For Natural Protection
from Estrogen's Effects
Frequently Asked Questions
What do perimenopause, premenstrual syndrome,
enlarged prostate glands, and early heart attacks have in common?
Estrogen. A new understanding of healthy estrogen
metabolism is providing a natural treatments for these and other
important conditions confronting both women and men.
Fortunately, phytonutrients discovered in
cruciferous vegetables offer a natural approach to resolving
estrogen imbalance. Dietary supplementation with an absorbable
form of one of these phytonutrients, called
Di-Indoly Methane (DIM), helps promote
healthier estrogen metabolism. DIM's hormonal balancing
effects have revealed these midlife problems are not due to estrogen
itself alone, but rather, to estrogen metabolism imbalances.
Q. What is DIM, and how can it help hormones?
A. DIM is a phytonutrient (plant nutrient)
found in cruciferous vegetables. These include cabbage,
broccoli, bok choy, Brussels sprouts, cauliflower, kale, kohlrabi,
mustard, rutabaga, and turnip. These plants have been
cultivated for thousands of years and were initially used for their
medicinal benefits. The connection between DIM and hormones
like estrogen has to do with similar characteristics between them at
the molecular level. DIM is not an estrogen or a hormone, but
like estrogen it shares the common characteristic of being poorly
soluble in water. Like estrogen, DIM can be metabolized only
by a special class of cytochrome enzymes that reside in cell
membranes in the non-water part of cells. It turns out that
DIM, when consumed in food or in absorbable formulations, encourages
its own metabolism. This special metabolic pathway for DIM,
and the enzymes involved, precisely overlap with the pathway needed
for healthy estrogen metabolism.
Stated simply, supplementing the diet with DIM
specifically promotes beneficial estrogen metabolism and helps
restore a healthy hormonal balance.
Q. What is estrogen dominance?
A. Middle-aged men and women experience
changes in hormone production and metabolism resulting in excess
estrogen action. There are three basic forms of this common
imbalance known as estrogen dominance.
Perimenopause. In women, slower
hormone metabolism in midlife can mean higher-than-normal levels of
estrogen and a deficiency in its healthy metabolites.
Faltering estrogen metabolism often occurs in women during
perimenopause, the years before menopause, and is characterized by
higher monthly estrogen levels prior to estrogen's dramatic fall at
menopause.(2) Additionally, progesterone levels fall during
perimenopause, resulting in a rising estrogen-to-progesterone ratio.
Middle-aged men. Rising estrogen
also becomes a problem for men during their 50s and 60s. In
overweight men, testosterone is increasingly converted into estrogen
by aromatase and rising estrogen also competes with falling
testosterone. This corresponds to a time during which estrogen
accumulates in the prostate gland. Estrogen is believed to
contribute to benign prostatic hypertrophy (BPH).(3)
Acquired estrogen imbalance. This
important form of estrogen dominance has to do with inherited
problems in estrogen metabolism and influences of diet and chemicals
on beneficial metabolite production. Acquired estrogen
imbalance affects both men and women. Almost 20 years ago, H.
Leon Bradlow, Ph.D., a renowned breast cancer investigator,
discovered women with breast and uterine cancer made too little of
the 2-hydroxy or "good" metabolite of estrogen and too much of the
16-hydroxy or "bad" variety.(4)
Since 16-hydroxy is an unregulated form of estrogen
prone to behave like "super-estrogen," higher levels create a
particularly unhealthy form of estrogen dominance. 16-hydroxy
estrogens can result in mutations, abnormal growth (as in cervical
dysplasia),(5) and an increased risk of future breast cancer.(6)
Overproduction of 16hydroxy estrogen is also seen in obesity,(7)
high-fat diets,(8) and exposure to a host of "estrogenic"
environmental chemicals.(9) Therefore, this dangerous form of
estrogen dominance can result from inheritance, diet, and
Q. What benefits can DIM offer?
A. Supplementing our diets with DIM can shift
the production of estrogen metabolites away from dangerous
16-hydroxy in favor of beneficial 2-hydroxy metabolites.
Taking DIM in an absorbable formulation encourages active and
healthy estrogen metabolism. DIM supports estrogen balance
by increasing beneficial 2-hydroxy estrogens and reducing the
unwanted 16-hydroxy variety. This improves estrogen metabolism
and helps resolve all three forms of estrogen dominance.
NaturoDoc Note: Remember, 2-hydroxy is good;
16-hydroxy is bad.
Q. Why not just eat more cruciferous vegetables?
A. Recent reports, like one from the Fred
Hutchison Cancer Center in Seattle, Washington indicate a
higher intake of cruciferous vegetables is associated with a lower
risk of prostate cancer.
This study indicates cruciferous vegetables are
protective for hormone-sensitive cancers. However, direct
measurements of upward, beneficial shifts in estrogen metabolism
indicate you would have to eat at least two pounds per day of raw or
lightly cooked cruciferous vegetables to derive the same benefit as
two capsules of specially formulated DIM. Benefits for
cervical dysplasia, PMS, BPH, and other conditions have not been
seen with the use of broccoli, cabbage juice, or dried powders or
extracts from vegetables.
Absorbable DIM formulations overcome the need for
active enzymes within the vegetable and chemical reactions in your
stomach to produce DIM. For similar reasons, absorbable DIM
provides many advantages over indole-3carbinol (I3C), another
cruciferous phytochemical available as a supplement. I3C is an
unstable precursor that requires activation in the stomach to be
converted into DIM. This means I3C must be taken at a much
higher dose and can undergo unpredictable and undesirable chemical
reactions in your stomach and colon. DIM, in a delivery system
to assure absorption, is by far preferable to the supplemental use
Q. How much DIM is recommended?
A. To replace the DIM from healthy amounts of
cruciferous vegetables in the diet, women should take a starting
dose of about 15 mg per day of actual DIM in an absorbable
formulation. Men should take about 30 mg per day of actual DIM
in the same absorbable or bioavailable formulation. These
amounts can be increased three to four times on an individual basis
to derive needed benefits for hormonal balance and metabolism.
Based on testing in men, improved estrogen metabolism, easier weight
loss, and prostate health require a higher dose of DIM than in
Since pure DIM must be provided in an
absorption-enhancing formulation, the dose for DIM sometimes
specifies the weight of the absorbable formulation, which is only
one-fourth, or 25 percent DIM. In the book, All About DIM,
the suggested dose of 100 to 200 mg per day for women and 200 to 400
mg of DIM per day for men refers to milligrams of such an absorbable
formulation.(15) This dose range for hormonal balance
corresponds to 25 to 50 mg per day of actual DIM for women and 50 to
100 mg of actual DIM for men.
Q. What’s exciting about the effect of DIM on
premenstrual syndrome (PMS)?
A. PMS symptoms of irritability, aggression,
tension, depression, mood swings, water retention, and breast pain
or swelling are frequently seen in perimenopausal women.(16)
While a reduction in PMS severity has been seen with nutritional
therapy, full resolution has been elusive. These interventions
have included lower-fat diets,(17) and supplementation with
minerals, Vitamin D,(18) and herbal extracts.(19)
PMS symptom improvement has been noted after
beginning dietary supplementation with absorbable DIM. These
results suggest DIM is able to correct the estrogen imbalance in
PMS. Torbjorn Backstrom, M.D., an eminent researcher in the
field (20), and others (21) have documented that estradiol, the
primary active form of estrogen, is elevated in PMS. Backstrom
also has shown the degree of estradiol elevation correlates with
Also encouraging is the observation that the enzyme
pathways promoted by DIM help metabolize pregnenolone sulfate.(23)
Pregnenolone sulfate is a brain hormone important for memory, but
which causes anxiety if levels are too high. Like estrogen,
pregnenolone sulfate is elevated in PMS.(24) Its healthy
metabolism produces beneficial, immune stimulating metabolites and
may help relieve anxiety. Absorbable DIM supplementation
promotes healthier metabolism of both estrogen and pregnenolone in
Q. What's the best supplementation approach to PMS?
A. A strong nutritional approach to PMS
includes bio-available DIM, chaste berry extract, Vitamin D,
calcium, and magnesium. Synergistic interaction of these
ingredients benefits PMS. An example of this synergy is the
ability of beneficial 2-hydroxy estrogens to increase progesterone
production (25), potentiating this effect by chasteberry
extract.(26) This new nutritional approach to PMS helps with
mineral and hormonal balance. DIM works in conjunction with
chasteberry extract to resolve the dominance of estrogen over
Q. How can helping estrogen metabolism benefit men?
A. Everyone knows estrogen is an important
hormone for reproduction in women. What is not often
appreciated is that estrogen levels, though lower than those in
women, are also essential in men. However, midlife changes in
men result in excess estrogen production beyond its minimal
Like perimenopausal women, men experience a tendency
to gain weight in midlife. Rising estrogen production can
result, since fat cells contain the aromatase enzyme that converts
testosterone into estrogen. Unmetabolized estrogen creates a
vicious cycle resulting in further estrogen production. This
occurs because fat is one source of more active aromatase enzymes,
causing further estrogen production and continuing weight gain.(27)
An open label study of DIM in overweight men and women showed it
promoted more efficient weight loss and more active fat
In this regard, DIM is similar to green tea extract
(28) and spices like cayenne pepper.(29) DiindolyImethane may
have a role in helping to intervene with excess estrogen production
associated with obesity and male aging. Besides
weight gain, another aspect of early aging in men is prostate gland
It has been clearly established that estrogen
accumulates in aging prostate glands at the same time enlargement
occurs.(30) This process is linked to difficulty with
urination and frequent urination at night. The role of
estrogen is still being established in this process, but research
using estrogen binding substances shows lowering estrogen levels
improves the symptoms of nighttime urination.(31) Use of
absorbable DIM by men with these same symptoms has proven
Q. Can DIM help improve the safety of hormone
replacement therapy (HRT)?
A. Despite a growing list of benefits
attributed to estrogen, which include younger-looking skin, more
comfortable sex, and better memory, women often view its potential
side effects as unacceptable. Study of postmenopausal women
receiving long-term HRT with estrogen and estrogen/progesterone
combinations has revealed an unequivocal increase in breast cancer
NaturoDoc Note: These studies were done with
Premarin, horse estrogens, and synthetic progestins, NOT
Added concerns relate to the increase in the
incidence of uterine cancer, and increased risk of life-threatening
blood clots, especially after bone fracture.(33) Most
recently, the nationwide HERS study reported the concerning finding
that women with a history of heart disease had an increased risk of
heart attack in the first year after starting estrogen.(34)
Many of estrogen's risks can be related to a lack of
its beneficial metabolites. It is now known that a lower risk
of future breast cancer is associated with higher 2-hydroxy estrogen
levels. Supplementation with bioavailable DIM increases
protective 2-hydroxy estrogen and therefore may reduce the risk of
HRT-related cancer. Reduction in the risk of abnormal blood
clot formation related to HRT estrogen would benefit women who
suffer fractures while on HRT, but also may benefit women with early
heart disease. It has been known since the Framingham Study in
Massachusetts that men with the highest estradiol level had the
highest risk of early heart attack.(35) DIM may help normalize
the cardiac risk in both men and women related to unhealthy or
underactive estrogen metabolism. Also, the beneficial
2-hydroxy metabolites have been shown to be powerful
antioxidants,(36) which may contribute to protecting against the
early stages of atherosclerosis and subsequent heart attacks.
DIM supplementation is a nutritional approach to
achieving a safer and healthier estrogen metabolism, or of
protecting it. Many of the benefits traditionally ascribed to
estrogen (protection from heart disease, healthy skin, bones, and
brain) may actually reside with its beneficial metabolites, the
2-hydroxy estrogens. DIM supplementation is a natural promoter
of this specific pathway of healthy estrogen metabolism.
To jump to our recommendations for alternative treatments to achieve
safe, natural hormone balancing, click
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