This is the second part of a 2-part blog series on how your body breaks down and detoxifies used oestrogen and how this relates to hormone imbalance. Click here if you haven’t yet part 1, which focuses on the liver’s role in oestrogen clearance. In part 2, we are looking at the gut’s role in this important process.
You see, the hormonal terrain as you move into and through your 40s is a rocky one, with hormone imbalance symptoms becoming more pronounced.
Oestrogen detoxification is a key concept to understand as you navigate your way through perimenopause because it plays a significant role in hormone imbalance symptoms but also breast cancer risk.
So, let me help you to understand the gut’s role in oestrogen clearance, and how to support it.
OESTROGEN BALANCE AND DETOXIFICATION OVERVIEW – RECAP
Oestrogen detoxification, or oestrogen “metabolism”, refers to how your body, particularly the liver and gut, breaks down and clears your used oestrogen from your body.
Remember, when it comes to oestrogen, you need to use it and swiftly lose it! This supports hormone imbalances, overall health and wellbeing, as well as future health risks.
3 Main Phases of Oestrogen Clearance
There are three phases of the oestrogen clearance process in the body.
The first two occur primarily in the liver and phases 2.5 and 3 involve the gallbladder (bile), the gut microbiome (bacteria), and your intestines.
This blog is about phases 2.5 and 3 specifically. Although this phase comes AFTER the first two, it is actually the most important phase. I’ll explain why this is later in this blog.
WHY IS HORMONE IMBALANCE SO IMPORTANT?
To have a smoother ride through perimenopause, you must support your body in efficiently clearing out used oestrogen.
Some of the common symptoms women start to experience due to hormonal imbalance include very heavy periods, clotting, mood swings, breast pain and swelling, headaches, weight gain, growth of fibroids or cysts, and acne breakouts.
Maintaining hormonal balance, as much possible in what is a rocky time for hormones, is crucial for minimising these symptoms and supporting overall well-being.
In order to address and minimise these symptoms you MUST be efficiently processing and clearing out used oestrogen.
It’s a process that’s occurring 24/7, it never takes a break.
Phase 3 Detoxification – the permanent route out of the body
Here, the used oestrogen that has gone through phases 1 and 2 detoxification in the liver gets swiftly moved through your bile through your intestines, or into your kidneys.
Note that even if you don’t have a gallbladder, you still make bile in your liver.
Once in the intestines, it needs to be excreted from the body via a bowel movement. Before it gets to the intestines it also goes through the gut microbiome. This is the collection of bacteria that lives in your gut. We will see why this is significant in a moment.
WHY IS PHASE 3 (AND 2.5) MORE IMPORTANT TO ADDRESS FIRST?
Because if it’s not working properly, the work done in phases 1 and 2 is in vein, leading to a back up of oestrogen waiting to leave the body that’s eventually reabsorbed back into circulation. And thus imbalanced hormone levels in the form of oestrogen excess and a worsening of oestrogen dominance.
Therefore, a person with compromised digestion, an unhealthy gut microbiome (gut bacterial imbalance or infections), or constipation, is unlikely to be clearing oestrogen out of their body efficiently.
This person is likely reabsorbing the oestrogen that was processed in phases 1 and 2 (the liver) rather than getting it out of the body.
The efficiency of Phase 3 relies on a healthy gut ‘microbiome’ and daily, healthy bowel movements.
PHASE 2.5 – THE GUT MICROBIOME
The relationship between the collection of bacteria in your gut (the gut microbiome) and oestrogen clearance is called the “estrobolome”.
Think of the estrobolome as an entire collection of microbes (bacteria) within your whole gut microbiome. This special collection of bacteria influences how you metabolise and regulate oestrogen.
A healthy gut microbiome also plays a role in improving insulin sensitivity, which is crucial for overall metabolic health.
For example, certain strains of bacteria can produce more of an enzyme called beta-glucuronidase. Beta-glucuronidase has the ability to separate the detoxified oestrogen molecule from its carrier molecule in the gut.
This leaves the old oestrogen molecule free to move back into your bloodstream and into circulation, instead of leaving the body in the stool.
Therefore, a healthy gut microbiome is essential for efficient oestrogen clearance.
This means having a healthy amount and diversity of different health supportive bacteria strains. And the absence of gut infections such as parasites, pathogenic bacteria, yeasts and mould.
Causes of Elevated Beta-glucuronidase Enzyme and Oestrogen Dominance
Low levels of friendly gut bacteria, and the presence of parasites, yeast, or mould infections, can cause elevations in beta-glucuronidase.
A comprehensive stool test such as GI Effects by Genova Diagnostics can provide a comprehensive assessment of your gut health and is the only way to know if you have elevated levels of beta-glucuronidase.
In the absence of testing, as it can be quite costly, you should start to address and look after your gut health as a way to reduce levels of this enzyme and support gut health generally.
PHASE 3 – stool formation and bowel movements
As long as the oestrogens that were processed through your liver have made it through your gut microbiome still attached to its carrier molecule, it is ready to leave the body permanently via a bowel movement.
You want to be passing a fully formed, snake-like stool AT LEAST once per day for this to be an efficient removal process. Otherwise, it may all just go back into circulation.
A healthy diet rich in quality fibre, vitamins, and minerals is essential for supporting regular bowel movements and efficient oestrogen clearance.
If used oestrogen goes back into circulation your body, you’re likely to experience those typical symptoms of oestrogen excess such as very heavy periods, clotting, mood swings, breast pain and swelling, headaches, weight gain, growth of fibroids or cysts, acne breakouts, and even an increased risk of breast cancer.
Therefore, supporting healthy stool formation and bowel movements is absolutely key for better hormone balance!
Causes of Constipation (bowel movements occurring less than once per day)
If you experience constipation, whether chronically or intermittently, then working on your gut health and digestion should be your first priority when it comes to oestrogen clearance.
Reasons for constipation include:
- Being under-hydrated
- Low fibre intake
- Not chewing properly
- Lack or bile / low bile flow
- Stress
- Lack of beneficial bacteria
- Gut infections (yeasts, parasites, mould)
- Small Intestinal Bacterial Overgrowth (SIBO)
- Low thyroid hormone
- Certains medications
SUPPORT FOR PHASE 3 (AND 2.5)
Increase Colours + Types of Plants
Eat a wider variety (diversity) of colours and types of vegetables, herbs, spices, berries, lentils and beans. Friendly bacteria thrive on it!
Aim to eat 20 to 30 different plants each day which is actually easier than you might think.
Eat ‘Prebiotic’ Fibres + Resistant Starches
Your friendly gut bacteria LOVE prebiotic fibre, they thrive on it. Prebiotic foods include onions, garlic, leeks, asparagus and Jerusalem artichoke.
‘Resistant starches’ are also a form of prebiotic fibre. There are four types and some may work better for you than others. These include:
- Resistant starch found in the coating of seeds, nuts, grains and legumes like lentils and beans
- Fermentable fibres in green bananas and raw potatoes (or raw potato powder e.g., added to smoothies or yoghurt etc.)
- Resistant starch that is made when some of the naturally occurring starches in white potatoes and rice are cooked and then allowed to cool
- Resistant starch powders such as inulin
Eat More Probiotic Foods
These are foods that contain live bacteria. Aim to have 1 cup per day of any of:
- Raw, unpasteurised sauerkraut
- Kimchi
- Kefir (preferably made using water or coconut water rather than cow’s milk)
- Live natural yoghurt
- Unflavoured kombucha
Eat 1-2 Tablespoons of Ground Flaxseed Everyday
Flaxseeds (or linseeds) are a good source of both soluble and insoluble fibre which can help to encourage healthier, regular bowel movements.
Additionally, flax contains lignans, which are a class of phyto (plant) oestrogens meaning they may ‘act’ like oestrogen in the body, binding very weakly to cell receptors and positively modulate oestrogen levels in the body.
Chew Your Food PROPERLY for Hormonal Balance!
Like, really really well! And take your time over your meals. Undigested food particles increase growth of pathogenic bacteria because they feed off the fermentation of food in your gut.
Hydrate Your Colon
This means to always be properly hydrated with water and quality electrolytes. This can include clean water, sparkling water, and herbal teas throughout the day.
Check for very pale urine (like the colour of straw or hay) in order to know if you are properly hydrated, if it’s very dark yellow (e.g., first thing in the morning) or even just too yellow if you are dehydrated.
Support Your Gallbladder
Consider bile support, for example you could take a bile acids supplement (such as TUDCA or ox bile), and increase bitter greens and herbs in your diet.
Even if you start with just one of these steps, you’ll quickly notice the benefits.
I’ve had clients that come to me with digestive issues such as bloating, gas and alternating between constipation and loose stools. And once they start chewing their food properly, they cannot believe how much their symptoms reduce if not disappear completely!
Can you test for the different detox phases?
Yes.
Phases 1 and 2 can be testes through a urine test called the DUTCH test, I use with my clients via Regenerus Labs. And phase 3 can be evaluated through a comprehensive stool test, I use the GI Effects test from Genova Diagnostics.
These tests are what’s known as “functional testing”, which means they are not available on the NHS or via a conventional medicine doctor. Your standard acute care doctor is unlikely to know about these tests.
If you are interested in having either or both of these tests done, you would need to be working with a functional medicine doctor or a Nutritional Therapy practitioner such as myself.
Additionally, testing for thyroid hormone levels can provide insights into ongoing fatigue and other symptoms related to hormone imbalances.
