INSIDER S GUIDE Interpretation and treatment: Estrogen Metabolism Assessment

Transcription

1 Functional Medicine University s Functional Diagnostic Medicine Training Program INSIDER S GUIDE Interpretation and treatment: Estrogen Metabolism Assessment By Ron Grisanti, D.C. & Dicken Weatherby, N.D. Limits of Liability & Disclaimer of Warranty We have designed this book to provide information in regard to the subject matter covered. It is made available with the understanding that the authors are not liable for the misconception or misuse of information provided. The purpose of this book is to educate. It is not meant to be a comprehensive source for the topic covered, and is not intended as a substitute for medical diagnosis or treatment, or intended as a substitute for medical counseling. Information contained in this book should not be construed as a claim or representation that any treatment, process or interpretation mentioned constitutes a cure, palliative, or ameliorative. The information covered is intended to supplement the practitioner s knowledge of their patient. It should be considered as adjunctive support to other diagnostic medical procedures. This material contains elements protected under International and Federal Copyright laws and treaties. Any unauthorized reprint or use of this material is prohibited Functional Medicine Training Program Page1 of 6

2 What is the Story with Estrogen? The National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health (NIH) has stopped early a major clinical trial of the risks and benefits of combined estrogen and progestin in healthy menopausal women due to an increased risk of invasive breast cancer. The large multi-center trial, a component of the Women's Health Initiative (WHI), also found increases in coronary heart disease, stroke, and pulmonary embolism in study participants on estrogen plus progestin compared to women taking placebo pills. There were noteworthy benefits of estrogen plus progestin, including fewer cases of hip fractures and colon cancer, but on balance the harm was greater than the benefit. The study, which was scheduled to run until 2005, was stopped after an average follow-up of 5.2 years. Full Story go to When this study came out in 2002, most people, including well-meaning traditional medical physicians, were in a state of shock. How could this have happened? The general consensus was estrogen should be stopped because it had the potential to cause breast cancer and a host of other deliberating health challenges. Unfortunately, the research on estrogen failed to take into account the important issue of estrogen metabolism as it relates to the specific individual biochemical make-up of the patient. As it now happens, estrogen is NOT the chief villain in the increase of estrogen related breast cancers. In fact, the real criminal happens to be the fact that some women simply have the inability to properly metabolize estrogen and that is where the problem begins. While estrogen is produced primarily by developing follicles in the ovaries, the corpus luteum, and the placenta, it is where estrogen is metabolized where we begin to see real health issues. Estrogen metabolism takes place mainly in the liver via 2 dominant pathways, resulting in either 2-hydroxy and 4-hydroxy or 16-alpha-hydroxy metabolites of estrone and estradiol. The Benefits of Estrogen Promote formation of female secondary sex characteristics Accelerate metabolism (burn fat) Maintenance of vessel and skin Reduce bone resorption, increase bone formation Increase hepatic production of binding proteins Increase HDL Decrease LDL, fat deposition Increase cortisol, SHBG Increase cholesterol in bile Functional Medicine Training Program Page2 of 6

3 Promotes lung function by supporting alveoli (in rodents but probably in humans). As the above clearly reveals, estrogen does have benefits. However, as time moved on clinicians and patients alike were left with unanswered questions. Why are certain tissues, such as the breast, susceptible to estrogen-induced cancer? Why are some women susceptible, but not others? Finally, the Estrogen Nightmare is Solved Researchers at Rockefeller University found that the body metabolizes estrogens into several different metabolites that can impact cancer development. One metabolite, 2-hydroxyestrone (2-OHE1), tends to inhibit cancer growth. Another, 16-a-hydroxyestrone (16-a-OHE1), actually encourages tumor development. A woman s "biochemical individuality" determines which of these metabolites predominates. Scientific research has proven that measuring the ratio of these two metabolites provides an important indication of risk for future development of estrogen-sensitive cancers. The studies also show that this risk is modifiable! A few innovative labs including MetaMetrix and Genova have led the way in providing women with these state of the art lab tests. Understanding Estrogen Metabolism As you have read above, the real issue is one s ability to properly and effective metabolize estrogen. This has been accomplished with the ability to measure estrogen metabolites. Estrogen is metabolized by two main, competing pathways, either to 2-hydroxyestrone or to 16 -hydroxyestrone. The balance between the estrogen metabolite 16 -hydroxyestrone and Functional Medicine Training Program Page3 of 6

4 2-hydroxyestrone is the real issue for ones risk for disease development such as breast cancer, auto-immune disease, etc. 2-Hydroxyestrone (2-OHE1) This metabolite of estrone has been called the "good" estrogen, and appears to represent a beneficial direction in estrogen metabolism. Normal levels of the 2-OHE1 imply a balanced metabolism and generally may be maintained through a lifestyle of good diet, exercise and reasonable intake of EPA, cruciferous vegetables, and flaxseeds. Changes in 2-OHE1 may be particularly important for women to monitor as their hormone status changes due to contraceptives, estrogen replacement therapies, diet, or exercise regimen. 16alpha-Hydroxyestrone (16alpha-OHE1) This metabolite of estrone is a powerful metabolite that stimulates target tissues and has been called the bad estrogen and may be associated with estrogen-dependent diseases, such as lupus and breast cancer. Normal or low levels are good to observe. Levels can rise in response to obesity, alcohol consumption, and toxic exposure. There are means to influence and perhaps reduce the production of this metabolite; exercise, intake of soy and cruciferous vegetables, and fish oil (EPA) all appear to be of potential benefit at keeping the levels normal or low. 2:16alpha-Hydroxyestrone ratio This ratio appears to be an important gauge of estrogen metabolism, in addition to helping physicians accurately monitor the clinical safety and effectiveness of natural and pharmaceutical hormone replacement therapy (HRT). 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. **Some labs use a different range showing levels above 2 to be clinically beneficial (MetaMetrix) Treatments that increase the 2:16 alpha-ohe1 ratio help to reduce the risk of estrogen dependent disease. These include: Cruciferous vegetables (e.g. broccoli, brussel sprouts, cabbage, cauliflower) Supplementation of indole-3-carbinol (I-3-C) or diindolylmethane (DIM) Omega-3-fatty acids (DHA & EPA) found in fish (e.g. mackerel, lake trout, herring, sardines, salmon) and marine algae also may help to lower cancer risk. Exercise Functional Medicine Training Program Page4 of 6

5 **It is worth noting that there may be an increased likelihood of osteoporosis with excessive 2-OHE1 production and individuals with a very high 2:16alphahydroxyestrone ratio. Environmental Estrogens Many synthetic chemicals mimic estrogen and exhibit estrogen-like activity in humans. Basically, these chemicals imitate estrogen in the body. Since the turn of the century, manufacture and use of synthetic chemicals has rapidly increased these estrogenic chemicals. The following is short list of some of the estrogenic chemicals which place additional stress on effective estrogen metabolism. Insecticides Herbicides Products associated with plastics (bisphenol A, phthalates) Ordinary household products (breakdown products of detergents and associated surfactants, including nonylphenol and octylphenol) Industrial chemicals (polychlorinated biphenyls (PCBs), dioxin and benzo(a)pyrene) Heavy metals (lead, mercury, and cadmium) Summary As we have just reviewed, the matter of estrogen is more related to our body s ability to metabolize it rather than the total elimination of estrogen. However, as it now stands, it is almost impossible to stay clear of all estrogens, especially the environmental estrogen. Our best advice to our patients and of course to ourselves is to be certain we have an efficiently functioning estrogen metabolism and to do our best to minimize our exposure to environmental estrogens. So the next time someone mentions that estrogen is bad and the primary culprit in a host of diseases, you will know better. The real question you need to ask is, how well is your body metabolizing estrogen? You now have a test that will accurately provide that answer. The Estrogen Metabolism Assessment. Credit is contributed to the following labs for their advancement in the field of functional medicine: Metametrix Clinical Laboratory 3425 Corporate Way Duluth, GA Functional Medicine Training Program Page5 of 6

6 Genova Diagnostics 63 Zillicoa Street Asheville, NC Functional Medicine Training Program Page6 of 6