Tips and Strategies for Healthy Weight Loss
Edge Marketing Lite • Jan 18, 2023

Happy new year! If you’re excited to get 2023 off to a good start by getting into better physical shape, you may not be alone. One study found that 48% of people who make new year’s resolutions named “weight loss” as a goal. However, the unfortunate truth is that many of them won’t succeed. Researchers have found that at least 80% of dieters regain those lost pounds within 12 months, or give up on healthy lifestyle habits soon after the new year.


But, we are here to remind you that sustainable, healthy weight loss is possible - you’ve got this!


The key is to take a step back and create a plan that works with your body. You want a weight-loss plan that you can sustain over the long run without creating the hormonal imbalances and stress that ultimately work against you. Here are some realistic, healthy strategies to help you reach your goals for the new year.



Why Exercising More Is Not The Answer


Exercise has many health benefits, and it’s the best step you can take to improve your overall health - but exercise alone won’t lead to weight loss for most people. The old phrase “you can’t outrun a bad diet” is certainly supported by math: Consider the calories burned in a half-hour-walk (about 150 for a 150-pound woman at an average pace) and how easy it is to consume 150 calories!


Even exercising for hours isn’t a license to eat whatever you want, unfortunately. In fact, over exercising can harm your weight loss efforts by increasing your levels of the stress hormone cortisol. Cortisol tries to help your body deal with a potential threat by raising blood sugar levels and stimulating your carbohydrate metabolism. Some people experience this spike in cortisol with high intensity interval training (HIIT), even though the duration of exercise is short due to the high intensity. 


Overexercising also raises the risk of injury. You want to remain active in the long run, so it’s important to create an exercise plan that will last instead of risking sustainability in pursuit of fast results.



Why Eating Less is Not the Answer


Your body’s wish to preserve energy is also the reason extreme calorie restriction doesn’t lead to sustainable weight loss. When you drastically reduce the number of calories you consume, your body wants to preserve as much energy as possible. The result can be a decline in your basal metabolic rate. Studies have found resting metabolism can drop dramatically while dieting, and this is a big reason why it’s difficult to sustain dramatic weight loss - just think of the long-term outcomes of the Biggest Loser TV show, where the vast majority of contestants regained their lost weight. 


Another factor is that without paying attention to proper nutrition, dieting leads to muscle loss, which in turn lowers your metabolism. Extreme calorie reduction and many fad diets can also lead to nutritional deficiencies that can disrupt hormonal balance.



3 Steps for Sustainable Weight Loss.


1 - Eat a balanced, unprocessed diet.


We all see so-called magic solutions that promise big results by focusing on one food or following a highly regimented plan. Although these may be effective in the short term, you’ll have better luck with a balanced diet that ensures you’re getting all nutrients.

Focus on quality protein, healthy fats and plenty of fiber in every meal. Avoid processed foods, foods high in sugar and alcohol as much as possible to achieve your weight loss goals.


One study that sought to determine if the adage “a calorie is a calorie” was correct discovered that the quality of calories consumed does make a difference. The researchers found that foods like potato chips and processed meats were more associated with weight gain than whole foods like fresh fruits and vegetables and whole grains. They concluded that the more natural foods had a better effect on insulin and feelings of satiety.


Researchers have also found a mindset shift helps with weight loss more than an overly restrictive plan. Eating mindfully - paying attention to each bite, savoring the flavors, and chewing slowly - naturally leads to consuming fewer calories by eliminating bad habits like mindless snacking. Learning to better interpret your hunger and fullness signals also helps get you in tune with your body and how it is really feeling around mealtime.



2 - Create a realistic exercise plan


This will vary a lot by person, so there’s no single answer for the best fitness regime. You want something you can sustain in the long run, with a balance of strength, cardio, and flexibility, but you also want to focus on activities you enjoy.


Exercise should add joy to your life, not stress out your mind and body. Working with a healthcare professional can help you determine the best plan for you.

In addition to creating a formal exercise plan, it’s also important to consider the role of non-exercise thermogenesis (NEAT). That’s a fancy way of summarizing the activity you get other than when you’re exercising, through things like fidgeting or walking around. NEAT is often not considered in weight loss plans, but it can burn as much as 2000 calories a day. Our modern lifestyles have reduced the amount of NEAT most people get, so look for opportunities to do things like take the stairs, walk some extra steps by parking further away, or just stand instead of sitting when you can.



3 - Be aware of sleep and stress patterns.

A growing body of research confirms that more elements contribute to weight loss than diet and exercise. The amount of sleep we get each night and how we deal with stress also affect our metabolism.

In fact, regularly sleeping less than seven hours a night is associated with a higher risk of obesity. Several factors come into play here. When you’re not sleeping enough, your body produces more of the hunger hormone ghrelin and less of the appetite-suppressing hormone leptin. You’re also more likely to feel stressed or make poor decisions when you’re tired, and less likely to keep up with your workout routine.


Stress is another often-overlooked influence on our weight. As we’ve seen in the results of overexercising, the stress hormone cortisol encourages your body to hang on to calories in case you need more energy to deal with a threat. Although this was beneficial centuries ago in case we had to flee from a predator, it works against us in today’s chronically stressful but sedentary environment. Weight gain from excess cortisol tends to collect around the belly, which is a bad sign for heart health.


Mindfulness practices like meditation and yoga help cope with stress and reduce cortisol levels. They can also help your mindful eating practice by teaching you to avoid distraction and focus on the moment, and help your sleep!



The journey to weight loss and better physical health can feel daunting, but it’s possible to do it in a way that lasts and boosts your vitality and overall well being for years to come. Call us and let’s work together on creating a plan that will help make 2023 your healthiest year yet!

 





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Digestion Dilemma: The Reasons You're Not Feeling Your Best

By Dana O'Keefe • 22 Mar, 2024
A well-functioning digestive system is essential for overall well-being, as it breaks down food into vital nutrients that fuel energy, growth, cellular repair, and more! When your digestion is functioning optimally, you may not even think twice about it. However, when issues arise, they can have widespread effects on your overall well-being. Poor digestion can manifest through signs such as persistent digestive discomfort, irregular bowel movements, nutrient deficiencies, food sensitivities, and unexplained weight fluctuations. Recognizing these indicators is crucial for addressing underlying concerns. In this blog post, we'll explore the top five signs of compromised digestion and provide actionable insights to improve and optimize your digestive health. 5 Reasons Why You’re Not Digesting Properly 1- Stress and Digestive Function You’ve likely felt “butterflies in your stomach” at some point – that queasy feeling accompanied by intense nervousness or excitement. These sensations occur because our gut and brain are intimately connected. If you feel stressed often, it can significantly alter your digestion. The digestive tract has a nervous system of its own called the enteric nervous system or ENS. The ENS contains thousands of complex neurons that control digestive functions. The ENS works in tandem with the central nervous system (CNS) to communicate messages between the gut and the brain. When the brain senses external factors like stress, it releases chemicals that stimulate the ENS to divert blood flow away from the gastrointestinal tract and toward other organs that support survival. When digestion is disturbed, the ENS communicates distress to the brain. Over time, chronically elevated stress hormones will lead to impaired digestive function. Identifying your stressors with non-judgemental awareness can be a powerful first step to improving digestion. Science confirms the value of keeping a mindful eating journal in which you record the trigger of the stress, its symptoms, and any eating activities surrounding it. Recording this information can help you to acknowledge any problematic stress and take action. Other relaxation practices like yoga can powerfully improve digestion. Not only can yoga help reduce stress by allowing us to tune into our thoughts, but certain poses and movements can help increase blood flow to the digestive organs, improving their function. 2 - Imbalanced Gut Microbiome Your gut is filled with trillions of beneficial bacteria, known as the microbiome, which are important for supporting the immune system and metabolism. A diversity of gut bacteria has been linked to human health and longevity, while lower levels of diversity are associated with several acute and chronic diseases. A pillar of good gut health and digestion is maintaining a balance between these good and bad strains of bacteria. If you are experiencing new or uncomfortable digestive symptoms, it could be a sign that the balance of bacteria in your gut is off. Several factors can lead to imbalanced gut bacteria, but these are some of the most common: ● A high-sugar diet. Studies show that consuming large amounts of sugar and processed foods can lessen the amounts of “good” bacteria present in the gut and increase inflammation. ● Antibiotic use. By targeting harmful bacterial infections, antibiotics inadvertently kill off other good bacteria that our bodies need. Increasingly, studies have found that even a short dose of antibiotics can have a profound negative effect on gut diversity. ● Alcohol consumption. In large amounts, alcohol has been shown to increase inflammation and the presence of “bad” bacteria in the gut (also termed dysbiosis). One study looked at the gut bacteria of 41 alcoholics and compared them to 10 healthy individuals who consumed little to no alcohol. Researchers found that imbalance was present in 27% of the alcoholic population, but it was not present in any of the healthy individuals. ● Lack of sleep. Sleep is a crucial ingredient of our overall health, and recent studies have found associations between irregular sleep patterns and harmful bacteria in the gut. Avoiding these red flags and consuming gut-friendly foods can help improve the diversity of your gut bacteria. We recommend: ● Probiotic rich foods such as yogurt, kefir, kimchi, miso, and sauerkraut. ● Prebiotic foods, which feed the good gut bacteria, like bananas, garlic, and asparagus. ● Plenty of fiber found in beans, whole grains, vegetables and fruits 3 - Enzyme Insufficiency Digestive enzymes are naturally occurring proteins responsible for breaking down food and liquids into smaller molecules that the body can absorb. This allows the body to access critical nutrients from food, which it uses to grow and perform vital functions. There are three main types of digestive enzymes: 1. Amylase, which breaks down carbohydrates, starches, and sugars. 2. Lactase, which helps you digest lactose, the natural sugar occurring in dairy products. 3. Lipase, which works with the liver allowing you to digest fats. When your body lacks digestive enzymes or doesn’t release enzymes as it should, several uncomfortable symptoms can occur, such as: ● Stomach cramping ● Malnutrition/Nutrient deficiencies ● Bloating ● Diarrhea ● Gas ● Unexplained weight loss When the pancreas doesn’t appropriately secrete these digestive enzymes, it affects your body’s ability to break down the foods you eat and absorb nutrients. Thankfully, there are steps you can take to support and increase enzyme production for better digestion: ● Digestive enzyme supplements: Many people find that over-the-counter digestive enzyme supplements help with problems such as acid reflux, gas, bloating, and diarrhea. Furthermore, combining these supplements with a probiotic has been shown to be effective. ● Enzyme-rich foods: Certain foods naturally have high digestive enzyme content. Incorporating more of the following can have a positive impact on digestion: Papayas, pineapple, pure honey, avocados, miso, and ginger. 4 - Food Intolerances & Allergies An increasingly common source of unwanted digestive symptoms is food intolerances and allergies. While both can produce similar symptoms, food intolerance does not involve the immune system and is not typically life-threatening like allergies can be. Food intolerance occurs when your body has difficulty chemically processing or digesting certain foods. If left untreated, they can cause several disagreeable symptoms, such as: ● Gas ● Bloating ● Fatigue ● Diarrhea ● Constipation ● Stomach pain or cramping If you are experiencing one or more of these symptoms often, you may have a food intolerance. It can be difficult to pinpoint exactly which food is causing the intolerance, though. We recommend trying an elimination diet if you have suspicions about a particular food–stop eating it for at least a couple of weeks and see how your body reacts! Allergy and food sensitivity testing performed by a practitioner can also be a useful step to take. These are some of the most common food intolerances: ● Dairy. As mentioned above, many people lack the enzymes to digest the natural sugars found in dairy products. Some people also experience a negative reaction to the whey protein within dairy. To identify whether dairy may be at the root cause of your symptoms, it’s important to completely avoid all dairy ingredients for a minimum of 2-3 weeks. ● Gluten. Gluten is a protein that is found in grains like wheat, rye, barley, kamut, oats, and spelt. People with celiac disease experience an immune response when they consume the protein, which over time can inflame the small intestine and lead to serious digestive problems. People who test negative for celiac disease but still experience discomfort when they consume gluten may have a milder form, called non-celiac gluten sensitivity. ● Caffeine. For many adults, a cup or two of coffee is an integral part of their morning routine. However, some people are more sensitive to caffeine and unpleasant experience reactions from consuming just a small amount. Researchers have found that this hyper-sensitivity to caffeine is largely genetic. If small amounts of caffeine cause you to feel anxious, jittery, or have difficulty sleeping, we recommend minimizing your intake and instead opting for decaf herbal teas and coffee. 5 - Dehydration Water is essential for human health. Proper hydration helps lubricate our joints, promotes brain function, and supports healthy skin. Hydration is also a critical factor for improving digestion and gut health. Your body uses fluid to lubricate the digestive system, which helps to move food along as it travels through your stomach, intestines, and colon. If there isn’t enough fluid to keep the food moving, it can get stuck or slow down. This can cause uncomfortable symptoms like constipation or bloating. Fluid is also used to transport the enzymes we discussed that are responsible for breaking food down. When you are dehydrated, it can actually cause inflammation in the intestines due to the constant rubbing of food against them without lubrication. OK, so hydration is important for digestive health, but how much water do we actually need? While water requirements are individual and highly variable based on metabolic needs, environmental conditions, and physical activity, it’s suggested that 2.2 liters (nine cups) per day for women and three liters (12 cups) for men is the ideal minimum amount. Here are a few tips for increasing your water intake: ● Keep a non-plastic water bottle in your car and try to take it everywhere you go! ● Limit caffeine and alcohol consumption, as these dehydrate you. ● Eat thirst-quenching foods with a high water content, such as watermelon, celery, cantaloupe, and spinach. Let’s not forget chewing habits! If you feel like you’ve been eating all the right things, yet are still experiencing unpleasant digestive symptoms, the problem may not be what you’re eating, but how! Yes, chewing plays a larger role in digestion than you may think. We tend to have busy lifestyles here in North America that allow us little time to slow down and enjoy our meals. However, eating too quickly can cause a range of digestive issues, no matter how healthy your diet is. When you don’t adequately chew your food, you’re actually creating more work for your digestive system. In turn, this can lead to stomach issues like bloating, cramps, and even acid reflux. Chewing is an important part of the digestive process, as saliva produces digestive enzymes that help move our food along. Here are a few tips to encourage proper chewing habits & digestion: ● Breathe deeply. Before sitting down to eat, take a few deep belly breaths to promote blood flow and relaxation. Take a minute to pause mindfully before a meal can help with overeating or eating too quickly. ● Pay attention. Rather than hurriedly eating in the car or mindlessly snacking during work, pay attention to what you’re eating and avoid distractions whenever possible. ● Chew 20-30 times. According to recent studies and traditional Ayurvedic practice, the magic number of chews for optimal digestion is approximately 20-30. Chewing your food 20-30 times per bite helps ensure proper nutrient absorption and can help in weight management. Everybody experiences digestive issues at some point. They can be uncomfortable, and embarrassing to talk about, and the root cause is often difficult to pinpoint alone. We have covered some of the most common causes of poor digestion and the lifestyle changes you can make to see improvements. If you have digestive issues that are not corrected with lifestyle changes or are getting worse, seeing a healthcare practitioner for a comprehensive diagnosis and treatment plan may be required. Don’t let poor digestion take control of your life – schedule a consultation with us today! Sources:. Cherpak CE. Mindful Eating: A Review Of How The Stress-Digestion-Mindfulness Triad May Modulate And Improve Gastrointestinal And Digestive Function. Integr Med (Encinitas). 2019 Aug;18(4):48-53. PMID: 32549835; PMCID: PMC7219460. Shree Ganesh HR, Subramanya P, Rao M R, Udupa V. Role of yoga therapy in improving digestive health and quality of sleep in an elderly population: A randomized controlled trial. 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Dtsch Arztebl Int. 2009 May;106(21):359-69; quiz 369-70; 4 p following 370. doi: 10.3238/arztebl.2009.0359. Epub 2009 May 22. PMID: 19547751; PMCID: PMC2695393 Landolt HP. "No thanks, coffee keeps me awake": individual caffeine sensitivity depends on ADORA2A genotype. Sleep. 2012 Jul 1;35(7):899-900. doi: 10.5665/sleep.1942. PMID: 22754033; PMCID: PMC3368971. Widjaja Lukito; Current Evidence in Water and Hydration Science. Ann Nutr Metab 28 December 2021; 77 (Suppl. 4): 1–6. https://doi.org/10.1159/000521769 Li J, Zhang N, Hu L, Li Z, Li R, Li C, Wang S. Improvement in chewing activity reduces energy intake in one meal and modulates plasma gut hormone concentrations in obese and lean young Chinese men. Am J Clin Nutr. 2011 Sep;94(3):709-16. doi: 10.3945/ajcn.111.015164. Epub 2011 Jul 20. PMID: 21775556.

Hormone Havoc: Identifying and Avoiding Everyday Disruptors

By Dana O'Keefe • 22 Mar, 2024
Your hormones play a crucial role in maintaining the delicate balance that keeps your body functioning at its best. From regulating metabolism and mood to influencing reproductive health and immune function, these chemical messengers orchestrate various aspects of your well-being. However, achieving hormonal harmony can be a delicate dance, and numerous factors in our daily lives can tip the scales in unfavorable directions. In the pursuit of optimum health, it's essential to recognize that your efforts might be sabotaged by common culprits known as hormone disruptors. These disruptors, often encountered in your everyday routines, have the potential to throw off the intricate balance of hormones, creating a ripple effect throughout your body. In this blog, we will dive into the world of common hormone disruptors, shedding light on the major players that could be working against your health goals. 8 Common Hormone Disruptors You Need To Know These disruptors affect the hormonal balance when they mimic, block, or disrupt the normal functioning of your hormones. They can bind to your hormone receptors, disrupting the information chain regulating hormone production. It’s hard to avoid some of these, but knowledge is an important first step in avoiding or minimizing your exposure! ● Pesticides and herbicides. Harmful pesticides are found in up to 75% of non-organic produce grown in the U.S. ● Bisphenol A. Commonly known as BPA, this synthetic compound lines food and drink containers. ● Parabens. Also synthetic compounds, parabens are used as preservatives in many cosmetic and body care products. ● Phthalates. These man-made chemicals are all around us! They’re found in things like soaps, shampoo, nail polish, body lotion, toys, and food and beverage packaging. ● Perfluoroalkyl substances (PFAS). These are added to products to increase their resistance to water and grease. ● Stress. Your stress response raises your level of the hormone cortisol, which has a domino effect on your other hormones. ● Poor sleep. Not getting enough high-quality sleep affects your body’s ability to regulate stress hormones like cortisol and the hormones that control your appetite, ghrelin and leptin. ● Lack of exercise. A sedentary lifestyle also impacts hormone regulation. Not getting enough movement in your day can lead to reduced insulin sensitivity, altered levels of growth hormone and cortisol, and disruptions in the balance of estrogen and progesterone. The Impact Of Hormone Disruptors The effects of hormone imbalances are far-reaching. Here are some of the major impacts: ● Endocrine system disruption. Your endocrine system is a complex network of glands that secrete hormones, including insulin, stress hormones like cortisol, adrenaline, thyroid hormones, estrogen, progesterone, and testosterone. ● Thyroid dysfunction. Hormone disruptors can compete with thyroid hormone at receptor sites, interfering with thyroid hormone synthesis. The result is thyroid dysfunction, which leads to conditions like hyperthyroidism or hypothyroidism. ● Reproductive system issues. Estrogen, progesterone, and testosterone are also vulnerable to dysfunction. BPA, for example, has a similar structure to estradiol, a type of estrogen, so BPA binds to estrogen receptors. Phytoestrogens, found in many soy products, can also disrupt estrogen in some people. When hormone disruptors attach to sex hormone receptors, the normal functioning of estrogen or testosterone in the body is disrupted. This can lead to infertility and other reproductive issues. ● Metabolic dysfunction. One notable effect of hormone disruption is the impact on metabolism. Many hormones impact your metabolism, and disturbances can lead to serious health issues like obesity, nonalcoholic fatty liver disease, and diabetes. Recent studies have found that exposure to hormone disruptors may be a strong risk factor for obesity. Although more research needs to be done, findings suggest that these disruptors impact energy balance, basal metabolic rate, gut microbiota, and hormonal control, all leading our body to store calories, and disrupting appetite regulation. Avoiding The Impact Of Hormone Disruptors After reading the above sections, it may seem like hormone disruptors are all around us. But knowledge is power. Now that you know what to avoid, you can take some simple steps to reduce your exposure. As a bonus, these steps will all lead to a healthier you! 1 - Hormone-friendly dietary changes Careful food choices are one of the most important things you can do to reduce the impact of hormone disruptors such as pesticides and BPA. ● Choose organic food whenever possible. More and more organic food is available! About 4% of U.S. total grocery sales is organic food. Even when buying organic, be sure to wash all produce. ● Eat less processed foods. Try to focus on the outer edges of the grocery store, and avoid the packaged and processed foods in the middle. Studies have found that ingredients found in overly processed foods interfere with hormone regulation. ● Don’t store food in plastic containers. Plastic containers can expose your food to hormone disruptors like BPA, so look for glass or metal containers. As well, if you buy canned soups or beans, look for BPA-free containers. 2 - Better personal care products There’s a growing market for natural personal care products, so you have many opportunities to find products without phthalates, parabens, or BPA. One report found that people who use natural body care and beauty products have better overall health than people who don’t. Not sure where to start? You can find ratings for hundreds of products on the Environmental Working Group site. 3 - Optimize your environment From the air you breathe to the water you drink, look to minimize contaminants and pollution wherever possible. ● Invest in an air purifier. With more of North America experiencing smoky summers from wildfires, this is more important than ever. Air purifiers with HEPA filters are often the most effective. ● Filter drinking water. Bottled water often contains harmful microplastics, so your best bet is to use a high-quality filter for the water you drink. If you used a filtered water jug, follow directions on how often to change the filter. ● Take a look at your cleaning supplies. The things you use to clean your home may not be so “clean” after all - up to 75% of cleaning products contain at least one harmful substance. Look for products labeled “green” and investigate do-it-yourself alternatives. You’d be surprised by how many things baking soda, lemon juice, or soap can get clean. 4 - Healthy stress management and proper sleep routine Chronic stress heightens vulnerability to hormone disruption, emphasizing the importance of integrating stress reduction techniques into daily life. Practices like yoga and meditation play a pivotal role in regulating the body's stress response, effectively managing stress hormone levels. Simultaneously, ensuring good sleep is paramount for hormonal balance, as disrupted sleep patterns can impact hunger-regulating hormones and disturb the delicate equilibrium between cortisol and melatonin. By incorporating mindfulness activities and prioritizing quality sleep, you can fortify your body against the adverse effects of chronic stress, fostering an environment conducive to optimal hormone production and balance. 5 - Move, move, move! Regular exercise plays a pivotal role in supporting proper hormone production and balance. Physical activity stimulates the endocrine system, prompting the release of hormones such as cortisol, insulin, and growth hormone. Engaging in aerobic exercise, strength training, or a combination of both has been shown to enhance insulin sensitivity, helping to regulate blood sugar levels and prevent insulin resistance. Moreover, exercise promotes the release of endorphins, the body's natural mood enhancers, which can contribute to reduced stress and anxiety. Additionally, consistent physical activity is linked to improved sleep quality, indirectly influencing hormonal balance by supporting the body's circadian rhythm. Overall, a well-rounded and moderate exercise routine is a powerful tool for maintaining proper hormone production and fostering overall health. By understanding where common hormone disruptors are found, how to avoid them, and how to minimize their impact by optimizing your hormone function, you can empower yourself to make informed choices that support hormonal balance and overall well-being. If you’d like some help with finding your ideal balance or more information on hormone health, make an appointment with us today! Sources: Environmental Working Group, “Shopper’s Guide to Pesticides in Produce,” https://www.ewg.org/foodnews/summary.php Heindel JJ, Blumberg B, Cave M, Machtinger R, Mantovani A, Mendez MA, Nadal A, Palanza P, Panzica G, Sargis R, Vandenberg LN, Vom Saal F. Metabolism disrupting chemicals and metabolic disorders. Reprod Toxicol. 2017 Mar;68:3-33. doi: 10.1016/j.reprotox.2016.10.001. Epub 2016 Oct 17. PMID: 27760374; PMCID: PMC5365353. Robles-Matos N, Artis T, Simmons RA, Bartolomei MS. Environmental Exposure to Endocrine Disrupting Chemicals Influences Genomic Imprinting, Growth, and Metabolism. Genes (Basel). 2021 Jul 28;12(8):1153. doi: 10.3390/genes12081153. PMID: 34440327; PMCID: PMC8393470. Rancière F, Lyons JG, Loh VH, Botton J, Galloway T, Wang T, Shaw JE, Magliano DJ. Bisphenol A and the risk of cardiometabolic disorders: a systematic review with meta-analysis of the epidemiological evidence. Environ Health. 2015 May 31;14:46. doi: 10.1186/s12940-015-0036-5. PMID: 26026606; PMCID: PMC4472611. Amir S, Shah STA, Mamoulakis C, Docea AO, Kalantzi OI, Zachariou A, Calina D, Carvalho F, Sofikitis N, Makrigiannakis A, Tsatsakis A. Endocrine Disruptors Acting on Estrogen and Androgen Pathways Cause Reproductive Disorders through Multiple Mechanisms: A Review. Int J Environ Res Public Health. 2021 Feb 4;18(4):1464. doi: 10.3390/ijerph18041464. PMID: 33557243; PMCID: PMC7913912. 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