;12(12):2557-2563.
Sharma AK, Basu I, Singh S. Efficacy and safety of ashwagandha root extract in subclinical hypothyroid patients: A double-blind, randomized placebo-controlled trial. J Altern Complement Med. 2018;24(3):243-248.
Farhangi MA, Dehghan P, Tajmiri S. Powdered black cumin seeds strongly improve serum lipids, atherogenic index of plasma, and modulate anthropometric features in patients with Hashimoto’s thyroiditis. Lipids Health Dis. 2018;17:1-7.
Javidi N, Salari R, Niroumand S, Yousefi M. Investigation of the effect of a herbal composition based on blackseed on patients with primary hypothyroidism: A randomized controlled trial. Avicenna J Phytomed. 2024;14(3).
Tekieh MF, Esfahanian F, Emadi F, Gholami M, Emaratkar E. Effect of Nigella sativa on thyroid function in patients with hypothyroidism treated with levothyroxine: A triple-blind randomized controlled trial. Med Sci. 2019;23:606-614.
Küpper FC. Iodine in seaweeds—Two centuries of research. Springer Handbook of Marine Biotechnology. 2015:591-596.
Arbaizar B, Llorca J. Fucus vesiculosus induced hyperthyroidism in a patient undergoing concomitant treatment with lithium. Actas Esp Psiquiatr. 2011;39(6):401-403.
Stansbury J, Saunders P, Winston D. Promoting healthy thyroid function with iodine, bladderwrack, guggul, and iris. J Restor Med. 2012;1(1):83-90.
Tripathi YB, Malhotra OP, Tripathi SN. Thyroid-stimulating action of Z-guggulsterone obtained from Commiphora mukul. Planta Med. 1984;50(1):78-80.
Köhrle J. Selenium and the thyroid. Curr Opin Endocrinol Diabetes Obes. 2015;22(5):392-401.
Beserra JB, Morais JBS, Severo JS, et al. Relation between zinc and thyroid hormones in humans: A systematic review. Biol Trace Elem Res. 2021;199:4092-4100.
Ruggeri RM, Barbalace MC, Croce L, et al. Autoimmune thyroid disorders: The Mediterranean diet as a protective choice. Nutrients. 2023;15(18):3953.
Ihnatowicz P, Wator P, Drywien ME. The importance of gluten exclusion in the management of Hashimoto’s thyroiditis. Ann Agric Environ Med. 2021;28(4).
Mezzomo TR, Nadal J. Effect of nutrients and dietary substances on thyroid function and hypothyroidism. Demetra: Food Nutr Health. 2016;11(2):427-444.
Mizokami T, Wu Li A, El-Kaissi S, Wall JR. Stress and thyroid autoimmunity. Thyroid. 2004;14(12):1047-1055.
Baishya A, Metri K. Effects of yoga on hypothyroidism: A systematic review. J Ayurveda Integr Med. 2024;15(2):100891.
Wang X, Li Y, Xie H, et al. Effect of acupuncture on Hashimoto thyroiditis: A systematic review and meta-analysis. Medicine. 2024;103(9):e37326.

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Violets

Jessika Thiele — Mon, 11 Nov 2024 16:55:21 +0000

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Iris

Jessika Thiele — Sun, 01 Sep 2024 14:23:59 +0000

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Irish moss

Jessika Thiele — Wed, 14 Aug 2024 09:31:29 +0000

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Aniseed

Jessika Thiele — Fri, 26 Jul 2024 08:25:16 +0000

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Rose geranium

Jessika Thiele — Wed, 26 Jun 2024 08:27:28 +0000

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Milk thistle

Jessika Thiele — Wed, 27 Dec 2023 11:37:22 +0000

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Mugwort

Jessika Thiele — Sat, 16 Dec 2023 19:12:23 +0000

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Marjoram

Jessika Thiele — Wed, 04 Oct 2023 11:08:03 +0000

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Schisandra

Jessika Thiele — Sat, 03 Dec 2022 15:25:38 +0000

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Hormonal health: Stress and immunity

Jessika Thiele — Tue, 18 Oct 2022 13:31:32 +0000

We explore hormonal health for men and women. We find out how hormonal health works and how to treat hormonal imbalances.

Understanding hormonal health and the HPA axis

We often hear the words ‘hormonal health’ associated with the female reproductive system. However, hormones are in fact messengers within the endocrine system (the body’s hormonal system), which affect all genders (although some hormones have more specific roles within the male and female reproductive systems).

The endocrine system works closely with the nervous system and together they coordinate the regulation of all the body systems and functions (1), including metabolism, energy levels, and reproductive, cardiovascular and digestive systems.

Through a series of feedback mechanisms, hormones help to keep health in balance or in a state of homeostasis, and the reproductive system relies particularly on this intricate balance of hormones to function properly. Many factors can impact these feedback mechanisms which stimulate or suppress the production and release of hormones, and subsequently affect the function of the organs they are delivering messages to. Stress is one of the major factors affecting this. The HPA axis is an important mechanism central to stress responses and hormone balance. In particular, it affects stress hormones, and sex hormones (which relate to the reproductive system).

Stress is the term used to describe a “state of threatened homeostasis or disharmony” (2). This article will focus on stress and the HPA axis, and how this network creates changes to hormonal health through the interrelationship and dialogue between the nervous system, endocrine system, and reproductive system. This article will also offer advice on how to restore balance.

How do hormone health and the HPA axis work?

The HPA axis refers to a signalling system between three organs within the endocrine system: the hypothalamus, pituitary, and adrenal glands. The function of the HPA axis is to optimize performance according to circadian, environmental, and physiological demands (1). It is a natural response system of the body which allows us to adapt to stress by redirecting energy resources to meet real or anticipated demands (3).

The HPA axis is also an important mechanism in hormone health and balance. In response to the stimulus of stress, a cascade of hormonal messengers is released throughout the neuro-endocrine system which the HPA axis traverses. The production and release of steroid hormones are the end result of this cascade, but not the end of the response, which can continue through a series of negative feedback loops. Inappropriate or prolonged HPA axis activation is energetically costly, results in hormone imbalances, and if left unchecked is linked with numerous physiological and psychological disease states (3).

Cortisol is the main ‘stress hormone’ at the end of the cascade in the HPA axis, and it is released from the adrenal cortex into the bloodstream where it travels to effector sites in the body to carry out its function and make relevant physiological changes so that the body can deal effectively with the stress. This includes making more glucose available as an energy source to deal with the demands of stress and prepare the body for ‘fight or flight’ (4). Levels of cortisol circulating in the blood initiate negative feedback loops in the HPA axis, which can activate or suppress the further release of the hormones which then stimulate the release of more cortisol. In a healthy state levels of stress hormones are kept in balance through these negative feedback loops, and once the stress has passed the levels of cortisol will reduce, allowing a return to a state of homeostasis or healthy balance (5).

Adrenaline stimulates changes associated with this ‘stress response’ in the sympathetic branch of the autonomic nervous system. This activates the ‘fight or flight’ mode as blood is redirected from the organs to the skeletal muscles, heart rate increases and blood pressure rises, all preparing us physiologically to battle or run. In a healthy state it is natural to fluctuate between this sympathetic ‘fight and flight’ mode, and the parasympathetic ‘rest and digest’ mode of the autonomic nervous system.

Androgens are another hormone released by the adrenal glands as a result of HPA axis stimulation. These are termed male sex hormones because they contribute to the development of male features in men during puberty (5). They play less of a vital role in overall body functions compared to cortisol, but are important in the function of the reproductive system. In females they are a stimulus for libido, and when in excess androgens can contribute to the development of more masculine physical features, and cause disruptions in the female reproductive cycle.

Hormones which control the female reproductive cycle are also regulated by feedback loops between oestrogen levels, the hypothalamus, and the pituitary gland. Some of these hormones are also affected by the HPA axis, luteinising hormone (LH) secreted by the pituitary gland is one of them. The secretion of LH is stimulated by a decrease in oestrogen levels which naturally occurs during the first half of the menstrual cycle. This decrease in oestrogen levels is detected by the hypothalamus, which then sends gonadotropic-releasing hormone (GnRH) to the pituitary gland, which usually at the mid-cycle point prompts a surge in LH and oestrogen, as well as another hormone called follicle-stimulating hormone (FSH). It is this surge of LH and FSH together which initiates ovulation (6).

Stress and reproductive hormone health are closely linked when we consider that androgens are one of the end products of the HPA axis. Androgens are also converted to another sex hormone called oestrone. Increases in oestrone levels circulating in the blood stimulate excess production of LH, which can disrupt the natural hormone fluctuations in the female menstrual cycle and subsequently fertility (5). When LH levels are in excess this triggers the release of more androgens from the ovaries (6), and can result in something called androgen excess, which is often found in women with reproductive health issues such as polycystic ovarian syndrome (PCOS) and infertility.

The table below shows these hormones and their actions in the body.

Where produced/secreted	Name of hormone	Main action	Affected by	Other notes
Hypothalamus	GnRH (gonadotropic-releasing hormone)	Stimulates LH & FSH production in the pituitary gland
	CRH (corticotropin releasing hormone)	Activates CRH receptors, stimulates ACTH release (7) in the pituitary gland	Stress activates release of CRH	CRH is the central regulator of the HPA axis (7)
Pituitary	ACTH (adrenocorticotropic hormone)	Regulates production of steroid hormones (cortisol and androgens) (8) in the ACTH receptors of the adrenal cortex	CRH
	LH (luteinising hormone)	Triggers release of androgens from ovaries	GnRH (6)
	FSH (follicle stimulating hormone)		GnRH (6)
Adrenal	Glucocorticoids (mainly cortisol)	Stimulates the production of glucose (gluconeogenesis). Provides resistance to stress, dampens inflammation, depresses immune responses (5)	ACTH
	Androgens	Converted to oestrone* androgens have a masculinising effect in females (5)	ACTH	*rising levels of oestrone stimulates further production of LH

Understanding the root

Dysfunction of the stress response and HPA axis is extremely common nowadays (9). The fast-pace of modern life, and the pressure to be constantly doing or achieving something, creates a sense of mental stress for many people a lot of the time. We are almost always stimulated externally through television, social media, the news and other media during waking hours. Oftentimes they are used as a distraction from other stressors, or to ‘relax’, when in fact physiologically it is putting more stress on our nervous systems.

In addition to the everyday stressors of modern life which impact the HPA axis, the lifestyle accompanying this is far more sedentary than ever before. This has consequences, as exercise and movement is fundamental for managing stress and balancing hormones. In addition, the modern Western diet is typically far removed from a whole-food diet, often consisting of over-consumption of food, highly processed with many artificial ingredients, and an excess of refined carbohydrates. This type of diet is not only nutritionally deficient lacking the basic nutrients required for the body to repair and heal itself, but also presents additional stress on the body’s systems to process such food. This contributes to blood sugar highs and lows which in turn affect HPA axis function and hormone health (9).

There is a tendency within modern society to be living far from the natural rhythms of life which support our health and reduce the feeling of stress. These include being physically active, spending time outdoors in nature, being connected with a supportive community, and spending time with loved ones, all of which help to keep our body systems in greater harmony. The lack of this combined with the modern stressful lifestyle is a recipe for dysfunction of the HPA-axis and the systems it regulates, such as hormone health.

The circadian rhythm is one example. The circadian rhythm is linked to the day-night and waking-sleeping cycles, and it is partially governed by levels of cortisol, which naturally spike in the morning and drop at night, to ensure energy for daytime activity and a restful state for sleeping at night. This natural rhythm is intrinsically linked with the HPA axis. Lack of sleep is common in modern society, as sleep is often not prioritised over getting more done, meaning that our circadian rhythms become disrupted. Additionally, over-stimulation of the HPA axis (which can be triggered by lack of sleep or other causes), can lead to sleep problems due to disharmony in the natural variations of cortisol levels (9). This can have a knock-on effect causing imbalances in sex hormones and reproductive health.

Other factors affecting the HPA axis can include trauma of a physical nature (which can include accidents, injury, surgery, over-training or excessive exercise), and emotional trauma from stressful life events. Our perceptions of stress are also a big factor, which often come from the subconscious mind or unmanaged stress in the body. Whilst we may not consciously think we are stressed, we may be holding onto tension in our bodies or have aspects of our subconscious which mean we are more reactive to difficult situations (9).

Whatever the root source (which is likely to be from a combination of factors), prolonged activation of the stress response can lead to over-activation of the HPA axis which can mean that over time the body becomes less responsive to the effects of cortisol and the feedback loops stop working so well. This leads to constantly elevated levels of stress hormones and adrenaline (another hormone released from the adrenal gland as part of HPA axis stimulation) (5). This can often be accompanied by the feeling of being ‘tired and wired’ a lot of the time. If this continues there is eventually a deficiency in cortisol, and feeling exhausted. This is sometimes referred to as ‘adrenal fatigue’ or ‘burnout’.

As is made evident, hormonal balance is complex, and multifaceted. There are herbs which can help to rebalance reproductive hormones via the HPA axis, but it is essential that stress is managed holistically too. Herbal support can be provided to restore and nourish the adrenal glands, nervous and endocrine systems and improve the body’s resilience to stress.

Signs and symptoms

The list of symptoms may be very different from one person to another, but common symptoms include (9):

Wake up tired, or feeling fatigued throughout the day
Cognitive issues such as “brain fog”
Trouble falling asleep
Lower tolerance to stress, irritability, short temper
Weight gain, especially in the midsection
A weak immune system, getting sick more often
Hair loss in women
Low libido in men (80% of DHEA is produced by the adrenals and is involved in arousal)

Herbal solutions

There are many disorders associated with imbalances in the HPA axis and endocrine system. It is important to see a medical professional if you are struggling to manage stress or think you may have a medical condition.

Herbal solutions (except in acute conditions) usually work with the body’s natural healing potential, giving it a nudge towards working harmoniously. This means the body can function as it is designed to, within a healthy state of homeostasis. In the case of hormones and the HPA-axis, this is just what herbs are aiming to do, to give a nudge and ‘modulate’ rather than stimulate or suppress hormone levels.

Adaptogens

These are herbs which increase the body’s capacity to deal with stress. Adaptogens are usually given by herbalists because they seem to re-regulate disharmonies in the neuroendocrine and immune systems, helping to normalise and enhance their function (10). Adaptogens work well to regulate the HPA axis.

Ashwagandha plant (Withania somnifera)

Ashwagandha

Ashwagandha is a tonic and calming adaptogen that enhances endocrine function, particularly in re-regulating the thyroid, testes and adrenals. It is effective for fatigue, and cloudy thinking, stress-induced insomnia, and nervous exhaustion (10).

Siberian ginseng

Siberian ginseng is a mild adaptogen that strengthens the immune system, increases endurance and stamina, and speeds up recovery from excessive training. It can also help prevent immune depletion which is often caused by stress. It can enhance athletic performance, improve alertness and cognitive function when under severe stress or working long hours. It also helps to improve the quality of sleep and prevent night-time waking. It can rarely be over-stimulating for sensitive people (10).

Gotu kola

Gotu kola is helpful for poor memory, anxiety, mental fatigue and irritability. Some evidence shows it can possibly prevent the increase of cortisol and adrenaline levels (10).

Rhodiola

Rhodiola is cooling and so unlikely to cause over-stimulation, it is beneficial for the nervous system, helping to reduce fatigue, enhance alertness, and improve memory. It also helps balance blood sugar levels, enhance male and female reproductive function, and can help to relieve amenorrhoea and infertility caused by minor hormone imbalances (10). However due to its surge in popularity it is now an endangered species, and so one must be very careful when sourcing this medicine.

Shatavari

Shatavari is helpful for relieving minor hormonal imbalances that prevent pregnancy in women, and in cases of fatigue (10).

Reishi

Reishi is a mild adaptogenic fungi with effects which are cumulative, including improving adrenocortical function and relieving stress (10).

Licorice

Licorice is an adaptogen and adrenal tonic. Adrenal tonics help to improve the tone and function of the adrenal gland (11). Licorice benefits the HPA axis function, and helps to relieve symptoms of adrenal insufficiency such as fatigue, tiredness on waking in the morning, elevated cortisol and blood sugar levels (10). Adrenal tonics are particularly useful after prolonged periods of stress.

Holistic solutions

Diet

Blood sugar levels are closely linked to stress responses, and when we feel stressed or tired, we are more likely to let healthy eating habits slip. Eating a balanced diet will help to keep blood sugar levels balanced, maintain energy levels, and provide vital nutrients to allow sufficient energy production and healing to take place. Cinnamon is also useful for balancing blood sugar levels, as is going for a short walk after meals.

General guidelines:

Eat plenty of wholefoods (wholegrains, vegetables and fruit, pulses and legumes, nuts and seeds)
Ensure you get enough protein (this is vital for most processes in the body, including repair and energy production). Things like meat, fish, eggs are ideal sources of protein.
Eat less processed foods and refined carbohydrates (pre-packed / ready-made foods, foods with added white sugar)

Manage stress

Find out which things that trigger stress for you can be changed, and for those which can’t try to find strategies and other support which will help you to manage them. We all have different things that ground us and make us feel relaxed, from dancing to cooking. Make room for these nourishing activities so you can recalibrate and find balance consistently.

Learn to relax

This may sound obvious but in fact many of us have lost the art of relaxation, and feel we need to be doing something all the time. Relaxation can be deeply healing. Tension builds up in the body and must be removed for more ease. Consciously cultivating calm means when we do have inevitable stressful situations, our health and wellbeing are kept in good balance.

An example of a relaxation practise is Yoga Nidra, which is a form of guided relaxation referred to as ‘Yogic sleep’. In Yoga Nidra such relaxation can happen that one reaches the space between the waking and sleeping world, and the conscious and subconscious mind. This provides deep relaxation and helps to reset behaviours bringing more harmony into day-to-day life. This can be particularly helpful in altering our subconscious responses to stress.

Time in nature

Contact with nature is well established as reducing stress (12). Daily if possible!

Meditation

Give time to pause, reflect, and calm the mind.

Breathing

Our breath rate can be altered by HPA axis stimulation. For example, when one is stressed, our breath becomes shallow and only really goes as far down as the chest. This is when we are in the sympathetic or “fight or flight” state, and breathing this way is sure to activate that part of our nervous system. The opposite can also be true, and we can help to activate the parasympathetic (rest and digest) branch of the autonomic nervous system just by slowing our breath rate down so that the exhale becomes longer than the inhale.

Also, importantly when we breathe down into our bellies rather than chests this supports the shift into a more relaxed state. There are many techniques which can help with this such as 7:11 breathing, and also some pranayama practices from Yoga traditions such as deep breathing (Yogic breathing), anulom vilom and bhramari. These can all be helpful in slowing the breath rate down and resetting the autonomic nervous system.

References

Spencer RL, Deak T. A users guide to HPA axis research. Physiology & Behavior. 2017;178(1):43-65. https://doi.org/10.1016/j.physbeh.2016.11.014.
Guillams TG & Edwards L. Chronic Stress and the HPA Axis: Clinical Assessment and Therapeutic Considerations. The Standard. 2010;9(2). https://www.pointinstitute.org/wp-content/uploads/2012/10/standard_v_9.2_hpa_axis.pdf.
Herman JP, McKlveen JM, Ghosal S, et al. Regulation of the Hypothalamic-Pituitary-Adrenocortical Stress Response. Compr Physiol. 2016;6(2):603-621. doi:10.1002/cphy.c150015.
Fulford AJ & Harbuz MS. An introduction to the HPA axis. Techniques in the Behavioral and Neural Sciences. 2005;15(1);43-65. https://doi.org/10.1016/S0921-0709(05)80006-9.
Tortora G & Derrickson B. Principles of Anatomy and Physiology. 13^th Ed. Asia: John Wiley and Sons; 2011.
Tricky R, Women, Hormones and the Menstrual Cycle. 2nd ed. Canberra, Australia: Griffin Press; 2003.
Slominski A. On the role of the corticotropin-releasing hormone signalling system in the aetiology of inflammatory skin disorders. Br J Dermatol. 2009;160(2):229-232. doi:10.1111/j.1365-2133.2008.08958.x
Allen MJ & Sharma S. Physiology, Adrenocorticotropic Hormone (ACTH) [Updated 2021 Aug 17]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK500031/
Patel D. HPA Axis Dysfunction Explained: The Facts You Need to Know. Functional Medicine. https://webfmd.com/hpa-axis-dysfunction/. Published 2019. Accessed October 09, 2022.
Winston D, Maimes S. Adaptogens, Herbs for strength, Stamina, and Stress Relief. Rochester, Vermont.: Healing Arts Press; 2007.
Bone K, Mills S. Principles And Practice Of Phytotherapy. China: Churchill Livingstone Elsevier; 2000.
Hunter MC, Gillespie BW, Yu-Pu SC. Urban Nature Experiences Reduce Stress in the Context of Daily Life Based on Salivary Biomarkers. Frontiers in Psychology 10;2019. DOI=10.3389/fpsyg.2019.00722.

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Hormonal health: An Ayurvedic perspective

Jessika Thiele — Tue, 27 Sep 2022 19:08:44 +0000

Both women and men are affected by the hormone system, also known as the endocrine system. We find out more how hormonal health works.

Understanding hormonal health

The word “hormone” often conjures up negative images for women’s menstrual health, but it isn’t just women who are affected by the hormone system (also called the endocrine system). Hormonal balance for men is important too. This article focuses more so on stress hormones, the HPA axis and the nervous system.

Ayurveda takes a holistic approach considering the whole body, mind and spirit understanding that good health arises through balance of the doshas, dhatus (tissues) and strotas (channels) rather than focussing on individual organs or glands as modern science does.

In classical Ayurveda, the organs and glands do have names with locations but as their health is dependent on the correct metabolic functioning of the dhatu and not independent of, they are considered part of the dhatu (2).

How does hormonal health work in Ayurveda?

The doshas

According to Ayurveda, everything in the universe is composed five elements, ether, air, fire, water and earth. There are three primary life forces derived from the five elements that are responsible for all physical and psychological functions in the body and mind. These are known as the three doshas, vata, pitta and kapha (7).

Vata is closely related to prana (vital energy) and governs all movement. Pitta governs digestion, transformation and metabolism. Kapha controls anabolism and is the energy of building and lubrication that provides the structure to the physical form (2).

Everyone is born with their unique mix of doshas called prakriti which needs to be kept in balance to remain well and healthy. (2)

Each of the three doshas also has five sub-doshas which all carry out a more specialised role of the dosha function. For example, vata controls movement so its five sub-doshas will all control one particular type of movement. Pitta’s five sub-doshas control different types of transformation and kapha’s sub-doshas control different types of lubrication (2).

Dosha	Elements	Responsibility
Vata	Air and water	Coordination and movement, governs nervous function, hormone function, anything that moves in the body including the other two doshas.
Pitta	Fire and water	Transformation and all chemical and metabolic functions giving the body heat, ability to digest, assimilate and transform things.
Kapha	Water and earth	Cohesion so provides structure, support, stability and lubrication.

Table 1 (2)

Agni (digestive fire)

Ayurveda recognises that we are not what we eat, but what we are able to digest and absorb. If agni is weak then food cannot be properly digested and may ferment in the gut leading to the accumulation of ama (toxins). If agni is too strong it can burn the dhatu (tissue) resulting in dhatu degeneration (2).

The digestive fire in the gut is called Jatharagni. This transforms and breaks down food into a nourishing essence called ahara rasa. This essence is used to build the first dhatu, rasa dhatu (plasma and lymph). Each dhatu has its own agni (dhatu-agni) that works at a cellular level refining the essence and passing it on to the next dhatu. This process is repeated though all seven dhatus with the essence becoming more refined and potent. The last dhatu, shukra dhatu (reproductive fluids), produces ojas (vital essence/immunity) which then moves back through all the dhatus to nourish all the levels of the body. If Jatharagni or dhatu-agni is impaired then the dhatus will be low quality and ojas will also be low. The quality of the dhatus is also reflected in the strotas, organs and glands as these are built and maintained by the dhatu (2).

In modern science hormones are chemical messengers. In Ayurveda chemical messengers are the dhatu-agni (cellular fire) categorized into groups by function, such as digestion or reproduction (2).

Strotas (channels of circulation)

The body contains innumerable channels called strotas that are both visible and invisible. These are a network of collective systems that are the means of circulation and communication between the body, mind and metabolic functions. They provide the pathways for physical substances and emotions to travel and for waste to be removed. Strotas are built and maintained by the dhatu (2).

For proper functioning of a healthy body, endocrine system and hormones, the strotas must be open to allow free circulation of nutrients and other essential substances. If the strotas are blocked then the circulating substances accumulate in the channels affecting interrupting cellular communication, metabolism of the dhatu, preventing waste removal and forming ama (7).

Doshas and the endocrine system

From a modern science perceptive, the endocrine system deals with chemical communication within the body by way of hormones. It works closely with the nervous system. The endocrine glands communicate through the nervous system to coordinate the release of messenger hormones to control digestion, tense or relax muscles or regulate blood flow among other things (4). In Ayurveda, the nervous system and much of the hormonal function is controlled by vata (movement). Pitta is responsible for metabolism and transformation within the body, so controls the endocrine glands and hormones responsible for metabolism (3).

The inter-relatedness between the hypothalamus, pituitary and adrenal glands is referred to as the hypothalamus-pituitary-adrenal axis or HPA axis (4). The HPA axis plays an important role in how the body reacts to chronic stress. Besides regulating the stress response the HPA axis helps to maintain basal and stress-related homeostasis of the cardiovascular, immune, metabolic and central nervous systems. Disruption of the HPA axis is at the core of most health issues. For example, when the HPA axis is strong, a woman can often breeze through menopause, but if the HPA axis is depleted and overworked then menopause can be very difficult (4).

The hypothalamus collects information regarding the body’s internal wellbeing and regulates the secretion of hormones from the pituitary. It is part of the brain that activates, controls and regulates the autonomic nervous system, endocrine processes and many functions in the body including body temperature, hunger, thirst, sleep and sexual function (4). In Ayurveda, vata (movement) and pitta (transformation) control the hypothalamus (3).

The pituitary gland releases hormones that govern many vital processes. It receives information from the hypothalamus and other endocrine glands via a complex feedback system. In Ayurveda, the pituitary is also controlled by both vata and pitta (3).

The adrenal glands function closely with the nervous system so are primarily controlled by vata. Kapha controls the adrenal roles in kidney and water metabolism, and pitta is also present through the adrenal role in general metabolic balance. The importance of the adrenals is demonstrated by all three doshas playing a role (3).

The pineal gland produces melatonin and serotonin which are known to interact with the adrenals, thyroid, testes and ovaries. Ayurveda considers a major function of the pineal gland is linking the physical and subtle bodies (etheric, emotional and mental). Vata’s sub dosha, prana vayu controls the pineal (3).

Pitta controls the thyroid as it is responsible for basic metabolic function within the body. The parathyroid regulates levels of calcium and phosphorus in the blood and is also controlled by pitta.

The thymus is known to play a role in growth and immune function. In Ayurveda, the thymus is related to kapha and to ojas. It is also related to vata’s sub-dosha vyana vayu which controls balance within the body. (3)

The pancreas is unique in that it is both an endocrine and exocrine gland. In Ayurveda, it is primarily a kapha gland but is also influenced by pitta as the pancreas secretes digestive enzymes (2).

The testes and ovaries are both primarily kapha organs with a known relation to the immunological function and the shukra dhatu (reproductive tissues) which creates ojas (vital essence) (3).

Understanding the root

Dosha imbalance

Modern life is very fast. People are constantly in a state of stress from rushing around, trying to meet tight work deadlines, juggling childcare, social lives and trying to do as much as possible often because of fear of missing out. Modern technology makes it increasingly difficult to switch off and contributes to feelings of being disconnected. Sleep quality also suffers from staying up late or indulging in distractions (social media, films, TV, alcohol) rather than relaxation (self-care) in the evenings (8).

All of these things aggravate vata dosha which governs the endocrine and nervous system. Vitiated vata can cause problems to arise such as anxiety, foggy mind, irregular sleep, digestive issues. Although all three doshas are involved in the functioning of the HPA axis and the rest of the endocrine system, pitta and kapha are unable to move without vata. When vata is vitiated, it can then cause pitta and kapha to also become imbalanced. Imbalances in any of the doshas can cause hormonal disorders (2).

Agni and ama

Imbalanced agni can result from stress, imbalances within the doshas, eating ultra-processed foods or stale foods, from over-eating, eating in front of devices, eating when not hungry or eating late at night. Food that can’t be digested can ferment in the gut resulting in ama (toxins). Ama can be moved through the body by vitiated vata where it can lodge in a weak dhatu causing degeneration and disease. If agni is compromised then the dhatu will not receive the nourishment that they need to build healthy dhatu, organs and strota (7).

Vitiated vata can move ama through the strota where it will settle in any weak dhatu resulting in disease development. If there is a disorder of one endocrine organ, just treating that organ alone will not resolve the issues as the dhatu and strota that support the organ must first be healed and brought back into balance (4).

Environmental pollutants

There are increasing numbers of chemicals, pesticides, herbicides, heavy metals and plastics ending up in our food, water and air. Many of these are endocrine disrupters which are similar to human hormones so bind to endocrine receptors either stimulating or blocking normal hormone responses. Toxins from outside the body are known as garvisha (8).

Signs and symptoms

There are many disorders of the endocrine system with varying symptoms. It is always important to consult your health care provider about any symptoms you are experiencing. Some of the common symptoms of HPA axis dysfunction are: (5)

Wake up tired, or feel fatigued throughout the day
Cognitive issues such as “brain fog”
Trouble falling asleep
Lower tolerance to stress, irritability, short temper
Weight gain, especially in the midsection
A weak immune system, getting sick more often
Hair loss in women
Low libido

Herbal solutions

Adaptogenic herbs help the body and mind adapt to stress and balance cortisol by working on the HPA axis. They have a nonspecific defensive response to stress, can increase the power of resistance against multiple stressors physical, mental, chemical, or biological stressors and have a normalising influence on the body and mind (6). Many rasayana (rejuvenative) herbs have adaptogen properties. (7).

Young Ashwagandha plant (Withania somnifera)

Ashwagandha

Most adaptogens are stimulating but Ashwagandha is a calming adaptogen. It enhances endocrine function, especially helping to re-regulate the thyroid, testes and adrenal glands. Ashwagandha is very effective for anxiety, fatigue, foggy head, stress induced insomnia and nervous exhaustion due to its nervine and adaptogen functions (5). Ashwagandha has a sweet post digestive (vipaka) taste indicating its deep nutritive and hormonal properties as well as its ability to strengthen and nourish the nervous system (4).

Brahmi

Brahmi has the ability to calm mental turbulence and is particularly good at relieving vata disorders. It increases resilience to stress, combats nervous exhaustion and is used for low thyroid function. It is cleansing and can chelate heavy metals in the bloodstream to help remove them from the body (7).

Liquorice

Liquorice has an affinity for the digestive and endocrine systems. It is a remarkable restorative and rejuvenate herb. It’s an adaptogen and strengthening tonic. Through its action on the adrenal glands, it improves resilience to physical and mental stress (6).

Amalaki

Amalaki soothes pitta helping to relieve heat, inflammation and burning throughout the body. It is cleaning and nourishing so helps to purify the blood and build dhatu tissue. Amalaki enhances digestion, absorption and helps relieve debility caused by chronic stress. It is one of the ingredients in the ayurvedic formula Triphala and the main ingredient in Chayawanprash (7).

Bala

Bala is a great tonic and rejuvenation. It is one of the best adaptogens and nourishing herbs for vata, for increasing ojas, for enhancing energy, vitality, immunity and resilience to stress. It relieves tension, anxiety, nervous exhaustion and insomnia (7).

Tulsi (Ocimum tenuiflorum)

Guduchi

Guduchi enhances immunity, longevity and energy. It helps increase resilience to physical and emotional stress, promotes brain function and eases tension. Guduchi improves digestion, absorption and liver function, it promotes good gut microbiome and clears ama from the gut and strotas (7).

Tulsi

Tulsi has an uplifting and strengthening effect on the body and mind as it increases resilience to physical and emotional stress. It also helps to improve appetite, digestion and absorption. Tulsi protects healthy cells from toxicity and clears toxins from the body through its diuretic effect (7).

Shatavari

Shatavari is a nourishing tonic considered the most important sattvic rejuvenation for women. It is cooling and helps to restore balance when the body and mind are overheated or depleted. It helps to balance female hormones. Shatavari has an affinity for the mind and helps promote mental clarity. It is calming, reduces anxiety and increases resilience to stress (7).

Gokshura

Gokshura is a good rasayana for pitta and vata. It promotes clarity, calms the nerves and relives pain. It helps enhance resilience to stress and improves energy. It also helps with the elimination of toxins due to its affinity for the kidneys and urinary system (7).

Chyavanprash

The most famous ayurvedic jam. It is used as a nutritive tonic and rejuvenate for almost any condition of weakness or as an energy tonic for all three doshas. Its building and nourishing nature helps create strength, energy and vitality. It nourishes and protects ojas. It supports the immune function and body’s natural defences with its high vitamin C content. It stimulates healthy digestion and elimination. Amalaki is the main herb but it also includes long pepper, cloves, cinnamon, ghee, sesame seed oil and many others (7).

Ayurveda and herbal medicine are customised to each individual. It is always best to seek advice from a qualified practitioner who can give correct guidance.

Holistic solutions

Prioritise good gut health (7)

When feeling tired, low or stressed it is very easy to reach for comfort foods or high energy foods which tend to be highly processed, devoid of nutrients and negatively impact agni (digestive fire). Simple changes can support agni, prevent the formation of ama and greatly assist in recovering from chronic stress, hormone imbalance, or adrenal fatigue.

Reduce packaged foods, ready-made foods and foods high in white sugar
Reduce caffeine, nicotine and alcohol
Favour freshly cooked warm foods such as soups and stews
Include lots of root vegetables as they are nourishing, grounding and balance vata
Eat in a calm environment free of electronic gadgets or devices so you fully focus on your food
Eat slowly and stop when 75% full to leave space for digestion
Don’t eat until the previous meal has been digested
Try to eat the largest meal at lunchtime when digestion is strongest
Include good fats such as ghee, coconut oil, sesame seed oil and olive oil
Include digestive spices to support agni such as ginger, cumin, fennel, coriander

Slow down

Modern life is fast paced so the thought of slowing down can feel impossible. We don’t need to say yes to every social event or schedule our time so that is it completely full of work, hobbies, social dates or classes. It is ok (and important) to make time to do absolutely nothing.

Remove any known stressors that you can. For stressors that cannot be removed, see if it is possible to change the way you react to them with mindful practices.

Turn off your mobile phone and go for a walk in nature. Taking time to observe and be present in nature is very calming. The earth and water qualities will calm vata (7).

Reduce intense exercises that increase vata e.g. HIIT, running and choose slower forms of yoga such as yin or hatha, Tai Chi or Qi Gong (3).

Quieten the mind

Pranayama is one of the most powerful and direct practices that calms the mind. Not all breathing exercises are good for everyone as some are over stimulating. Nadi shidhana (alternative nostril breathing) is a powerful and quick breathing technique that also helps to calm the mind and to balance hormones (8).

Meditation

Meditation helps to balance the mind and emotions, to quieten the endless chatter in the head and clear mental ama. Research on meditation shows that it can increase ojas, enhance our resilience to stress, reduce cortisol levels, lower blood pressure and negative emotions (8).

Daily routine

Vata is balanced through routine. Try to wake at the same time each day, to eat meals at the same time and to be in bed by 10pm. Ensure your daily routine includes time for exercise and self-care practices such as reading, enjoying a relaxing bath and oil massages (7).

Abhyanga (self love massage)

The regular practice of abhyanga calms the nervous system, balances vata, lubricates and rejuvenates the tissues, and promotes healthy circulation throughout the body. It is no coincidence that the Sanskrit word for oil, sneha, also means love. The skin is the largest organ of the body. When we cover the skin in warm oil it calms the nervous system so it is less likely to release stress hormones which in term contribute to hormonal imbalances. Sesame seed oil is good for calming vata while coconut oil is better for soothing pitta (8).

Shirodhara

Shirodhara

This is a lovely treatment which must be carried out by a qualified practitioner. Warm oil is poured on the forehead over the third eye. This treatment directly targets the central nervous system and pineal and pituitary glands causing a state of deep relaxation (7).

Nasya

Nasya is the application of herbal oils to the nasal passage. This is the best way to deliver the balancing properties of the herbs and oil to the cerebral cortex. This practice calms the mind and soothes the nasal passage, it relieves accumulated stress and supports mental clarity (7).

Prioritise sleep

Too little sleep or bad quality sleep contributes to fatigue, light headedness, lowered immunity and endocrine disorders. If lack of sleep goes on too long the adrenal glands can become exhausted. Fatigue is our body communicating that it needs rest, not caffeine or sugary food. If we ignore this signal then imbalance arises. Sleep is one of the most nourishing and restorative things so aim to be in bed by 10pm (8).

Panchakarma

Panchakarma is a deep and thorough cleanse to remove ama, garvisha and excess doshas. It is very effective at relieving deep seated diseases and for improving physical and mental health. Panchakarma must be carried out by a qualified practitioner (7).

References

Hormones: What They Are, Function & Types. Cleveland Clinic. https://my.clevelandclinic.org/health/articles/22464-hormones. Accessed September 8, 2022.
Smith, V., 2016. Anatomy and Physiology in Ayurveda Dietekon, Switzerland: EIVS Gmbh
A Artreya,.1999. Ayurvedic Healing for Woman. India. NAB Printing
Yance D. Adaptogens In Medical Herbalism. Vermont: Healing Arts Press; 2013.
Patel D. HPA Axis Dysfunction Explained: The Facts You Need to Know. Functional Medicine. https://webfmd.com/hpa-axis-dysfunction/. Published 2019. Accessed September 09, 2022.
Winston D, Maimes S. Adaptogens. New York: Inner Traditions International, Limited; 2019.
McIntyre, A., 2012. The Ayurveda bible. Alresford: Godsfield.
Welch C. Balance Your Hormones, Balance Your Life – Achieving Optimal Health And Wel. Philadelphia: De Capo Press; 2011.
Tata, Jamshed R. “One Hundred Years of Hormones.” US National Library of Medicine National Institutes of Health, U.S. National Library of Medicine, June 2005, www.ncbi.nlm.nih.gov/pmc/articles/PMC1369102/. Accessed September 8, 2022.

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Maca

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Goji berry

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Bai shao

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Black cohosh

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Saw palmetto

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Liquorice

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Agnus castus

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Baikal skullcap

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Oats

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Astragalus

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Green tea

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Arjuna

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Beetroot

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Castor

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Brahmi

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Nettle

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Motherwort

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Ashwagandha

Jessika Thiele — Wed, 01 Jul 2020 09:42:08 +0000

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Polycystic ovarian syndrome (PCOS)

Peak — Thu, 30 Apr 2020 11:06:34 +0000

Polycystic ovarian syndrome (PCOS) can involve excessive androgen production, adrenal hyperplasia, insulin resistance, weight gain, anovulation, hirsutism and acne.

Understanding PCOS

Polycystic ovary syndrome (PCOS) is one of the most common hormonal disorders in individuals assigned female at birth. It is commonly associated with infertility, as up to 72% of those with PCOS experience infertility compared to 16% of women without PCOS (1). PCOS affects between 6–21% of women of childbearing age, however less than 50% of women are properly diagnosed, therefore many individuals remain unaware of the cause of their symptoms (1,2). There are, however, tried and tested treatments to manage symptoms naturally, as well as potentially reverse the imbalance by addressing the root cause.

The three main features of polycystic ovarian syndrome (PCOS) are immature ovarian follicles resembling cysts on the ovaries, an excess of male hormones and absent or irregular periods. Although it has been a relatively under-diagnosed condition for a long time, awareness and understanding of this disorder is increasing. This is important because PCOS is associated with an increased risk for developing type 2 diabetes, mood disorders, fatty liver disease, high blood pressure, high cholesterol, high blood sugar, heart disease and metabolic syndrome amongst other issues (3,4).

Fundamentally, PCOS is as a result of a hormonal imbalance. The endocrine (hormone) system functions by a complex mechanism of hormonal messengers, and further research is required to ascertain the impact of these hormonal imbalances in individual people. PCOS is often characterised by insulin resistance, which is a key hormone responsible for the control and maintenance of optimum blood glucose levels (3).

How does polycystic ovarian syndrome work?

Insulin resistance affects 50–70% of all people with PCOS, and whilst there are multiple reasons that PCOS can develop, it is well accepted that insulin resistance plays an important role (5). People with polycystic ovarian syndrome will often have insulin resistance and show elevated levels of insulin in the body (hyperinsulinaemia). Monitoring blood glucose levels is crucial to prevent the risk of developing complications including metabolic syndrome, high blood pressure, diabetes and high cholesterol.. In cases of insulin resistance, the pancreas secretes more insulin in order to regulate blood glucose levels, however desensitisation to insulin results in elevated blood glucose levels. This can lead to further complications and risk of developing diabetes (6).

The cysts associated with PCOS are in fact small underdeveloped follicles contained in fluid filled sacs that have failed to mature resulting in hormonal imbalances and irregular ovulation. The term cyst with regard to PCOS is misleading, as they are not true cysts, which are termed ovarian cysts and are distinct from one another. The fluid filled sacs are smaller in size than ovarian cysts and lack epithelial lining. The term polycystic refers to the presence of multiple fluid filled sacs on each enlarged ovary . This is distinct from ovarian cysts which usually resolve without intervention although can cause some symptoms including abdominal pain and bloating and tend to be larger in size than those associated with polycystic ovarian syndrome (7).

The ovaries are responsible for the production of androgens including testosterone, which, in cases of PCOS, are commonly elevated when compared to people without PCOS. The elevated levels of androgens known as hyperandrogenism are responsible for many of the presenting symptoms including hirsutism (increased facial and body hair).

Hyperinsulinemia (elevated insulin levels) stimulates the ovaries to increase testosterone production and decrease sex hormone binding globulin (SHBG) which results in elevated free androgen levels. This results in elevated levels of luteinising hormone (LH), which impairs follicle stimulating hormone (FSH) affecting follicular development and resulting in anovulation. This complex interplay of hormones can create a perpetuating cycle and affect fertility (6).

Understanding the root

The exact cause of polycystic ovarian syndrome (PCOS) is unknown due to its complex pathophysiology, and each case is individual so working with a professional health practitioner is recommended for the best treatment outcomes (8). However, there are a few risk factors associated with its development including:

Metabolic syndrome
Smoking
Excessive alcohol consumption
Sedentary lifestyle
Obesity
Epilepsy and/ or use of valproic acid to treat epilepsy
Type 1 and 2 diabetes
Premature puberty
Family history of PCOS
Altered action of luteinising hormone
Insulin resistance
Acanthosis nigricans (a skin disorder)
A genetic predisposition to hyperandrogenism (8)

A reduction in adipose tissue may decrease the severity of symptoms as it can reduce insulin resistance and help to rebalance hormones. However, being overweight is not a defining feature of PCOS, and many people with PCOS present with either a healthy weight or can be underweight. This highlights the importance of working on an individual case by case basis within practice.

Blood tests can offer some insight into different biomarkers which affect PCOS.

Biochemical features of PCOS can include:

High levels of androgens (dehydroepiandrosterone sulphate (DHEAS), androstenedione, testosterone)
High levels of luteinising hormone (LH) and an elevated serum LH:FSH (follicle stimulating hormone) ratio (often 2:1 or higher)
High levels of prolactin
High levels of oestrone
Oestradiol can also be increased in some cases
Low levels of sex hormone binding globulin (SHBG) (9)

In order to obtain a formal diagnosis, insulin resistance will often be assessed through testing blood glucose levels. This can be done by measuring the fasting blood sugar and fasting insulin level in the morning. Glucose tolerance tests are also helpful to measure blood sugar and insulin levels. If insulin levels are higher than average this can indicate insulin resistance. Measuring basal body temperature can provide insight into ovulation patterns.

Insulin resistance and metabolic syndrome can lead to further complications with the cardiovascular system, cholesterol levels and risk of diabetes. The interplay between insulin resistance and female sex hormones is responsible for many of the symptoms associated with polycystic ovarian syndrome and can lead to further complications (5,6).

Signs and symptoms

Painful ovulation
Oligomenorrhea (irregular periods) or amenorrhea (missing periods)
Irregular appetite
Constipation
Disordered gonadotropin output
Insulin resistance and elevated fasting blood insulin levels
Increased ovarian androgen production
Low libido
Fatigue
Mood changes
Anovulation, menstrual irregularity and infertility
Obesity
Fertility problems
Acne (a sign of hyperandrogenism)
Oily skin (a sign of hyperandrogenism)
Excessive hair growth (hirsutism) and hair loss (a sign of hyperandrogenism)
Weight gain or trouble losing weight
Anovulatory menstruation and relatively excessive androgen and luteinising hormone are a normal part of puberty for young girls. Early weight gain is now marked as an important indicator for the development of polycystic ovarian syndrome from this normal developmental stage (3).

Herbs for polycystic ovarian syndrome (PCOS)

Fenugreek (Trigonella foenum-graecum)

Hemp seed oil (Cannabis sativa) is packed with essential fatty acids that help to reduce cholesterol and support a healthy metabolism (10).
Bitter melon (Momordica charantia) reduces fasting and postprandial blood glucose without increasing insulin and appears to enhance tissue sensitivity to insulin.
Milk thistle (Silybum marianum), gymnema (Gymnema sylvestre), ginseng (Panax ginseng), pine bark (Pinus pinaster), he shou wu (Polygonum multiflorum) and berberine-containing herbs such as barberry (Berberis vulgaris) and Oregon grape root (Berberis aquifolium) are also helpful for reducing insulin resistance (11).
Fenugreek (Trigonella foenicum-graecum) reduces fasting blood glucose without increasing insulin levels (12).
Gymnema stimulates insulin production (13)
Guggul (Commiphora mukul) supports thyroid function, clears stagnation and fluid accumulation from the pelvic area.
Agnus castus (Vitex agnus castus) helps to regulate hormone levels including progesterone, androgens and prolactin(14).
Black cohosh (Actaea racemosa) can be used for hormonal regulation. Black cohosh is a herb facing sustainability threats, with decreasing wild populations as well as adulteration issues in supply. Care and attention in sourcing this herb from sustainable supplies is essential to protect populations and ensure quality.
Liquorice (Glycyrrhiza glabra) and rehmannia (Rehmannia glutinosa) support optimal adrenal function.
Psyllium (Plantago ovatum) reduces postprandial glucose and insulin levels whilst also increasing fibre, which also reduces fasting blood glucose without increasing insulin levels.
Turmeric (Curcuma longa) helps to regulate metabolism, supports liver function and clears congestion in the pelvic by increasing circulation.
Shatavari (Asparagus racemosa) helps clear congestion in the female reproductive tract and supports healthy ovulation and improves fertility (15).
Gokshura (Tribulus terrestris) can help improve fertility.
Ashwagandha (Withania somnifera) supports and strengthens the nervous system during periods of stress (16).
White peony (Paeonia lactiflora) and liquorice have traditionally been used in combination in Chinese medicine, which is now supported by clinical trials demonstrating their efficacy in the regulation of testosterone and prolactin levels.
Motherwort (Leonurus cardiaca) is also traditionally used as a uterine tonic, to nourish and strengthen the uterus.

In traditional Chinese medicine (TCM), herbalists will prescribe herbs as part of a multi-herb formula for treatment of complex conditions. An example of this is jia wei xiao yao wan, a polyherbal formulation commonly prescribed by TCM practitioners that contains eight herbs. Translated as “free and easy wanderer”, it is often indicated in the treatment of polycystic ovarian syndrome. More information on TCM formulations can be found in our article The art and science of herbal formulation: Traditional Chinese medicine (17).

Holistic solutions

Ketogenic diet

The ketogenic diet consists of a diet high in healthy fats, protein and low in carbohydrates. This stimulates the body to go into ketosis where the liver begins producing ketones to metabolise as energy rather than glucose, and so fat is metabolised faster. This diet has been shown to be effective in treating PCOS and accompanying symptoms including reducing brain fog, insulin resistance and excess weight. A systematic review of clinical trials on the ketogenic diet in individuals with PCOS concluded that it is effective for balancing sex hormones, improving insulin resistance and aiding weight loss (18). Dietary interventions are best explored under the guidance of a health practitioner, as this diet is not suitable for everyone and is not recommended long term.

Avoid endocrine disruptors

Avoid chemicals that can disrupt sex hormones known as endocrine disruptors. People with PCOS have been found to have higher levels of BPA, an endocrine disruptor that mimics oestrogen by binding to oestrogen receptors (17). These include:

Pesticides (19)
DBP
DEHP
BPA
Bisphenol A
Phthalates
Dioxins

Acupuncture

Acupuncture has been shown to have positive effects on restoring hormonal balance within the body and forms an excellent adjunct therapy to herbal interventions. A randomised controlled trial conducted on 84 people with polycystic ovarian syndrome found acupuncture to improve hyperandrogenism and sex steroid levels by up to 30% (20). A systematic review found acupuncture improved overall ovulation rates when compared to placebo (21).

Exercise

Regular exercise is recommended as a supportive treatment measure. Exercise enhances tissue sensitivity to insulin, as 80% of glucose uptake occurs in the muscles so regular exercise can help to regulate blood glucose levels and reduce insulin resistance (22).

Rest well

Good quality and duration of sleep is crucial for healthy hormone production, stress reduction, mood, brain function and weight management (21).

Vitamin D

Studies show that between 67% – 85% of women with PCOS are deficient in vitamin D. This can exacerbate symptoms of PCOS such as weight gain, hormone imbalance, insulin sensitivity, low mood and problems with fertility. Therefore, ensuring adequate vitamin D levels can help to support PCOS (24).

References

Joham AE, Teede HJ, Ranasinha S, Zoungas S, Boyle J. Prevalence of Infertility and Use of Fertility Treatment in Women with Polycystic Ovary Syndrome: Data from a Large Community-Based Cohort Study. Journal of Women’s Health. 2015;24(4):299-307. https://doi.org/10.1089/jwh.2014.5000
Sirmans S, Pate K. Epidemiology, diagnosis, and management of polycystic ovary syndrome. Clinical Epidemiology. 2013;6(6):1-13. https://doi.org/10.2147/clep.s37559
Rasquin L, Mayrin JV. Polycystic Ovarian Disease. Nih.gov. Published 2022. https://www.ncbi.nlm.nih.gov/books/NBK459251/
Bone K, Mills S. Principles and Practice of Phytotherapy: Modern Herbal Medicine. 2nd ed. Edinburgh Churchill Livingstone, Elsevier; 2013.
Ovalle F. Insulin resistance, polycystic ovary syndrome, and type 2 diabetes mellitus. Fertility and Sterility. 2002;77(6):1095-1105. https://doi.org/10.1016/s0015-0282(02)03111-4
Purwar A, Nagpure S. Insulin resistance in polycystic ovarian syndrome. Cureus. 2022;14(10). :https://doi.org/10.7759/cureus.30351
London Women’s Centre. The Difference between PCOS & Ovarian Cysts explained. London Women’s Centre. Published November 14, 2017. Accessed May 30, 2019. https://www.londonwomenscentre.co.uk/info/news/difference-ovarian-cysts-pcos
Singh S, Pal N, Shubham S, et al. Polycystic Ovary Syndrome: Etiology, Current Management, and Future Therapeutics. Journal of Clinical Medicine. 2023;12(4):1454. https://doi.org/10.3390/jcm12041454
Huffman AM, Samar Rezq, Jelina Basnet, Romero DG. Biomarkers in polycystic ovary syndrome. Current Opinion in Physiology. 2023;36:100717-100717. https://doi.org/10.1016/j.cophys.2023.100717
Prociuk MA, Edel AL, Richard MN, et al. Cholesterol-induced stimulation of platelet aggregation is prevented by a hempseed-enriched dietThis article is one of a selection of papers published in the special issue Bridging the Gap: Where Progress in Cardiovascular and Neurophysiologic Research Meet. Canadian Journal of Physiology and Pharmacology. 2008;86(4):153-159. https://doi.org/10.1139/y08-011
Kong WJ, Zhang H, Song DQ, et al. Berberine reduces insulin resistance through protein kinase C–dependent up-regulation of insulin receptor expression. Metabolism – Clinical and Experimental. 2009;58(1):109-119. https://doi.org/10.1016/j.metabol.2008.08.013
Sharma RD. Effect of fenugreek seeds and leaves on blood glucose and serum insulin responses in human subjects. Nutrition Research. 1986;6(12):1353-1364. https://doi.org/10.1016/s0271-5317(86)80020-3
Baskaran K, Ahamath BKizar, Shanmugasundaram KRadha, Shanmugasundaram ERB. Antidiabetic effect of a leaf extract from Gymnema sylvestre in non-insulin-dependent diabetes mellitus patients. Journal of Ethnopharmacology. 1990;30(3):295-305. doi:https://doi.org/10.1016/0378-8741(90)90108-6
Abbaspoor Z. Effect of Vitex agnus-castus on Menopausal Early Symptoms in Postmenopausal Women: A Randomized, Double Blind, Placebo –Controlled Study. British Journal of Medicine and Medical Research. 2011;1(3):132-140. https://doi.org/10.9734/bjmmr/2011/163
Pandey AK, Gupta A, Tiwari M, et al. Impact of stress on female reproductive health disorders: Possible beneficial effects of shatavari (Asparagus racemosus). Biomedicine & Pharmacotherapy. 2018;103:46-49. https://doi.org/10.1016/j.biopha.2018.04.003
Lopresti AL, Smith SJ. Ashwagandha (Withania somnifera) for the treatment and enhancement of mental and physical conditions: A systematic review of human trials. Journal of Herbal Medicine. 2021;28(1):100434. :https://doi.org/10.1016/j.hermed.2021.100434
Liao WT, Chiang JH, Li CJ, Lee MT, Su CC, Yen HR. Investigation on the Use of Traditional Chinese Medicine for Polycystic Ovary Syndrome in a Nationwide Prescription Database in Taiwan. Journal of Clinical Medicine. 2018;7(7):179. :https://doi.org/10.3390/jcm7070179
Khalid K, Apparow S, Mushaddik IL, Anuar A, Rizvi, Habib A. Effects of Ketogenic Diet on Reproductive Hormones in Women With Polycystic Ovary Syndrome. Journal of the Endocrine Society. 2023;7(10). :https://doi.org/10.1210/jendso/bvad112
Hussain MS, Mishra AK. Exploring the connection: endocrine disruptors and polycystic ovarian syndrome. International Journal of Basic & Clinical Pharmacology. 2024;13(3):403-407. :https://doi.org/10.18203/2319-2003.ijbcp20241003
Jedel E, Labrie F, Odén A, et al. Impact of electro-acupuncture and physical exercise on hyperandrogenism and oligo/amenorrhea in women with polycystic ovary syndrome: a randomized controlled trial. American Journal of Physiology-Endocrinology and Metabolism. 2011;300(1):E37-E45. :https://doi.org/10.1152/ajpendo.00495.2010
Jo J, Lee YJ, Lee H. Acupuncture for polycystic ovarian syndrome. Medicine. 2017;96(23):e7066. https://doi.org/10.1097/md.0000000000007066
Hulett NA, Scalzo RL, Reusch JEB. Glucose Uptake by Skeletal Muscle within the Contexts of Type 2 Diabetes and Exercise: An Integrated Approach. Nutrients. 2022;14(3):647. https://doi.org/10.3390/nu14030647
Dorsey A, de Lecea L, Jennings KJ. Neurobiological and Hormonal Mechanisms Regulating Women’s Sleep. Frontiers in Neuroscience. 2021;14. https://doi.org/10.3389/fnins.2020.625397
Mohan A, Haider R, Hajar Fakhor, et al. Vitamin D and polycystic ovary syndrome (PCOS): a review. Annals of Medicine and Surgery. 2023;85(7):3506-3511. :https://doi.org/10.1097/ms9.0000000000000879

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