PMS, the Immune System and Metabolic Typing® with William Wolcott
Hello, I am Julie Donaldson and I am a clinical nutritionist with functional health training. I specialize in restoring balance in complex, chronic and acute health conditions. I welcome you to peruse other articles that may be of interest to you in your health investigation!
“I am just finishing my period and .... WOW .... What a difference!!!!!! Typically within the first 48 hours of starting my period, if I eat a substantial meal it evokes a reaction in my body I describe as an extreme purge. This usually involves a combination of vomiting, diarrhea, extreme nausea, breaking out in a terrible sweat, feeling extremely weak - it happens all at once and can occur over the course of 20-40 mins. The 1st night I ate a normal sized dinner and hours later my lower abdomen felt full, but that was the lightest version I have ever experienced.
Day two started out fine, like painless and amazing, I was in disbelief all morning. I SIMPLY CANNOT BELIEVE that my period has improved so much and there really are no words to express my gratitude ~ NONE! It’s SO remarkable and I still can’t quite grasp the magnitude of it all! ”
We in the world of Metabolic Typing® have a little secret! For most women, actually, it might be a big secret…and that is that you do not have to suffer another month of PMS in your life. This article features William Wolcott, the world’s leading authority on and creator of Official Metabolic Typing®, and author of The Metabolic Typing Diet. Bill will shed direct light on how MT supports a healthy menstrual cycle. I will also be highlighting the immunology of menstruation and how disruptions in the immune system can contribute to menstrual challenges. Most education for women focuses strictly on the hormonal side of the story - what you’ll read here is cutting edge information. For all women (and the people who love them), a healthy menstrual cycle is a huge part of overall holistic health. The cycle can clearly consume over half of each month, a substantial percentage of one’s life in which to feel stress. Let’s take a look at how to optimize and balance your reproductive cycle.
Stop suffering the agony of PMS
From the simple idea to the more complex…
Let’s begin with simplicity. The truth of menstruation is that it is a huge additional process for the female body to complete every month. As tribal women, we were supported and revered during this time of the month - duties were taken over by others and we were encouraged to rest and restore during pre-menstruation and completion of the cycle. There was wisdom in tribal cultures that taught us to conserve energy at a time when it was being expended in massive amounts. Just stop and think about it…the body is creating a baby bed, tearing it down and finally, repairing the endometrium. Every single thing the body does on a regular daily basis requires energy, and all of those needs continue alongside this process. Ask yourself this question - “If my body is building and tearing down a substantial foundation, should I expect it to do this on the same nutritional intake while running as fast and hard as I always do?” Surely something will be depleted in this scenario. The body has to prioritize where energy is used, and if there is only so much to go around, “something’s gotta give”, so to speak, when the demands are very high. When consulting with clients, I often compare this to trying to run a car with too little gas or oil in the engine…it will burn out if pushed in this way. Every one of your nearly 30 trillion cells is utilizing ATP (adenosine triphosphate) to complete its assigned tasks.
MT®, ATP production and the balancing of homeostatic mechanisms
The unique ability of Metabolic Typing® (MT) to stabilize homeostatic mechanisms in the body provides the foundation for optimizing mitochondrial function. MT is one of the only true forms of personalized nutrition. Meeting genetically-based nutritional requirements is the foundational determinant of health or disease. Even worse than running an engine on too little oil is using the wrong fuel – you can’t use diesel in a gas engine or gas in a diesel engine!
The most important homeostatic mechanisms are blood sugar, body temperature, body fluid composition, gas concentrations (oxygen and carbon dioxide), and blood pressure. To maintain homeostasis, levels of glucose, gases and metabolic products all have to be tightly regulated. A series of metabolic processes that begin with nutritional processing make this possible. Here is a basic outline of those processes:
Digestion
Food is introduced into the oral cavity. The breakdown of proteins, fats and carbohydrates begins with saliva.
Chewed/swallowed food enters the stomach. Gastric juices further digest the food.
Complex carbohydrates are broken down into glucose and other byproducts in the intestines. The glucose is absorbed by the walls of the intestines and enters the blood stream. Amino acids and fatty acids from proteins and fats are also diffused through the plasma membrane to be absorbed by the cells of your body.
Cellular Respiration
Blood with oxygen from the lungs and glucose from the intestines is pumped out to the capillaries where the oxygen and glucose diffuse into individual cells.
Inside each cell, a chemical reaction called glycolysis splits the glucose molecules and produces enzymes and energy-carrying molecules called ATP (adenosine triphosphate). (ATP is the "gas" to every one of your body's trillion cells.)
The Krebs cycle steps use some of the enzymes produced by glycolysis to produce additional enzymes, more ATP and carbon dioxide.
The enzymes produced by glycolysis and the Krebs cycle enter the electron transport chain and produce a large number of ATP molecules. The final hydrogen reaction products combine with oxygen to form water.
Elimination
The carbon dioxide and water diffuse out of the cells into the blood stream and are passed back to the heart through the veins.
The blood is pumped through the lungs to eliminate carbon dioxide and through the kidneys to eliminate surplus water.
Cellular respiration is dependent upon successful completion of the Krebs cycle...
...and that successful completion of the Krebs cycle is dependent upon the right mix of nutrients for your individual metabolism. Because carbohydrates, proteins and fats feed into and are processed differently in the the cycle, this balance deserves careful attention. If we miss a key component (based upon our individual metabolic patterns) in a meal, we'll fall short of optimal production of ATP. While carbohydrates, proteins and fats are ultimately all converted into acetyl-coenzyme A to complete the cycle, they reach that point via different mechanisms. The Krebs cycle is the most important part of the process of aerobic respiration because it drives the formation of electron carriers. These carriers transport the energy used to create a large number of ATP molecules in the final steps of aerobic respiration.
Let’s dive a little deeper and talk about where ATP comes from, getting some answers from Bill Wolcott.
JULIE: Bill, in your own words, how do you explain the change in energy (ATP) demands for a woman preceding menstruation?
BILL: Nutrients play active roles related to function and homeostasis at every level of hierarchical organization -- systems, organs, glands, tissues, cells nuclear, sub-nuclear, genetic -- in both quantitative (the amounts of specific nutrients) and qualitative (the balance of specific nutrients) considerations. And depending on the specific hierarchical level, nutrients may be stimulating or sedating, acidifying or alkalinizing. On one level a nutrient may be stimulating and acidic yet on another level the same nutrient may be sedating and alkaline. In this way, specific nutrients (and foods, of course) stimulate or sedate the FHC's and FMP's and thereby play a direct role in the regulation of all elements of metabolism.In this way, the foods we consume and the nutrients they contain either stimulate or sedate the Fundamental Homeostatic Controls and Foundational Metabolic Processes that regulate all elements of metabolism.
To explain in simple, common language: If the right nutrients for a person’s metabolic individuality are available at the right place, at the right time, in the right form to be utilizable, in the right amounts (sufficient quantity), and the right balances, then optimal function is possible, successful stress resolution can occur, and homeostasis will be restored and maintained. THE REVERSE IS ALSO TRUE!
When there is a quantitative or qualitative deficiency of the right nutrients in a given situation, the body is unable to respond appropriately to maintain biochemical balance, metabolic efficiency, and optimal (normal) function. And that is exactly what happens when PMS occurs
Everything that happens in the body in terms of health or disease, foundationally speaking, depends on the creation, maintenance, and control/regulation of energy. Physiologically speaking, that principle expresses itself through the concept of homeostasis or failed homeostasis. When any stress is resolved, there is a return to homeostasis. However, if failed stress resolution occurs, homeostasis is not achieved and the body is left in a state of chronic defense.
We are “engines of metabolism” and that is individual, requiring individual approaches to nutrition. The extra needs a woman has during this time emphasizes the truth of this even more. Not every woman suffers from PMS. And not every woman who does needs the same diet to resolve the issue!
JULIE: Bill, how does this affect a woman’s individual nutritional needs, especially when there is a large immune component with menstruation?
BILL: Consider this scenario: A woman is following a specific dietary intake that results in positive outcomes in terms of satiety, energy, mood, performance, etc. Those are indicators that her diet meets the demands of her metabolism. Then her metabolism changes at a particular point in her menstrual cycle. That hormonal shift creates a new demand for different balances of nutrients. If her diet/nutritional intake fails to meet the new nutritional requirements, dysfunction occurs, resulting in adverse symptoms that are expressed through appetite, cravings, low energy, moodiness, etc., and all manner of performance may suffer as a result. But if her diet and nutritional intake changes to meet the demands of her altered "metabolic type" then stress demands once again are met, homeostasis is restored, and adverse symptoms disappear. For the sake of this discussion, you can think of the hormonal shift as being like changing from a gas to a diesel engine. If the fuel does not change to meet the new engine requirements, the energy output (ATP) of the engine can’t meet the demand and dysfunction occurs.
Metabolic Typing® identifies both the type of engine of metabolism one has and also the proper fuel requirements for optimal function and energy production. If the MT program is followed properly long enough, the problem will simply no longer exist. That's a fact of the clinical application of MT over the past 40 years.
Understanding some of the key components of the immunology of menstruation
Testing immune markers in the blood
We’re moving into some more complicated territory now, talking about the immune system in menstruation. What’s important to simplify and understand before diving into this territory is this: already an energy-consuming hormonal process, menstruation also involves immunity. This means that the body is expending more energy via the intersection of the endocrine and immune systems. Additionally, we all know that the immune system can operate with deficiency or with excess - either scenario is a disruption in normal menstrual cycling. The body is working constantly to maintain balances in the multitude of immune cell types and immune pathways - when this is negatively impacted by acute or persistent pathogenic stresses and failed homeostasis, menstruation may also be negatively impacted.
Let’s check in with Bill Wolcott again on this topic.
JULIE: Bill, can you comment on how MT applies to the question of immunology and individuality?
BILL: Decades ago, scientists made the pronouncement that "immune function is dependent on the proper biochemical balance." At first glance, that idea appears universally acceptable and simplistic to the point of being mere common sense. But nothing could be further from the truth. What is not yet universally understood is that every human being is a biological, biochemical, and metabolic individual with unique nutritional requirements. That literally means that the diet or nutritional protocol that optimizes immunity for one person of a given Metabolic Type can undermine immune function in a different person of a different Metabolic Type. We see this played out in common experiences of everyone in daily life: A diet that causes one person to lose weight and gain energy, for example, can have little or no effect on another person, and actually make a third person gain weight and lose energy. In short, to achieve the proper biochemical balance to optimize immunity, one must eat right for their Metabolic Type thereby meeting genetically-based requirements for nutrition.
Normal menstruation is an inflammatory process, where the endometrial (lining of the uterus) concentrations and functions of several leukocyte types can change greatly through the menstrual cycle, especially during the premenstrual and menstrual phases. Leukocytes are part of the body’s immune system. They help the body fight infection and other diseases and are operative in all immune inflammatory processes. Types of leukocytes are granulocytes (neutrophils, eosinophils, and basophils), monocytes, and lymphocytes (T cells and B cells). These leukocytes have a range of functions related to mucosal protection, embryo implantation, and the process of menstrual tissue breakdown, repair and remodeling. They are also involved in decidualization, a process that results in significant changes to cells of the endometrium in preparation for, and during pregnancy. This includes morphological and functional changes (the decidual reaction) to endometrial stromal cells (ESCs), the presence of decidual white blood cells, and vascular changes to maternal arteries. The sum of these changes results in the endometrium changing into a structure called the decidua.
Many immune cells have been identified in the endometrium, and those with most relevance to the processes of menstruation include uterine natural killer cells (NKC’s), macrophages, mast cells, neutrophils, dendritic cells and T-regs. A range of disturbances in endometrial immune cell numbers, distributions and functions, and in a range of different inflammatory and other mediators, have been identified in women with heavy menstrual bleeding, PMS and endometriosis.
A certain type of leukocyte, the neutrophil, plays a significant role in the balance of menstruation and cellular remodeling. Mast cells, located in close proximity to blood vessels, utilize neutrophil chemoattractants which then work with macrophages to recruit neutrophils. Neutrophils complete the majority of autophagy in the cycle. (Autophagy is the body’s way of cleaning out damaged cells, in order to regenerate newer, healthier cells. “Auto” means self and “phagy” means eat. So the literal meaning of autophagy is “self-eating.” It is also referred to as “self-devouring.”) While that may sound ominous, it’s very beneficial to your health - this is because autophagy is an evolutionary self-preservation mechanism through which the body can remove the dysfunctional cells and recycle parts of them toward cellular repair and cleaning. Clearly, menstruation involves a significant amount of both.
Studies have demonstrated that the increase of neutrophil autophagy should promote the residence of NK cells in endometrium/decidua. The increased numbers of resident NKCs in the endometrium, triggered by high levels of autophagy during menstruation, supports immune defense and normal cycling with enzymes that kill abnormal and viral cells.
As discussed earlier, mast cells are activators for these processes. Mast cells produce histamine, arachidonate, heparin (blood-thinning) products and a large number of influential cytokines. They have important effects on endothelial cell function. Many of us are aware, however, that mast cell conditions that often accompany chronic immune challenges can be produced in excess and can then also be cause for excessive bleeding problems.
Macrophages are another key contributor to the successful outcome of the menstrual cycle. Macrophages are abundant in the endometrium during tissue breakdown and repair. As scavenger cells, macrophages can eliminate dying cells in the uterus as well as endometrial cells in the peritoneal cavity following the retrograde flow of menstrual blood. Retrograde menstruation is an ordinary process happening in almost all menstruating women (up to 90 %) so it is considered to be normal unless it is associated with the development of endometriosis. This simply means that your menstrual blood is flowing backwards rather than leaving your body via the “normal” route. Generally, it will flow into your fallopian tubes and because they are porous, it can get out of the tubes and into your pelvic cavity. Potentially, irregular contractions in the uterus contribute to retrograde flow. Most bodies are perfectly capable of disposing of blood cells that are deposited into the pelvic cavity. In the case of endometriosis, this function is compromised and they are deposited in larger quantities, causing inflammation and pain in the sex organs and potentially in the abdomen/digestive tract.
Our recent experiences with both infection and vaccination for COVID-19 and abnormal menses are explicit, current examples of how immune onslaught can derail normal menstruation.
Again, to sum up this section, balance in the immune system is a necessary requirement for balance in menstruation. Inadequacies or excesses in immune responses will produce PMS symptoms, especially in the circumstance of improper nutrition for the energy needs.
Epithelial and endothelial contributions in menstruation
The epithelium and endothelium are very important protective structures in your body. Epithelium generally lines pathways that are open to the external environment, such as your respiratory tract and digestive system. In general, endothelium lines fully internal pathways, such as your vascular system (i.e. blood vessels) and cornea. Both play roles in hormonal function, intersect with immune function, and can be destructed/harmed by acute and chronic immune conditions. T cells, neutrophils, platelets and monocytes collect in response to inflammation and immune threats. When unable to reach resolution, they there and become amassed in the endothelium. Monocytes will then migrate out of the lining and contribute to oxidative stress which can impact normal cycling.
Coinciding with changes in autophagy are endocrine gland responses, where hormones are produced/released. In the glandular epithelial (outer) walls, a protein called Caspase-3 is increasing significantly during the secretory phase of menstruation, reaching a maximum during the late-secretory phase. Clearly, the adrenal and sex glands are in active and rapidly-changing states throughout all of the cycles of menstruation. The balances of estrogen and progesterone are obvious requirements of healthy menstruation. Endocrine glands are also very dependent upon healthy liver function, as the liver produces multiple enzymes for hormone production. A healthy liver is dependent upon proper individual nutrition.
Serum levels of a hormone may rise faster than tissue levels. Many factors affect the passive and active delivery of hormones to tissues. For instance, localized inflammation can lead to increased transcellular gaps that increase permeability and allow hormones into cells more rapidly. This can become too-much-of-a-good thing. The endothelium acts as a barrier between blood and tissue, modulating the delivery of molecules like hormones. Even as a selectively permeable barrier, the endothelium is not uniform. Rather, this barrier permeability fluctuates over time and throughout the body. This fluctuation is important because the endothelium is “an important rate-limiting determinant of hormone and substrate access to target tissues.” This barrier function underlies the endothelium’s ability to regulate hormone access to the target tissues.
Sex hormones, particularly estradiol, also alter vasodilation and endothelial function. Many sex hormones affect nitric oxide synthesis. Nitric oxide generating systems have been localized to blood vessels, glandular epithelium and endometrial tissue in the non-pregnant human uterus, where the molecule may play a role in the control of menstrual bleeding by limiting platelet aggregation and causing vasodilatation of the spiral arterioles. You may read more on the importance of nitric oxide here.
On this topic, we must also consider the glycocalyx. A thick coating around specific cells in the body, it is used as an identifier to distinguish between its own healthy cells, transplanted tissues, diseased cells and invading organisms. The health of the endothelium and the immune system are impacted by the health of the glycocalyx.
Within the endothelium, the micro-thin, gel-like endothelial glycocalyx (EGX) is the “primary molecular sieve” governing permeability. Every artery, vein, and capillary is lined with the protective shield of the EGX. The EGX is made up of glycoproteins and polysaccharides, and it is a semipermeable barrier between the blood and endothelial cells.
When the EGX degrades, shedding pieces and becoming thinner, a range of negative effects occur:16
Breakdown of sieve functionality (loss of oncotic pressure gradient)
Widening of endothelial clefts
Increased leukocyte and platelet adherence
Reduction in microvascular outflow
Summations and solutions: what does all of this mean?
Personalized nutrition and implementing a lifestyle with it
In all of this complexity, we can summarize with the following:
Menstruation (like all body processes, but intensified) requires personalized nutrition. With the gift of nutrition that is delivered with the right foods in the right ratios for your needs, PMS need not ever be a part of your life again. We will use daily records and observe responses in addition to implementing your plan.
The immune system is in a constant state of flux but with tight requirements for modulation. Both acute and chronic immune conditions can alter the homeostasis of the system.
Menstruation is not just an endocrine process, it is an inflammatory immune process. As such, the requirement for personalized nutrition becomes even more highlighted. A multitude of factors is at play and the intersections of those needs attention. While your hormones matter, without attention to the immunology, resolution can be elusive. We will test your biochemistry and talk about imbalances in immune expressions.
There is HOPE! You need not suffer another month of PMS when you investigate your whole health and begin to live the lifestyle of your MT. Clients of True Nature see an end to their PMS, usually within the first 2 months.
Contact me at Julie@truenaturehealthconsulting.com to begin your process of healing today. We provide holistic telehealth services, allowing you to receive care from anywhere.