Estrogen plays a role in various body functions. However, high levels of estrogen can pose health risks, such as weight gain, thyroid dysfunction, breast or ovarian cancer, and blood clots. How can you get rid of excess estrogen you ask? The answer is supporting proper estrogen detoxification in the body. There are three phases of estrogen detox. The body metabolizes estrogen using two phases in the liver and then eliminates it in our stool.
During the first phase of estrogen detox, metabolism can go one of three pathways:
-2-OH: ideally, 60-80% of estrogen goes down this pathway and is the most beneficial pathway since it has anti-cancer properties.
-4-OH: ideally, less than 10% goes down this pathway. This is the least desirable pathway since it can make reactive estrogen products that can potentially damage DNA.
-16-OH: ideally, 13-30% goes down this pathway. We don’t want too much estrogen going down this pathway since it can exacerbate high estrogen symptoms, but it is vital for bone health.
Why is my body favoring a negative pathway?
There are several reasons that you could be favoring a less desirable pathway:
Inflammation! If you have inflammation in the gut, poor digestion, etc. could impact this pathway.
high fat, low fiber diets (think keto and low carb)
nutrient deficiencies (especially B vitamins, vitamin C, and vitamin E)
What are the ways I can support healthy phase 1 metabolism?
Supporting gut health and digestion (especially bile—you can do this with digestive bitters)
Raw carrots (especially with coconut oil and apple cider vinegar)
Whole food vitamin C
You can see which pathway your estrogen is going down with a DUTCH complete test.
Diindolylmethane (DIM) can support estrogen going down the 2-OH pathway. I only use DIM to support this pathway on rare occasions. I prefer to get to the root of what is causing excess estrogen and/or poor estrogen metabolism rather than lowering it.
Friendly reminder: estrogen isn’t bad. We need estrogen, especially for other hormones such as progesterone. Without adequate estrogen, we won’t ovulate. So let’s all stop taking DIM supplements to lower our estrogen (especially if you haven’t done any hormone testing to see if estrogen is high) and support estrogen detox instead.
After phase 1, estrogen metabolism, 4-OH, and 2-OH estrogens are deactivated by methylation (different from MTHFR but still involves COMT). This is an essential step. Why? Because we need to neutralize estrogen so that the body can eliminate it.
I like to think of this as a bathtub (Dr. Carrie Jones gave this analogy at a conference I went to and I’ll never forget it!). Phase 1 estrogen detox is like filling a bathtub. Once your bathtub is full, you have to drain it—there’s where phase 2 comes in. To drain the bathtub, your body uses methylation, amino acids (such as glycine and glutamine), magnesium, and SAM to support the enzyme COMT in turning your estrogen into a water-soluble compound. This allows the estrogen to be in a form that can easily be eliminated. If you do not drain your bathtub, the estrogen can recirculate and cause issues.
What can I do to support phase 2 of estrogen detox?
Understand your genetics. If you have the MTHFR gene, while that is not the same type of methylation, you may have a harder time having adequate levels of specific B vitamins, which can negatively impact phase 2 estrogen detox. The COMT gene is an important one to understand since that directly impacts how well you methylate AKA phase 2 estrogen detox.
Consider your gut health. If you have an overgrowth, dysbiosis, or a parasite/pathogen that could be causing inflammation in the gut, this can impact the absorption of nutrients (especially B12) and also how well you are draining that bathtub.
Replenish nutrient deficiencies. We need adequate levels of B6, folate, B12, magnesium, choline, methionine, methyl donors, and TMG (tri-methyl-glycine).Foods to consider: eggs (including the yolk), bone broth, leafy greens, grass-fed/pasture-raised beef, organ meats, and bone broth. Phase 2 is heavily dependent on genetics and specific nutrients. If you’re struggling here (a DUTCH complete test would tell you), those are the areas you will want to focus on.
Once we go through phases 1 and 2 of estrogen detox, we now have estrogen that is all packaged up with a little bow and ready to leave the body. How does it get out; you may be wondering. Well, through our solid waste (a.k.a. our poop). Estrogen is transported to our bile, made in the liver, stored in the gallbladder, and then excreted into the digestive system. We all have what is called estrobolome, which are bacteria that handle estrogen excretion. We then poop out our estrogen and repeat the process all over again. Our bodies are continually detoxing estrogen—all day, every day.
What can impair phase 3 estrogen detox?
Inflammation: To get the estrogen into your bile to be excreted, we need a transporter. Inflammation slows this transport process down and can make phase 3 estrogen detox slow leading to unwanted excess estrogen symptoms (mood swings, breast tenderness, painful, heavy periods, etc.)
Gut Bacteria: If our estrobolome is out of balance, we may not excrete estrogen properly. If we have dysbiosis in general in the gut (an imbalance in the good and bad bacteria), this can increase a retoxification enzyme.
High Beta-glucuronidase: Beta-glucuronidase is an enzyme produced by intestinal bacteria that can take your nicely packaged estrogen and rip it apart. This means your body reabsorbs that estrogen and has to do all of that work over again. When we have an overgrowth of harmful bacteria, parasites, pathogens, or yeast, beta-glucuronidase can increase and cause retoxification of estrogen (and other toxins).
Poor Digestion: When we don’t break down food properly, it can increase inflammation in stress in the gut leading to an imbalance in gut bacteria.
Constipation: We have to poop if we want to eliminate the estrogen that is in our stool. If you’re struggling with constipation, you are likely recycling estrogen, which can lead to higher levels.
How can you support the 3 phases of estrogen detox?
Phase 1: If I had to pick two things for you to do to support phase 1 estrogen detox, it would be eating 1-2 raw carrots a day (with a protein and fat) and considering adding in broccoli sprouts.
There’s also an interesting study that digs into the different foods that can support this phase. You can find it here.
Phase 2: While you can include certain foods to support phase 2, it’s driven by genetics. If you are struggling, you may want to consider getting your DNA tested to support this properly.
Phase 3: If sluggish bile and transport is the issue, increasing sulforaphane intake via broccoli sprouts is ideal; green tea, dark chocolate, and foods high in flavonoids help this. Digestive bitters also help to stimulate bile flow and can be great to use prior to meals. Urban Moonshine is a high quality brand.
To see if there is an imbalance in bacteria and/or high beta-glucuronidase enzyme levels, you would need to do a stool test. I recommend the GI map from @dxsolutionslab.
Probiotic-rich foods (sauerkraut, raw apple cider vinegar, kimchi, kefir, beet kvass, kombucha, water kefir)
Take a quality probiotic. I love Just Thrive
Drink adequate water for your body.
Our hormones (i.e., estrogen) are vital, but their levels can sometimes get out of normal range. Having balanced hormones is possible. Correcting hormone balance is achievable with a personalized approach to nutrition, smart supplementation, and mineral balance. We believe in testing, not guessing, when it comes to health—which is why we created our Master Your Minerals course, in which you’ll learn how to build your own hormone-healing protocol based on your HTMA results.
Amanda Montalvo is a women's health dietitian who helps women find the root cause of hormone imbalances and regain healthy menstrual cycles.