Botanical of the Month – St. John’s Wort

Annex Naturopathic

As a naturopathic clinic and dispensary, we like to educate our patients on how to take in local herbs and foods as part of their lifestyles for long term health.

Each month we've been highlighting a local, seasonal, Ontario herb in order to help you understand and familiarize yourself with useful medical herbs and foods that grow in our backyards.

Last month we looked at Red Clover

This month we take a look at St. John's Wort.

What is St. John's Wort?

St. John’s Wort is a common plant that has been naturalized in North America, and can be found in Ontario (easier to find in North of Toronto).

Hypericum perforatum displays beautiful yellow flowers from June to August.  It grows up to 1 meter high and has small, oval leaves which may have small black dots.

The flowers contain glands that when the fresh flowers crushed, will stain a dark vibrant red-purple colour, representing one of the key chemical ingredients of the plant, hypericin. 

This colour is greatly represented in tincture and oil extracts of St. John’s WortI saw an abundance of this gorgeous plant on a relaxing camping trip in the Lake Superior region, and is one of the most common herbal remedies I use in practice.

Parts Used: Aerial parts, bud and flowers (dried and fresh)

Uses of St. John's Wort

St. John’s Wort is not typically eaten but is used for medicine.  It has a number of different medicinal uses and has a strong affinity to the nervous system.

Traditionally, when taking internally, St. John’s Wort has been used as a sedative to treat nervous anxiety, and also is used to treat neuralgic pain.

Externally it’s used as an anti-inflammatory to treat sunburns, promote wound healing, treat bruises, and viral skin eruptions (ie Shingles).

Hypercum perforatum has been traditionally used to “clear liver heat” making it a useful remedy for liver inflammation (hepatitis).

Depression

There has been extensive research on the anti-depressant properties of St. John’s Wort, with many clinical trails exhibiting the benefit of this herb in the treatment for depression.

This plant has been found to provide anti-depressant actions, and though hypericin, pseudohypericin, and hyperformin are the most-studied chemical constituents of St. John’s Wort, many other constituents in this herb have also been found to have this property.

Isolating and administrating one constituent alone does not seem to provide the same anti-depressant effect as using the whole plant.  It is possible the combined (synergistic) action of many chemical constituents in this plant is what is responsible for the strong influence on the neurological system.

Flavonols and xanthines are other constituents found to have anti-depressant activity.  This is a beautiful representation of the importance of wholism where the entire plant is the of value, not only one microscopic ingredient of the plant.

St. John’s wort has been found to affect neurotransmitter activity by inhibiting reuptake of serotonin, GABA, noradrenaline, dopamine and L-glutamate.  Hypericum perforatum also inhibits binding of these neurotransmitters to their receptors.

This is a similar mechanism to how prescription anti-depressants work - inhibiting reuptake and binding.   Hypericum perforatum also appears to inhibit the activity of enzymes important in mood, such as monoamine oxidase (MAO-A and MAO-B), and catechol-O- methyltransferase (COMT), both involved in neurotransmitter processing and elimination.

St John’s Wort also is considered an anti-inflammatory -  increased levels inflammation have been strongly associated with  depression, and the anti-inflammatory action of St. John’s Wort presents another reason for the strong anti-depressant property of this herb.

Infections

Hypericum perforatum has been found to be active against a number of  bacterial microorganisms, but it’s most powerful effect appears to be against viruses.

The anti-viral action  is specific to enveloped viruses, possibly through preventing the fusing of the viral envelope to the host cell.

Enveloped viruses include herpes viruses, varicella zoster (chicken pox and shinges) virus, cytomegalovirus, Epstein-bar (mononucleosis, “kissing”) virus, hepatitis virus, HIV and many other viruses.

Ways to take St. John's Wort

Hypericum perforatum is commercially available to take in a standardize capsule containing an alcohol extract of the herb, typically with a specific dose of the constituent hypericin.

This is the form that has been used in many clinical trials that have shown great benefit of this herb in the treatment of depression.

It is also efficacious in tincture form.  This is my preferred method, as less processing of the herb, preserves the essence and energy of the plant.

An oil can be made fresh flowers and leaves and to be used topically as an anti-inflammatory and anti-viral.

Teas and decoctions are also made from this plant and may be best used for its anti-inflammatory, astringent and pain-relieving effects.

Clinical trails have shown alcoholic extracts of St. John’s Wort being most efficacious for treating depression, so the tea may not be the best choice if being used for this condition.

Caution

Do not use St. John’s Wort without consulting a physician who is familiar with herbal medicine.

Never combine St. John’s Wort with anti-depressant medication as this can potentiate the effect of the medication, potentially leading to overdose symptoms.

This plant increases the activity of a liver enzyme called CYP3A4, involved with phase 1 liver detoxication so should not be taken if on medication that is metabolized by this enzymes as it can reduce the efficacy of the medication.

Hypericum perforatum can potentially (though rarely) cause photosensitivity in susceptible individuals, causing skin redness, so be cautious of this effect and discontinue if it occurs.

If you’re curious about whether this herb might be suitable for you, feel free to contact us for an appointment.

If you’re curious to learn more about this subject or would like to consult with one of our NDs feel free to book a visit or contact us.

Yours in Health,

Dr. Tanya Lee, N.D

Annex Naturopathic Clinic
572 Bloor St W #201, Toronto, ON M6G 1K1
-https://goo.gl/maps/uVRBvcyoUa62

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References: 

1. Hoffman D. Medical Herbalism. Rochester, Vermont: Healing Arts Press, 2003.
2. World Health Organization. WHO Monographs on Selected Medicinal Plants, Volume 2, World Health Organization, 1997
3. King, J. King's American Dispensatory. Ohio Valley Company, 1898

To get additional ways about health, wellness, and alternative medicine, please visit us here: naturopathic clinics toronto

How To Treat Chronic Headaches With Diet & Lifestyle Changes

Annex Naturopathic

I can’t count how many times a patient has come in to our naturopathic doctor clinic with one complaint, and only when asked, they non-chalantly mention they suffer headaches on a daily basis: “but I just take Tylenol and it goes away”, or “it’s normal for me”, or “I’ve had them all my life”.

Let me just set something straight: Headaches are not normal, and the source should be treated.

What are headaches?

A number of medicine-based websites define "headache" as any pain of the neck and head area.

Simple definitions equals simple treatments right? Pain=painkiller?

If I were to rewrite that definition, I would probably add that “headaches are a symptom of a underlying cause.”

Even reputable medical resources don’t recognize the cause for common headaches, only really delving in to what drugs may suppress the pain.

Finding the cause of any symptom is the essence and root of treatment, and finding and treating cause may enable one to be rid of all these nasty symptoms.

What are the causes of headaches?

We want to make sure that the causes are not life-threatening or serious.

Your healthcare provider will determine this through a thorough intake of the history and character of the headaches,  as well as a physical examination of your neurological system.

If there are any warning signs, you will be referred for blood tests and possibly CT or MRI scans of the head.

If everything is clear, your healthcare practitioner will categorize your headache based on its characteristics.  These include:

• Cluster
• Tension
• Migraine
• Chronic daily headache – Types included in this are: chronic migraine, chronic tension-type, new daily persistent, and hemicrania continua, all defined by the type of pain.

Chronic daily headaches are the most common headaches experienced by people and are the focus of this article.

The World Health Organization (WHO) states that 1 out 20 adults suffer from these types of headaches every day.

Its causes can be broken down to the basics: diet, lifestyle and nutrition.  Some causes of common headaches include:

• Stress
• Poor dietary habits, and conditions associated such as diabetes, cardiovascular disease (high blood pressure)
• Smoking
• Nutrient deficiency
• Dehydration
• Muscle tension – posture
• Eyesight
• Poor sleep
• Food allergies

Now does it make sense that popping 4-8 painkillers a day would target these causes?

It may temporarily decrease the pain, but the underlying causes are still there.  Diet provides the basis of the environment by which your body functions, and a poor diet only causes poor bodily function.

Things like coffee, soda, pop, and fast foods are not only dehydrating and lack nutrients, but can spike blood sugar levels after consumption, and consequently cause insulin levels to rise.

When insulin rises, it causes a massive drop in blood sugar, leading to blood flow changes to the brain, causing headaches.

A poor diet also makes one susceptible to high blood pressure (a leading cause of headaches), thereby increasing the risk for cardiovascular disease.

Refined sugars can also cause hormone imbalances (such as cortisol and epinephrine) leading to problems with stress, sleep, and energy.

Stress can also cause tightening of the neck and shoulder muscles, as well as increasing blood pressure, both of which contribute to recurring headaches.

Headaches can be a good indicator that it may be time to improve your dietary habits to prevent chronic disease.

A diet full of junk not only has negative effects on blood sugar, but also causes havoc on your gastrointestinal system.

The intestinal lining is often damaged due to poor nutrition, leading to food sensitivities and decreased nutrient absorption.

Also, the good bacterial flora is often compromised, and the increased sugars feed unwanted microbes such as yeast, allowing them to grow and cause gastrointestinal problems.

Food allergies can manifest in a number of different ways, such as skin conditions, asthma, allergies, and more.

But more often than not, symptoms could be as unclear as fatigue and headaches.

Ways treat headaches

As you can see, these are several reasons why headaches may be a good indicator of your overall health.

A good diet not only prevents and treats all that was mentioned above, but also improves the health of your adrenal glands (and cortisol release) allowing you to cope with stress efficiently, decreasing your future risk of chronic diseases such as diabetes and cardiovascular disease.

Naturopathic doctors are skilled in determining these causes as well as implementing treatments that can reverse these effects, without the use of synthetic pain killers.

Diet and lifestyle modifications are essential to all aspects of health, and while they improve, so do the headaches.  Here are a few tips for preventing headaches during the day:

• Keep hydrated – drink AT LEAST 6 cups of water a day
• Decrease snacks and drinks loaded with refined sugars (candy, pop/soda, etc)
• Make sure to be replenished with proper electrolytes, especially after strenuous exercise
• Reduce coffee consumption to 1x/day and replace extra cups with lower-caffeinated teas such as green tea
• Get a good night’s sleep
• Relieve stress through mediation, exercise, spend time with those whose company you enjoy
• Take breaks from your computer during the day to relieve eye strain
• Get fresh air
• Ensure your digestion is working optimally - weak digestion equals poor absorption of nutrients, where deficiencies can lead to headaches

Naturopathic doctors can also perform treatments that provide symptomatic relief to headaches while we are improving the diet, such as acupuncture, botanicals and homeopathic medicines.

Please contact your healthcare provider if:

• If you experience an abrupt, severe headache (feels like a Thunderclap)
• If you're present with fever, stiff neck, numbness, tingling, visual disturbances, confusion, trouble speaking
• Associated with seizures
• Progressive headaches, associated with cough, or exertion
• Progressive headaches after a head injury

If you’re curious to learn more about this subject or would like to consult with one of our NDs feel free to book a visit or contact us.

Yours in Health,

Dr. Tanya Lee, N.D

Annex Naturopathic Clinic
572 Bloor St W #201, Toronto, ON M6G 1K1
-https://goo.gl/maps/uVRBvcyoUa62

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References:

1. World Health Organization [homepage on the Internet]: World Health Organization (WHO); c2010 [updated 2004 March; cited 2010 Feb 2].Available from: http://www.who.int/mediacentre/factsheets/fs277/en/
2. The Mayo Clinic [homepage on the Internet]: Mayo Foundation for Medical Education and Research (MFMER); c1998-2010 [updated 2009 June 23; cited 2010 Feb 2]. Available from: http://www.mayoclinic.com/health/chronic-daily-headaches/DS00646/DSECTION=symptoms
3. Beers MH, Porter RS, Jones TV, Kaplan JL, Berkwits M, editors. The Merck manual of diagnosis and therapy. 18th ed. Whitehouse Station (NJ): Merck Research Laboratories; 2006.
4. Gardner, L. and Reiser, S. "Effects of Dietary Carbohydrate on Fasting Levels of Human Growth Hormone and Cortisol." Proceedings of the Society for Experimental Biology and Medicine. 1982;169:36-40.
5. Wright RJ, Frier BM. Vascular disease and diabetes: is hypoglycaemia an aggravating factor? Diabetes Metab Res Rev. 2008 Jul-Aug;24(5):353-63

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How To Treat Estrogen Dominance Through Diet And Lifestyle

Annex Naturopathic

Estrogen dominance is a sinister hormone imbalance that typically isn’t caused by one single factor.

Our previous two articles - What Are The Causes of Estrogen Dominance?, and Estrogen Dominance: The Hormone Imbalance You’re Told You Don’t Have - outlined the main reasons why someone may have estrogen dominance and the health conditions associated with having poor estrogen metabolism.

Understanding that liver health, diet, inflammation and environmental exposures all play a crucial role in your estrogen health, here are a few simple changes you can make in order to optimize your estrogen status

1. Support liver health

We have a whole article on why liver health is important, and now we know that liver health is also important in preventing estrogen dominance.

Improve your liver health by eating clean, emphasizing consumption of bitter leafy greens, drink a good amount of water and reduce your toxin load by reducing preservative-laden foods.

2. Eat Brassicae family (Cabbage) vegetables

This food group is particularly important in estrogen dominance.

Brassicae family vegetables contains a compound called Indole-3-carbinol (I3C), which has been found to favour healthy phase 1 conversion of estrogen to 2-OH-estrogens in women, which we know is protective against estrogen dominant conditions, while decreasing other metabolites (16-OH-estrogens), known to exacerbate estrogen dominant conditions (1-3).

This group of veggies are a great source of fibre, which is also great for binding and clearing estrogens, contain tonnes of antioxidants that help protect the liver against oxidative damage.

Members of this family include:

• Broccoli
• Cabbage
• Cauliflower
• Brussel sprouts
• Kale
• Rutabaga
• Rapini
• Kohlrabi
• Bokchoy
• Collard Greens

I always suggest lightly cooking these vegetables before consuming - raw forms can be hard on the stomach and can also slow down thyroid function.

3. Reduce stress

Practicing stress-relieving activities is good for overall health.

The stress hormone cortisol, when secreted in excess, will alter blood sugar metabolism - increasing glucose and insulin.

High insulin states perpetuate inflammation, and promote obesity, two risk factors for estrogen dominance.

Imbalanced cortisol on its own has been linked to higher inflammatory states.  Progesterone, the hormone that balances estrogen and regulates its effects, is also lowered by high cortisol and inflammation.

Try reducing stress by exercising, practicing mediation and mindfulness.

You can read more about how to reduce stress from a previous article.

4. Eat clean meats and reduce meat consumption

Diet full of poor quality saturated fat and trans-fats promote inflammation - poor quality meats tend to be riddled with high amounts of these type fats.

Animals fed grain and corn aren’t as lean and tend to be fed antibiotics and injected with hormones to increase their weight for greater profit.

These added chemicals not only increase the chemical load on our body when we consume these foods, the added hormones add estrogen to our bodies, promoting estrogen dominance!

Go with grass-fed, pasture-raised meats, or at least try to pick meats that are raised hormone and antibiotic-free.

Compounds found in well-cooked meat (heterocyclic amines and metabolites) can bind to and active estrogen receptors (4).To control levels of inflammation related to increased meat consumption, try eating 4-5 ounces, high quality red meat 1-2x a week, poultry up to 3x/week, and fish 2-3x/week.

Focus on legumes and eggs to fill the protein for the rest of your meals.  If you go with soy, pick organic soy, and eat 1 cup cooked 1-2x/week for a balanced phytoestrogenic effect.

Dairy should be avoided as many people are sensitive to dairy and it’s proteins (not just lactose), and milk from pregnant cows are very high in estrogen.

If you choose to eat dairy, go for ethically raised, organic cheeses and yogurt as they are better for the digestion, and stay away from liquid milk forms as a whole.

5. Avoid chemical products

As we saw, there are a number of chemical compounds that mimic estrogen in the body, increase aromatase, are liver toxic, and in general are carcinogenic.

Chemicals specifically found to lead to estrogen-dominant conditions, specifically cancers, include (4):

• Found in cosmetic products and soaps:
  • metalloestrogens such as aluminum salts
  • parabens
  • cyclosiloxanes
  • triclosan (found in hand sanitizer)
  • phthalates
  • musk
  • UV sunscreens
• Plastic packaging:
  • Styrene - a widely used plastic for food packaging
  • Bisphenol-A (BPA): the WORST - found to activate aromatase, lower progesterone effect, bind and activate estrogen

6. Balance your progesterone

Many women are walking around with low levels of progesterone, typically due to stress - which could be the biggest reason why estrogen dominance is present.

Symptoms of low progesterone include

• PMS symptoms such as depression (intense), breast tenderness in the upper outer quadrants of the breast, acne, migraines and night sweats
• Pre-menstrual spotting or spotting throughout the cycle (breakthrough bleeding)
• Many women come in feeling that their PMS symptoms start long before 1 week before their menstrual flow - typically starting right after ovulation. This is a classic sign progesterone deficiency.

If you suspect that you might have estrogen dominance, progesterone deficiency, or you’re unsure, book with one of us - we are able to provide a thorough assessment on your hormonal health.

We also offer testing to assess estrogen dominance through measuring the different estrogen metabolites (such as 2-OH, 4-OH, 16-OH) through urine testing.

If you’re curious to learn more about this subject or would like to consult with one of our NDs feel free to book a visit or contact us.

Yours in Health,

Dr. Tanya Lee, N.D

Annex Naturopathic Clinic
572 Bloor St W #201, Toronto, ON M6G 1K1
-https://goo.gl/maps/uVRBvcyoUa62

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References

1. Rogan EG. The natural chemopreventive compound indole-3-carbinol: state of the science. In Vivo. 2006 Mar-Apr;20(2):221-8.
2. Michnovicz JJ. 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.
3. Reed GA., et. al. A phase I study of indole-3- carbinol in women: tolerability and effects. Cancer Epidemiol Biomarkers Prev. 2005 Aug;14(8):1953-60.
4. Fucic A et. al. Environmental exposure to xenoestrogens and oestrogen related cancers: reproductive system, breast, lung, kidney, pancreas, and brain. Environ Health. 2012 Jun 28;11 Suppl 1:S8

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What Are The Causes of Estrogen Dominance?

Our last article outlined what estrogen dominance is, and how liver health plays a role in estrogen metabolism and estrogen dominance.  There are a number of other causes for estrogen dominance - many of which are influenced by your day to day lifestyle.  It may be surprising to you to find out that many daily exposures can increase your chance of developing estrogen dominance.

Inflammation

Inflammation is the worst.

This chronic condition has been tied to basically all disease - heart disease, cancer, mental health conditions, to name a few.  Inflammation plays a crucial role in the development of estrogen dominance.

As we know from the previous article, proper liver health is crucial for proper estrogen metabolism, and one way inflammation can impact estrogen dominance is burdening liver function.

However, there’s another way inflammation can directly affect estrogen dominance - through activation of an enzyme called aromatase, a cytochrome P450 enzyme active in the liver, skin, bones, ovaries, adipose tissue, adrenal glands, brain and breasts - everywhere where estrogen has an effect on the tissue.

Aromatase is an enzyme that is key for estrogen synthesis in a healthy biological female and works in regulation with the body to keep estrogen conversion from androgens healthy and limited.

Estrogen dominant conditions, such as endometriosis, breast cancer, ovarian cancer, are associated with increased and dysregulated aromatase activity(1).  There has been direct relationship between inflammation and aromatase activity, with much of the research looking in to how obesity, a disease of chronic inflammation, activates aromatase.

The link between inflammation and increased aromatase is a vicious cycle - increased adipose tissue is riddled with inflammatory structures (crown-like structures) which secrete pro-inflammatory signals.

These inflammatory signals increase aromatase activity in the adipose tissues, which in turn increases estrogen production.  Excessive estrogen can cause problems with blood sugar (insulin resistance) and can mess with your hormone leptin, the hormone that makes you feel full - therefore promotes obesity.

These inflammatory crown-like-structures were not only found in adipose tissue but in breast tissue in overweight-obese women undergoing surgery for breast cancer.(2).

But it’s not just related to weight - both obese and non-obese women with marked inflammation (detected on bloodwork), and conditions of inflammation such as insulin resistance (high blood sugar) are at higher risk of developing breast cancer through increased aromatase activity (3,4).

Pain occurs typically in response to inflammation, so it makes sense that if estrogen dominance is an inflammatory condition, why symptoms are centred around pain (painful periods, painful breasts).

Endocrine Disrupting Chemicals

There are a number of environmental causes for increases of aromatase activity.  Bisphenol A (BPA) is a chemical commonly found in plastic that has been found to increase both aromatase and inflammation.

BPA has been deemed an ovarian, uterine and reproductive toxicant - therefore do not consume! (5)  Other causes such as alcohol, chemical home care products, the birth control pill, smoking and pesticides (glyphosates) all increase aromatase activity (1).
BPA has also been found to increase the production of the “bad” estrogen metabolite, 4-OH-estrogen, compared to 2-OH pathway, which we know increases risk of estogen-dominant conditions (remember the last article?)

Not only do these chemicals increase aromatase activity, they can directly bind to estrogen receptors, stronger than actual estrogen, causing excessive estrogen-like effects on the tissue.

These are called xenoestrogens, can play a large role in the development in estrogen-related cancers such as breast cancers, uterine and ovarian cancer (7).

Xenoestrogens are a group of chemicals found in environmental pollutants (pesticides), chemical products (BPA in plastic) cosmetic products [parabens, metalloestrogens (cadium, aluminum), phathlates, musk etc].

Progesterone Imbalance

This hormone is an important factor in estrogen dominance.

Progesterone is responsible for “balancing” estrogen, so appropriate levels of progesterone are important for preventing estrogen-dominant conditions.

Just like estrogen, progesterone is affected by inflammation - an inflammatory molecule called prostaglandin-E2 (PGE-2), not only stimulates aromatase, but also blocks progesterone receptor expression, therefore reducing the progesterone effect.

Progesterone can also be reduced in the face of high stress - this is because progesterone and the stress hormone cortisol, are made from the same ingredient, pregnenolone.  When you’re stressed, your body needs to make more cortisol, so progesterone production suffers.

High cortisol also encourages inflammation, as we know further encourages estrogen dominance by increasing aromatase, and blocking progesterone.

So now that we know environmental factors, stress and inflammation can also contribute to estrogen dominance, the next article will centre around how we can improve estrogen, progesterone balance and reduce inflammation through diet and lifestyle methods.

If you’re curious to learn more about this subject or would like to consult with one of our NDs feel free to book a visit or contact us.

Yours in Health,

Dr. Tanya Lee, N.D

Annex Naturopathic Clinic
572 Bloor St W #201, Toronto, ON M6G 1K1
-https://goo.gl/maps/uVRBvcyoUa62

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References

• Patel S. Disruption of aromatase homeostasis as the cause of a multiplicity of ailments: A comprehensive review.J Steroid Biochem Mol Biol. 2017 Apr;168:19-25.
• Morris P et. al. Inflammation and increased aromatase expression occur in the breast tissue of obese women with breast cancer. Cancer Prev Res (Phila). 2011 Jul;4(7):1021-9.
• Brown KA et. al. Menopause Is a Determinant of Breast Aromatase Expression and Its Associations With BMI, Inflammation, and Systemic Markers.J Clin Endocrinol Metab. 2017 May 1;102(5):1692-1701.
• Iyengar NM., et. al. Metabolic Obesity, Adipose Inflammation and Elevated Breast Aromatase in Women with Normal Body Mass Index.Cancer Prev Res (Phila). 2017 Apr;10(4):235-243
• Peretz J et. al Bisphenol a and reproductive health: update of experimental and human evidence, 2007-2013.Environ Health Perspect. 2014 Aug;122(8):775-86
• Kim EJ et. al Association between urinary levels of bisphenol-A and estrogen metabolism in Korean adults.Sci Total Environ. 2014 Feb 1;470-471:1401-7
• Fucic A et. al. Environmental exposure to xenoestrogens and oestrogen related cancers: reproductive system, breast, lung, kidney, pancreas, and brain.Environ Health. 2012 Jun 28;11 Suppl 1:S8

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Estrogen Dominance: The Hormone Imbalance You’re Told You Don’t Have

As a female naturopathic doctor, I have a a great deal of experience in women's health issues. Much of it treating conditions like hormone imbalances and their effects on our quality of life.

Hormone imbalances are a complicated thing though.

Often times women will feel that their hormones are off, but after blood work and basic analysis, it’s likely that everything will come back “normal”.

So how is it that hormones are normal, yet one day your body feels completely off, or that you one day find that you have fibroids? or endometriosis? or fertility issues?

What are some of the signs and symptoms that could lead you to potentially prevent and actually treat these conditions, instead of coming up with band-aid solutions to cover up the symptoms?

What is Estrogen Dominance?

Estrogen dominance is a hormonal condition that is often never detected in conventional medicine - the term dominance may indicate that a high level of estrogen would be detected on routine blood work, but this is not often the case.

In fact, estrogen typically comes back “within normal range” in women who have estrogen dominance - how is this so?

This is because estrogen dominance is a functional hormonal imbalance and is not a “excess” condition.

A functional hormonal imbalance indicates that while the body is clearly performing daily as it should, there are signs and symptoms that one experiences, whether it be mild or debilitating, indicate that the overall system is compromised.

This may not be a big deal, but if undetected and left untreated, can lead to chronic disease.

Signs and Symptoms of Estrogen Dominance

The interesting thing about estrogen dominance is that it’s highly common in our society - many women experience symptoms of estrogen dominance monthly, some more severely than others.

The typical symptoms of estrogen dominance include:

• PMS symptoms such as irritability, breast tenderness/swelling, premenstrual pain, acne, constipation, bloating, headaches
• Painful periods
• Irregular periods
• Insomnia
• Cyclical moodiness

Many women experience these symptoms and are told they are “normal”.

They are considered normal because these symptoms are a “societal norm”, meaning that many people have these symptoms so therefore it’s normal, but from a health perspective, this is not normal!

If you have mild symptoms, it’s likely that you’re fine, but if any of these symptoms become  severe and affect your day to day living, you definitely should consider being assessed for estrogen dominance.

Mainstream treatment for these symptoms usually involve being on hormonal contraception (birth control), anti-depressants, or pain-medications, and while these may help control your symptoms, none of these solutions actually target the root cause.

If the root cause isn’t treated, it can lead to chronic disease

Associated Symptoms

When you have increased amounts of estrogen in your body, this can highly affect estrogen-sensitive tissues.

The tissues that are most affected are in the breast and uterus.

Why is breast tenderness and swelling caused by estrogen-dominance?

It’s because your breast tissue is hyper-stimulated.

Why do you feel pain during your menstrual flow, or experience extremely heavy flows when you have estrogen-dominance?

This is because your uterine lining is hyper-stimulated by estrogen dominance.

When these tissues are hyper-stimulated, that leads to “cell proliferation” - long term cell-proliferation in the breast can lead to breast cancer.

Long-term cell proliferation in the uterus is called endometrial hyperplasia, which is a risk factor for uterine fibroids, endometriosis and uterine cancer.

What causes estrogen dominance?

Estrogen dominance is when there is an abundance of estrogen wrecking havoc on the body that isn’t being balanced by other hormones, or properly cleared by the liver.

Reasons for why someone can have estrogen dominances are stemmed from:

1. Biochemical imbalances and genetic-related dysfunction of liver detoxification
2. Increased estrogen production due to chemical exposure and inflammation
3. Relative excess due to another hormone deficiency
4. Environmental and dietary exposure to xenoestrogens.

I will go through each of these reasons in detail in upcoming articles.

Today we will focus on liver detoxification.

Estrogen and liver detoxification

Estrogen is activated and then detoxified by the liver.

Liver detoxification occurs in phases.

Phase 1 Liver Detoxification

Phase 1 is responsible for exposing a hydroxyl-group (OH) to the estrogen (estrone E1 for this discussion) molecule, which breaks it down to many different estrogen “metabolites” with this OH group.

Each metabolite has it’s own impact and function on the body.  When the liver is working properly, it breaks estrogen down so the ratio of these metabolites favour optimal estrogen effect: an abundance of the protective 2-OH-E1 metabolite.

When the liver is having problems with phase 1, then it may favour the production of other estrogen metabolites, ones that have carcinogenic (cancer-causing) effects on the estrogen-sensitive tissue - these metabolites are 16-OH-E1 and 4-OH-E1.

The reason why the liver may favour the production of some metabolites versus the other comes down to which enzymes are activated.  2-OH-E1 is produce through the CYP1A1 enzyme, 4-OH-E1 through CYP1B1 and 16-OH-E1 CYP3A4, all of these are part of Phase 1 enzyme system called the Cytochrome P450 system.

One could have a genetic abnormality in the enzyme for 2-OH-E1 (CYP1A1), or could be lacking the essential “cofactors” to the enzyme, rendering the enzyme more sluggish and unable to keep up with 2-OH-E1 production.

One could also be exposed to environmental toxins that can also render the enzyme functionally slow, or simply have a diet that isn’t rich in foods that favour the production of 2-OH-E1.

Or for some reason, the enzymes for 4 and 16-OH-E1 can be upregulated, favouring their production over 2-OH-E1.

Phase 2 Liver Detoxification

Phase 2 is all about conjugation - binding the now hydrolyzed estrogen to a methyl-group to exert further effects of the body and to prepare the estrogen for excretion out of the body.

2-OH-E1 and 4-OH-E1 are conjugated by the same enzyme called COMT - this enzyme is essential for turning these in to 2 and 4 -methoxy-E1.  2-methoxy-E1 is protective to the body, while 4-methoxy-E1 is neutralized by this process.

COMT is also important for producing antioxidants by the liver, which are protective against cancers.  Therefore, if this enzyme is dysfunctional (for reasons as suggested for the other enzymes above), then the protective and neutralizing effects are diminished.

In fact, studies found that women who have genetic abnormalities in the COMT gene had higher risk for estrogen-related disease, such as uterine fibroids, endometriosis, breast and uterine cancer (see below for references).

This genetic susceptibility also has been found to be dependent on ethnicity - for example women of African descent being the one of the most susceptible groups for uterine fibroids.

What we do know is that liver health is important for regulation of estrogen-metabolism and can play a significant role on how we develop estrogen-related disease.

Our phase 1 and phase 2 health decline as we age, our exposure to environmental pollutants and our nutrition.  Take a look at our article on Liver Health to find out ways we can improve the strength and functionality of our detoxification processes, potentially improving our estrogen health.

Next week we will go through how inflammation, and other hormone imbalances can be associated with estrogen dominance and nutritional and herbal strategies to improve our overall hormonal health and to prevent chronic disease.

If you’re curious to learn more about this subject or would like to consult with one of our NDs feel free to book a visit or contact us.

Yours in Health,

Dr. Tanya Lee, N.D
Annex Naturopathic Clinic
572 Bloor St W #201, Toronto, ON M6G 1K1
-https://goo.gl/maps/uVRBvcyoUa62

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References

1) Shen Y et. al. Role of single nucleotide polymorphisms in estrogen-metabolizing enzymes and susceptibility to uterine leiomyoma in Han Chinese: a case-control study.J Obstet Gynaecol Res. 2014 Apr;40(4):1077-84. 

2)Huang CS et. al. Breast cancer risk associated with genotype polymor- phism of the estrogen-metabolizing genes CYP17, CYP1A1, and COMT: a multigenic study on cancer susceptibility. Cancer Res 1999. 59:4870–4875

3) Al-Hendy A, Salama SA., Catechol-O-methyltransferase polymorphism is associated with increased uterine leiomyoma risk in different ethnic groups.J Soc Gynecol Investig. 2006 Feb;13(2):136-44.

4) Zhao XM., et. al. Polymorphism of catechol-o-methyltransferase gene in relation to the risk of endometrial cancer. Zhonghua Fu Chan Ke Za Zhi.2007.42:116–119

5)Juo SH, et. al., CYP17, CYP1A1 and COMT polymorphisms and the risk of adenomyosis and endometriosis in Taiwanese women. Hum Re-prod 2006. 21:1498–1502

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