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.

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.

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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