Balancing Act: Supporting Estrogen Metabolism for Hormonal Health
By Dr. Stacy Dunn, ND, LAc, FABNO, FABORM
Estrogen is a vitally important hormone responsible for supporting bone, cardiovascular, cognitive, and reproductive health. However, as is true with all hormones, balance is key. Creating healthy hormonal balance is crucial for good health, yet is increasingly difficult given modern processed diets, sedentary lifestyles, and everyday exposures to endocrine disruptors such as xenoestrogens, (synthetic chemicals that mimic estrogen). And as our estrogen exposure increases, our risk for estrogen-associated conditions such as fibroids, endometriosis, PMS, polycystic ovarian syndrome, breast cancer and uterine cancer, increases as well.
Estrogen and Estrogen Metabolism
Estrogen is a steroid hormone produced by both men and women. The term ‘estrogen’ collectively describes the three major types of estrogen: Estrone (E1), Estradiol (E2), and Estriol (E3). Estrone is the weakest of the three types of estrogen. It is produced by the adrenal glands, fatty tissues, and ovaries, and is the predominant form of estrogen present after menopause. Estrone can convert to Estradiol if a stronger estrogen is required by the body. Estradiol is our most potent estrogen and is produced primarily in the ovaries. It is the predominant form of estrogen during our reproductive years and is the form of estrogen most commonly prescribed for hormone replacement therapy (HRT) for menopausal symptoms. Estriol is the weakest of the three estrogen types and is produced during pregnancy to help prepare the body for childbirth.
Estrogen, whether it was made by the body, derived by a plant (phytoestrogen), or developed in a lab, undergoes detoxification in the liver to break it down and
Supporting Estrogen Metabolism for Hormonal Health
remove it from the body. These phases of detoxification are a bit technical – but really interesting and super important, so stay with me!
There are 3 phases of estrogen metabolism. The first 2 phases occur in the liver.
PHASE 1 (called hydroxylation) uses enzymes to transform estrogen into intermediate compounds, or metabolites. These metabolites are highly reactive and have the potential to cause oxidative and DNA damage. There are 3 possible metabolites:
2-OH: considered a “good” or protective metabolite and less estrogenic. (Cruciferous veggies, exercise, isoflavones, and green tea promote this pathway).
4-OH: considered a “bad” metabolite that can cause permanent DNA damage and has the strongest estrogenic effect. (Xenoestrogens such as PCBs and dioxins selectively activate this pathway).
16-OH: considered a “bad” metabolite that is linked to an increased risk of estrogen-related health conditions including breast cancer.
PHASE 2 detoxification neutralizes these metabolites, creating water-soluble compounds that can then travel into the kidneys or intestines for excretion. This process of neutralization (called conjugation) is supported by b-vitamins and sulfur rich foods such as garlic, onions, cruciferous veggies, and eggs.
PHASE 3 involves eliminating these now water-soluble compounds through the kidneys and intestines. Gut health is essential for this process, as dysbiosis can lead to reabsorption of estrogen – after your liver has worked so hard to prepare it for elimination! Dysbiosis is an imbalance in the gut bacteria that often occurs as a result of stress, a poor diet, and antibiotic use.
Dysbiosis leads to elevated levels of beta glucoronidase, an enzyme in the gut which breaks apart the conjugated, water-soluble estrogen so it cannot be excreted and is, instead, reabsorbed back into circulation.
Factors contributing to Estrogen Imbalance
There are 3 ways estrogen levels become elevated in the body: increased endogenous production, exposure to exogenous estrogens, and poor estrogen detoxification.
Increased endogenous production can result from alcohol consumption, obesity, lack of exercise and/or stress.
Sources of exogenous estrogen include medications such as hormonal contraceptives and hormone replacement therapy (yes, even bioidentical HRT). Xenoestrogens are another exogenous source of estrogen, and we are exposed to hundreds of these chemicals daily. Xenoestrogens such as BPA, Phthalates, Dioxins, Parabens, and PCBs can be ingested, inhaled, or absorbed through the skin. They are found in many of our everyday products such as household cleaning products, plastic storage containers, bug spray, lotion, fingernail polish, perfume, bottled water, paper receipts, bleached toilet paper, fertilizer, non-organic food, air fresheners. The list goes on and on. Mold is yet another source of exogenous estrogen exposure. The estrogenic mycotoxin zearalenones (ZEA) is produced by the Fusarium species, ZEA is found primarily in contaminated grains and cereals.
Supporting Estrogen Metabolism for Hormonal Health
Poor estrogen detoxification can result from impairment to any of the phases of detoxification. As we learned above, liver and gut health are crucial to these processes. Detoxification can be impaired by nutrient deficiencies, liver dysfunction, drugs and environmental chemicals, and genetic variability impacting enzymes involved in detoxification.
Lab Assessment
Functional and conventional lab testing is critical for identifying patterns of hormonal imbalance as well as potential root cause(s). Assessments may include: ∙ DUTCH Complete Panel provides an in-depth analysis of sex and adrenal hormones, as well as estrogen metabolites. If you want to know if you are metabolizing estrogen through 2-OH (“good”) pathways versus 4-OH and16- OH (“bad”) pathways, this is the test.
∙ GI Effects Stool Analysis can assess levels of beta-glucuronidase and intestinal dysbiosis contributing to poor estrogen detoxification.
∙ Nutritional Genome Panel to assess genetic polymorphisms (SNPs) to assess function of the enzymes crucial for detoxification, such as COMT, MTHFR, and CYP450 enzymes.
∙ Environmental Toxins panel to identify xenoestrogen exposure. ∙ Mycotoxin panel to assess for ZEA exposure.
∙ Methylation panel to assess need for nutritional support for your methylation pathways. Methylation is one of the chemical processes involved in conjugation (Phase 2 detoxification).
∙ Liver function tests to see if you liver function is impaired or needs a little extra support.
Supporting Estrogen Metabolism for Hormonal Health
Strategies for Estrogen Balance
- Eat a diet high in cruciferous vegetables, such as broccoli, cabbage, cauliflower, and brussels sprouts. These promote 2-OH (good) metabolites and support liver health.
- Increase your fiber intake to support estrogen metabolism in the digestive tract. High fiber diets are associated with lower levels of beta-glucoronidase, and reduced circulating estrogen. Fiber also helps to reduce constipation, and constipation also allows estrogen to be recirculated. Aim for 35g of fiber a day through fruits, vegetables, legumes, nuts, and seeds.
- Increase your intake of ground flax seeds (1-2 Tablespoons daily) for additional fiber as well as aromatase (an enzyme that converts androgens to estrogens) inhibition.
- Avoid alcohol, which inhibits estrogen detoxification and increases estradiol levels.
- Avoid xenoestrogens – use glass or stainless steel in place of plastic, filter your water and indoor air, use natural cleaning and personal care products. (EWG Skin Deep website is a great resource for checking personal care product ingredient safety profiles).
- Buy organic foods when possible to avoid pesticide (xenoestrogen) exposure. The EWG Clean 15 and Dirty Dozen lists can help you prioritize which foods to buy organic.
- Consider supplements:
– DIM supports phase 1 detoxification enzymes, shifting production towards favorable metabolites.
Supporting Estrogen Metabolism for Hormonal Health
– Calcium D-Glucarate supports phase 3 detoxification by inhibiting beta glucuronidase.
– Probiotics to restore the gut biome and aid in efficient elimination.
Conclusion
While balanced estrogen levels are essential for good health, excessive levels carry the risk estrogen driven cancers and other health concerns. While a number of environmental and lifestyle factors can influence estrogen production, metabolism, and balance, with proper assessment and treatment, optimal metabolism and detoxification can be supported to ensure healthy levels of this vital hormone.
