Oestrogen Excess: Part 1
I often hear patients commenting on how they have read somewhere that doing a liver detox can assist with hormone balance. And while this statement is not entirely incorrect, it is important to understand why and how we can support these pathways.
Our liver detox pathways are working 24/7/365 no matter what. Our liver is not the only organ used to detoxify, with the skin, kidneys, lungs and gut being an important part of the process (as well as our lymphatic system which is also involved).
Our hormones, in particular oestrogen, once used need to be excreted out of the body via these processes. It will head through Phase 1 & Phase 2 liver detoxification and then onto the bowels or kidneys for removal.
What happens though if this isn’t working efficiently?
First it is important to understand that oestrogen comes in many forms:
Oestradiol (E2) our main source of ovarian oestrogen required for ovulation and baby making.
Estrone (E1) which is a weaker form of oestrogen and can be converted into E2. It is also made in the fat cells.
Xenoestrogens. These come from our environment and these little suckers are things like endocrine disrupting chemicals (EDCs) from things like pesticides, plastics and personal care products. The “oestrogen” used in the oral contraceptive pill is a type of xenoestrogen.
Oestrogen Metabolites or the breakdown components of oestrogen, which if are let loose in the body can wreak havoc.
Oestrogen Excess can occur where these oestrogens are high in relation to progesterone. Symptoms you may see include heavy periods; breast pain; PMS; irritability; fibroids and more. It really depends on what oestrogen is doing in conjunction with your progesterone (aka are you ovulating, and is it “robust”).
A little more on the pathways.
PHASE 1- Liver
Think of this phase as water pouring into the bathtub, or oestrogen entering the liver. Enzymes take your O and convert them to O metabolites, some of which are better than others.
Enzyme CYP1A1 & 1A2 converts O to a form called 2-OH which is the preferred pathway and less carcinogenic.
Enzyme CYP1B1 converts O into a form called 4-OH which although is a normal part of the process, in excess can cause DNA damage and is more carcinogenic.
Enzyme CYP3A4 converts O into 16-OH which generally makes things grow and proliferate. This is a good thing for bones for example, but not so good if you have things like fibroids and endometriosis.
Each of these metabolites are highly reactive oxidative intermediates. They need to go through the rest of the biotransformation process to be able to be ready for excretion, and at this stage they can still act upon oestrogen receptors, albeit in a weaker form than their predecessors.
The above pathways don’t just deal in oestrogen but loads of other things like medications and environmental toxins for example. They rely on many nutrients and minerals to function effectively and can be directly affected by certain medications, alcohol and genetics.
PHASE 2- Liver
Think of this phase as the water leaving the bathtub through the plughole. These by products are considered safer and less reactive than their predecessors as they no longer will react with DNA. An enzyme called COMT is in charge of P2 O metabolism (among other things!). It requires an array of B vitamins, Magnesium, Zinc, Methionine, Choline and SAMe to name a few. Basically COMT is like mum picking up it’s naughty toddler (phase 1 metabolite) to carry across the road (to the bowels and kidneys in this case).
Certain genetic SNPs, gut infections, EDCs, medications, heavy metals, nutrient deficiencies can cause this enzyme to work slowly.
PHASE 3- Gut and Kidneys (poop and urine)
Now the O is packaged up in a neat, safe little package it is excreted via the bile (poo) or urine. Think of this part as the plumbing pipes that take the water out and away from the house. Constipation, bloating and gas are sure signs this pathway isn’t up to scratch. We also need bile here! If you are sans gallbladder, then you may have some issues with this phase.
In our gut we have a nifty little thing called the Oestrobolome, which is the part of the microbiome that deals in oestrogen. It’s job it to assist with the metabolism and modulation of oestrogen. If the oestrobolome gets a little unruly, we get an increase of an enzyme called Beta-glucuronidase.
Remember that neat little package ready to be pooped out? Well beta-gluc unties that little package allowing the oestrogen to be reabsorbed back into the bloodstream, adding to the total oestrogen load.
Case in point: good gut health is vital for hormone balance!
Now if you start a liver detox of any description, can you see where things can go wrong? What if you are pushing Phase 1, and your Phase 2 and 3 isn’t up to scratch (which is pretty common!)? What if you are constipated? What about the plastic water bottles, toxic skin care, and lack of water intake? No point pushing liver pathways if you have shit gut health and your toxic load is through the roof!
Now that you understand a little more about Oestrogen, where it comes from, what too much does and how we get rid of it, the next blog will be focussed on the things you can do to optimise your oestrogen.
And because I know I will be asked…
You can test your oestrogen metabolites through DUTCH Testing which gives an insight to Phase 1 and Phase 2 (among a load of many other very useful things). A stool test can give you levels of Beta-Gluc and overall gut health. I love both of these tests, but don’t always recommend them unless I know it will change or assist my treatment plan (as they can be $$).
J Xx