Breast Health: Where to Start with Estrogen Metabolites

Hello everybody and a very big welcome to our free webinar, breast health and where to start with estrogen metabolites. Super excited to be here and talking about this subject. We had an immense sign-up list for this, so this is obviously a hot topic. I'm glad to know that, and I want to thank Goova Diagnostics for helping to put this on and coordinate everything. That Goova does, you have no idea. We were just in North Carolina visiting the lab, how much they put in to doing these tests. I mean, I used to work in a lab myself a long time ago, Bioh Health, and I've been around all these labs for a long time. I just kind of forgot it. When you send off a Goova test kit, there are so many people that have to absolutely be on the ball, 100%, to make that test work, and they do a great job. So just a shout out to Goova, just providing us with the service that they do. And I feel like on our part as practitioners, we need to support these companies. I mean, they need our dollars, they need us to order a lot of tests so that they can stay in business. And so order as many Goova tests as you can. I do certainly and have done for 30 years. So it's a great group of people, and we want them to be there. They're really supporting us as an industry.

And for those of you that are new, uh, that it's the first one of these that you've done, I want to welcome you. So super excited, and I'll introduce myself just briefly. I am Dan Kish. I started the Kalish Institute in 2006. We have trained over 7,000 doctors, and we focus mostly on lab interpretation skills development and patient communication, and you know, building successful practices. That's really what we're all about. And it's exciting for me to see practices that I helped set up 15, 18 years ago now being super successful and out there. It's for those of you that have children, it's kind of like having kids. You're like, wow, you've been to practice for 15 years. It's like having a 15-year-old child. You're really excited about when they get on the honor roll or something. So we, we've created some of the just amazing practices. And, um, I'm super excited to be able to be part of this movement. I've been doing this for 31 years now, and a lot of the work that I teach is predicated on the teachers that I've had. Richard Lord is one of my current teachers, who's one of the original lab developers for many of these tests, and Dr. Bill Timmons, Glenn Freder, the list goes on and on and on. I've worked with the Mayo Clinic, I've worked with all kinds of different academic institutions, and primarily, we're really oriented around, for the purposes of these kinds of sessions, just giving you some practical take-home skills that you can apply in your practice.

We have a QR code there if you want to scan that with your phone for a 400% discount on this upcoming class. So you need to have this code GDX 24. This will all be emailed to you if you signed up for this lecture, so you'll get an email of this, but you can just snapshot it right now if you want. And, um, that is a discount on our upcoming Interpreting Genova Female Hormone Labs Plus Protocols That Work seminar or boot camp, or whatever you want to call it. That's coming up in in a few weeks, in in the, uh, end of May. So that is a, this class is just like an introduction to the concept. The, the Interpreting Genova Female Hormone Labs and Protocols That Work is like how you actually do this with the real protocols and all the application stuff. And that also has a series of live calls, uh, in the course, so that we'll be reviewing labs that you can send in your own lab test that you've run on yourself or on your patients, and we can review them and make all those work. So if you guys are really interested in applying this in your practice, this is a great way to get started, uh, with the upcoming Genova class. And again, thank Genova for, um, helping sponsor that.

All right, so now let us take a look here. Our materials. So let's forget that slide. I can't even see it. So we, we're thinking about what are the things that causes, what are the things that cause female hormone imbalances, and then how do we fix them? And in this specific instance, we're going deep into one topic, which is estrogen metabolites and how they work. Um, there's a much broader, you know, area to all this, but the steps are basically the same: addressing the hormone component, the cardiometabolic component, the detoxification component, getting the diet and digestion figured out, you know, making sure that the body can get rid of all these things. And in fact, if you just did these three steps on here, you, for most of your patients, you probably wouldn't have to do anything else. We're going to get into the weeds on when you have to do these other things, but this is just to point out that restoring the overall health to the tissues and the cells is really what we're talking about. And that for estrogen metabolites, obviously, these are, you know, your body breaking down estrogen into little things that's then getting rid of. And that getting rid process, the detoxification process, you know, methylation, all these different things that help us break down and excrete hormones are really where the problem lies. And so if you're working on that stuff, you're going to, just by your very nature, you know, clear these estrogen metabolites. That doesn't work well enough for everyone, so you have these extra things that we're talking about today. But that's the starting point. Just don't want to forget about that, because for the rest of the talk, we're going to forget about lifestyle and just get really into lab interpretation. But you can fix a lot of these things with, with, uh, with lifestyle alone.

So I have a model. I like to have models of how this all happens. That when we're first under stress, we have stress hormone and female hormone issues that can then cause enough stress that we start to have gut-related problems and detox systems, you know, start to get screwed up. And basically, for the correction that we're talking about today, we're really correcting female hormone issues by working with the detox system. I think that's the easiest way to think about it. And if you get into these labs, there's a couple things you should know. One is that you should test and correct the female hormones themselves. But to take care of the metabolite problems, you're going to be testing and correcting the detox system and antioxidant systems of the body. Okay? And that by getting normalizing detox, normalizing oxidative stress, all that stuff getting fixed will fix the the estrogen metabolite problem. Okay? So it's a hormone correction that's done through detoxification pathway clearance, you know, making that work, and through reducing oxidative stress. Similarly, on the GI testing, and you can order a GI Effects test from Goova. On the GI Effects test, you will see a marker called beta-glucuronidase. And that particular marker shows that there's a gut bacterial problem which is triggering estrogen dominance. So you can have gut-generated female hormone issues, you can have detox system generated female hormone issues. So ultimately, we're doing all these tests: adrenals and female hormones, GI Effects for the gut, and then the metabolomics or NutraVal for the detox systems and oxidative stress. So those are three essential tests: hormones, adrenals and female hormones, which we're going to look at today; GI Effects, so you get that beta-glucuronidase and you see if the gut microbiome is responsible for part of the hormone problem; and then a metabolomics or NutraVal, which will show you the detox pathways and oxidative stress pathways. And that's my complete workup on every new patient: adrenals, GI, and, um, metabolomics. And when, once you get into this, you realize you can't really treat without all three tests. I mean, you can, but it's not going to be that effective. You know, I have a, I started to get into a new fitness program in January, and, um, I've always worked out, but I have a new way of working out now, and I have someone that designs the exercise programs for me. And so if I showed up one day at the gym and I said, "Hey, Nick, how's it going?" He's like, "Hey, Dan." We always do a fist bump. I don't know why, it's what you do in gyms, whatever. So, "Hey, Nick." And, and, and Nick was like, "Yeah, you know, for the next six months, we're just going to work on your left arm, and we're not going to do any squats or deadlifts or anything, and you're just, we're just going to do pull-ups with your left arm." I'd be, "Well, that's insane. I don't want to like just work on my left arm for six months. That's ridiculous. Can't we do both arms and legs?" So just doing a hormone test for hormone correction is like just doing an isolated exercise for your left arm for six months and not working out your whole body. So adrenals, GI, and metabolomics, and you'll have it made. And you need to learn those. Typically, you know, in, you can't learn them all at the same time. You can learn them, you know, one step at a time, uh, but then you want to put them all together. I just want to point out the bigger picture for those of you that are newer to this stuff.

All right, so now we're going to talk a lot about methylation. So it's worth just mentioning what it is briefly. So methylation is the movement of the single carbons, it's the slinging of single carbons around through this methylation cycle that's represented at the top of the diagram here. And most of have heard of methylation, most of us have heard of like MTHFR. And but methylation is dependent on B6, B12, folate, methionine, choline, trimethylglycine. There's a kind of a decent list of nutrients that are required for methylation to work properly. And then in order to methylate, you need to get these carbons from somewhere. Okay? This is methylation here. The origins of those carbons, the origins of those carbons are amino acids: five of them, serine, glycine, histidine, tryptophan, and glutamine. So there's five amino acids that contribute the carbons that are responsible for methylation. And so you do need the B vitamins, that's obvious: B12, B6, folate is a big one, etc., etc. But you also need the amino acids. I just point that out because a lot of times people don't know. If you're ordering a NutraVal from Goova and you see low serine, glycine, histidine, glutamine, then you're going to think, "Oh, that could be impacting their methylation pathways, as well as other things that those amino acids do." So methylation, you know, involves a lot of nutrients, let's just say that.

And here's a breakdown, a little more specific here, get into the weeds a little bit. So nutrients required, right here, we have our B6, B12. You also need some of these things, some cysteine, methionine, methyl folate. Okay? These are all the cycles that we're talking about, and all this is measured on these various tests that we do. So methylation is going to become important in a minute. We also have oxidative stress as a concept that's very important because if you generate a lot of free radicals, that can damage your tissues. And if DNA is damaged, that can lead to a higher risk of different forms of cancer. So on the metabolomics and NutraVal testing, you will see oxidative stress markers. And we see these every day in the different classes that I teach where students are submitting labs every day. We see high oxidative stress. In fact, it's unusual for someone to not have a lot of oxidative stress. But they don't tell you where the oxidation is coming from or what's getting oxidized necessarily. It just shows what their overall load is. And then you can recommend antioxidants to try to balance that out.

Here's an example of what oxidative stress does. So if we have too much oxidative stress, as I mentioned a second ago, you have the potential for DNA becoming damaged and DNA adducts forming, which puts you at risk for different forms of cancer. You can also have, or you will also have with high oxidative stress, a decrease in methylation. So high oxidative stress decreases our capacity for methylation, and or because you could say because oxidative stress, when it's high, increases our need for glutathione. So if there's a lot of oxidative stress, methylation shuts down in order that we can increase glutathione production. And it's kind of amazing that we can even do that. This probably explains why human beings are even still around, given how toxic the environment is, because we can make glutathione on demand. We can make that. It's the most powerful antioxidant in the body, and you can make it. You can't make vitamin C. There's a lot of antioxidants you can't make, but you can make glutathione. So if your body requires it and there's a lot of oxidative stress, methylation gets cranked down and glutathione production goes up. That becomes super important. And you can test for all of these things on a simple NutraVal: oxidative stress, methylation. You can test for B6, B12, and folate. There's individual markers for each of those B vitamins. There's a marker for B6, a marker for B12, and a marker for folate. Believe it or not, if you do the NutraVal with amino acids, it'll also test for cysteine and methionine. All these things are tested for. It includes a glutathione test. Everything's on the labs. Okay? But these are just the pathways. You can kind of see the context in it all. And obviously, this is more biochemistry. We probably don't need to focus on that too much.

So now estrogen metabolism in its relationship to things like breast cancer risk. There's a lot of research that's been done on this. And just to show you a couple of different studies that estrogen metabolites, when they're not, you know, when there's more, they say in the words here, "more extensive to hydroxylation of parent estrogens is associated with lower risk and less extensive methylation of potentially genotoxic for hydroxylation pathway." So when we look at the labs in a minute, the four pathway is the one that is associated with higher risk of postmenopausal breast cancer, and the two hydroxy pathway is the one that's considered protective. Okay? So the two, that's all you need to remember. The four is the bad one, and the two is the good one. And that's going to matter a lot. I, matter of fact, I can just, just give you a preview of where that matters right now. Let me just show you real quick, because that's what we're measuring on the test, uh, here. And it's a lot of complicated pathways here, but just remember two and four. That is, that's something you can wrap your mind around today. So you see the two hydroxy, that's the good one, and you see the four, that's the not so good one. Okay? So two is good, four is bad. When we look at the test, and these are the metabolites, the different types of metabolites, uh, that they're measuring on the lab. And there's, um, more research studies than I think anyone could probably read on this subject. If you're interested in, I just pulled a couple of them from some journals. You can see that there's been a, a lot of interest in this. And remember here again, there's the two enhanced two hydroxylation of parent estrogen associated parent estrogens is associated with reduced risk of, uh, breast cancer. Lots of studies on that. There's another one.

So here's what you need. You do kind of need to memorize this part. So let's just talk about it for a second. So here's the actual estrogen, estradiol, one of the three forms of estrogen. And there's two different ways it can be broken down or metabolized. You can go down this pathway over here, and this all has, you know, these fancy terms, CYP1A1, you don't need to memorize that. CYP1B1, don't need to memorize that. But you do need to know that the estrogen can be broken down either to the two hydroxy or the four. Right? And the four is the not so good one, and the two is a protective one. And then wherever you see COMT or CompT here, CompT and CompT, that stands for catechol-O-methyltransferase. So that's a methylation process. So if you make the two, or let's say if you make the four, me, actually, I'm messing this up. So you can't see it. If you make the four and you can methylate it, you can metabolize that four and break it down, then it goes over to this form, the form of hydroxy, and then it gets neutralized, and you're okay. If you don't have the methylation capacity, we just looked at methylation a minute ago, right? If you don't have B6, B12, folate, all those things that we just looked at, you don't have the amino acids that you need, if you can't methylate very well, then something very, very bad happens. The four hydroxy turns into these compounds down here, into these quinones, and eventually creates DNA adducts, that's damage to the structure of the DNA, and that is going to cause the, and they say in scientific terms here, "potential for mutagenic damage." Okay? Meaning that, you know, you can, high risk of cancer. So you don't want these DNA adducts formed. You want the four hydroxy going over this way because you're methylating it. The two again is protective. Two is protective. And all this is revolving around COMT, which is what the methylation process. That's why it's so important that you can methylate properly. And if you can't methylate very well, then you're in trouble.

I went, there's my, my good friend and I, just one of the most wonderful people I've ever met, Ben Lynch. Some of you may know Ben Lynch. He's a genetics, he's a naturopath by training, but he's really kind of cornered the market on MTHFR and genetics. But he did a talk one time for my advanced group, this is years ago. And so Ben's doing this whole complicated talk on methylation, makes what I'm talking about today look like baby speak. Okay? So he's doing a complex methylation talk, and then it's like 55 minutes into it, and then everyone's wondering, "Okay, well, where is this heading? Like, what are we supposed to do, Dr. Lynch?" And he says, "And every single one of these pathways can get, can be completely reversed and changed." And he was talking about exactly what we're talking about now, by doing one thing. And we're all waiting for the supplement he's going to pull out where he's going to talk about. It says, "If you have the patient eat lettuce every day, they'll get the full folate, and then none of this will happen." And it was like one of those, "Ah, mic drop moments." Okay, Ben, you got us there, didn't you? We thought it was going to. So it's lifestyle. If you're eating lettuce and you're getting folate all the time, a lot of these things don't happen. So you can resort to supplements, and I do with all my patients, but don't forget the lifestyle part. If they're not eating a salad every day, it's not worth doing any of these other things that we're talking about. And broccoli, broccoli turns out to be very important for this as well.

Here's another diagram of the exact same thing, just a different view. It's on its side, kind of. Now here's our estradiol molecule, exact same thing. Okay? You're going to break it down into these different forms. And here's our COMT again, remember. And remember, the two is the good one. That's what we want to have happen. If it goes down the pathway to the bad one, the bad one is the four. That can be bad, or it can be not that bad if you have methylation or COMT, this enzyme is working properly. You can methylate it, then you're going to make it harmless. If you can't, it's going to become a problem. So, same thing, just a different diagram to reinforce that concept.

So if you can't break down these potentially harmful estrogens, and if you have a gut problem that shows high beta-glucuronidase, high beta-glucuronidase means there's a lot of estrogen being recirculated back into the body. And if you have a high exposure to things like environmental toxins, etc., etc., then the body can end up in a state of estrogen dominance. And that's going to put you at higher risk for cancer, autoimmune disease, thyroid problems, even issues like diabetes. Okay? So there's a big connection between environmental toxin exposure and all these different things. And so then the beauty of it is, I mean, you only have one liver. It's not like there's a liver, you know, like liver B or something like a second liver that's for your estrogen metabolism. And it's all happening in one liver. So you just have to fix one set of detox pathways to clear what? To clear all these estrogen metabolites that we're talking about, to void their cancer risk, as well as clearing heavy metals and mold and arsenic and toluene and benzene and DDT and whatever else crap is accumulated in the person's liver, you know. So there's just one liver to fix. And there's only one gut to fix. And so that part of this, you know, makes it not that hard. You also need to always consider the genetic issues because some people have a problem with that, uh, COMT enzyme that we're just looking at. Some people have a problem with MTHFR, which means that their supplement dosage amounts of supplements you need to give them may be higher than a typical person would be otherwise. And then glutathione is the master protector for all this. So if things are going bad, and there's the four hydroxy, and it's going down the wrong way, if you have enough antioxidants, you can neutralize all of this stuff, neutralize it and prevent the formation of DNA adducts. There's all kinds of studies on this. This is right off a study that I was looking at the other day. And, and Resveratrol, NAC, and Resveratrol have been shown to reduce the formation of the estrogen DNA adducts. So again, if that metabolite, that four, sneaks by and it gets down and it's going towards DNA adducts, you have a second backup system to nuke it. In comes your NAC, Resveratrol, whatever it is you're using for antioxidant protection, and that'll neutralize, uh, the, the damage that could happen there otherwise.

So these are, this is showing you what the treatments are. Need to treat, you know, methylation when you find that it's a problem. You need to treat with NAC and Resveratrol when you see that there's a lot of oxidative stress. And get these things kind of fixed, get fixed up. There are specific treatments that are very, uh, limiting is not the right term, but they're very specific. So calcium D-glucarate is typically used for improving what we call Phase 2 glucuronidation. This would be the breaking down of, uh, of these metabolites that we're talking about. So that's an easy one. Also, people use DIM. That's frequently used as well. And that's a compound formed in the body. That's your broccoli, cabbage, Brussels sprouts, all that. And this is, no, again, a very strong argument for broccoli. And I had broccoli last night, and I had, uh, cauliflower today. For lines, you don't want to overdo it with too many cruciferous vegetables, that can cause problems too. So you want to like be walking around, you know, just eating broccoli five times a day. But you need to get it, you know, every day, you know, a certain amount or every couple of days. You should for sure be eating these foods, probably every day, but not to an excess, you know. So it turns out that you can do a lot of this with food. But then, you know, in the short term, when we're working with supplements, you, for sure, want to use the supplements because you're just going to, you know, fix things quickly.

So to increase the two, the two is the good one. We're going to look at the labs in a minute. You see the twos. If the two is low, you want to increase it. How do you do that? Here's the short list: Serine, Indole-3-carbinol or DIM, Omega-3s, Curcumin, and then methylation support. That's going to increase the good one. That's what you want. You want the protective one to go up. You also are going to have estrogen metabolism, the breakdown of estrogen, is going to be impacted by xenoestrogens. So these are chemical, chemical compounds that mimic estrogen. That's a bummer. But that means basically that you need to make sure that you've got as much as possible a reduction in the exposure to chemicals and heavy metals in the person's day-to-day life and an elimination of whatever is stored in their tissues. The simplest, best way to do that is with sauna or sweating. Um, you can also do it with juicing, you do with supplements, you do with IVs. There's lots of ways you can do it, but sauna is probably the, uh, tested way to get chemicals out of the body, just sweat them out. And then if you, the more body fat you have, the more potential problems you may have with estrogen. And then liver structure, liver function is just going to be completely destroyed with alcohol consumption. So if the person is drinking alcohol every day, you have to start to work with that first, or you're not going to get anywhere. And then COMT pathways. We saw how that pathway is involved in all these different things that we're talking about. So here's the, you know, this is the stuff they use to fix it: B6, B12, folate, magnesium, trimethylglycine, which is also known as betaine or TMG, SAMe. Some people use SAMe, some people use methionine, some people use both. SAMe is kind of expensive. I usually use methionine, but you can use SAMe. And then you want to work with the stress response. And most of the companies, the professional branded supplement companies, will have, you know, a product that's designed that has all this stuff in it, so you don't have to give a different bottle of each thing. That's usually pretty easy to ascertain. And if you can't figure it out, just ask your supplement sales rep, you know.

Okay, and this is my trick slide. See how I did that? That all. Right. So it's not even, it's not very funny, but I think it's kind of funny. So COMT pathway treatments, that's for that specific enzyme. But remember the name of the enzyme, catechol-O-methyltransferase. It's transferring methyl groups. So the methylation treatments, the MTHFR type treatments, they're exactly the same. Okay? Because this is methylation, it's the same, same. So you don't have to learn anything new there.

Now let's review this real quick. And I go over these pathways over and over because you do have to memorize this, or the lab makes absolutely no sense. Okay? And so I personally really enjoy physiology. And I, I like actually study physiology just like for fun on weekends, which I'm not really proud of. Um, but it's just who I am as a human brain person. That's that's how my brain works. But I don't inflict that on any of my teaching. But I do sort of point out pathways that you just have to learn, or, or you're not going to understand the test. And if you don't understand the test, then you can't really explain it to the patient, so you're kind of in trouble. So this pathway, you just have to, you just have to learn this at some point. With estradiol is in the center here. There's other forms of estrogen. And this is an oversimplification. If you know, you're thinking, like, what about the 16? What about estriol? It's more complicated than this, but this is the important part. So you just want to start with this, right? And you can learn more about this, you could study this for years if you feel like it. So you've got your estradiol that's in the center. And remember, we have these different genes. There's CYP1B1, and there's a breakdown into the four. And now we've already said that the four is the bad one. But here's our COMT, that's our catechol-O-methyltransferase, that's that little enzyme. So that enzyme grabs this guy here and just says, "Uh-uh, you're getting out. I'm turning you into 4-methoxyestradiol, and you're going out of the body, broken down, gone." So what happens if your COMT is not working? If there's a block here, there's a block here, that's not good, because then the four goes over this way, and now we're making these quinones, and then that's just one step away from DNA adducts, and that's basically high risk for cancer. So you can stop the whole process through methylation right here. You can stop it. If it's getting really bad over here, with antioxidants, it's that simple. And I think I just showed you which they are, uh, the NAC and Resveratrol. Remember that NAC and Resveratrol work, have been shown to work for that particular process. Then you have estradiol also converting into the two hydroxy. This is the good one again. You use the COMT gene, or, or enzyme, to break it down to the two methoxy, and then it gets excreted out of the body. Okay? So it turns out this is super, super important. And if the twos are low, you want to boost them up. I showed you how to do that. And if the fours are high, you want to get them out, which we're going to look at in a little more detail. There's the same thing again here. But here's the part that you probably need the most.

So now all that we just said can be resolved by getting Phase 2 and Phase 1 detox pathways working properly, and by making sure the person's hydrated, so they're, you know, there's enough fluid in their system that they're peeing these things out, and that their gut is working reasonably well, so that they're going to come out in the stool. And remember, if the gut's not working well, and you run a GI Effects test from Goova, and you see beta-glucuronidase is high, that means that estrogens are being recirculated back into the bloodstream because of a gut problem. So a gut problem can cause everything that we're talking about here. That problem can cause it. And obviously, a liver detox or liver clearance problem can cause it. So you got to get Phase 1 and Phase 2 working. And here, this is the whole methylation process. It's kind of tucked into Phase 2. And here's the nutrients that you can use: glycine, taurine, glutamine, N-acetylcysteine, cysteine, methionine. And every company, every good company that we work with has a Phase 2 detox product. So someone has thought this through for you. They're all probably going to have, yeah, they're all going to have an antioxidant product as well. And so you, you don't have to like reinvent the wheel here. But you should understand these pathways because this is what you're actually treating. And this stuff works really well. I mean, you could get somebody better in a couple months doing this.

So we're going to look at the labs in a second. You want to test for and correct the estrogen metabolites. You need to address methylation, glutathione production, we talked about that, and then all these redirecting of the pathways. So you need to learn a methylation protocol, you need to learn an antioxidant support, glutathione program, probably should have a general sense of calcium D-glucarate, DIM, and how those work. And then diet, lifestyle, you can do, do those things, you got it made for all these different problems. Okay?

So as a reminder for those of you that joined us late, we are partnering with Goova to offer you a class starting May 23rd on Interpreting Goova Female Hormone Labs and Protocols That Work. So we'll be getting into depth on the protocols. You can scan that QR code there. I'm a really big fan of QR codes. I don't know why, I just think it's a really great thing. It's so, so convenient. You need the QR code, you need the written code, which is GDX 24. GDX 24. And that'll get you the $400 off at the, uh, at the, uh, checkout time when you, when you get that. So that class is starting pretty soon. If you're interested, sign up for it, check it out. And it's, um, a whole bunch of lectures that I put together that are online, and then there's live calls where we review the labs of the students in the class. So you can submit your Goova labs, and we'll go over protocols and design programs for you based on on what your patients are showing. Okay? Or testing yourself. We always, always recommend that practitioners test themselves if you haven't tested yourself recently. Okay? So that's that.

Let's pull up some tests here, and I'm going to go over a couple of labs, and then we will look at questions. So if you do have questions, type them in to the box there, and I'll address, I'll address as many questions as I can at the end here. But let's look at a test and see how this actually shakes out. So there's, um, a test that recently Goova put together. I think this is just a few months old, which is an amalgamation of a whole bunch of different tests, and it's a really great idea. So it's one test box from which you can do either serum, saliva, or urine panels. So in the old days of 2023 and before that, you had to order separate tests. So it's very convenient. You can do it this way. But we're going to just be focusing on met, um, estrogen metabolism. But I'll show you just a quick overview. This is called an Endo Plus. So you can test for the adrenals, thyroid, sex hormones, and estrogen metabolism. And here, where we're focusing on for today, let me just make this, uh, more obvious for you. And can I just, given, given aside as a, just a general promotional for functional medicine, is, you know, this stuff really works. This is not an abstract science class. This is, you know, in your practices, if you learn how to do this, people will get better consistently. And in fact, I don't want to jinx it, and I am knocking on wood, although I think it's like melamine, it's not real wood, but I'm, oh, there's real wood over there. I'm knocking on wood. But that's like one of the easiest things to fix in practice is estrogen problems. If you understand how to use progesterone, you know, you kind of to get that dialed in, you understand how to interpret these labs, how to either give estrogen or get rid of estrogen depending on what the patient needs. This is one of the easier natural medicine things to fix. And it's, it can cause a lot of symptoms for the amount of suffering that women go through for these kind of problems. Super easy to fix. You know, my first 10 years of practice was just doing these kinds of programs almost exclusively. And so anyways, if you're interested in, in a functional medicine career, and you want to not, you know, pull your hair out every night with, you know, really difficult cases, this is a really great way to go. Okay? So, um, for those of you that don't have the experience yet, these things work. You'd be shocked how well this works. You will be shocked if you get into it.

So let's look at the estrogen metabolism section here, right? Uh, and I don't know how much easier it could get. They just tell you right here, methylation activity up, two, the two hydroxy is down. Okay, that's the good one, remember. Um, the 2-16 ratio is down. The 16, we didn't talk much about. 16's kind of complicated. You, you have to look that one up later. That one's complicated. But the two, just remember the most important part is the two and the four part. And then the four hydroxy here. So they're just giving you like clues about this all left and right. So let's take a look at the actual test report itself, and then you'll see why the pathways are helpful to memorize. Well, we don't have to deal with any of this. That's the good news. We can just kind of come down to here where we have the estrogens part. How easy was that? Okay? So now, and we've been, this is another chart we looked at a whole bunch of them. I try to show a bunch of them because they're these same pathways are represented in different ways. And whether it's on its side or upside down or go pointing to the left or pointing down, you know, you want to be able to, you know, juggle this in your brain easily. So here we have our estradiol. We've been looking at that for the whole hour. Yeah. Here's our CYP1A1, remember that. And here's our CYP1B1. So we've already gone over this a whole bunch of times, but it's a slightly different diagram. But get used to it here. Um, it's a little confusing, but true. Estradiol converts into estrone, it's another form of estrogen. Then we get your CYP1A1 down into the two hydroxy and two methoxy. And there's our COMT. That's the thing that matters right there. COMT. So we want to increase the two, that's the protective one. Decrease the four. Here's our four. It gets converted into its inactive form, the four methoxy, with COMT. Conveniently, it's the same enzyme. Remember I made my joke slides? It's the same exact stuff you do to fix methylation as you do to fix COMT, because COMT is methylation. Okay, super simple. And then the 16 is complicated. I don't want to confuse people, so I'm not going to talk about it. Look it up. It's complicated. And it's not that important compared to what we're talking about. It's something you could learn later. You know, we just get the two and the four down, and then you can study the 16 later. It matters, but a little bit compared to what we're talking about. And then this, this is a nice little summary of the other things that we're supposed to be measuring. Obviously, we're just talking about metabolites today, but you actually going to test for and correct the hormones themselves too. Not going to forget about the hormones. So you actually can measure the hormones themselves here, um, if you do the salivary or the blood. And again, the test kit comes with the option to do urine, saliva, or blood, or any combination of that. So if you want to do everything on a patient, you can do it all with one test kit. Um, that may be a little overkill for some people, but you always want to know their DHEA status and their testosterone status and get all these other things down in. And then here's an example of an adrenal panel, like can also be part of this test kit. That's some from saliva samples, salivary samples. And then here are what we're talking about today. These are the estrogen metabolites. So all we're trying to memorize today, doing this in bit pieces, is twos are good and fours are bad. Here's the two. So the two being low, not okay, right? That is bad. Worst case scenario would be if the two was low and the four was high. This case, that's not happening, but you will see that. That's extra bad. And then they give you these ratios and this other stuff. Methylation activity. And again, we talked a lot about methylation. Methylation is the key to making all this work. How do you get methylation working? You eat a piece of lettuce, right? Salads every day, vegetables, um, healthy foods that have antioxidants and all the B vitamins in them, especially folate. And let's see, melatonin. We're not really talking about thyroid. We're not talking about at all. I think that covers off on the bulk of it. Yeah.

So let's go ahead and see. Let me just show you another example. So again, here's the whole test, Endo Plus, and we're looking at estrogen metabolism. You can see there, methylation activity, etc. Here's another example, Endo Plus, estrogen metabolism. And let's see, one more here. Let's see, yeah, let's take a look at this one. So here we go again, estrogen metabolism. And here's our estrogen metabolism section where there's, you know, everything's graphed out, and they color code the, the chart, and it's not too complicated. Uh, green is good, red is bad. So for example, the estradiol coming into the equation here is red because it's low. The two hydroxy is red because it's low, and the two is a good one, that's the protective one. So if it's low, it's not a good thing. Uh, the 16 is low, but we're not talking about that. And then the four is okay. So your worst case scenario will be if the twos are low and the fours are high. And on top of that, if you're having, uh, problems with oxidative stress, then that makes the whole thing that much worse. Again.

So I just want to show you one more thing, and then we'll get to questions. Uh, hang on. Let me just pull this one thing because I think this will help because there, there's this whole other side of this, you know. So it's estrogen metabolism. It's how your liver is really working on the estrogen in the first place. So let me show you here. And you can do either the NutraVal or the Metabolomics. The NutraVal is superior, but it's more expensive and it includes a blood draw, so it's not so realistic for some patients. The Metabolomics is urine only and is a great test. You can do either NutraVal or Metabolomics for. But one, the thing that we're, it's directly relevant to what we're talking about, um, with this test today, is your methylation balance, your detox capacity, your ability to clear things, and your oxidative stress. Okay? And so on this test, we just make some queries here, as you can see. You're going to look first at methylation. Remember, we're talking all about methylation this whole time. And there's a section here that says methylation markers. All right? So with methylation markers, if these are high, you've got a methylation problem. Boom. Your COMT thing, you, you know, right away. It may not even be estrogen per se that's the issue. It could be the methylation is the problem. So in other words, you can have estrogen dominance because you can't get rid of the estrogen, not because you have too much estrogen in your system, but because you can't get rid of it. Joel Evans says this. He's the main hormone teacher ATM. I've heard him say this over and over again. I've been to every IFM module like at least five or six times. I, I used to go to them as a student over and over again since the '90s. I used to go. It's like 30 years I've been going to IFM. They used to be called HealthComp, but whatever. I've been going to IFM events for like 30 years. And then I was, you know, working with them for three years. So I went to every module. I just sat and listened to these lectures so many times. But one of my favorite things that Joel says is that, um, hormone balance is a combination or an integration of what's being produced and what's being metabolized. So if this is screwed up here, even if there's no real problem with estrogen itself, you're not going to be clearing it properly, so it's going to build up. So this in and of itself could cause estrogen dominance and these all these metabolite problems that we're talking about. Then the other super important things on this test, um, and we're just going to cover on a few, a few of them, is that if all this stuff slips through the cracks, and you've got the one, the four is, you know, out of control, antioxidants like glutathione will just knock that down and prevent that risk of cancer from even happening. So glutathione is measured here. You can see lipid peroxides are measured. There's 8-OHdG. These are all profound oxidative stress markers, uh, as is CoQ10. So you can protect the system even if things are going bad, if you have antioxidants. Now, if your glutathione levels are low, and you have this estrogen metabolism problem, then you're at an even greater risk of potential cancer problems from happening. So this is kind of a little bit of the bigger picture. So you can see how these labs tie into one another. And we have like one minute left before I need to go to questions. So let me see if I can get away of doing this in the, I have like 30 seconds, but I'm going to go fast. That this, this will give you the whole, the whole view of everything that you need. So this is a, a GI Effects test. I just want to show you this one marker on here. And this, I'm not saying you should do this tomorrow. You know, usually people, you know, learn these things one at a time, but eventually you want to learn all of these steps. So here's a GI Effects from Goova, classic GI test. And there's this marker on here, beta-glucuronidase. You see that right there? Beta-glucuronidase. So if beta-glucuronidase goes high, if beta-glucuronidase goes high, that means that estrogens are recirculating from the gut back into the bloodstream, and that's going to trigger this entire problem that we're.

talking about so you understand the status of beta glucuronidase. If you treat it, it's going to be calcium de glucarate and DIM. Remember, those are the treatments.

And if you understand the status of methylation, and I'll go over the treatments one more time just as a quick refresh. Um, here, if you have a camera, you can just take some snapshots of these slides if you want. But here's, well, here's the liver detox stuff. This is all kind of obvious: sulfur-containing amino acids, antioxidants, B vitamins, all that. Um, but here's your methylation treatment. Remember, it's the same as a comp T treatment. That's it, right there. That's like the whole protocol there.

And then, um, oh yeah, and then the other things you may want to do is if you want to increase the twos. You're seeing all these labs with low twos. There's your protocols for that. And every major supplement company we work with has all these things. Easy to do. Okay.

And then one other thing here for estrogen dominance, if you want to keep it simple, you can use calcium de glucarate and DIM. So those are the different protocols I want to emphasize. All right.

So let me go back here and we're going to go to questions. Got a few minutes left. And don't forget to sign up if you're interested in learning more. Uh, let's go to questions here. Um, let's see. You guys will get a copy of a recording for sure, so you can share that with friends. And this is a free webinar. The more people you share it with, the better. So that's a good thing. Uh, someone else who's been in practice, Dr. Hamilton for 31 years. We like that. Oh, the metabolomics versus the neutral? So the metabolomics does not have a blood draw. So you don't have the, uh, plasma amino acids. That's the main difference. There's other subtler differences. I'm using the metabolomics now more and more because it's just so much easier to not do the blood draw. So I'm kind of a, you know, support of that. You guys will all get copies of a link to the recording in the next day or two, right?

Um, could you use Bwen products? Absolutely, as long as you're testing. Yeah. You know, and here's the thing is that if you're doing a comprehensive protocol and you're fixing the gut and the liver, all these problems are going to go away. You're going to get methylation working. You're going to get the metabolism of the estrogens working. If you fix a gut and the liver. If you don't fix a gut and the liver and you just dump a whole bunch of hormones in someone, then you can see how easily it could go badly. But if you're going to fix their gut and their liver as part of your overall holistic program, then you're, you're going to be in fine shape to be able to do this.

Um, let's see. And, you know, estrogen and women over the age of 50 really got a bad rap for a while. It's coming back now as being safer. And I think it's mostly just using it in a careful way, you know.

Um, are the, are the treatments the same with genetic SNIPs? Treatments are the same because we're looking at the functional expression of those SNIPs with the lab. So obviously, you never treat a SNIP. You treat a SNIP that's manifesting. And the dosage ranges may go higher in someone with a SNIP, and the length of time they need the treatment may be longer. Those would be the biggest differences.

What conditions would you recommend the Endo Plus for? Well, it covers all the different types of female hormone testing. So it's a general Women's Health test. Um, and you could do any combination of the blood, urine, and saliva that you wanted depending on the patient.

Do we have time? Okay, one more, one or two more questions here. Uh, I'm not going to be able to get to all the questions, sorry about that. We're going to run out of time. Um, is there, yeah, the 16 is kind of the in-between one. You should read about it. It's not that interesting. The two and the four are the ones that are really important.

Would the upcoming course be a good place to start if you want to get info and helping? Yeah, that's the whole point. So this class is like all the stuff you need to do to get started, you know. And we don't even charge much for them. I don't know what the fees are. You get 400 bucks off on this thing, but it's a huge amount of information and it's a reasonable price. If you guys are interested, you should for sure do it.

Um, uh, so for men, it's much different. Prostate is much different. Yeah, we're not covering off on that today. Um, but it's a completely different set of protocols and everything's different.

Um, so best test to get from Goova? Test your hormones with this Endo Plus. Test your GI Effects and do a neutral or a metabolomics if you don't want to deal with the blood draw. Just those three tests should be the standards that you do on every new patient, basically. That's a woman. For men, it would be slightly different.

Endo Plus is the name of the combined test. Endo Plus. That's the new one. Um, it's really just an amalgamation of their other test kits. It's not a new test per se, but it's, it's just easier to do because everything's in one box.

Um, let's see. I think I maybe one or two more, but you guys are asking a lot of questions, which is great. I wish I had more time. Um, well, if you're asking questions, oh my gosh, it's like literally 30 questions. I'm not going to be able to get to. I'm totally bummed about that. Um, sorry about that, you guys. But anyways, I have to leave now. But, um, if you're that interested and you're asking tons of questions, sign up for this class and we can ask questions all day long in this class and submit your labs and get everything figured out.

Okay, so I'm going to have to head out now, but thank you guys so much for attending. I'm glad that they were so much interested in the work here and I look forward to working with you guys in the future. All right, bye now.