By Jonathan V. Wright, M.D.
Over the last three years, you’ve probably read a lot (especially from me) about “good” and “bad” estrogen. The first time you see these references it can be somewhat confusing: How can estrogen be good and bad? Isn’t it just one substance?
Unfortunately, it’s not quite that simple
But before we get into that, let me tell you why it’s so important to make the distinction: First, measuring your levels of various estrogens is a simple technique to help predict if you’re at higher risk for certain types of cancer (especially breast and uterine). Then, once you have that information, supplementing with the right kind of estrogen (along with some other supplements and a diet rich in certain foods) can reduce your risk of ever getting those cancers –or possibly even help treat existing cases. And there’s some exciting new research showing that one type of estrogen might also be the long-awaited answer for women battling autoimmune diseases like multiple sclerosis.
All of these great benefits from estrogens–but since not all estrogen is created equal, let’s take a few minutes to go over some of the intricacies.
Five estrogen metabolites you need to know about
The term estrogen doesn’t actually describe a single molecule; instead, it’s a “group word” covering two dozen or more molecules all built on a common framework. Since these molecules are transformed (metabolized) one into another into another, they’re also all called estrogen metabolites.
The “early days” of estrogen research focused mostly on three estrogen metabolites called estrone, estradiol, and estriol.
Over the last three decades, with improved analytic techniques and evolving research interest, attention has turned to some of the other estrogen metabolites, including those “good” and “bad” estrogens that I refer to quite a bit in Nutrition & Healing. The technical terms for these are 2-hydroxyestrogen (good) and 16a-hydroxyestrogen (bad), and together they make up what’s known as the 2/16 ratio. High 2/16 ratios generally mean a lower risk of estrogen-related cancers (like breast, uterine, and ovarian). Low 2/16 ratios mean higher risk of these same cancers. (I’ve also observed an unusual number of low 2/16 ratios in men with newly diagnosed prostate cancer, and men with a strong family history of cancer.)
But there’s another estrogen ratio that’s just as important as the 2/16 for estimating your risk of estrogen related cancer. Now that recent research has confirmed its importance again, I think it’s time to revisit the “estrogen quotient” (EQ).
Calculate your cancer risk with this simple equation
As I mentioned above, early estrogen research focused mostly on three estrogen metabolites: estrone (also labeled E1), estradiol (E2), and estriol (E3). Although it’s only present in small quantities in the body, estradiol is the most “potent” estrogen, responsible for most of the feminizing changes of puberty. Unfortunately, estradiol and its nearby metabolite estrone were both found to be carcinogenic. Researchers found that the body treats these two hormones with extreme care, rapidly converting them to estriol. As far as anyone could tell, estriol didn’t have any carcinogenic tendencies.
With all of this in mind, one doctor, Henry Lemon, M.D. (a women’s cancer specialist), came up with an equation that, like the 2/16 ratio, can estimate a woman’s risk of breast cancer. He called this idea the estrogen quotient, or EQ, and formally it’s the amount of estriol divided by the sum of the amounts of estrone and estradiol. In mathematical terms, it looks something like this: EQ = E3 / (E1 + E2).
If a woman’s EQ is low, her risk of breast cancer is higher. Basically, the higher the EQ, the better.
Sounds too easy to be true, but time after time the EQ proved itself. Take a look at some of Dr. Lemon’s EQ research:
In 34 women with no signs of breast cancer, Dr. Lemon found the EQ to be a median of 1.3 before menopause and 1.2 afterward. The picture was quite different in 26 women with breast cancer. Their median EQ was 0.5 before menopause and 0.8 afterward.
In another study, Dr. Lemon found that women with higher EQs survived significantly longer after cancer surgery than women with lower EQs.
So, knowing that women need more estriol to boost their EQs, Dr. Lemon also tried using estriol treatments for breast cancer. He asked a small group of women with untreatable breast cancer (because it had metastasized to bones) to take large dose of estriol. By the end of the study, an astounding 40 percent of these women had their cancers go into remission.
Less estriol, more cancer
Of course Dr. Lemon’s EQ and estriol findings met with their share of criticism, and some researchers did publish claims disputing Dr. Lemon’s results. But there was also plenty of additional evidence supporting him. For example:
* In one study of 150 close relatives (sisters and daughters) of breast cancer patients, researchers found that the majority had lower levels of estriol and higher levels of estrone and estradiol than women without a family history of the disease.
* American women (who have higher levels of breast cancer) have lower levels of estriol than Asian women (who have lower levels of breast cancer). Asian women living in Hawaii had levels of estriol midway between American women and Asian women living in Asia…and their levels of breast cancer were also midway between American and Asian women.
* Estriol enhances the ability of white blood cells to consume viruses, bacteria, and cancer cells.
* Women who have had children have significantly lower risk of breast cancer than women who have never had a child. During pregnancy, estriol levels climb enormously-by 1,000 times or more. Even after childbirth, estriol levels usually remain higher than they were before pregnancy.
This last bit of “pro-estriol” evidence concerning pregnancies leads me to some recent estriol research, which is once again reviving the “more estriol, less cancer” hypothesis. But before we get to that, a word or two about “estrogen” replacement therapy in Europe and Japan.
Safe, effective menopause symptom relief.
At a convention last fall, I listened to a European professor report her estrogen research findings. When I asked her about her thoughts on conventional hormone replacement therapy (the kind that caused so much trouble last year, which uses horse estrogen called Premarin), she laughed, and said that no one in Europe would even think of prescribing it. She noted the safety of estriol, and pointed out that although “estrogen” prescriptions are used much less frequently in Europe than North America, when estrogen is prescribed, it’s almost always estriol. “We’re not horses!” she said.
The situation is the same in Japan. Estrogen research reported from there mostly involves the use of estriol, not estrone or estradiol, and especially no Premarin or its equivalent. In one recent Japanese study, 53 postmenopausal women took 2 milligrams of estriol daily for 12 months.1 Not only did 85 percent of the women find relief from their menopause symptoms, but at the end of the study, researchers performed ultrasound breast examinations on all of the women-the results for all 53 women were completely normal. The researchers concluded that estriol is a safe way to combat those nagging problems (hot flashes, etc.) that menopause usually brings.
[Note: 2 milligrams of estriol is the amount I prescribed and pharmacist Ed Thorpe compounded into the world’s very first “Triple Estrogen” prescription in the 1980s. To date, 2 milligrams of estriol is the most commonly prescribed amount. However, I never recommend taking it every day, but instead copy Nature’s pattern with a monthly “pause.”]
Another important study, this one performed in Israel, investigated how estriol might work to prevent cancer. The researchers found that estriol interferes with the pro-carcinogenic effects of estradiol by covering as many of the body’s estrogen receptors as possible, so that not as much estradiol can be “absorbed.”
This brings us back to the new research concerning estriol and breast cancer that I mentioned earlier.
A one-time boost can protect you for up to 40 years
In this one, 15,000 women were studied during a pregnancy occur-ring between 1959 and 1967.3 Invasive breast cancer cases or deaths from breast cancer were tabulated through 1997. What makes this study so remarkable is the fact that it looked ahead so far into the future of such a large group of women. Prospective studies like this are considered much more reliable than retrospective studies (ones that look back on information after it has occurred). And the results of this particular prospective study make it even more impressive:
The researchers found a clear protective effect based on the amount of estriol the women produced during their pregnancies: More estriol, less cancer later in life! Women in the uppermost 25 percent of estriol production during pregnancy had (j)percent less breast cancer over the next 30-40 years than women with the lowest 25 percent of estriol.
The authors concluded (cautiously, of course-they’d be laughed out of their lab coats by mainstream medical “experts” if they didn’t downplay findings that nature might know best after all): “If confirmed, these results could lead to breast cancer prevention or treatment regimens that seek to block estradiol estrogen action using estriol, similar to treatments based on the synthetic anti-estrogen, tamoxifen.”
After a decade or two of neglect, the EQ and the “estriol hypothesis” of estrogen-related cancer prediction and prevention (and maybe even treatment, like Dr. Lemon’s unpub-lished research) are back! And some researchers are even starting to admit that maybe, just maybe, estriol in its natural form might work as well (even better than) synthetic drugs like tamoxifen.
And as if this news weren’t exciting enough on its own, there’s another brand new use for estriol and the EQ, which might give some much-needed hope and relief to people suffering from auto-immune diseases, especially multiple sclerosis.
82 percent fewer MS lesions in just three months
Autoimmune disease is well known to be “sexist,” and strikes many more women than men. It’s also well known that autoimmune diseases like rheumatoid arthritis and multiple sclerosis (MS) often go into remission during pregnancy, only to return in force after child-birth. Many “experts” attribute this effect to the estrogen-offsetting effects of progesterone, which also increases dramatically during pregnancy.
But recently, one innovative group of UCLA researchers decided to see if those effects might be due to estriol instead. Using a “pregnancy dose” (8 milligrams), they investigated the effects of estriol on 12 non-pregnant women with either relapsing-remitting (RR) or slowly progressive (SP) multiple sclerosis.
The volunteers underwent four observation periods: First, six months of initial observation with no treatment, then six months of estriol, followed by another six months without estriol, then a final four months of estriol for the RR group only.
After the first three months of estriol treatment, brain scans showed the number of MS lesions in the RR group decreased by 82 percent, and the volume of those lesions decreased by 79 percent (both compared with pre-treatment scans). The decrease persisted for the rest of the first treatment period. When the women stopped taking the estriol over the next six months, the number of lesions gradually increased again–all the way back up to pre-treatment levels.
During the next four months of renewed estriol treatment, MS lesion volumes again decreased by 88 percent and lesion numbers also decreased-this time by “only” 48 percent (which is still a significant improvement).
Unfortunately, there were only small improvements in the SP (slowly progressive) group. Despite this, the changes in the RR group were so dramatic that the researchers want to pursue studying estriol for other autoimmune diseases as well.
If you’re suffering from an autoimmune disease, you don’t have to wait for all the academic research answers to come in. Estriol therapy is very safe, and, if nothing else has worked for you, it’s an option you and your physician should consider exploring now.
There’s much more to say on estriol and the EQ but, unfortunately, I’m out of space for this month. So in next month’s Nutrition & Healing, I’ll discuss how to test your EQ- either on your own or with your doctor’s help-and what to do if yours is unfavorable. JVW
Citations available upon request and on the Nutrition & Healing website: http://www.wrightnewsletter.com