Synthetic and Natural Estrogens
Estrone (E1), estradiol (E2) and estriol (E3) are the three estrogens. Synthetic estrogen (premarin) is made up of E1 and E2 estrogen. E1 is the main estrogen that the body makes post menopausally, and most researchers believe that high E1 levels increase the risk of breast cancer. Therefore, we no longer prescribe Tri-Est, we use Bi-Est instead. E2 or estradiol is the estrogen that plays a role in the 400 functions mentioned previously. E3 is the estrogen that helps to prevent breast cancer, so much so that it is now being used experimentally instead of Tamoxifen to treat breast cancer. Research suggests that E3 may also hold promise as a treatment for multiple sclerosis. However, E3 does not offer the bone, heart and memory protection that E2 does. E3 estrogen is 80 times weaker than E2.
The metabolism of estrogen in women changes after menopause. The body metabolizes estrogen into two major pathways and one minor. The two major are 2 and 16-hydroxyeone (2-OH and 16 OH, respectively). The minor pathway is 4-hydroxyestrone (4-OH). 2-OH is the good metabolite. 2-OH does not stimulate cell growth and it blocks the action of stronger estrogens that may be carcinogenic. 16-OH has a significantly stronger estrogenic activity, and studies that it may increase the risk of breast cancer. 4-OH is also not desirable as it may directly damage DNA and cause mutations, thus it is thought to promote cancer development. Premarin breaks down exclusively into 4-hydroxyestrogen. Therefore it is not big surprise that Premarin was a problem.
In our practice, we check women’s estrogen metabolism. It only makes sense to see if they are making too much E1. It makes sense to look to see if they are making the wrong kinds of estrogen. In the United States 2 and 16-hydroxyestrogen testing is readily available, and in some countries it is also possible to measure a woman’s 4-hydroxyestrogen levels as well. We are not measuring 4-hydroxyestrogen in the United States yet, but it is a minor pathway and it is more important to be aware of a woman’s 2-hroxyestrogen and 16-hydroxyestrogen levels.
How can you encourage the body to metabolize estrogen into 2-OH? The first thing to do is measure the patients estrogen levels. Moderate exercise raises 2-OH levels, so the second thing to do is get your patient to exercise regularly. Cauliflower, kale, Brussels sprouts, and cabbage, all push estrogen metabolism down the 2-OH pathway. As does flax and soy. Soy presents a confusing picture though because the literature is split. One half of people believe that soy decreases breast cancer, while the other half believes it increases breast cancer. * Kudzu helps, and supplementary indole-3-carbinol for women who already have breast cancer is 500 mg a day. A high-protein diet, or in other words, not eating too many carbohydrates will push metabolism down the 2-OH pathway. *The Omega-3 fatty acids EPA and DHA, vitamin B6, vitamin B12, and folate all help to raise 2-OH levels. If a patient is obese, then they do tend to make more 16-OH. Therefore women who are overweight have an increased risk of breast cancer. See our Natural Estrogen Protection product and cardio support.