Endocrine Essentials: Estrogens
featuring Debbie Rice, ND, MPH
Audio Only:
Episode 6
Published May 24, 2022
On this week’s episode, we’re joined by the Director of Clinical Education for Precision Analytical, Dr. Debbie Rice, to explain estrogen and estrogen metabolism. Dr. Rice is an expert in female hormone health and will dive into the complexities of estrogen including where it’s created, how the body uses it, and what happens when there’s too much. Join us this week as we talk about the importance of estrogen and why it’s so often misunderstood.
About our speaker
Dr. Rice is the Director of Clinical Education for Precision Analytical and practices part-time as a naturopathic doctor where she focuses care on pediatric health, hormone health, thyroid health, and adrenal health. She has had experience working with communities in need, both in the United States and internationally. Her training has been primarily in women's health, pediatric care, hormone therapy and hormone function, as well as complimentary adjunct care. Dr. Rice utilizes multiple modalities including diet and lifestyle, botanical medicine, and conventional approaches that meet the patient where they are in their health journey.
Please Note: The contents of this video are for educational and informational purposes only. The information is not to be interpreted as, or mistaken for, clinical advice. Please consult a medical professional or healthcare provider for medical advice, diagnoses, or treatment.
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Full Transcript
00:00:00:02 - 00:00:18:07
Noah Reed
Welcome back to the DUTCH podcast, where integrative medicine providers can expand their understanding of functional endocrinology and testing. And everyone, no matter who you are, can learn more about their body’s most complex communication system. I'm Noah Reed, vice president of sales and marketing for the DUTCH Test.
00:00:18:12 - 00:00:35:18
Noah Reed
And coming up on this week's episode, we bring you another installment of our Endocrine Essential series with our very own Dr. Debbie Rice. Dr. Rice is an expert in female hormone health. And we'll tell you everything you need to know about estrogens, where estrogen is created,
00:00:35:22 - 00:00:58:04
Noah Reed
how does the body use them, and what happens when there's too much? Follow along as we talk about this complex and often misunderstood reproductive hormone in this week's podcast. Dr. Rice is the director of clinical education for Precision Analytical and practices part-time as a naturopathic doctor, where she focuses care on pediatric health, hormone health, thyroid health
00:00:58:04 - 00:01:13:11
Noah Reed
and adrenal health. She has had experience working with communities in need, both in the United States and internationally. Her training has been primarily in women's health, pediatric care, hormone therapy and hormone function, as well as complementary adjunct care.
00:01:13:19 - 00:01:25:16
Noah Reed
Dr. Rice utilizes multiple modalities, including diet and lifestyle, botanical medicine and conventional approaches that meet the patient where they are in their health journey. All right. Let's get started.
00:01:26:05 - 00:01:31:17
Mark Newman
Thanks, Noah, and thanks to our director of clinical education, Dr. Debbie Rice, for being with us today.
00:01:31:23 - 00:01:33:12
Debbie Rice
I'm excited to be here.
00:01:34:00 - 00:01:48:05
Mark Newman
She leads a terrific team that we have of 12 or so clinical consultants that do a really good job of explaining what we do to our clients. She's well positioned to do that because she really gets this stuff.
00:01:48:09 - 00:01:58:16
Mark Newman
But she was also one of our first clients of using the DUTCH test in her practice for years, actually, before coming on staff with us. So, that gives her a really good perspective to answer some questions for us.
00:01:58:17 - 00:02:09:02
Mark Newman
So, today we are going to pick her big brain and dig into the topic of estrogen. So, let's just start with the beginning. What is estrogen and why do we care?
00:02:09:21 - 00:02:21:18
Debbie Rice
So, I think it's a great question. I think estrogen is one of those things that when you think of estrogen, you think of women, you think of females and female hormone and reproductive physiology. You think of the menstrual cycle.
00:02:21:18 - 00:02:43:00
Debbie Rice
You think of development, breast health, ovarian health, uterine health. But males also have estrogen, also very important for male physiology and function. But I like to remind people that as much as estrogen is a very big part of reproductive health, it's also important for brain health, cardiovascular health, bone health.
00:02:43:00 - 00:02:50:13
Debbie Rice
Right. So, it's a it's a multifactorial hormone, but with the biggest bang for its buck, with female hormone physiology.
00:02:51:10 - 00:03:09:02
Mark Newman
And when we hear conversations about estrogen, usually the topic is either something that's positive, like the things you just mentioned, or we might get into conversations about risk for certain types of cancers or estrogen dominance or those sorts of things.
00:03:09:02 - 00:03:18:23
Mark Newman
So, when you think of estrogen, what comes to mind? Good, bad, like how do you what what's the ins and outs of estrogen in terms of whether it's good for us or bad for us?
00:03:19:06 - 00:03:37:21
Debbie Rice
I feel like estrogen gets a really bad rap because a lot of people are like, no, on the estrogen. And I think there's been this underlying theory or thought process that estrogen is bad just because of previous studies and research that has been done.
00:03:37:21 - 00:03:49:06
Debbie Rice
But estrogen is really good, right? Like estrogen helps female. And this is going to be more specific to females. But it helps regulate your mood. It helps regulate your metabolism. It helps regulate your body's capacity to sleep and wake.
00:03:49:07 - 00:04:03:17
Debbie Rice
Right. Like it helps with that circadian response. It actually helps with lubrication of your joints. So, we have to have a certain amount of estrogen to be able to be on a day-to-day basis. So, I don't I don't see estrogen as good or bad.
00:04:03:17 - 00:04:15:12
Debbie Rice
It's a balance of what your estrogen is doing in your body. And we have to remember that estrogen doesn't just live by itself in your body. Right. Like there are other hormones that are associated with estrogen and how estrogen works.
00:04:15:12 - 00:04:33:15
Debbie Rice
Estrogen influences how you ovulate and the signaling for progesterone. Right. So, it's this very complicated and nuanced, beautiful dance between estrogen and progesterone. And it's also influenced by testosterone and DHEA. Right. Like there are so many components that influence or influenced and influence estrogen.
00:04:33:21 - 00:04:45:05
Debbie Rice
So, I don't think you can just say estrogen is good or estrogen it's bad. We need to look at each person, what their estrogen is doing, why, how and create that evaluation from there.
00:04:45:20 - 00:04:59:13
Mark Newman
And if we were going to be sort of reductionist just for the sake of our audience, what are the top things that you see? Let's start with females for women who are deficient in estrogen or have too much estrogen.
00:04:59:15 - 00:05:02:06
Mark Newman
Like what are the key symptoms that you see on both ends of that spectrum?
00:05:02:07 - 00:05:20:13
Debbie Rice
I was just talking to somebody about this because it's like, oh, you can have very similar symptoms if you don't have enough estrogen or if you have too much estrogen. So, a lot of the more common symptoms that you have with low estrogen will be like hot flashes, night sweats, not able to sleep irritable and emotional.
00:05:20:22 - 00:05:31:19
Debbie Rice
But you swing the pendulum to the other side and you can also have that if you have too much estrogen. I think the other component of too much estrogen is where you can have it's easy to gain weight, difficult to lose weight.
00:05:32:23 - 00:05:51:06
Debbie Rice
The for cycling females, when you have too much estrogen, we're also looking at heavy periods, fibroids, clotting periods, painful periods, painful breast tenderness. So, it depends on which side of the pendulum you're swinging on with too much estrogen.
00:05:51:06 - 00:05:52:05
Debbie Rice
Not enough estrogen.
00:05:52:18 - 00:06:11:03
Mark Newman
Right. And of course, we like to reduce things to one variable because our brains can handle it better. But we know that estrogen and progesterone have this dance that they're doing in terms of balancing each other. So, can you just explain the concept of estrogen dominance, how that relates to both estrogen and progesterone?
00:06:11:09 - 00:06:27:03
Debbie Rice
Yeah, I mean, I say yeah, like it's simple, but it's not that simple because estrogen gets to play a lot more in the menstrual cycle. It has more of a chance to do bad things than progesterone does. Right.
00:06:27:03 - 00:06:37:10
Debbie Rice
So, we rely on estrogen to do this really big push so that we can ovulate and then it's supposed to calm down and then kind of come up and match progesterone in the luteal phase or the second part of the cycle.
00:06:37:20 - 00:06:59:11
Debbie Rice
So, estrogen gets the opportunity to be a part of the all phases of the menstrual cycle. Right. So, it has more of a chance to do things wrong or right. And if you end up getting for whatever reason, whether it's stress or different signaling or even genetics, right, you can get it more increased signaling with estrogen.
00:06:59:11 - 00:07:18:05
Debbie Rice
And if the signaling doesn't calm down, you may not get appropriate progesterone balance with that. And that's where you can come up with estrogen dominance. And estrogen dominance can show up as either irregular cycles or, again, painful cycles where you're not getting the calming down of the estrogen.
00:07:18:05 - 00:07:40:13
Debbie Rice
Do estrogen just gets to go wild. And I like to call progesterone the soothing mama hormone that comes in and like calms estrogen down. If you don't get that calming of progesterone that's estrogen just goes wild and that's where estrogen could be bad, where you don't have the normal physiologic signaling or capacity to balance that estrogen.
00:07:41:04 - 00:07:41:18
Debbie Rice
So, does that answer your question?
00:07:41:18 - 00:07:54:10
Mark Newman
Yeah. Yeah. When we're looking at estrogen and progesterone, it's hard to have that conversation in terms of how we assess those before we talk about what it is exactly that we're measuring, because estrogen is, of course, the sort of generic term.
00:07:54:11 - 00:08:04:16
Mark Newman
Yes. So, can you translate that to us in terms of estrogen as opposed to the actual chemicals, biochemistry, things that we're measuring in something like a DUTCH test.
00:08:05:05 - 00:08:08:19
Debbie Rice
Like the difference between E1, E2, and E3 or?
00:08:08:19 - 00:08:14:06
Mark Newman
Sure, yeah. What are what are what is the primary estrogen? What are the things that we're that we're actually measuring?
00:08:14:08 - 00:08:29:20
Debbie Rice
Yeah. So, on the DUTCH test, we measure E1, E2, E3 and what those do in the body, like how they get processed in the body. But it's also important to understand what are the different estrogens. So, as you said, estrogen can be a very generic term.
00:08:29:20 - 00:08:44:16
Debbie Rice
A lot of times when people are talking about estrogen, they're talking about estradiol, and that's also known as E2. That is the most potent estrogen in the body for cycling females. E1 is also estrone and we have E3, which is estriol.
00:08:45:00 - 00:08:58:22
Debbie Rice
So, when we're looking at these different estrogens, you know, the the body converts to E1 and so that's kind of like your lead into production for E2 and you want an E2 can convert back and forth into each other.
00:08:58:22 - 00:09:17:07
Debbie Rice
A lot of times it stays in that E2 form because it's the most potent form. It can also convert to E3, which is the weakest form of estrogen. It is. It is also mostly seen in pregnancy. The placenta ends up making a bunch of E3, but the most potent form of estrogen and the one that people generally
00:09:17:07 - 00:09:20:09
Debbie Rice
talk about is estradiol.
00:09:20:09 - 00:09:35:17
Mark Newman
And estradiol we can measure in saliva, we can measure it in urine with the DUTCH test, we can measure it in serum. What are some of the advantages of measuring it specifically before we talk about the metabolites, which is usually the first thing that comes to mind of why urine is well, metabolites.
00:09:35:17 - 00:09:46:19
Mark Newman
But if we if we ignore those for a second and just look at measuring estradiol in urine, like, like does it work in urine as well as measuring it elsewhere? Like what's the advantage of urine testing or pros and cons, really?
00:09:46:22 - 00:10:06:06
Debbie Rice
Yeah. I mean, we have great research to support the the the comparison between estradiol on let's say a DUTCH test versus estradiol in serum. They're quite comparable. So, when we look at that and I have a choice of if I'm going to look at estrogen, you know, estrogen in general, I'm going to pull an
00:10:06:06 - 00:10:17:21
Debbie Rice
estradiol from a DUTCH test because I want to know a more comprehensive look. I don't want just the estradiol. But if you just want estradiol, you certainly could test that in serum. It depends on what information you're looking for.
00:10:17:21 - 00:10:31:12
Debbie Rice
Right. You there is capacity to do salivary testing with estradiol my preference because I feel more comfortable with the research and validity is to do either serum and or DUTCH.
00:10:31:23 - 00:10:45:23
Mark Newman
Okay, so when we're looking just at estradiol serum, we would call the gold standard I think for estradiol. And then we have peer reviewed published data that says that we have a reasonably equivalent estradiol, which puts us on a good sort of equal footing there.
00:10:46:05 - 00:11:00:17
Mark Newman
And then the real benefit of urine, as you mentioned, is the other things that we get to look at that you you really don't have a window into in either saliva or in serum testing. So, what are those metabolites and what do they tell us?
00:11:01:03 - 00:11:15:05
Debbie Rice
So once you get your E1, E2, E3, those primary estrogens, you can look at what those estrogens are doing. So, when we're talking about estrogen metabolism, we're really asking what is estrogen doing in the body? How is it getting processed in the body?
00:11:15:11 - 00:11:29:04
Debbie Rice
And the big things that we look for in estrogen metabolism would be after you go through E1, E2, you drop into phase one metabolism. So, the body has this process, right? Like just how people process trash and recycling, right?
00:11:29:11 - 00:11:42:13
Debbie Rice
There's a whole system that has to happen for how, you know, trash gets processed, how things get recycled. Same thing in the body, right? We have a phase one and a phase two process in the liver and we can see that in dried urine testing.
00:11:42:13 - 00:11:53:18
Debbie Rice
So, we have your phase one metabolism. This is the metabolites that are associated with that are your 16-OH, your 4-OH, and your 2-OH. And I feel like that's the question of is that the good, the bad and the ugly.
00:11:53:18 - 00:12:05:18
Debbie Rice
When we're looking at phase one metabolism, we want to look at not just how much of those metabolites are being made, but what the ratio of those metabolites are. So, we can see is your phase one metabolism keeping up with what it needs to do?
00:12:05:18 - 00:12:25:16
Debbie Rice
Can it recycle? Can it clear out everything the way that it's supposed to? We also rely on phase one metabolism to go through phase one and into phase two metabolism. And that phase two metabolism is that like final punch through the liver on can we get that estrogen cleaned up and cleared out of the body?
00:12:25:22 - 00:12:41:20
Debbie Rice
And so that's what we get to look at. The phase two metabolites would be like the 2-methoxy, right? So, the methylated forms of estrogen. And I think it's important to understand that. So, we know not only how the body is or how much the body is producing of estrogen, but is it clearing appropriately?
00:12:41:20 - 00:12:45:04
Debbie Rice
And where can we intervene if it is not?
00:12:45:15 - 00:12:52:13
Noah Reed
So, you said the good, the bad and the ugly with two, four and 16. Like which which one is which?
00:12:52:22 - 00:13:08:07
Debbie Rice
That's a great question. So, we're going to always say that the good is the 2-OH, so the 2-OH or the 2-hydroxy is going to be the good. That's the one that we really want to push down that pathway because that pathway is it doesn't have a strong bond to the estrogen receptor.
00:13:08:07 - 00:13:18:03
Debbie Rice
So, the body can kick it off easier, it can clean it out easier. So, we really want to push it down. The 2-hydroxy pathway now, the bad and the ugly may be a discussion depending on who you're talking to.
00:13:18:03 - 00:13:32:02
Debbie Rice
I would say the ooh, the ugly one is the 4-OH because that one's really naughty, that is the one that can it binds to the estrogen as estrogen receptor really strongly. So, the body has to work really hard to get that 4-OH.
00:13:32:09 - 00:13:40:18
Debbie Rice
Once it kicks it off, though, the hope is that it can get methylated and out. But that's the one that can cause damage to DNA, right? So that's one that goes in there and just like tears everything up.
00:13:42:01 - 00:13:58:20
Debbie Rice
So, the 16-OH would then be the ugly, which I say is like, you know, the middle child. So, there are good parts of it, but there are bad parts of it, right? The good parts of the 16-OH it has proliferative properties in the good parts of the proliferation that can be good for bone health.
00:13:58:20 - 00:14:12:17
Debbie Rice
The bad parts of that proliferation are like breast and ovarian tissue where you can get like cyst or over development in that way. So, that's how I would describe the 16-, 4-, and 2-OH.
00:14:13:02 - 00:14:29:22
Mark Newman
So, you're talking about proliferation and you're talking about DNA damage with some of those metabolites. So, those are, as I think of them, related but different in terms of like there's I don't think a really a good angle on DNA damage, right.
00:14:29:22 - 00:14:41:01
Mark Newman
Like that, whereas proliferation is that sort of good and bad in that right in that balance of what estrogen is doing that you want that balance of it doing estrogenic things.
00:14:41:07 - 00:14:42:17
Debbie Rice
Right, whole point of estrogen.
00:14:42:17 - 00:14:55:22
Mark Newman
So, which of the which of the estrogens that we measure like have that estrogenic impact as far as doing things that estrogens do which which are strong in that sense, you said estradiol is the most potent.
00:14:56:05 - 00:14:58:16
Mark Newman
So, which other ones are giving it sort of an estrogen punch?
00:14:59:14 - 00:15:13:15
Debbie Rice
So, I the 2-OH is going to be part of that and the 16-OH I mean I feel like if you're getting a bunch of estradiol going through that, you know, the hose of estrogen, you're going to have a lot of estrogenic effect no matter what's happening.
00:15:13:20 - 00:15:24:16
Debbie Rice
So, if you're distributing that estradiol into 2-OH and 16-OH, you're still going to have a pretty estrogenic effect. But the 16-OH is going to be fairly estrogenic, the 2-OH is going to be
00:15:24:16 - 00:15:30:02
Mark Newman
The strongest estrogen of the metabolites that's not estradiol. Is that right?
00:15:30:06 - 00:15:31:05
Debbie Rice
The 16-OH?
00:15:31:05 - 00:15:47:00
Mark Newman
Right, yes. Yeah, I think I think I saw a study that showed it was about a fifth of estradiol. So, it's got some punch, not as much as estradiol, but it does have some punch. So, whether that's good or bad can depend on the overall picture.
00:15:47:02 - 00:16:07:11
Mark Newman
Right. If you have a low estrogen person that's pushing that 16, it might help the low estrogen state to to sort of have what it's missing. Whereas if someone's pre-menopausal and making lots of estrogen and on top of that, they push down the 16 hydroxy pathway pathway, then it would exacerbate
00:16:07:11 - 00:16:09:13
Mark Newman
the high estrogen situation? Mm hmm.
00:16:09:14 - 00:16:10:23
Debbie Rice
It absolutely could. Okay.
00:16:11:06 - 00:16:22:16
Mark Newman
So then but then the effect of the 4-OH is more related to we think of as more related to the cancer in terms of being able to pluck off a piece of the DNA, the naughty metabolite. Okay. Got it.
00:16:23:19 - 00:16:40:10
Mark Newman
So, we're talking about a bunch of different concepts here. So, when you look at a DUTCH report, we've got quite a few estrogen metabolites. So, how does your brain work through that in terms of a hierarchy of information of I was talking to you before about when I look at the androgens, I'm looking at how much DHEA
00:16:40:10 - 00:16:52:12
Mark Newman
do you make, how much testosterone do you make, and how do you metabolize it? So those are like my big questions. They're like, what for you are the big fundamental questions that you're asking yourself as you look at all of those hormones and metabolites?
00:16:52:15 - 00:17:05:18
Debbie Rice
Yeah. So, we we want to look at how much estrogen is made. So, we're looking at how much E1, E2 and E3 are there. And then we want to see how the body distributes or metabolizes clears all of those estrogens out.
00:17:06:01 - 00:17:16:13
Debbie Rice
Right? So, depending on how much you want E2, E3, you have, we can see how estrogenic are you just on that level? And then we have what I kind of look at it as a three step or a three-tier process, right?
00:17:16:13 - 00:17:29:20
Debbie Rice
Like how much production is being done and then what happens in phase one metabolism? And with that phase one metabolism, am I worried about the 2-OH am I worried about the 16-OH or the 4-OH? And then we look at the methylation.
00:17:29:20 - 00:17:42:00
Debbie Rice
Are you able to clear all of those phase one metabolites through methylation so you can get it into the stool and cleared out through the body? I always say you read a DUTCH test from top to bottom, but you treat a DUTCH test from bottom to top.
00:17:42:10 - 00:17:43:03
Mark Newman
Oh, interesting. I like that.
00:17:43:03 - 00:17:54:23
Debbie Rice
Because we want to make sure that. Right, like if everything is coming through the funnel, we want to make sure that the bottom rung of the funnel is open because if it's not, you're you're going to have a problem, whether it's with production, whether it's phase one or phase two.
00:17:55:05 - 00:17:58:12
Debbie Rice
So, that's what I'm looking at when I'm looking at a DUTCH test.
00:17:58:20 - 00:18:14:09
Mark Newman
So, it's a multilayered sort of thing because as I'm hearing you describe it, the metabolism itself is important because it clears out estradiol, it clears out estrone, and that's one concept. And then it just so happens that those metabolites have their own effects, right?
00:18:14:09 - 00:18:28:12
Mark Newman
The 16-hydroxy is estrogenic, the 4- is potentially carcinogenic, the 2- is protective. So, it's both the the drain. But then they themselves have impact that you want to be considering as you're looking at that sort of this three-dimensional picture.
00:18:28:12 - 00:18:42:00
Debbie Rice
Yes. So, interesting. Which I think adds to the complexity, but also the beauty of the comprehensiveness of a DUTCH test, because you can't just look at a serum equivalent of progesterone and estradiol and be like, here's your estrogen ratio.
00:18:42:07 - 00:18:52:20
Debbie Rice
It's not that simple because we have multiple layers of estrogen effect that happen. So, you want to look at each of those layers relative to the progesterone for, you know, for example, to look at that.
00:18:52:23 - 00:19:04:23
Mark Newman
And when you have too much estrogen or not enough progesterone, how are you actually assessing that? I know some lab tests when when it's simple. It's simple, which is nice, right? You have an estradiol while you have a progesterone and you can look at a ratio.
00:19:04:23 - 00:19:15:10
Mark Newman
Whereas for us it's like the estradiol’s got a lot of punch estrone’s got a little more punch. The 16-hydroxy has got a little more than that. And then progesterone is there to balance all of that estrogenic impact.
00:19:15:10 - 00:19:26:04
Mark Newman
Right. So, how do you assess when you stare at that picture whether whether someone's actually in a state of estrogen dominance? How do you assess that?
00:19:26:18 - 00:19:44:11
Debbie Rice
So, and I think that that that is a multilayered question and answer, because you can look like if I just look superficially at an estradiol level and the progesterone and say their estradiol is nicely in range, they're in this beautiful luteal range, their progesterone is in a beautiful area range that superficially looks balanced to me.
00:19:44:22 - 00:19:58:15
Debbie Rice
But if we look under the hood, we might be able to see that there's more 16-OH or they're not clearing their 2-OH very well. And that's going to add to that evaluation of what that estrogen dominance and or progesterone deficiency could be.
00:19:59:16 - 00:20:13:23
Mark Newman
So, then if in in one case, you might just say, hey, you don't make enough progesterone to balance this estrogen, the estrogens. Okay, then we're going to talk about progesterone right when the conclusion is more like we need to drag that estrogen down a little bit, get it cleared, whatever.
00:20:14:02 - 00:20:20:06
Mark Newman
Yeah. What are you looking at and what tools do you sometimes grab to get that in better balance?
00:20:20:13 - 00:20:35:19
Debbie Rice
Yeah. So, it's going to be how is that phase one looking? Are those ratios appropriate? And if all of those are okay, is the methylation okay. Right. So, if if the ratios of phase one are off, we're going to know that we want to work on phase one.
00:20:36:05 - 00:20:50:11
Debbie Rice
But because we want to treat from bottom to top, we want to see, okay, even if phase one is off, we want to look at phase two because as much as we try to fix phase one, if phase two is closing that like that, we're not opening that bottom rung at all.
00:20:50:11 - 00:20:57:20
Debbie Rice
It is going to do is make your phase one more efficient so that you can continue to recycle your estrogens even better without clearing them.
00:20:58:17 - 00:21:17:18
Mark Newman
Right. And methylation being more of a ubiquitous sort of situation process. If you're not methylating, it's important for more than just your estrogens. So, if you start at the bottom and you're not methylating and you support that, and then you move on to phase one and phase one has a problem, which I guess would mean either you're
00:21:17:18 - 00:21:24:07
Mark Newman
not pushing it down the 2-hydroxy pathway, something like that. What do you do, what tools you have in your toolbox to help with that.
00:21:24:13 - 00:21:26:00
Debbie Rice
To open methylation?
00:21:26:00 - 00:21:28:21
Mark Newman
Know also for phase one metabolism.
00:21:28:23 - 00:21:45:19
Debbie Rice
Yeah. So, for phase one metabolism, what we're usually looking to do, we want to be very mindful of the liver because the liver is like the main metabolism of everything, right? So, we have to remember that we're not working in a silo when we're talking about estrogen metabolism and helping to support or clear that.
00:21:46:01 - 00:22:01:15
Debbie Rice
So, we want to be very mindful of of how we intervene there. But in general, we're looking to upregulate or improve how the 2-hydroxy pathway is like how open that 2-hydroxy pathway is. We really want to push funnel everything down that 2-OH pathway.
00:22:01:21 - 00:22:16:10
Debbie Rice
And things that can do that are things like sulforaphane, broccoli sprout powder, milk. That's like those kinds of things lifestyle wise. We also want to work on not having a bunch of inflammatory foods and those kinds of things.
00:22:16:17 - 00:22:17:18
Debbie Rice
So, is that what you're looking for?
00:22:17:18 - 00:22:34:18
Mark Newman
Yeah, yeah. So, that's a funnel we might want to open if somebody has too much estrogen and we just need to reduce their estrogen production. So, let's say phase one looks fine. Phase two methylation is looking okay, but they're just estrogen.
00:22:34:18 - 00:22:44:04
Mark Newman
People like making lots of estrogen. What are some of the things you think about to address it at that level of just reducing production or like what else do you think about it?
00:22:44:07 - 00:22:59:12
Debbie Rice
Yeah. So, we also want to look at the cause, right? Like, is it more of an ovarian issue or is it because there's inflammation? Is it because there's adipose tissue that are creating that push to estrogen production? So, evaluating that component.
00:22:59:21 - 00:23:16:00
Debbie Rice
But if all of that is good and it's just more of like they just like to make estrogen something like dim and and or you I-3C can be really helpful to eliminate or reduce that estrogen load or estrogen burden on the body.
00:23:16:10 - 00:23:20:17
Mark Newman
By and that's another tool that helps push it down that 2-OH pathway.
00:23:20:18 - 00:23:21:03
Debbie Rice
Does.
00:23:22:01 - 00:23:29:02
Mark Newman
What about calcium deglucurate how does that I know that's an estrogen lowering herb. Is that an herb or what do you call that?
00:23:30:02 - 00:23:30:17
Debbie Rice
That's a good.
00:23:30:19 - 00:23:31:11
Mark Newman
Supplement.
00:23:31:13 - 00:23:33:00
Debbie Rice
It yes.
00:23:33:02 - 00:23:35:11
Noah Reed
Nutritional supplement. Very good. Yes. Right, yeah.
00:23:35:18 - 00:23:39:08
Mark Newman
So how does calcium deglucurate help us in the fight against high estrogen?
00:23:39:17 - 00:23:57:20
Debbie Rice
So when we think about calcium deglucurate, yes, it can help with estrogen metabolism, but it's it's a star player in actually phase three metabolism. So, phase one in phase two, we can see in urine because that's in dried urine, phase one and phase two are showing up there.
00:23:58:03 - 00:24:17:13
Debbie Rice
Phase three is in the stool. And what happens is beta glucaronidase it is is in this stool. And what it does is once your phase one or phase two drop estrogen into phase three, it drops it in a way that it's packaged up really nicely so that estrogen can just go out in this stool if you have
00:24:17:13 - 00:24:25:10
Debbie Rice
a lot of beta glucaronidase it comes in and like tears open that package. I call it like the Grinch comes in and it's like, wow. And then sends that estrogen back into the body.
00:24:25:11 - 00:24:26:22
Mark Newman
That's the recirculation.
00:24:26:23 - 00:24:40:12
Debbie Rice
Yes. Okay, so what calcium deglucurate does is it manages beta glucaronidase so that you don't have so much beta glucaronidase it is to come in and to open that package. So, that's where it's really the star players in phase three.
00:24:40:12 - 00:24:48:15
Debbie Rice
But it can also help kind of like milk thistle in like a general detoxification for estrogen metabolism.
00:24:49:13 - 00:25:06:04
Mark Newman
Okay. And we're thinking about this and saying all this, I think, with the assumption that it relates to our female friends. Can you talk a little bit about estrogen production, phase one? Phase two? Like, how does that whole story play out for the gentleman?
00:25:06:13 - 00:25:25:14
Debbie Rice
It's going to be the same thing. So, if you were to come to me and your estrogen metabolism was not great at all, the same ideas for treatment and evaluation are going to be the same between male and female, because that is like once you hit that estrogen, like once your testosterone has aromatized to estrogen, same pathway
00:25:25:19 - 00:25:26:21
Debbie Rice
same process.
00:25:26:23 - 00:25:33:00
Mark Newman
And what are the consequences maybe that are unique to a male patient for having too much estrogen?
00:25:33:17 - 00:25:49:16
Debbie Rice
So, a lot of times we can see, right, this is where males may have fatigue, mood changes, depression. Man boobs. Right. Like you start to have more central adiposity or belly nice little barrel that can happen with high estrogen.
00:25:49:16 - 00:25:49:22
Mark Newman
Okay.
00:25:50:13 - 00:26:06:00
Debbie Rice
And one of the things that I always want to be aware of is when we talk about lowering estrogen in males, this is a very important topic because you want to have enough estrogen. Because estrogen helps to potentize testosterone receptors.
00:26:06:00 - 00:26:22:20
Debbie Rice
Right. So, you need to have that estrogen to support testosterone in males. But you don't want to just clear out your estrogen. We have seen that if if you have a good amount of testosterone, but we drop your estrogen too low, that can also contribute to symptoms of low testosterone difficulty.
00:26:23:07 - 00:26:36:06
Debbie Rice
Difficulty with any of those testosterone things we think of libido, erection, climax, those things can also happen if you don't have enough estrogen. So, it's a very delicate balance. You don't want to just drain all of the estrogen for males either.
00:26:36:08 - 00:26:49:09
Noah Reed
So, Dr. Scott talked about in the previous episode, when we're talking about, you know, how the cycle works for females, that progesterone balances estrogen for women. Is that the same in men as well? Mm hmm.
00:26:49:16 - 00:27:10:00
Debbie Rice
That is a very fine and complex topic. I think progesterone is not as well understood in males. What we do see is high progesterone can be associated with higher stress. Higher stress response. Low progesterone can be associated with low testosterone symptoms.
00:27:10:11 - 00:27:17:08
Debbie Rice
Now, does it come to a true balance of estrogen and progesterone in males? I don't know that we have supportive research to go through all of that.
00:27:17:23 - 00:27:31:08
Mark Newman
In terms of where the estrogen is coming from. Obviously, in my reproductive female, the ovaries are pumping out estrogen. That's the first thing I think of in a male patient. It's going to be different. Postmenopausal women, their ovaries generally are done making estrogen.
00:27:31:11 - 00:27:37:15
Mark Newman
So where does it actually come from? Like what is producing estrogen in women and men?
00:27:38:02 - 00:28:07:00
Debbie Rice
So, for cycling females in female physiology, it's going to the biggest amount of estrogen is going to come from ovarian production in males, 20% male physiology, 20% comes from the latic in the testes. But otherwise, for males and for females, we get it more peripheral, meaning that your testosterone gets converted into estrogen.
00:28:07:00 - 00:28:23:02
Debbie Rice
And so that seems pretty simple for male physiology. But in females that are post-menopausal, that can also happen from fat tissue. That's the main source that we see for post-menopausal females is fat tissue aromatizes that testosterone to
00:28:23:02 - 00:28:24:03
Debbie Rice
Estrogen. Okay.
00:28:24:03 - 00:28:44:15
Mark Newman
So, for a premenopausal woman, the ovaries making most of it and in post-menopausal women and men, then that's the steroid cascade that we love to stare at. Really plays that big role, right? Because we can see DHEA moving to androstenedione and then testosterone and both of those then getting converted to estrogen and estradiol, which makes sense because
00:28:44:15 - 00:28:56:13
Mark Newman
I know when we dug through our database and just put people in tiers of post-menopausal women, of how much DHEA do you make? High, low. And then you look at the amount of estrogen they have. There's a direct relationship there.
00:28:56:13 - 00:29:09:07
Mark Newman
So, the substrate of our DHEA is important for that. So, then is adrenal health in a post-menopausal woman then important for estrogen production in that phase of life?
00:29:09:11 - 00:29:24:17
Debbie Rice
Absolutely. 150,000%. Yes. I always say that the adrenal glands become the second ovaries in menopause. So, when your ovaries are done, like they have taken their Coronas and they have retired to the beach, they are not coming back.
00:29:25:03 - 00:29:27:08
Debbie Rice
So the adrenal glands have to make up for that.
00:29:27:22 - 00:29:46:11
Mark Newman
So that's and that's a good sort of promotion of what we're trying to do is never to just look at something in isolation, but to look at adrenal health and reproductive health. Because if you have a premenopausal woman who has struggling adrenals, then and her ovaries are hanging in there, then you know what's coming right?
00:29:46:11 - 00:29:59:11
Mark Newman
Is that those give way naturally. Exactly. So, which is a good a good sales pitch for the comprehensiveness of DUTCH and always looking at the whole picture when we're looking at both our men and our women.
00:29:59:11 - 00:30:17:16
Debbie Rice
One, it's important to understand your baseline. So, I understand, right? Like, yes, absolutely. We want to look at that in perimenopause and postmenopausal females. But we also need to understand the baseline, right? Like if you're a cycling female that you are burning seven candles at all the ends, you're not set up for success in transition in period
00:30:17:16 - 00:30:28:09
Debbie Rice
post menopause. Right. So, we want to be able to understand where you're at now as a cycling female so we understand how to support you moving forward, not just getting on the train after, you know, you burn yourself out.
00:30:28:20 - 00:30:41:02
Noah Reed
So, you talked about phase three. You talked about phase two. We talked about phase one and supplementation, a little bit of lifestyle. What are maybe some environmental factors that would cause estrogen dominance?
00:30:41:06 - 00:30:55:17
Debbie Rice
Oh, my gosh. Like so many things, especially in our world today, there are all sorts of chemicals. Like it's it's really overwhelming, right? Like, if you sit down and look at it, it's almost like just don't leave your house and don't use any lotion.
00:30:55:17 - 00:31:09:21
Debbie Rice
Maybe not even wash your clothes because there are so many endocrine disruptors. Right. So, when you hear that big key word like endocrine disruptors, what does that mean? And it can it can really affect how your body is signaling not just ovarian health.
00:31:09:21 - 00:31:26:11
Debbie Rice
Right, but adrenal health. Testicular health. Right. Like thyroid health, like all of those things. And so when we're looking at environmental contributors and or endocrine disruptors, these are things that can be in your makeup, your lotions, your laundry detergent, all of that.
00:31:26:18 - 00:31:43:14
Debbie Rice
And we don't know, well, it would be very difficult to have like just a full comprehensive list of like this does this this does this right. Like we know that there are some big key environmental players in this and a lot of times they will push more of an estrogen response.
00:31:43:14 - 00:32:04:01
Debbie Rice
Right. So, we also think plastic, plastic water bottles that sit out in the sun heating up your food in a plastic thing in the microwave, really, all of that can add to some of that endocrine disruption or estrogen exogenous, what we call exogenous estrogen production or affect in the body.
00:32:04:14 - 00:32:11:02
Noah Reed
Is there a phase of life that this would affect me more like during my reproductive years or during puberty or when I'm older?
00:32:11:03 - 00:32:24:12
Debbie Rice
That's a good question. I feel like puberty and like when you're building and making things is going to be a big part of that. But I would say it's relevant all the time because I feel like there's like when you're a kid, you're not going to be playing around with makeup and doing all of that.
00:32:24:12 - 00:32:43:20
Debbie Rice
So as teenagers, that's going to be a big thing, as you know, even for women that are. And our men that are using a lot of lotions, skin creams, products. The awareness is important, but I would say a lot of that even just marketing, goes more towards women.
00:32:44:03 - 00:32:45:23
Debbie Rice
And so being aware of that.
00:32:46:05 - 00:33:01:22
Mark Newman
Well, I would say the the biggest impact could be when you're the size of a thimble, right? When you when you are 12 weeks in the womb, you are differentiating your sexual organs. Right. And now you have this 20 something 30 something year old woman using these products.
00:33:01:22 - 00:33:16:00
Mark Newman
Like it's not great for her, but she's fully formed. Right? Right. Her endocrine system is fully formed. So, when you're forming the endocrine system, I mean, I would say that's a time of particular vulnerability is and you can see you can see the effects of it, right.
00:33:16:01 - 00:33:32:11
Mark Newman
You can you can measure phthalates in a woman who's pregnant and you can there is a measurable difference in their genitals when they're born, like for the baby boys, because they're basically taking anti testosterone when they spray their perfume on and when they put a lotion on that has something that's so safe, you don't have to put
00:33:32:11 - 00:33:33:02
Mark Newman
it on the label.
00:33:33:07 - 00:33:33:20
Debbie Rice
Right?
00:33:33:21 - 00:33:45:00
Mark Newman
Right. And then you can measure the difference in like in the geometry of the genitals of the boys. It's like, wow, that's a really big deal. So, I think that's a really vulnerable time is when we're looking at having babies.
00:33:45:01 - 00:34:01:02
Mark Newman
Yeah. Is in and is really being careful about that. So, I think that's important. Well, this has been a wealth of information. We really appreciate you taking a spin through estrogen and its impact on us and our patients.
00:34:01:15 - 00:34:05:05
Mark Newman
So, thank you for joining us and and giving some clarity to that topic.
00:34:05:06 - 00:34:08:06
Debbie Rice
Thank you for having me. I love it. I love all the hormones.
00:34:09:20 - 00:34:10:08
Mark Newman
Thanks, Debbie.
00:34:11:12 - 00:34:25:02
Noah Reed
It's been great having you on the show and in person, Dr. Rice, to discuss all things estrogen and estrogen detox. I know this is a big topic that a lot of people will benefit learning more about. And a big thank you to all of our listeners who joined us this week.
00:34:25:06 - 00:34:41:23
Noah Reed
If you have any questions, please send them to podcast@dutcthtest.com. Don't forget to like and subscribe so that you can stay up to date on what's happening with the DUTCH podcast. Stay tuned for next week's episode with another very special guest, Dr. Kelly Ruth.
00:34:42:05 - 00:34:55:20
Noah Reed
Mark Neumann will be back in the studio and we'll get to learn together about female androgens. You won't want to miss this conversation, so join us again for another insightful episode of hormonal education. I'm Noah Reed. Thanks for joining us today.
00:34:56:02 - 00:34:56:21
Noah Reed
Until next time.