Table of Contents
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Estrogen Dominance – Part 2
By: Michael Lam, MD, MPH
Estrogen Reduction Protocol
Strictly speaking, all of us, men or women alike, suffer from estrogen dominance. There simply is so much of it around and it is impossible to fully escape its impact. Plastics, car exhaust, meats, soaps, carpet, furniture, and paneling are just some of the examples. You may have on-and-off sinus problems, headaches, dry eyes, asthma, cold hands and feet, and may not attribute them to your exposure to xenoestrogen. Over time, the exposure can cause more chronic problems such as arthritis, and gallbladder disease.
While a definitive diagnosis can be made through a thorough history and physical examination, together with laboratory tests of estrogens and progesterone levels, this is seldom done. Instead, synthetic estrogen such as Premarin ,or combination synthetic estrogen and synthethic progesterone (such as Pempro) are often passed out on the premise that symptoms presented are due to estrogen deficiency without any consideration for the progesterone part of the equation. In reality, many are suffering from relative estrogen dominance.
This naturally oriented protocol is designed to reduced the body’s estrogen load and prevent onset of cancer. If you already have been diagnosed with cancer, more aggressive action will be needed including include all these steps.
1. Natural Progesterone
The typical domino effect of estrogen dominance starts with proliferation of estrogen sensitive cells, leading to overgrowth of endometrial lining, to PMS, to PCOS, to uterine fibroid, to hysterectomy, to severe iatrogenic (doctor-caused) hormonal imbalance (when estrogen is given alone with opposing progesterone), to misguided medication for depression and anxiety, to bone loss and reduced libido. These all can be reduced if the amount of estrogen in the body is normalized by administration of natural progesterone as a balancer.
Natural progesterone is therefore a cornerstone of estrogen reduction therapy. It helps to reduce the risk of ovarian, endometrial and breast cancers, while unopposed estradiol causes that is frequently associated with fibrocystic breast disease, endometriosis, PMS, fibroids, and breast cancer. If you have symptoms of estrogen dominance but have not been diagnosed with estrogen-related cancer, natural progesterone will still be valuable for its cancer prevention properties. Specific dosage varies depending on the condition. Baseline saliva testing of estrogen, progesterone, and their respective ratios should be undertaken. The body normally produces 20 mg of progesterone a day. Replacement of this physiological amount in natural cream form is suggested in most cases. There is a tremendous variation in the amount that should be taken for optimum effectiveness. It is recommended that you consult a naturally oriented physician prior to treatment.
2. Dietary Adjustments
Overeating and under-exercising are the norm in developed countries. Populations from such countries, especially in the Western hemisphere, derive a large part of their dietary calorie from fat. They also show a much higher incidence of menopausal symptoms. Studies have shown that the estrogen level fell in women who switched from a typical high-fat, refined-carbohydrate diet to a low-fat, high-fiber, plant-based diet even though they did not adjust their total calorie intake. Plants contain over 5,000 known sterols that have progestogenic effects. Cultures whose eating habits are more wholesome and who exercise more have a far lower incidence of menopausal symptoms because their pre- and postmenopausal levels of estrogen do not drop as significantly.
In non-industrialized societies not subjected to environmental estrogen insults, progesterone deficiency is rare. During menopause, sufficient progestogenic substances are circulating in the body to keep the sex drive unabated, bones strong, and passage through menopause symptom-free.
Some years back, scientists discovered that unfermented soy and various cruciferous vegetables such as broccoli, cauliflower, cabbage, kale, bok choy, and Brussels sprouts contain a high level of phyto-estrogen. These compounds’ chemical structure resembles estrogen but are many times weaker in potency. Women consuming these vegetables reported some relief of menopausal symptoms such as hot flashes. The prevalent wisdom is that women in menopause lacks estrogen , and phyto-estrogen replenish the body with estrogen. Soy and cruciferous vegetables is heavily promoted.
It is now known that these vegetables work by competitively occupying the estrogen receptor sites on the cell membrane to prevent internal estrogen from exerting its effects on the cell. Those who have estrogen dominance may therefore experience relief of symptoms as phyto-estrogen is many times weaker than the estrogen in our body.
While phyto-estrogen may work and relief symptoms, the long term effect is probably undesirable because the estrogen receptor sites are still occupied, although by the less potent phyto-estrogen. Over consumption of phyto-estrogenic food such as unfermented soy and cruciferous vegetables on a long term basis may actually not reduce the risk of estrogen dominance significantly. Its akin to replacing one potent devil with a lesser potent one. It is far more beneficial to rid of the estrogen from the receptor sites and replace them with progesterone. Estrogen load will therefore reduce significantly, and the risk of estrogenic diseases such as breast cancer will be less.
Furthermore, phyto-estrogen have been shown to inhibit the conversion of T4 to the active T3 thyroid hormone, and can trigger hypothyroidism.
Women with estrogen dominance should only take unfermented soy such as tofu and cruciferous vegetables in moderation. Those with a history of thyroid imbalance should refrain from such vegetables.
A plant-based unprocessed whole-food diet is recommended. At least 15 grams of fiber should be consumed a day. Avoid high-glycemic foods such as refined sugar. Avoid alcohol or drugs that can damage the liver which will lead to an increase in estrogen due to the lack of estrogen breakdown. Caffeine intake from all sources is linked with higher estrogen levels regardless of age, body mass index (BMI), caloric intake, smoking, and alcohol and cholesterol intake.
3. Coffee and Tea
Studies have shown that drinking more than two cups of coffee a day may increase estrogen levels in women. It could also lead to problems such as endometriosis and breast pain.
In a clinical trial conducted, about 500 women between the ages of 36 to 45 were studied. These women were not pregnant, not breast-feeding or having hormonal treatment. They were interviewed regarding their diets, smoking habits, height, and weight. Their hormone levels during the first five days of their menstrual cycle was also measured. The results showed that women who consumed more than one cup of coffee a day had significantly higher levels of estrogen during the early follicular phase of their menstrual cycle. Those who consumed at least 500 mg of caffeine daily, the equivalent of four or five cups of coffee had nearly 70% more estrogen than women who consumed less than 100 mg of caffeine daily. Coffee consumption increases estradiol levels. There are three different forms of estrogen in the body – estrone, estradiol, and estriol. Estradiol is the form that is pro-cancerous.
Having high levels of estrogen for women in such cases can be detrimental as it can lead to breast cancer in women and prostate cancer in men. Those who have a family history of cancer also have a higher risk. Women should limit their intake of coffee to no more than one to two cups daily to decrease their risk of having more serious health problems. Excessive chronic coffee intake is associated also with Adrenal Fatigue and reduced progesterone production. The proper progesterone to estrogen ratio is therefore not maintained, resulting in further estrogen dominance.
Coffee (especially when accompanied with sugar) also creates an acidic internal environment. The body will try to neutralize the acid by withdrawing valuable minerals such as magnesium and calcium from the bone. This leads to mineral depletion if chronic and ultimately osteoporosis.
In summary, coffee consumption can lead to increased estrogen, adrenal gland exhaustion, and osteoporosis. Clearly, coffee is not the women’s best friend by any means.
The liver has two mechanisms designed to help detoxify the body. They are called Phase 1 and Phase 2 detoxification pathways. Individual xenoestrogen and metabolites, once entered our body, usually follow one or both of the pathways.
Phase One – Detoxification Pathway
In Phase one, enzymes present in the liver cell help convert toxins into metabolites through a series of chemical reactions (such as oxidation, reduction and hydrolysis). One example of the phase one pathway involves the Cytochrome P-450 enzyme. Toxins are rendered harmless in this process and excreted through the kidneys. During this process, free radicals are often produced which, if present in excessive amounts, can damage the liver cells. Fortunately, the body has a built in protection mechanism and antioxidants (such as vitamin C and E and natural carotenoids) can reduce the damage caused by these free radicals. If these antioxidants are lacking, the toxin exposure is too high, the toxic chemicals can become very dangerous because some of them may be converted from relatively harmless substances into potentially carcinogenic substances.
In our polluted environment, excessive amounts of toxic chemicals such as pesticides ,alcohol or medication, can disrupt the P-450 enzyme pathway by causing over activity or ‘induction’. Substances that may cause overactivity (or induction) of the P- 450 enzyme pathway include caffeine, saturated fats, trans-fat, paint fumes, car exhaust, cigarette smokes, and barbiturates. As a result of this induction, high levels of free radical can be produced inside the body. In order to enhance Phase 1 detoxification pathway and prevent free radical overload, a wide variety of anti-oxidants including ascorbic acid, lipoic acid, grape seed extract, quercetin, and N-acetyl-cysteine is needed by the body.
Phase Two – Detoxification Pathway
In Phase two, the liver cells, in a process called conjugation, add another substance (eg. cysteine, glutathione, glucuronide, sulphur or glycine molecule) to the toxic drug or chemical which has entered the body. Once conjugated, the metabolite compound, whether it is toxic or not, is neutralized and is rendered less harmful to the body. In Phase 2, drugs, toxins, and hormones are converted into execretable substances that are in urn excreted from the body via watery fluids such as bile or urine.
Studies have shown that calcium d-glucurate, a natural ingredient found in certain vegetables and fruits can inhibit beta glucuronidase activity resulting in increased elimination of toxins from the liver. Supplements of calcium d-glucurate will enhance the glucuronidation pathway critical in the conjugation process. In addition, methionine, folic acid, taurine, N-acetyl-cysteine are very useful synergistic nutrients that will help this pathway.
Estradiol (E2) is the principal and most active estrogen circulating inside our body, and its breakdown, like many other steriodal hormones, occurs in the liver. The half-life of estradiol (E2) is about 3 hours. There are multiple pathways that convert E2 to metabolites that have widely different biological activities.
Estrone is the second most potent estrogen in circulation. It is easily converted back and forth from estradiol through enzymatic reactions. Both estrone and estradiol are metabolized by a process called hydroxylation. Some of the hydroxylated products are converted into estriol ( E3), while others are further broken down and secreted out the body. E3 is further conjugated in the liver and excreted in the urine.
Normal pre-menopausal women produce several hundred micrograms of estradiol every day. Some of this estradiol find its way to binding with the nuclei in a wide variety of tissues, resulting in genetic transcription as well as cellular division. While the production of estrogen is going on, a similar amount of estradiol is removed from the body, primarily in the liver. This on going production and destruction process results in a constant balance of estradiol in our body.
Since the metabolites are estrogen derivatives, they all possess estrogenic properties in varying degrees, as they are all part of the estrogen family. The degree of the hydroxylation (either through the two-hydroxylation or sixteen alpha-hydroxylation process) provides an indication of the metabolite’s estrogenic potency.
Metabolites such as 2-(OH)-estrone or 2-(OH)-estradiol are considered good estrogen. They are derived from hydroxylation of estrone and are the most prevalent metabolite of estradiol and estrone. These good estrogens are present in decreased level in people who are obese and in women who are on a diet high in animal fat . These good estrogens can be increased by consistent moderate exercise, a diet high in protein and low in fat, and by the consumption of food containing indol-3-carbinol such as cabbage and broccoli. In addition to being good estrogens, both 2-(OH)-estrone and 2-(OH)-estradiol have been found to be powerful anti-oxidants and can protect the lipid proxidation process by circulating iron molecules.
Another metabolite of estrone is called the 16 alpha-(OH) estrone. This is called the genotoxic form of estrogen or “bad” estrogen. It has been shown to be more potent than estradiol. Due to its ability to combine with estrogen receptors and transforming the nuclei to synthesize DNA, the risk of breast cancer is increased significantly. For this reason, it is also called the transforming estrogen. Another bad metabolite is 4-(OH)-estrone. This is a free radical generator and its role as far as being a “bad estrogen” is still under intense investigation.
It should be clear that just as there are good and bad cholesterols, we have good and bad estrogens. 2-(OH)-estrone is considered good, being a potent anti-oxidant and has anti-cancer properties 4-(OH)-estrone as well as 16-alpha-(OH)-estrone are considered bad, being free radical generators and at high level they are considered to be important indicators of cancer risk. The ideal ratio of 2-(OH)-estrone to 16-alpha-(OH)-estrone as measured in the urine is 2.0 or more.
Studies have shown that 73% of breast cancer patients have a ratio below 2.0. In other words, their 16-alpha- (OH) estrone level is high compared to the 2-(OH)-estrone. Studies have also shown that women 35 years and older with breast cancer have 2-(OH)-estrone to 16-alpha-(OH)-estrone ratio that is lower than control groups. Those women with the lowest ratio have a 30% greater chance of developing breast cancer compared to the highest 2/3. The ratio of 2-(OH)-estrone to 16-alpha-(OH)-estrone is significant and is an important predictive indicator of breast cancer risk in postmenopausal women. Fortunately both levels can be measured in the urine.
In summary, estrogen is metabolized in the liver. Herbs that fortify the liver will speed up estrogen clearance from the body. Estrogen that is not metabolized by the liver will continue to circulate and exert it.
The most impressive research has been done on a special extract of milk thistle (Silybum marianum) known as silymarin, a group of flavonoids compounds. These compounds protect the liver from damage and enhance the detoxification process.
Silymarin prevents damage to the liver by acting as an antioxidant. It is much more effective than vitamin E and vitamin C. Numerous research studies have demonstrated its protective effect on the liver. Extremely toxic chemicals such as carbon tetrachloride, amanita toxin, galactosamine and praseodymium nitrate produce experimental liver damage in animals. Silymarin has been shown to protect the liver against these toxins.
Silymarin also works by preventing the depletion of glutathione. The higher the glutathione content, the greater the liver’s capacity to detoxify harmful chemicals. Moreover, silymarin has been shown to increase the level of glutathione by up to 35 %. In human studies, silymarin has been shown to exhibit positive effects in treating liver diseases of various kinds including cirrhosis, chronic hepatitis, fatty infiltration of the liver, and inflammation of the bile duct. The common dosage for silymarin is 70 to 200 mg one to three times a day.
In addition, avoid caffeine, alcohol and medications that interfere with the liver’s detoxification mechanism.
5. Maintaining ideal body weight
Half of the adults in Europe and 61% of American adults are overweight. If you are overweight, lose it as fat cells increase estrogen production. Aromatase is an enzyme that helps produce estrone locally within fat cells. Estrone (one of the three main estrogen in the body) in turns fool the pituitary gland into thinking, through a normal negative feedback mechanism, that there is a sufficient amount of estrogen on board. Ovaries are therefore instructed not to produce hormone. Progesterone output is thus reduced, setting up an environment of estrogen dominance. Obesity also is associated with a higher output of testosterone that in turn will cause the liver to put out more SHBG (sex hormone binding globulin). The more SHBG, the more hormones are bound are not available to the cells.
Over-consumption of calories leads to increased metabolic activity in the body. This in turn leads to excessive free radical formation. Free radicals damage cells and cause genetic mutations, which ultimately can lead to cancer. Cancer is more common in overweight people. The evidence on weight is strongest for post-menopausal breast cancer and cancer of the endometrium (lining of the womb), gall bladder, and kidney.
Obesity is normally defined by the body mass index or BMI, which is calculated by dividing weight in kilograms by height in meters squared. An index of between 18.5 and 25 is considered healthy, while those with a score between 25 and 29 are classified as overweight and those whose BMI is higher than that are considered obese. The target weight should be to attain ideal body weight. Your ideal body weight can be calculated easily. For women, the formula is 100 pounds plus 5 pounds for every inch above 5 feet. Therefore, for a woman standing 5 feet 6 inches tall, her ideal weight is 100 + (5 pounds/inch x 6 inches) = 130 pounds. Give or take 5 pounds for large or small frame size respectively.
Properly performed exercises have been shown to modulate hormonal imbalance through the pre-menopausal years and beyond. Those who exercise regularly are also happier, less depressed, and have an optimistic outlook on life. This results in increased life expectancy. Statistically, life expectancy increases by two hours for every hour spent doing the proper exercises.
Numerous studies have confirmed that vigorous exercise can reduce breast cancer risk. Dr. Esther M. John, an epidemiologist at the Northern California Cancer Center in Union City, found that even moderate consistent exercise over a lifetime can reduce a young woman’s risk of developing breast cancer by 33%, and the risk of breast cancer after menopause by 26% as compare to those who are sedentary. Moderate exercise is brisk walking 2 miles three times a week. In another study reported in the Journal Cancer, it was found that postmenopausal women who exercise 1 hour each day can significantly cut their breast cancer risk. Regardless of age, regular exercise is a proven key to reduction of breast cancer, not to mention the cardiovascular health benefits.
Precision anti-aging exercises must incorporate flexibility, cardiovascular, and strength training exercises. All it takes is 5 minutes of flexibility training every day, 20-30 minutes cardiovascular training 3 times a week, and 15-20 minutes of strength training 2 times a week. A properly structured program takes an average of 30 minutes a day, which is less than 2% of the entire day. Daily exercise can be broken down in to 10 minute blocks.
7. Nutritional Supplementation
A. General foundational coverage
Pyridoxine 50-100 mg, fish oil 200-1000 mg, natural vitamin E 90-400 I.U., Magnesium 200-800 mg, vitamin C 100-1000 mg, folic acid 100-800 mcg; quercetin 350-1,000 mg.
B. Conversion of estrogen metabolite
Diindolylmethane (DIM) 60 mg standardized extract once or twice a day-The use of DIM is compatible with other phyto-nutrients such as soy, black cohosh, red clover, and chaste berry extract. Not everyone likes vegetables, and scientists are able to isolate the active ingredient of cruciferous vegetables. It is called Indole-3-Carbinol (I3C). Unfortunately, I3C has drawbacks. Fortunately, I3C combines with stomach acid to form 3,3′-Diindolylmethane (DIM) which is safe. DIM supplementation is available. DIM is a balancer of estrogen metabolism. It increases 2-hydroxyestrone (2-OHE), which is also known as the good or protective estrogen. It can be used in conjunction with a phyto-estrogen such as isoflavone as well as other phyto-nutrients such as soy, red clover, and chaste berry extract in selected cases. Women who are on oral contraceptives are advised DIM is contraindicated as it might reduce the effectiveness. DIM works well together with Tamoxifen and inhibits angiogenesis. DIM also raises progesterone level when necessary. It is interesting to note that both isoflavone and DIM work along different pathways. While studies have shown that supplementation with 200 mg per day of soy isoflavone increases the production of estrogen metabolites, the effect is much less than that seen with absorbable DIM. From a nutritional supplementation perspective, 70 to 400 mg may be used.
C. Liver Function Enhancement
- AntioxidantsAntioxidants such as vitamins A, E, and especially C are essential for detoxification as they help the cells neutralize fee radicals that cause mutation and cellular damage. This is critical during the Phase I detoxification process in the liver where free radicals are released.Vitamins should be taken as a cocktail in optimum amounts because each vitamin is unique and works on a particular part of the body. For example, both vitamins A and E are fat-soluble and are found in our fatty tissues. They are particularly effective in preventing the oxidation of cell membranes, which are made up of phospholipids.
On the other hand, vitamin C is water-soluble and fights free radicals in the plasma. Vitamin C is especially vital in any detoxification program, as the body needs it for energy to process and eliminate waste.
- MethionineMethionine is one of the essential amino acids needed for good health but cannot be produced by the body, and so must be provided through our diet.One of the important functions of methionine is its ability to be a supplier of sulfur and other compounds required by the body for normal metabolism and growth. Sulfur is a key element and vital to our life. Without an adequate intake of sulfur, our body will not be able to make and utilize a number of antioxidant nutrients. Methionine is also a methyl donor; capable of giving off a molecule with a single carbon atom with three tightly connected hydrogen atoms, called a methyl group which we need for a wide variety of chemical and metabolic reactions inside our body.
Meat, fish, and dairy products are all excellent sources of methionine. Good food sources include sesame seeds, brazil nuts, and soy protein concentrate. Vegetarians can obtain methionine from whole grains, but beans are a relatively poor source of this amino acid.
Together with choline, and inositol, methionine belongs to a group of compounds called lipotropics, which help the liver to process fat in the body. Once in the liver, methionine is converted into s-adenosyl methionine (SAMe). As much as 8 grams of SAMe is produced in the liver each day when conditions are ideal. However, the amount of SAMe produced in the body can be reduced significantly when the liver function is compromised.
Methionine is a valuable nutritional compound of multiple benefits to the body. In Europe, doctors have been using it with excellent results to treat depression, inflammation, liver diseases, and certain muscle pains. Methionine is an especially important nutrient beneficial to those suffering from estrogen dominance, where the amount of estrogen in the body is excessively high when compared to its opposing hormone called progesterone. Similarly, those who are on oral contraceptives or estrogen replacement therapy will find methionine to be helpful. Since estrogen is cleared through the liver, an enhanced liver function will reduce the body’s estrogen load. Specifically, methionine converts the stronger and carcinogenic bad estradiol (E2) into estriol (E3) that is the good estrogen.
The body can convert methionine into cysteine, a precursor of glutathione. Methionine therefore protects against glutathione depletion if the body is over loaded with toxins. Because glutathione is the key neutralizer of toxins in the liver, high glutathione levels protect the liver from the damaging effects of toxic compounds. Methionine is also used by the body to make a substance called choline that is essential for healthy cellular membrane function.
Most people consume enough methionine from a typical diet. The daily requirement varies depending on the body weight, but approximately 100 to 1,000 mg a day is sufficient for those who are not estrogen dominant.
Most of us do not need to have methionine supplementation if we are in good health. However, strict vegetarians and anybody who follows a low protein diet should consider methionine supplementation. Those whose diet is high in soy should also consider methionine supplementation, as soy is low in amino acids. When taking methionine supplementation, intake of taurine, cysteine, and other sulfur containing amino acids, as well as folic acid should also be included. Recommended dosage ranges from 500 mg to 4,000 mg in divided dosages throughout the day.
Because of this ability to enhance estrogen clearance from the liver, methionine supplementation should be considered for anybody with symptoms of estrogen dominance, including breast cancer. Excessive methionine intake in the presence of folic acid and vitamin B6 deficiency can increase the conversion of methionine to homocysteine that is linked to heart disease and strokes. Therefore it is essential that supplementation of folic acid and vitamin B6 be added as well. Supplementation of up to 4 grams of methionine daily for long periods has not been associated with any serious side effects.
- SAMeSAMe is the metabolite of methionine and has many good attributes. A daily dose of up to 1,600 mg of SAMe has been used to fight hepatitis and cirrhosis. Another major application of SAMe involves the alleviation of depression. A dose of 800 to 1,600 mg a day helps to elevate mood and provides relief to those who are clinically depressed. Methionine and SAMe both have anti-inflammatory effects therefore they are often used in combination to treat osteoarthritis. A daily dose of 5g of methionine has been linked to reduced lymph rigidity and Parkinson’s disease. However, the use of SAMe has not been able to reproduce similar effects. SAMe nevertheless, is helpful to those who have multiple sclerosis. SAMe’s anti-inflammatory properties have also proven helpful with fibromyalgia when taken at 1gram a day. In Britain, methionine as well as SAMe is frequently used in the treatment of chronic fatigue.
- TaurineTaurine is an important amino acid in our body. It is found mostly in our central nervous system, skeletal muscle, and in greater concentration in our heart and brain. It is made from two sulfur-containing amino acids called methionine and cysteine in conjunction with vitamin B6. Methoinine and cysteine are found in egg yolk and meat.Taurine is commonly found in animal protein but not in vegetable protein. Vegetarians with a low intake of protein may have difficulty producing taurine in their bodies. In addition to meat, taurine is found in abundance in shell-fish. Vegetarians as well as those on a low fat diet will have to be mindful of the amount of taurine consumed.
In cells, taurine keeps potassium and magnesium inside the cell while keeping excessive sodium out. In this sense, it works like a diuretic. However, unlike prescription diuretics, it is not a cellular poison. It does not act against the kidney, but improves kidney function instead. Taurine is very useful in fighting tissue swelling and fluid accumulation. People with heart failure, liver disease, late-stage ovarian cancer, and congestive heart failure frequently have unwanted fluid accumulation inside their bodies. Taurine has been very successfully used to treat people with high blood pressure. When excessive fluid in the body is normalized, the blood pressure becomes normalized. Taurine supplementation functions to dampen the sympathetic nervous system, thereby relieving arterial spasm. When the blood vessels relax, the body’s blood pressure will fall.
There have been studies showing the positive effectiveness of taurine on heart failure. Aside from having diuretic properties, taurine is able to strengthen the heart muscles and maintain proper calcium balance. Together with CoQ10 and carnitine, taurine is able to regulate the heart’s contractility and guard against the toxic threat of chemotherapeutic drugs such as adriamycin (doxorubicin). Working together with magnesium, taurine also is able to regulate heart rhythm and help to stabilize it.
Taurine is an important amino acid in the female body. The female hormone estradiol depresses the formation of taurine in the liver. Women who are on estrogen replacement, birth control pill, or those suffering from excessive estrogen (this is a widespread condition commonly called estrogen dominance) may need more taurine. Taurine is also helpful in clearing excessive fluid retention during menstrual periods. Furthermore, synthetic estrogen replacement therapy blocks the production of taurine in the body , as well as in the case of chemotherapy and the lack of good bacteria in the intestinal tract.
Suggested Dosage: Between 1 and 3 g a day, there is usually no problem. However, at a dosage of more than 5 g a day, taurine may occasionally cause loose stools. The general dosage for people who have edema, high blood pressure, and seizure disorders range from 0.5 to 4 g a day. In high doses, taurine may increase slightly the secretion of stomach acid.
- Fish OilA diet low in fish oil decreases the ratio of 2-(OH)- estrogen to 16-alpha-(OH)-estrogen and thereby increases cancer risk. Intake of fish oil also has been observed to inhibit the formation of human breast cancer cells in laboratory studies.Lean fish, which is typically found in warmer water, tends to have lower concentrations of EPA and DHA and higher concentrations of arachidonic acid (AA). Several theories have been proposed to explain the link between the high intake of fish oil and the low risk of cancer. Among the most important is the inhibition of ecosinoids production from AA, and omega 6. Ecosinoids belong to a class of compounds that are derived from poly and saturated fatty acids including prostaglandins, hydroxyl, prostaglandins, and leukotrienes. Prostaglandins are unsaturated fats that perform a wide variety of actions. Prostaglandin E2 (PGE2) has been linked to the formation of several types of breast and prostrate cancer. Tumor cells generally produce a large amount of AA derived from PGE2. Fish oil inhibits the oxidation of AA to PGE2. Ecosinoids derived from AA is also related to the modulation of estrogen metabolism. DHA has been shown to improve the response of breast tumors to cytotoxic agents.
Inflammatory molecules called leukotrienes are one of several substances that are released by mast cells during an asthma attack, and it is the leukotrienes, which are primarily responsible for the bronchoconstriction. In chronic, more severe cases of asthma, general bronchial hyperactivity (or smooth muscle twitchiness) is largely caused by eosinophils, which are attracted into the bronchioles by leukotrienes (and other chemoattractants), which also produce leukotrienes. Thus, leukotrienes seem to be critical both in the triggering of acute asthma attacks and in causing longer-term hypersensitivity of the airways in the case of chronic asthma. Leukotrienes are derived from arachidonic acid, the precursor of prostaglandins.
Suggested Dosage: 500 to 10,000 mg a day
- Calcium D-GlucarateD-Glucaric acid is a nontoxic, natural compound. One of its derivatives is the potent beta-glucuronidase inhibitor (1,4-GL). Detoxification is increased by 1,4-GL, one of the carcinogens and tumor promoters by inhibiting beta-glucuronidase and preventing hydrolysis of their glucuronides. The inhibitor 1,4-GL and its precursors such as calcium D-glucarate may exert their anti-cancer action through alterations in steroidogenesis. This is accompanied by changes in the hormonal environment and the proliferative status of the target organ. Glucarates may directly detoxify any environmental agents responsible for cancer formation. It has been postulated that D-glucarate exerts some of its effects by equilibrium conversion to D-glucarolactone, a potent beta-glucuronidase inhibitor. Laboratory studies comparing calcium glucarate (CGT) with a known chemo-preventive agent, 4-HPR during Initiation Phase (I), Promotion Phase (P), and Initiation plus Promotion Phase (I+P) together show that CGT reduced tumor multiplicity by twenty-eight percent, forty-two percent and sixty-three percent for the various stages respectively as compared to 4-HPR which reduce tumor multiplicity sixty-three percent, thirty-four percent and sixty-three percent respectively. The maximum effect occurred during the P and I+P phases. In particular, studies have shown that the chemo-preventive effect is synergistic when CGT is used together with 4-HPR.This is one of the most important nutrients to enhance liver function.
Suggested Dosage: 250 to 1,000 mg a day
- SilymarinMuch research has been done on a special extract of milk thistle (Silybum marianum) known as silymarin, a group of flavonoid compounds. These compounds protect the liver from damage and enhance the detoxification process.Silymarin prevents damage to the liver by acting as an antioxidant. It is much more effective than vitamin E and vitamin C. Numerous research studies have demonstrated its protective effect on the liver. Experimental liver damage in animals is produced by extremely toxic chemicals such as carbon tetrachloride, amanita toxin, galactosamine, and praseodymium nitrate. Silymarin has been shown to protect the liver against these toxins.
Silymarin also works by preventing the depletion of glutathione the higher the glutathione content, the greater the liver’s capacity to detoxify harmful chemicals. Moreover, silymarin is shown to increase the level of glutathione by up to thirty-five percent. In human studies, silymarin is shown to exhibit positive effects in treating liver diseases of various kinds including cirrhosis, chronic hepatitis, fatty infiltration of the liver, and inflammation of the bile duct. The common dosage for silymarin is 70 to 200 mg one to three times a day.
Suggested Dosage: standardized extract 200 to 800 mg a day
- N-acetyl-cysteine (NAC)NAC is also a good natural chelator of lead and mercury from dental amalgam fillings, cadmium and lead from paint and cigarette smoke. Because it is produced in living organisms from the amino acid cysteine, it is a natural sulfur-containing compound and a natural and powerful anti-oxidant as well. These duo properties make NAC an indispensable nutrient in liver fortification and a detoxification tool concurrently.N-Acetyl Cysteine is a more stable compound than taking oral cysteine, but as it is metabolized, some N-Acetyl Cysteine may be oxidized and become insoluble. This may form kidney stones. It is therefore recommended that individuals taking NAC should also be taking vitamin C to prevent NAC oxidization.
Estrogen is metabolized in the liver. By enhancing liver function, more estrogen is broken down in the body, reducing the overall estrogen load.
Suggested Dosage: 350 to 2,000 mg a day
- Lipoic AcidLipoic Acid is called the universal antioxidant for its ability to dissolve well in water and in fat environments. Lipoic acid increases the effectiveness or potency in other antioxidants. It can cross the blood brain barrier while others cannot. It easily reaches all parts of the liver where other nutrients have difficulty.One of the most beneficial effects of alpha Lipoic acid is its ability to regenerate other essential antioxidants such as vitamins C and E, coenzyme Q10, and glutathione. The evidence is especially strong for the ability of Lipoic acid to recycle vitamin E. This is apparently achieved directly by quenching tocopherol radicals or indirectly by reducing vitamin C or increasing the levels of ubiquinol (a derivative of CoQ10) and glutathione that in turn, helps to regenerate tissue levels of vitamin E.Suggested dosage: 125 to 1,000 mg a day
- QuercetinExtensively researched, this flavonoid only damages cancer cells, and leaving normal cells intact. Food sources include onions and apples. It acts synergistically with chemotherapy agents like tamoxifen, cisplatin, Adriamycin as well as radio therapeutic agents. It is a potent aromatase inhibitor and reduces the metastatic potential of cancer cells. It stimulates the immune system like reishi and maitake mushrooms, potent antioxidant and free radical scavengers, and alters the mitotic cell cycle in tumor cells and genetic expression. Most importantly, it is anti-angiogenesis and enhances apoptosis. It increases the intracellular glutathione level, thereby enhancing liver function.It acts synergistically with hyperthermia treatment protocols.Quercetin inhibits mutant P53 protein that arrests the G2 end phase of the cell cycle. Most drugs only inhibit the G1 phase. It induces apoptosis of cancer cells. It suppresses glycolysis and ATP production, interferes with ion pump systems, various signal transduction pathways, and inhibition of DNA polymerase B and I. It binds to estrogen receptor sites, working like tamoxifen and inhibits the growth of estrogen positive and estrogen negative cells. It inhibits mutant P21 genes found in over 50 percent of colon cancers which signals DNA replication in cancer cells.
Vitamin C enhances the effectiveness of quercetin, and vice-versa. One caution is that tangeretin, a flavonoid found in citrus fruits, completely blocked the inhibitory effect of tamoxifen on mammary cancer in mice. Another study also shows that tamoxifen and genistein synergistically inhibit the growth of estrogen receptor-negative breast cancer cells. Until more confirmatory studies are conducted and the flavonoid-tamoxifen interactions more thoroughly investigated, it is best to avoid high therapeutic ( over 1,500 mg) doses of flavonoid compounds in breast cancer treated with tamoxifen. Low remission and preventive doses (350 to 1,500 mg) are acceptable and helps to reduce estrogen sensitive receptors.
Suggested Dosage: 350 mg to 3,000 mg a day
- Grape Seed ExtractIn 1951, a French researcher named Dr. Jacques Masquelier patented the process of extracting proanthocyanidins from the bark of the European coastal pine tree. The extracted proanthocyanidins, which are powerful antioxidant nutrients from the bioflavonoid family of compounds, were named Pycnogenol® (pronounced Pick-nah-geh-nol).The name pycnogenol can refer to two things. Besides Dr. Masquelier’s trademarked compound, Pycnogenol® is also the name of a variety of compounds that contain proanthocyanidins (the active ingredient in Pycnogenol). These compounds can be derived from a variety of natural sources, such as grape seeds, which contain a high concentration of these substances.
The extracted proanthocyanidins (PCO) functions the same way as vitamins C and E. By scavenging free radicals, it can help to fortify Phase I of the liver detoxification pathway, resulting in an increase of estrogen clearance. With less estrogen, heavy menstrual bleed can be normalized.
What makes PCO so effective? Firstly, it is rapidly absorbed due to its excellent water solubility and distributed throughout the body within twenty minutes. It can be retained for as long as 72 hours while it neutralizes free radicals and prevents oxidation. It also works synergistically with other anti-oxidants like vitamin C, quercetin, and lipoic acid, thereby enhancing their effects. The results usually noted are delayed signs of aging, improved circulation as well as a stronger immune system. PCO also arms the human body with excellent antioxidant nutritional support for a variety of body repairs. It makes capillaries less susceptible to fragility and rupture; consequently, PCO is useful in blood vessel related conditions like varicose veins, peripheral hemorrhage, diabetic retinopathy, and high blood pressure.
Compared to other nutrients normally prescribed for the above conditions, PCO demonstrated a threefold improvement of their damaged capillaries. PCO works by inhibiting the release of unwanted collagenases, which breaks down proteins. Whenever there is tissue damage and/or inflammation, these collagenases are released, thus causing the decay of the fragile capillary walls. Proanthocyanidins strengthen our capillary walls, making them valuable for circulatory disorders of all kinds, including varicose veins, hardening of arteries, and impaired blood flow to the brain.
Nineteen years after Dr Masquelier patented the process, proanthocyanidins were also extracted from grape seeds. The Pycnogenol® bioflavonoid concentration is eighty-five percent while that of grape seeds’ stands higher at ninety-two percent to ninety-five percent. The cost of the grape seed extract is also much less expensive.
Some people have replaced their vitamins supplements totally with Pycnogenol®, thinking that it offers better protection. This is an incorrect assumption. It should be understood that any compounds with proanthocyanidins couldn’t take the place of the other vitamins. PCOs work together with vitamins to increase the overall effectiveness of each other. In other words, PCOs should be taken in addition to and not in place of common well-researched and established antioxidants such as vitamin C and E. For practical purposes, the small difference in bioflavonoid concentration between Pycnogenol® and grape seed extract is insignificant for the same dosage. Based on cost factors however, grape seed extract is usually recommended.
Suggested dosage: 100 to 1,000 mg a day
Significantly, higher dosages are needed for specific problems. To limit heavy menstrual flow, up to 3,000 mg a day may be required. Therapeutic effects can be seen as early as one month, with menstrual flow reduced from 7 to 4 days.
D. Control of Estrogen Dominance Symptoms
Gamma-aminobutyric acid (GABA) for emotional stability at 250 to 2,000 mg; taurine for excessive fluid accumulation at 300 to 3,000 mg; chromium polynicotinate to help control sugar cravings at 100 to 800 mcg; Glutamine to enhance energy and gastric function at 300-3,000 mg a day.
Avoid Iron unless you are anemic.
Avoid copper unless advised by a health care professional.
8. Reduced Environmental Estrogen
Last but not least, external estrogen load is a key component that should inspire everyone to:
- Disposde of all pesticides, herbicides, and fungicides.
- Throw away cosmetics with toxic ingredients and switch to organic and clean.
- Throw away nail polish and nail polish removers.
- Use organic soaps and toothpastes.
- Don’t use fabric softeners as it puts petrochemicals right on your skin.
- Use only naturally based perfumes. Most perfumes are petrochemically based.
- Have a good water filter for your source of water.
- Do not use plastic goods since all plastic leaches into the environment.
- Eat only organic based whole foods.
- Avoid surfactants found in many condoms and diaphragm gels.
- Avoid new carpets as they can give off noxious fumes.
- Be aware of noxious gas such as that from copiers and printers, carpets, fiberboards and computer monitors that emit high levels of electromagnetic force (EMF).
- Avoid X-rays as much as possible.
- Do not microwave food in plastic containers, and especially avoid the use of plastic wrap to cover food for microwaving.
- Wash your food well to eliminate all the pesticides. Bathe the washed food in ozonated water for 20 minutes before cooking.
9. Stress Reduction
The adrenal gland is where stress is expressed. Chronic stress leading to Adrenal Fatigue is a leading cause of progesterone depletion and thus estrogen dominance. Balancing excessive estrogen requires taking into consideration steps to reduce and remove stressors which compromise adrenal function. Many women with estrogen dominance will see their symptoms improve by simply optimizing the adrenal gland function for the simple reasons that a properly functioning adrenal gland will put out the necessary progesterone needed to balance any excessive estrogen.
10. Pregnenolone and DHEA Supplementation
Pregnenolone and DHEA are precursors of progesterone, estrogen, and androgen. Fortification of the adrenal function with these two hormones is particularly effective in reducing Adrenal Fatigue, together with identification and removal of stressors. This is especially true if there are signs of chronic stress response.
Vivian is a 46-year-old mother of two. She has a history of mild PMS. For the past year prior to her consultation, she began having heavy periods as well as urinary urgency. She would go to the bathroom more frequently. A qualified gynecologist saw her and complete investigation followed. Ultrasound study of her uterus showed the presence of two uterine fibroids (4.2 x 5.7 x 4.9 cm, and 2 x 1.8 cm respectively). This is the cause of her frequent bathroom visits, compression of fibroids on her bladder. Her surgeon recommended a total hysterectomy with removal of ovaries. This is the standard conventional treatment. She wants to avoid surgery if possible. She knew she was suffering from estrogen dominance but was not sure how to properly proceed for the maximum result in a short time frame.
Vivian consulted with me to plan a strategy that could help her reduce the fibroids naturally. After discussing various options, both natural and conventional, Vivian decided to try the natural way. She began a personalized estrogen reduction program. A complete personalized nutritional cocktail was prepared for her to help reduce her internal estrogen load. Lifestyle and dietary changes were implemented. The correct amount of natural progesterone cream was administered and adjusted over time. Vivian stayed on the program faithfully. She had a repeat ultrasound done six months later. The results were astounding. The larger fibroid has shrunk by twenty-five percent. It measures 4.6 x 4.4 x 3.3 cm. The smaller fibroid has shrunk by fifty percent. It measures only 1.6 x 0.8 cm. Vivian’s urinary urgency due to the compression of the fibroids on the bladder has subsided.
This is just one of many examples of cases showing how a good estrogen reduction program can effectively control and often, reverse uterine fibroid growth. Embarking on a properly tailored estrogen reduction program should be considered for anyone suffering from estrogen dominance. There is no downside and everything to gain. Surgical intervention should be considered only as a last resort.
Estrogen Dominance is the result of excessive estrogen and progesterone deficiency. It affects about fifty percent of Western women. It is an epidemic of gigantic proportion. The primary causes are excessive environmental estrogen, obesity, stress, poor diet, lack of exercise, and unopposed estrogen given as part of a hormone replacement therapy. Estrogen dominance is a major root cause of a myriad of conditions including PMS, endometriosis, cystic breast disease, PCOS, uterine fibroids, and breast cancer. Fortunately, the level of estrogen in our body can be reduced. Following an estrogen reduction protocol will go a long way to reduce the amount of estrogen in the body, curing women from the dreaded illness mentioned above.
In females, a large part of the hormonal balance is controlled by three major glands: adrenal, thyroid, and ovaries. Maintaining a proper balance among these three glands is of critical importance in any estrogen dominance recovery program. Excessive estrogen affects both thyroid and adrenal function, and in turn, dysfunctional thyroid and Adrenal Fatigue makes estrogen dominance worse. They all go hand in hand. When not functioning properly, these three glands, controlling the majority of hormones in the body, can lead to a viscous downward cycle of hormonal imbalance. Worse yet is that conventional medicine often misleads us into treating symptom after symptom without addressing the root cause. A wide variety of prescriptions from sleeping pills to anti-depressants is dispensed. Unfortunately, such symptom-based protocols will often make matters worse instead of better.
As a result, many following the advice of well-trained but misguided doctors may not find relief with conventional medicine or even with natural compounds unless special attention is paid to the thyroid and adrenal glands proper functioning during recovery. Any attempt to overcome one without paying attention to the other will more likely than not result in failure and discouragement for the physician and the patient. The key is to find a qualified naturally oriented physician who is experienced in all aspects of hormonal balancing. A knowledgeable physician can tell which part of the hormonal system is imbalanced with a detailed history. Laboratory tests are seldom necessary in the hands of a good clinician.
The menstrual cycle is like a fine-tuned symphony, a fascinating interplay of hormones and physiological responses played out in the orchestra of our magnificent body. Mother nature prepares you for a potential pregnancy every cycle, whether or not you want to actually conceive. Let us take a tour of the normal 28-day cycle known as the menstrual cycle.
Menstruation (Day 1)
Day 1 of your cycle is defined as the first full day of menstrual bleeding. The uterine lining built up from the immediate preceding cycle is sloughed off and cleared away. Hormone levels from the previous cycle take a sharp decline. The result is a myriad of physical and emotional symptoms commonly associated with menstruation.
Pre-Ovulation (Days 2 through 14)
The menstrual bleeding usually lasts a few days. From Day 2 on, the body is already starting to prepare itself for the next cycle. Under the influence of the follicle stimulating hormone (FSH) and the luteinizing hormone (LH) from the pituitary gland, the ovarian follicle starts to manufacture and secrete estrogen. Estrogen causes the uterine lining to grow. About 15 to 20 eggs start to mature in each ovary during this period. Each egg is encased and protected in its own follicle. The follicles also produce estrogen, the hormone necessary for ovulation to eventually occur. The level of estrogen slowly rises during this period as the uterus lining thickens and starts its preparation to receive the egg if ovulation occurs. A race progresses for one follicle to become the largest. Eventually, ovulation occurs when one ovary releases an egg from the most dominant follicle.
Ovulation (Days 14 and 15)
Although it averages about two weeks, this race to release an egg can take anywhere from about eight days to a month or longer to complete. The key factor that determines how long it will take before you ovulate is how soon your body reaches its estrogen threshold. The high levels of estrogen will trigger an abrupt surge of LH. It’s this LH surge, which causes the egg to literally burst through the ovarian wall, usually within a day or so of the occurrence that we called ovulation. After ovulation, the egg tumbles out into the pelvic cavity, where it is quickly transported into the fallopian tubes. The remainder of the ruptured follicle (called the corpus luteum) recedes back to the ovary and begins an important task of secreting progesterone. Why is progesterone so important? It causes an increase in blood vessels to the uterine lining in order to provide nutrients for the fetus in case fertilization occurs. It also inhibits other eggs from developing, and causes the Basal Body Temperature (BBT) to rise about half a degree.
Luteal Phase (Days 15 through 30)
The luteal phase is the time (usually 11 to 14 days) following ovulation. In simple terms, it is the last two weeks of the menstrual cycle.
The egg can be fertilized within 24 hours of release, while it is still in the fallopian tubes. If the egg is fertilized, the pituitary gland produces human chorionic gonadotrophin (hCG), which causes the increased production of progesterone. The progesterone level reaches its peak on days 19 to 22, after which the level starts to fall if no fertilization takes place. The progesterone in turn causes the BBT to remain high throughout the luteal phase and after the 14th day. High progesterone levels are also responsible for morning sickness.
If the egg is not fertilized within 24 hours, the corpus luteum regresses and slows its progesterone production. After reaching peak production on days 19 through 22, the progesterone level starts its decline. Without progesterone’s support of the rich uterine lining, menstruation starts as the slough begins and the uterus clears itself and prepares once more for the next cycle.
From the beginning of menstruation counting forward to ovulation can vary tremendously from 8 to 14 days. However, the time from start of menses, counting backwards, to ovulation of the previous month is quite consistent at 14 days. This can be significant for those who have irregular cycles and are trying to determine when ovulation is taking place each month.
This menstrual cycle occurs on a monthly basis from onset of menses at age 12 or thereabouts. The exact number of days varies from person to person. In general, the menstrual cycle lasts anywhere from 28 to 35 days. It is usually only interrupted by pregnancy.
Peri-menopause (age 45 to 50)
Peri-menopause is a transitional stage of two to 10 years before the complete cessation of the menstrual period (and thus, onset of menopause). Its average duration is six years, and can appear in women from 35 to 50 years of age. Peri-menopause is caused by the declining function of the ovaries, although women are still menstruating. A woman can find she experiences puzzling changes, and not know why. What is actually going on is a steep decrease of progesterone with a gradual decrease in estrogen. The manifestations of peri-menopause can vary greatly. Some of the common symptoms include:
- Menstrual cycles becoming shorter, longer, or unpredictable the closer a woman approaches menopause.
- Headaches and breast engorgement before periods
- Cramping with periods and mid-cycle pains
- Bleeding problems, such as spotting or heavy periods
- Weight gain around the waist
- Muscles becoming less firm
- Hot flashes (recur during menopause)
- Depression, fear, and apathy
- Nasal congestion, recurrent respiratory infections
- Memory loss and foggy thinking
- Loss of balance and dizziness
- Reduced sex drive
No two women will experience peri-menopause in the same way. Unfortunately, this is a time when attention to hormonal balance is overlooked. Women are told that there is little they can do to avert many of the same symptoms that often occur during menopause. It is also a critical time for women as it represents the last window of opportunity for hormonal balancing before the dawning of menopause.
Menopause (age 50 and beyond)
The onset of menopause signals the ending of a woman’s reproductive cycle. Menopause actually begins after the women’s last period, at an average age of 50. This event marks the culmination of many years of pre- and peri-menopausal changes during which hormones secreted by the ovaries estrogen and progesterone decline.
The timing of the average menopause is linked to a number of factors. Smokers, those who are nutritionally depleted, those who do not have children, and those who had their uterus removed without the removal of ovaries tend to have an earlier menopause by up to two years or more due to reduced estrogen output from the ovaries.
Women who are obese or suffer from PMS or fibroids tend to have a later menopause because of excessive estrogen.
Menopausal symptoms vary considerably from person to person. Asians are known to have few to no symptoms other than irregular menses. Western women, however, have much higher incidences of body changes such as hot flashes, night sweats, fatigue, thinning of hair, insomnia, breakthrough bleeding, breast tenderness, vaginal dryness, food allergies, indigestion, reduced libido, forgetfulness, heart palpitations, loss of bladder control, frequent urination, night sweats, painful intercourse, and joint pains, to name a few. Changes in metabolism may lead to osteoporosis, a rise in blood pressure, increased fats in the blood, atherosclerosis, and increased risk of stroke. Changes in emotion can result in depression, anxiety, and irritability. The average woman gains eight pounds in the first two years of her living hell.
Typically, menopause is diagnosed when women have the following:
- FSH blood levels greater than 50 mIU/mg and
- Estradiol serum levels less than 50 pg/ml; or
- No menstrual period for one full year
A pelvic ultrasound will typically show a thin endometrium (lining of the uterus) and small ovaries that may be atrophied.
Menopause usually progresses through three stages that last about 10 years. The first few years signifies onset of menopause. These years are the most problematic.
For the past 40 years, the conventional wisdom is that menopause is caused by the absolute deficiency of estrogen. Estrogen replacement has been prescribed to millions of women since the mid 1960s. This explanation has now been shown to be an incomplete answer. Many women who cannot be prescribed estrogen found relief if given natural progesterone alone. Clearly there is more to the menopausal picture than deficiency of estrogen alone. Let us now look more deeply into female hormones.
About The Author
Michael Lam, M.D., M.P.H., A.B.A.A.M., is a western trained physician specializing in nutritional and anti-aging medicine. Dr. Lam received his Bachelor of Science degree from Oregon State University, and his Doctor of Medicine degree from the Loma Linda University School of Medicine in California. He also holds a Master’s degree in Public Health. He is board certified by the American Board of Anti-Aging Medicine where he has also served as a board examiner. Dr. Lam is a pioneer in using nontoxic, natural compounds to promote the healing of many age-related degenerative conditions. He utilizes optimum blends of nutritional supplementation that manipulate food, vitamins, natural hormones, herbs, enzymes, and minerals into specific protocols to rejuvenate cellular function.
Dr. Lam was first to coin the term, ovarian-adrenal-thyroid (OAT) hormone axis, and to describe its imbalances. He was first to scientifically tie in Adrenal Fatigue Syndrome (AFS) as part of the overall neuroendocrine stress response continuum of the body. He systematized the clinical significance and coined the various phases of Adrenal Exhaustion. He has written five books: Adrenal Fatigue Syndrome - Reclaim Your Energy and Vitality with Clinically Proven Natural Programs, The Five Proven Secrets to Longevity, Beating Cancer with Natural Medicine (Free PDF version), How to Stay Young and Live Longer, and Estrogen Dominance. In 2001, Dr. Lam established www.DrLam.com as a free, educational website on evidence-based alternative medicine for the public and for health professionals. It features the world’s most comprehensive library on AFS. Provided free as a public service, he has answered countless questions through the website on alternative health and AFS. His personal, telephone-based nutritional coaching services have enabled many around the world to regain control of their health using natural therapies.