Case 11: Hot Flashes, Loss of
Libido and Compromised
Estrogen Metabolism 
(contd.)

 

A Functional Medicine Approach

First and foremost, the cookbook approach to nutrition is simply a "crap shoot" and may or may not help a patient. Applying functional diagnostic testing puts you, the doctor, in a position of superiority as a diagnostician. In addition, your clinical results both subjectively and objectively are more predictable.

Now isn't that the way you want to practice... Evidenced Based Nutrition.

Here is the real story behind Janet's health challenges.

As you can see on the lab test Janet's estrone (El) is above the reference range. Estrone is the second most potent estrogen after estradiol. Estradiol (E2) is below the reference range. Estradiol is the most potent estrogen. Although total estrogens decline in menopause, estrone becomes the predominant circulating estrogen.

In the postmenopausal woman, estradiol arises from estrone. Estrone and estradiol are reversible reactions.

estrogen

 

Now do you see a problem with the flow of estrone to estradiol?

As you can see, estrone is measured at 56 and estradiol at less than 20.

Hmm..

Now this is what I am talking about.

There is a biochemical/hormonal glitch in the estrone =======>estradiol pathway.

In layman's terms, the estrone is backed up, constipated, stuck and not overflowing to feed the estradiol pathway.

With me?

This is a BIG problem and is further evidenced by the compromised estrogen metabolites.

Let's see how this all works out.

Look below at Janet's test (or click here to read a PDF copy)

Let's take each of the metabolites and get you up to speed on what is happening.

The first metabolite is 2-Hydroxyestrone (2-OHE1). This metabolite level was below the expected range at 100. Low levels are viewed as suboptimal and increase a woman's risk estrogen-dependent diseases, such as lupus and breast cancer. Low levels of this metabolite may be due to genetic/racial factors, poor exercise habits, obesity, and dietary influences such as imbalanced fatty acids and a low intake of cruciferous vegetables (includes kale, collard greens, broccoli, cauliflower, cabbage, Brussels sprouts, and turnips) and lignans.

The second metabolite is 16alpha-Hydroxyestrone (16alpha-OHE1) and although within the normal reference range it is on the "high side of normal at 517. This is way too high for what I like to see. This metabolite when elevated has been found to be associated with estrogen-dependent diseases, such as lupus and breast cancer. So low normals are good to observe.

Next listed under the estrogen metabolism is 2:16alpha-Hydroxyestrone ratio. In general, the higher the ratio, the less association there is with estrogen-dependent diseases such as breast cancer and lupus, and the more likely the person has a beneficial hormone metabolism. A 2:16alpha-hydroxyestrone ratio in serum greater than 0.4 is generally thought to be beneficial.

menopausal

So you may be thinking how this all pans out to help Janet with her symptoms.

Well let's think about it.

Why do you think the estrogen patch did not help?

Do you think she would have felt any better with bio-identical hormone replacement like bi-est?

Well, this lies in the fact that she was unable to convert estrone to estradiol.

With the treatment protocol I placed her on, Janet's symptoms quickly improved.

Now I know.. I know... you are asking what did I recommend for Janet to help her?

Ok.. my main course of treatment was to simply open up the backed up flood gates of estrone to "fuel" the bottomed out estradiol. This was done via Indole-3-carbinol and Calcium D-glucarate. She was also encouraged to eat four to five serving of  cruciferous vegetables a day.

There is more to Janet's protocol, however, the above played a significant role in helping her get better.

Medical Citations:

Lord RS, Bongiovanni B, Bralley JA. Estrogen metabolism and the diet-cancer connection: rationale for assessing the ratio of urinary hydroxylated estrogen metabolites. Altern Med Rev. 2002 Apr;7(2):112-29.

Michnovicz JJ. Increased estrogen 2-hydroxylation in obese women using oral indole-3-carbinol. Int J Obes Relat Metab Disord. 1998 Mar;22(3):227-9.
 
Bradlow HL, Telang NT, Sepkovic DW, Osborne MP. 2-hydroxyestrone: the 'good' estrogen. J Endocrinol. 1996 Sep;150 Suppl:S259-65.
 
Michnovicz JJ, Bradlow HL. Altered estrogen metabolism and excretion in humans following consumption of indole-3-carbinol. Nutr Cancer. 1991;16(1):59-66.
 
Michnovicz JJ, Adlercreutz H, Bradlow HL. Changes in levels of urinary estrogen metabolites after oral indole-3-carbinol treatment in humans. J Natl Cancer Inst. 1997 May 21;89(10):718-23.
 
Mueck AO, Seeger H, Lippert TH. Estrogen-dependent neoplasia - what is the significance of estradiol metabolites] Zentralbl Gynakol. 2003 Nov;125(11):458-66.
 
Niwa T, Swaneck G, Bradlow HL. Alterations in estradiol metabolism in MCF-7 cells induced by treatment with indole-3-carbinol and related compounds. Steroids. 1994 Sep;59(9):523-7.
 
Calcium-D-glucarate. Altern Med Rev. 2002 Aug;7(4):336-9.
 
Heerdt AS, Young CW, Borgen PI. Calcium glucarate as a chemopreventive agent in breast cancer. Isr J Med Sci. 1995 Feb-Mar;31(2-3):101-5
 
Keck AS, Finley JW. Cruciferous vegetables: cancer protective mechanisms of glucosinolate hydrolysis products and selenium. Integr Cancer Ther. 2004 Mar;3
 
Kabat GC, O'Leary ES, Gammon MD, Sepkovic DW, Teitelbaum SL, Britton JA, Terry MB, Neugut AI, Bradlow HL. Estrogen metabolism and breast cancer. Epidemiology. 2006 Jan;17(1):80-8.
 
Muti P, Bradlow HL, Micheli A, Krogh V, Freudenheim JL, Schunemann HJ, Stanulla M, Yang J, Sepkovic DW, Trevisan M, Berrino F. Estrogen metabolism and risk of breast cancer: a prospective study of the 2:16alpha-hydroxyestrone ratio in premenopausal and postmenopausal women. Epidemiology. 2000 Nov;11(6):635-40.
 
Ursin G, London S, Stanczyk FZ, Gentzschein E, Paganini-Hill A, Ross RK, Pike MC. A pilot study of urinary estrogen metabolites (16alpha-OHE1 and 2-OHE1) in postmenopausal women with and without breast cancer. Environ Health Perspect. 1997 Apr;105 Suppl 3:601-5. 

Meilahn EN, De Stavola B, Allen DS, Fentiman I, Bradlow HL, Sepkovic DW, Kuller LH. Do urinary oestrogen metabolites predict breast cancer? Guernsey III cohort follow-up. Br J Cancer. 1998 Nov;78(9):1250-5.


 

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