Why Your Estrogen Level Isn’t the Whole Story: The Detox Pathways Your Provider Isn’t Checking, Especially with Hashimoto’s, with Dr. Carrie Jones

Inna Topiler CNS MS (00:06.346)

We’re digging into hormones today, but not in the way that you may think. And this is for you, no matter of your age, because today we’re talking about what happens to estrogen after your body produces it. Or if you’re taking hormone replacement, what happens after you take your hormones? And if you’re in menopause and are not on hormones, you still have that little bit of estrogen. So we’re talking about what happens with that. And my guest, Dr. Carrie Jones, and I get into the nitty-gritty because

This is a topic that you need to know and understand because it literally affects everything in your body. And you have way more control over this than you may think. And this is definitely way more than I know your provider is explaining. And if you don’t know Dr. Carrie, she’s the hormone queen. She’s an internationally recognized speaker, consultant, author, and educator on women’s health and hormones with over 20 years in the industry. And you may have heard her as the co-host of the Root Cause Medicine Podcast or her own podcast.

Hello hormones. I am so excited for this conversation. Let’s dig in.

Inna Topiler CNS MS (00:01.1)

Dr. Carrie Jones, I am so excited to connect with you. Welcome to Thyroid Mystery Soft, Hashimoto’s and Hypothyroidism Revealed.

Dr. Carrie (00:09.111)

my gosh. Thank you so much for having me. I can’t wait to can’t wait to hang out and talk.

Inna Topiler CNS MS (00:13.512)

Yes, and so much to talk about. So on the show we talk a lot about hormones because they go so hand in hand with Hashimoto’s, with thyroid, with really any autoimmunity. They’re such cornerstones there because they affect everything in the body, including of course our immune system and inflammation. And we’ve had many episodes on the importance of having enough hormones, especially as we get into that perimenopause, menopause stage. But what we have not talked about enough, nearly enough really, I think, is

Metabolism of hormones. What happens once we have the hormones, whether we’re producing them ourselves or we’re naturally placing them? Because there’s a whole cascade of events that goes on. And that’s really going to dictate how someone’s going to feel, how HRT is going to work for them or how it’s going to affect their fertility or their cancer risk or any of those things. So I’d love to get into all of that today.

Dr. Carrie (01:06.35)

It’s one of my most favorite topics. I’ll I’ll I’ll be honest and here’s why it’s one of my most favorite topics. I will sometimes post quizzes on Instagram, social media, just to see what people’s medical knowledge is. And one time I posted about estrogen. How long do you think estrogen lives in the body? And I had, you know, do you think it lives, you know, hours? Do you think it lives days, weeks? Forever. And the amount of women who wrote who checked the box for forever and I was like, Forever. Like like the estrogen you got at puberty, like it just circulates around and round and round. I thought, no.

It has to go at some point. That’s called estrogen metabolism. Very important.

Inna Topiler CNS MS (01:42.498)

So let’s dive into that. And of course, everyone who listens to the show, they want to know what things are, but also why they happen. And we don’t necessarily need to know every bitty, nitty, gritty piece of the science. But I think it’s so important for people to understand. Let’s say you produce, and let’s start with if someone is still cycling. And we can go into HRT and breast cancer risk and all the other stuff after. But if someone is still cycling, what actually happens when they produce the estrogen? Because we know we have it.

Dr. Carrie (02:09.709)

That’s sometimes that’s what it feels like, doesn’t it? It totally goes into a black hole. So we have, and I’ll give the like rough overview to set the stage and then we can get into each section. So once your body is done with the estrogen, it’s bound to the receptor, done the thing, and it’s let go, and now it has to be degraded. So the different tissues have the ability to start breaking estrogen down. But the biggest organ we have that does it is the liver, which is why the liver gets all the love.

Inna Topiler CNS MS (02:09.954)

But then after that it’s like it goes into some black hole and then something happens, or maybe not.

Dr. Carrie (02:39.159)

But you can start the breakdown process in places like your breast tissue, which is why estrogen metabolism and breast cancer is important. But the liver’s really the big gun. So in the liver, we go through what we call phase one estrogen metabolism or estrogen detoxification. And what that does is it converts it into what we call a metabolite. So it’s basically estrogen that went through a wardrobe change. And we have to keep going through these wardrobe changes to eventually neutralize it.

make it water soluble so you can get rid of it. So when we get to this phase two, phase two is called conjugation. It just goes through a bigger wardrobe change. And in each stage it requires certain nutrients, certain enzymes, certain genetics to do it. And by the time we hit phase three, that’s the that’s the full exit plan. That’s are we gonna be pushed into the bile, then our intestines and out through our stool or is it pushed into the kidneys and we urinate it out?

And this is important because some people think of detox and they think, well, I sweat, I have a sauna, or I do breath work. And I’m like, those are wonderful. That is not how hormones leave the body. They either get urinated out or they get pooped out. But they have to go through these phases to neutralize them and make them water soluble. And if anything goes wrong in these phases, if we if the phase gets backed up, if it can’t get to the next phase, if the phase is going the wrong direction, this is where women of any age are like, well, now I have PMS. Now I have heavy periods.

Now my breasts are tender. Now I’m having all these, you know, like estrogenic acne. Or I’m getting more migraines. Or my perimenopause risk for breast cancer I was told is higher. What does that mean? Or HRT isn’t working for me. I feel like I’m going through puberty again. I’m a tiny bit of estrogen, but I feel horrible. And I’m like, I bet I wonder if your body is not processing it well.

Inna Topiler CNS MS (04:27.316)

Yeah. Now tell us more about why exactly we have to process it because this kind of goes back to the point that you said with the people who said, estrogen stays in your body forever. Well what’s wrong if we need estrogen, right? Estrogen is good for us. So what’s wrong with us just maintaining and holding our estrogen?

Dr. Carrie (04:38.605)

Mm-hmm.

Yes.

Dr. Carrie (04:48.895)

Other than a forever chemical, nothing in our body stays forever. So we have cells that turn over all the time. We have to get rid of our hormones. We have to get rid of enzymes. We have to break everything down. Basically, it’s out with the old and in with the new. So once the estrogen has done its job, it’s almost like you have a key, like an actual key to your house, and you put it in the lock. That’s the receptor. And when you turn the lock and get into your house, now the key breaks. So what happens is it’s gotta be.

cleared out of the system so that the next key, the new key, that better key, can come along behind it and bind to the receptor. So I want out with the old, in with the new, and that’s why detoxification is so important. But if detoxification slows down, goes wrong, it can increase certain side effects and symptoms, which then also, you know, creates more problem with somebody’s overall health. So you can’t keep it forever. We do have to get rid of it.

Inna Topiler CNS MS (05:44.064)

That makes sense. And I think a lot of people don’t realize that we produce estrogen every day. It’s not like we produce it one and then it’s there. Like we keep producing it. And so for so many people, you know, and we’ll talk about, you know, this kind of phrase of estrogen dominance, which gets thrown around a lot. And, you know, it’s a problem certainly for certain ages. But people often think that, I’m producing too much estrogen. But so often, right? It’s not that.

Dr. Carrie (06:06.849)

Yes, it’s the opposite.

Inna Topiler CNS MS (06:08.47)

it produce we just can’t get rid of it. So we’re producing a normal amount and then we’re just storing, storing, storing and accumulating.

Dr. Carrie (06:14.571)

And in the menstrual cycle, we produce a lot in that early stage, the follicular phase. And so if somebody’s follicles are pretty healthy, pretty robust, doing their job, they make a massive amount of estrogen estradiol. But in a second stage, the luteal phase, that’s where progesterone really s shines. We should make w even way more estrogen than than we make progesterone. We have a lot of progesterone that we make. But estrogen goes up a little bit, and that’s really where the detoxification shines. So if somebody has a lot of estrogen in the first phase, I’m like,

What’s interesting is that I always say, out with the old, in with the new, because we routinely as women, if you’re cycling, make estrogen every day to various degrees. And estrogen is pulsed. It’s not turned on like a garden hose. But in the first part of our cycle, the follicular phase, it’s pulsed so that we have a lot of estrogen. We need a whole lot to be formed so that we ovulate, support our brain, our bones, our uterus, everything in the whole body.

But in the second stage of our cycle, our luteal phase, we don’t make as much estrogen. We do make estrogen, but just not as much. So all that estrogen that’s come through in the follicular phase, think of it like water into a bathtub. It’s going to come flying into the bathtub. And if the second part, if the drain is full, the sewer line is full, basically if estrogen can’t get detoxified out of the body, remember more estrogen is coming behind it with the next new follicular phase. So we have to make sure this process of water coming in,

Water draining out is working. And with estrogen detox, we want to make sure that it’s happening appropriately down the different pathways. Because certain pathways, what we call, are estrogenic. That’s what can contribute to, again, PMS, tender breasts, growing fibroids, endometriosis, feeling bloated. Other pathways we consider more genotoxic, so increase the risk for cancer. So as women get older, they’re considering going on HRT. They have cancer risk in their family.

their own genetics or other risk factors, then we have to make sure that I’m like, you can still do estrogen. I just want you to go down the proper pathway. So I want people to realize, yes, you need estrogen. We love estrogen. We’re not vilifying estrogen, but I do need it to get cleared out of the body appropriately because more is just coming right behind it.

Inna Topiler CNS MS (03:27.248)

Yeah, and that’s what people need to understand because I think a lot of times we don’t think about the fact that we produce estrogen every single day. And so it’s oftentimes if people have symptoms, they think, I’m overproducing. And they think my whole life I produce too much. And so I’m waiting for the day where I don’t produce as much. But really, very likely they’re producing just the right amount. They just have certain detoxification issues where they actually can’t excrete that.

Now you mentioned the different pathways, and I think this is really interesting because again, I don’t think this is talked about enough, and I don’t think people realize that. And so with those pathways, we have our main estrogen, estradiol, and then we also have estrone and estriol. So tell us a little bit about those three and then how they kind of work together and when we have which, and then what happens with them. That’s a lot of questions.

Dr. Carrie (04:14.67)

So estradiol is E2 and that is our main. When you think of all the estrogenic symptoms, good or bad, that’s usually the one that you’re thinking of. Estradiol is a potent one. It binds to the receptors. It does the thing. It gets all the research behind it. It’s what women tend to take if they need estrogen. But estradiol can turn into E3, which is estriol, or E1, which is estrone. And then estrone, they can go back and forth. They can create estradiol as well. So we have all these estrogens.

that do a little bit different things in the body, bind to the estrogen receptors, and can help in different ways. We make estrone predominantly when we make it when you’re cycling, but we make it more when you’re post-menopausal. Whereas estriol, still very important, but we tend to make that one more when you’re pregnant. Now, we have them all at different times, but these key areas of our life, one will dominate a little bit more than the other. With estrone though, estrone,

can be a little more, let’s say, pro-inflammatory. Because what happens is it binds the most. We have two main types of estrogen receptors, alpha and beta. Alpha is the one that we think about with growth and proliferation and all the female things. And estrone predominantly binds to that one. Whereas we have a different one, beta, where estradiol binds 50-50, estriol binds predominantly to the beta.

which sounds very confusing and very scientific, but the point is the body’s like, okay, I have these three estrogens. They bind at different rates and affinities, they’re just different receptors, which means they do different things depending on when I need them, where she is in her stage in life. Is she pregnant? Is she postmenopausal? What’s going on with her hormones? And that’s what makes it really nice and key so that when she has the up and down of her menstrual cycle, then it’s almost like…

like a backstage, the backstage producer of a play who’s like, okay, estradiol go, okay, estriol go, okay, estrone go, okay, not yet estrone, okay, now turn in the estriol go, you know, and so it’s, estradiol, so it’s really coordinated, it’s very orchestrated until it’s not. And then people are like, I don’t feel good, I have all these symptoms. I’m like, okay, we have a few estrogens to look at, we have a few receptors to look at, we have detoxification to look at. So no matter what your age is,

Dr. Carrie (06:31.564)

The way we look at estrogen, should not be just micro focusing on that popular potent E2 estradiol. We have these two other estrogens. And then on top of that, they have to get broken down. So from there, we even have this bigger family of estrogens that I think a lot of people don’t even realize how big the family tree goes.

Inna Topiler CNS MS (06:51.312)

Yeah, yeah. And I want to get into that. But before we do that, can you talk a little bit about what helps the E two and E1, like when one’s produced and they kind of go into each other, does that depend on the liver?

Dr. Carrie (07:03.319)

Mm-hmm.

Well, so there’s an enzyme that converts them back and forth to each other. And so people can have a genetic snip in the enzyme. So they may actually prefer E2 because that enzyme is fast. Or that enzyme has been deemed slower. And so they stay predominantly as E1. Now here’s what’s the kicker. Your E1 and E2 can be, let’s call it, put in a holding pattern where they can’t bind to anything, but they’re just sitting there waiting just in case.

And the technical term for that is we can sulfate it or glucuronidate it. So on top of the E182, we can have an E1 with little S on it or a little G on it. And so we even have this holding pattern. And then when the body says, OK, I need you now. So let’s say because of the cycle, let’s say because of inflammation, let’s say because of infection, let’s say because of pregnancy, then we can take these little S’s and G’s off. And then we can take estrone, convert it into estradiol. Or if the body’s like, I don’t want estradiol right now.

right here in this tissue. I can convert it over to E1. So it can be tissue dependent and it also can be very liver dependent on what’s going on in the liver. Now the liver is a big lifter, but I think a lot of people forget these things can happen, like I said, in the breast tissue, in endometrial tissue. I mean, it can happen other places.

Inna Topiler CNS MS (08:25.072)

Yeah. Yeah. And with estriol, I know that that’s more common in pregnancy. And I’m curious, is it because it has an anti kind of inflammatory immune sort of sedating effect?

Dr. Carrie (08:37.078)

It does. And I think because it gets, it’s so high in pregnancy that a lot of, let’s say conventional practitioners feel it is only important in pregnancy. And yet, Estriol, I was just reading a paper the other day about the anti-tumor impact of Estriol. And because it binds to that other receptor, estrogen receptor beta, which is considered more anti-inflammatory, tumor-suppressive,

Estriol is actually, in my opinion, really important as women go through perimenopause and menopause at the same time. And I have always found anecdotally, women have a lot of those beta receptors vaginally. And so even though we hear all the time about low-dose vaginal estrogen and low-dose vaginal estradiol in particular, I’m like, but you guys, women have a lot of beta receptors down there, and estriol could be the missing piece for lubrication, for vaginal health.

I had a lot of patients who were like, I mean, I’m using estradiol, but it’s okay. I’m like 50 % better. I’m like, great, let’s add an estriol. And then they were like, that was it. That’s what I needed. I feel great. Some women do great with just the plain estradiol, but because of all those extra receptors down there, I’m like, let’s feed them. Let’s give them some E3.

Inna Topiler CNS MS (09:51.367)

Yeah, that makes sense. Now, do you find that people who have autoimmunity have more estriol? Is that a pattern that you’ve seen? I’m just curious.

Dr. Carrie (10:00.654)

I would say with autoimmunity, I see not so much E3 itself, although you would think that. I tend to just sometimes see, if they’re in a flare-up in particular, I will see more of its breakdown metabolite called 16, 16-hydroxy. That will tend to be higher. And I don’t think it’s on purpose. I mean, I don’t think it’s intentional. I think it’s a byproduct because to create the 16-metabolite, we need an enzyme.

called CYP3A4, which is your detoxification superhighway. It cleans out most medications. It cleans out most environmental toxicants. It deals with stuff in the immune system. And so if you’re in an autoimmune flare and it’s due to, unfortunately, maybe something you got exposed to or a bacteria or virus or something, then I think that pathway is a, let’s call it a self-fulfilling prophecy.

up regulates to get rid of things and it automatically increases the 16 which is more estrogenic. So I do not always but if I see that high 16 and somebody’s like my Hashimoto’s is you know I’m having a flare right now I’m like I can I can see it in the way your body is trying to process out things and it’s showing up in the estrogens as well.

Inna Topiler CNS MS (11:17.82)

Yeah. Yeah, that’s really interesting. One thing that I found, and I asked this question because when I do my Dutch test, and for everyone listening, I know we talk about the Dutch a lot, but it’s a urine test for hormone metabolites. And what I notice, and of course, everyone’s different, it could just be my pattern, but my estriol is always on the higher end when you look at the little graphs, you know, where things should be in the middle. You know, the other ones are normal and then estriol is higher. And I’ve done it several times in different parts of my life.

Dr. Carrie (11:35.968)

Mm-hmm.

Inna Topiler CNS MS (11:45.719)

And it’s always been higher n when I was pregnant, but also definitely when I was not pregnant. And I was just wondering, like, having autoimmunity because it has that n like immune suppressing, naturally like anti inflammatory effect, like maybe that’s just my body’s way of trying to stay calm, you know?

Dr. Carrie (11:50.531)

Right.

Dr. Carrie (12:02.582)

And for you, really could be the other not in the estrogen family, but in the androgen family, we will see the it’s a big word. I did not name it. It’s called the EDO chelan alone. And there is very little research on EDO chelan alone, which is a derivative of DHEA. What are androgens? But what we do know is it is pro inflammatory in in research where they injected rats with EDO chelan alone, like just set immune bells off their

for their immune system. So if somebody is dealing with autoimmune and again, not well controlled or in a flare, a lot of immune imbalance, we will see that marker be elevated. It’s not a diagnostic. I have no study to point to it, but we just saw it over and over and over again. And knowing that it pisses off the immune system, I’m like.

Well, that’s interesting. know your immune system’s not happy because this marker is high. We’ve got to work on the immune system.

Inna Topiler CNS MS (13:04.242)

It’s amazing how our body is just a huge set of signs. There’s signs everywhere and it’s just about looking and seeing, okay, well, this means this, this means this. And a lot of times, you know, we feel we know something’s going on, and then we have these other biochemical signs. And thankfully, because we have all of these things and all this knowledge and all this research and people like you who were hormone queens who know this so well, right? We can put the pieces together, which I think is so important. So let’s talk about

Dr. Carrie (13:08.785)

yeah.

Dr. Carrie (13:25.75)

Ha ha ha ha ha.

Inna Topiler CNS MS (13:32.55)

The breakdown of the estrogens. We talked about E1, E2, E3, and you mentioned a little bit the 16, but let’s kind of back up a little bit and tell us once you have your E1, E2, E3, they go into each other’s side, but then they have to get metabolized and they go through the different pathways and the different types of estrogens to talk to us about that.

Dr. Carrie (13:34.158)

.

Dr. Carrie (13:50.552)

Mm-hmm.

So I’m actually going to start with E3 because that’s the one that large majority of the time it skips. It doesn’t go through the phase one that we call hydroxylation. It skips and goes right into phase two. So E3, once it’s made in the body, immediately goes through something called sulfation and glucuronidation and then is excreted. So we’re not actually going to talk about E3 right now. We’re going to back up and talk about E1 and E2 because what happens is those then go through the

we call hydroxylation, which is to start the neutralization process so then we can make it water soluble and get rid of it. So when it goes through these pathways, we have three choices, kind of like three doors we can go through. One is called the two pathway. They’re numbered. One is called the four pathway, and one is called the 16 pathway. The two pathway, the two hydroxy pathway, or on a Dutch test or other urine test, you’ll see it is 2-OH. just means hydroxy.

So the two pathway we consider, it’ll be at a green arrow, green means good, that’s the better pathway we prefer. And the reason for that is it largely doesn’t cause any harm or damage. And then when it continues on, it forms something else called a two methoxy, which is anti-cancer. The next pathway is called the four pathway. And the four pathway, unfortunately, is genotoxic. If it continues on and forms a nasty little thing called a quinone. So if it breaks away of its pathway and goes down the quinone pathway,

Now, unfortunately, we can get holes in our DNA. And a hole in our DNA is not necessarily a bad thing. We have a DNA repair system. But if we have a lot of holes, then this, of course, means that repair can go wrong. I say it to people, if you’re driving and you get a flat tire, AAA can come change your tire, no problem. But if every single person on the road gets a flat tire, it’s a little overwhelming. Things may not go well when trying to repair all those tires. It’s the same in your genes.

Dr. Carrie (15:42.637)

Then we have the 16 pathway, which we’ve already mentioned. And the 16 pathway is considered estrogenic. So it’s not toxic to the genes, but it is able to bind to those estrogen receptors mildly. It’s not as strong as estradiol, but still it could cause the high estrogen symptoms we’ve mentioned, heavier periods, tender breasts, fibroid growth, et cetera. So it’s almost estrogenic, but like at the next layer down, at a layer that nobody’s looking at.

which is why some women get told, your estrogen’s fine, but their surface level, estradiol level is fine. But when we look the next layer down, I’m like, ooh, but your 16 is high and that’s the problem. So that’s all, the whole thing I just said is considered phase one detoxification. None of them can be zero. The body will push you down all three pathways to various percentages, depending on your genetics, your lifestyle, supplements, things like that.

Inna Topiler CNS MS (16:21.287)

Yeah.

Dr. Carrie (16:38.166)

And then from there, we move on into phase two, but I’ll stop at phase one because it’s kind of a lot to go through all those numbers.

Inna Topiler CNS MS (16:47.408)

Yes. And I love how you explain that with what each means, because I think often they’re talked about as, you know, there’s the good and the bad and like the very bad, which it is kind of that. But but I I think it’s important for people to understand that like the four, which we know is kind of like the very bad or the ugly or however you want to call it, but it’s specifically toxic to the genes. Because I don’t think that that is something that people understand as much. They know, that’s not good to have, right? And then the sixteen is the more estrogenic one, and then the two. So

Dr. Carrie (16:55.086)

Mm-hmm.

Dr. Carrie (17:12.717)

right.

Inna Topiler CNS MS (17:16.922)

What is the best way for people to test that? How would they know?

Dr. Carrie (17:20.888)

So you can’t do it in a blood test. You can’t do it in a saliva test. You can’t do it in a stool test. So you have to do it in a urine test. And you already have mentioned the Dutch test is a really popular dried urine test that’s out there and available to, it sounds crazy. So it’s Dutch, it stands for dried urine test for comprehensive hormones. And it allows people to collect their urine at home. You basically just pee on a strip of paper.

let it dry, mail it back to the lab, and we can catch what these little pieces of hormone called metabolite that are coming through.

You are

Inna Topiler CNS MS (18:02.459)

Yeah, I’m here.

Inna Topiler CNS MS (18:06.78)

that’s so weird. Let me just see my Wi Fi looks good on my end. I’m just checking. Okay.

Dr. Carrie (18:11.852)

The time, it’s still timing, but I’m like, no. You blacked out and now you’re back.

Inna Topiler CNS MS (18:19.11)

Sometimes I feel like if the internet like glitches a little bit on either one of our side like I don’t know if that happens to your reverse side, but it’s sometimes also I find the video gets really blurry, for a second and then but I think it’s okay.

Dr. Carrie (18:23.82)

Yeah, Riverside can do that. Yeah.

Yeah.

Okay, but yeah, you blacked out for a second and then came back. So I was just like making sure you froze, then you were gone and then you were back. And so I was like, ooh, let me just double check you’re still here. You’re still frozen, but I can see your face frozen.

Inna Topiler CNS MS (18:36.873)

it was actually blacked out. It wasn’t just frozen.

Inna Topiler CNS MS (18:44.06)

That’s okay. Thank you. That’s very, very weird.

Inna Topiler CNS MS (18:51.14)

Hmm.

Dr. Carrie (18:52.578)

But I’m sure it’s fine on the river that, know, Riverside will fix it. I was just making sure you’re back. Okay. Yeah. All right.

Inna Topiler CNS MS (18:56.74)

Yeah, I think so. Okay. All right. So yeah, so let’s take it from where you were saying,

Well I’m trying to think when we freeze.

Dr. Carrie (19:10.83)

Do you me to it again? Like you can’t test it in blood, you can’t test it in saliva. Okay. Okay. Yeah.

Inna Topiler CNS MS (19:13.904)

Yeah, let’s let’s do that. Cause then I had another follow up question for you for that. And like, you know, I talk about the Dutch, but I I think it’s always good for you to explain it. It just, you know, in case we have new listeners and stuff that we’re not assuming that they know. So yeah, let’s talk about that.

Dr. Carrie (19:25.422)

Sure. Yeah, I’ll just start with that. Yep. So to test this, you can’t test it in the blood. You can’t test it in saliva. You can’t test it in stool. But you can test it in urine. And the most common, most popular is a dried urine or a spot urine test. So you’ve already mentioned one test, which is a favorite of mine, the Dutch test. And Dutch is an acronym. It stands for dried urine test for comprehensive hormones. And basically, because the body is breaking down these estrogens and the

a lot of them go through the kidney and out into the urine, we can pick them up on this urine test. So you do it at home and you urinate on these strips of paper four, if not five times through the day, because they get a weighted average of all of it. You let them dry and then mail them back to the lab. And what’s nice because we can then see from a detoxification standpoint, what has come through the kidney. And you can’t get that in blood and you can’t get that in saliva and you can’t get like that aspect in stool. So when people

talk about the two or the four, the 16 or the good or the bad, really we’re looking to see the pathway all the way through because the four itself is not necessarily like the worst molecule in the world. But if it goes down the wrong pathway, that genotoxic pathway, if we don’t neutralize it, make it water soluble, that’s where we can cause issue with genes. And by catching it on that urine test, the dried urine test, I can very easily, you can very easily see like, no,

your four levels are high and you’re not continuing to go off into the other proper pathways of detoxification.

Inna Topiler CNS MS (21:00.05)

And it’s something that I think is so important to test for because so often people think, well, I just want to check my level, but it’s you have your level, but then what is it doing after that, which is really crucial. And this is important at any age too. You know, I think with all the talk of replacing hormones, and obviously, you know, people already understand that estrogen itself does not cause cancer, right? And there was the flawed studies and all of the things we’ve talked a lot about that on the show. And

Right. At the same time, when you start replacing estrogen, especially if you’re starting at menopause or postmenopause when you didn’t have hormones and now you do, you want to make sure that you see that pathway and what’s happening. And the same thing is if you are still cycling, whether it’s fertility or you have PMS or whatever the issue is, right? Whether it’s endogenous or exogenous hormones, they’re still going to go through those same pathways. Now, let me ask you this because I know my listener

Dr. Carrie (21:53.294)

Yes.

Inna Topiler CNS MS (21:56.303)

is one it’s was is going to want to ask this. If you test it, say when you’re 25 with your own hormones, and then you go through menopause and you get on biodenttical hormone replacement therapy, do we assume that your metal like say you fixed your metabolism early on if there was a metabolism issue and you fixed it, do you think that that’s going to stay fixed, so to speak, in the same or when you do biodental hormones, even though they’re bioidentical, does the body

In some way see them as different and metabolize them differently? D do we see those patterns?

Dr. Carrie (22:29.998)

The body does not see the bioidentical. So for example, if you tested at 25 and then at 45, you end up on the estradiol patch, that’s still estradiol. It looks just like the estradiol in your body. So it’s not going to be treated any differently. But what can happen is that you may find genetically some of the enzymes that dictate those pathways, you were born with faster pathways. So you were born with somebody who creates more four than the average bear because that enzyme is dictated

by CYP, 1B1, and if you do genetic testing and find out you’re a fast 1B1 person, then off and on through your life, you’re probably gonna have to help support the other pathways, slow down that 1B1 pathway, try to get it off the 1B1 pathway, or just continue on like, wow, I really need to support the next phase, phase two, and of course elimination phase three. So at 25, if you find that out, then by the time you hit 45, hopefully you’ve been doing those things off and on through your whole life.

so that when you go on any kind of hormone, estradiol, patch or gel or injection or pellet or whatever it is, that your body is like, not a problem. I know what this is. I’ve had it my whole life. And then you’re doing the lifestyle and the diet and the supplement nutrient support to encourage the other pathways or to encourage continuing on so it can be eliminated properly by the body.

Inna Topiler CNS MS (23:54.333)

Now, for people who do have that four pathway or higher, maybe they saw it on a test, or maybe after listening to this, they’re gonna understand how important this is and they’ll ask their provider or they’ll order their own test, and then let’s say they do see the four, which like we said, ideally we don’t want to have. What are some of the things that they can start to work on? because they may not know at that point if it’s the CYP liver SNP or if it’s perhaps something in their lifestyle.

Dr. Carrie (24:18.51)

Mm-hmm.

Inna Topiler CNS MS (24:22.628)

And no, chances are it could be both. So what are some lifestyle things that can shift that?

Dr. Carrie (24:28.29)

The big thing is, remember, most of this, a lot of this happens in the liver. So anything liver supportive is healthy. This includes, I’m always like, what medications are you taking? Are you a smoker? Do you drink alcohol? Do you vape? The National Institutes for Health feels that 24 % of people have fatty liver. Like 24 % of adults is a big percent, which means, what are we doing for liver health? How are we supporting it?

What’s your diet look like? Is it a lot of processed foods? Is it a lot of fried fatty foods? Is it a lot of charred meats? Is it a lot of soda? So thinking just even in like, what am I consuming? Because all of that goes right down into the liver. Am I eating vegetables? Am I getting enough fiber? Am I hydrating? Hydration is such a big one. Am I taking nutrients that are supportive to the liver? Do I take any herbs for the liver? B vitamins for the liver? Essential oils? Or excuse me, fatty acids for the liver?

like fish oils and eating primrose oil and choline and things like this that are good for our phospholipids. So again, you have to take everything I’m saying. not encouraging that at all. I’m just saying what are you doing to help your liver relative to what is, maybe what are some habits you’ve picked up that aren’t so helpful to the liver? So that’s like the first overarching, like let’s love our liver, we gotta support our liver. And alcohol and vaping is probably a really big one, including

the medications you don’t think about, like acetaminophen, Tylenol. People will pop it for pain or for headaches and not realize, you know, all of a sudden they’re doing it every day several times a week and that’s really heavy going through the liver and that’s just over the counter, let alone other medications people are on. Then we get into what can I do specifically for these pathways? First and foremost, these pathways are what are called heme dependent, which means they require iron.

So if you’ve been struggling with low iron, iron anemia, iron deficient, then making sure you’re getting iron rich foods, figuring out why you’re not absorbing your iron. Maybe if you have heavy periods, are you bleeding out your iron? Should you go get hemorrhoids evaluated? Is it time for a colonoscopy? Like some of these things around iron, I’m like, ooh, that’s a big key player here. From a dietary point of view, we love the brassica family. So your broccoli, your kale, your cauliflower, your Brussels sprouts.

Dr. Carrie (26:48.542)

There is a component when you chew up those foods that’s called indole 3 carbonyl, I3C. And when I3C hits your stomach acid, so yes, you have to have good stomach acid, it turns into a couple of compounds. But one of those compounds is called DIM, diendelmethane. It can be taken as a supplement, you can get it from food. And DIM helps shift those pathways more towards the two pathway. So even from a

dietary choices alone, we can love our liver more and we can help support that two pathway better.

Inna Topiler CNS MS (27:23.942)

Yeah. Yeah. And because so many people listening have thyroid issues and Hashimoto’s, the one thing that I do want to say is that I think there there’s a big myth out there about cruciferous vegetables. I mean, yes, like cooking them can help, but really, I mean, the way I see it and teach it is that it’s, you know, could be possibly somehow Malgorchan, but we just don’t see that here. You know, I think the

Dr. Carrie (27:29.794)

Mm-hmm.

Inna Topiler CNS MS (27:51.379)

plastics. I mean, there’s so many other things that are such bigger goitrogens that the cruciferous vegetables, even if they’re raw, I just have not seen them affect thyroid function negatively. But if you’re nervous, cook them. Not the amount that people are gonna have. Yes, exactly.

Dr. Carrie (27:53.89)

Yes.

Dr. Carrie (28:02.888)

Not in the amount. Yeah, I was going to say not the amount. Yeah, exactly. If I love that you said the endocrine disruptors too, because if somebody had to choose, know, somebody was like, I’m either going to give up all the great region family completely, or I’m going to read labels and switch out my my cleaning products and my skincare products and my personal products and you know, switch out of plastic and

and eliminate the synthetic fragrance, I would way rather you do that. I’m going to work to avoid the forever chemicals, the PFAS. I’m going to get an air purifier for my house. I would way rather you put the money for that than vilify broccoli or vilify a little bit of Brussels sprouts sometime. Food is medicine. Now, if you were eating eight cups of broccoli a day, we may have to have a conversation. But also, I’m like, a little bit of broccoli. Let’s get rid of all the.

synthetic crap that we’ve got clogging up our liver and all these pathways.

Inna Topiler CNS MS (28:59.622)

Exactly. And you can always cook it and then it’s not an issue, but people don’t have to be scared of raw either. So yeah. And I think eating eight cups of raw broccoli probably is not gonna sit well in anyone’s tummy. So that is not gonna happen. Yeah. Yeah. No, that’s great. So with dim, because that is a popular supplement, people sometimes take that on its own, but also there’s so many different formulas out there. Like there’s a PMS formula that will have dim in it. There’s a lot of

Dr. Carrie (29:01.664)

Yeah. Yeah.

Dr. Carrie (29:09.568)

No, probably not.

Dr. Carrie (29:19.694)

Mm-hmm.

Inna Topiler CNS MS (29:27.526)

Kind of perimenopause, like hormone balancing, so to speak, for formulas that will have a little bit of dim in it. So that, you know, if you’re you’re kind of balancing or elevating estrogen in some way, then that you’re detoxifying it properly. Do you think that dim is something that is helpful for everyone? Like let’s just say someone maybe can’t do the test, right? you know, whether it’s budget, whether it’s insurance, whatever it may be, but

Dr. Carrie (29:50.499)

Mm-hmm.

Inna Topiler CNS MS (29:54.565)

So they don’t know what their four pathway is, but they know the four is bad. And so they think prophylactically, can I do something to help that? Or can that be a detriment if someone doesn’t need it?

Dr. Carrie (30:07.2)

If somebody doesn’t need it, can be a detriment. Here’s why. We are talking about estrogen detox from start to finish. So phase one, phase two, phase three. But just like the bathtub analogy, it’s water goes in, then you have the drain, and then you have the sewer line. So if your sewer line is clogged, it really doesn’t matter what you do upstream until you unclog the sewer line. So I always tell people, if you give DIM, DIM is upstream. That’s in the water category. So DIM will impact

estrogen up there. It’ll impact your actual estrogens. It’ll lower your actual estrogens out of circulation. Well, if you already have low estrogen, like let’s say you’re perimenopausal, but low estrogen or postmenopausal, but low estrogen, you’re not going to feel that good with it. In fact, you’re going to probably feel worse. You’re going to say, I have hot flashes and night sweats and my everything’s getting drier and my joint pain’s back and I hate this product. Why would I take it? And then from there, yes, you will address this shifting of the two towards the two pathway, but

If you have issues with phase two or issues with phase three, it’s just like water clogging up in a bathtub. If the drain doesn’t drain and the sewer line’s clogged, it’s still gonna overflow and impact your bathroom. So you wanna make sure we’re talking about all the phase one and DIMM, but do you hydrate? How’s the health of your kidneys? Do you have regular bowel movements? How’s the health of your gut and your microbiome, your digestive tract? And then we move backwards from there. So I do love DIMM. I don’t love it for everybody.

and I don’t love it that it’s sort of handed out like candy is like, this is the panacea for all things estrogen. I’m like, until it’s not, until it makes things worse and then it becomes a problem.

Inna Topiler CNS MS (31:43.154)

Right.

Inna Topiler CNS MS (31:46.493)

Yeah, and I’m so glad you’re saying that. I was actually taught, I mean, this was a long time ago, that not necessarily the dim is good for everyone, but this kind of the premise of if, you know, and this is also back in the day when hormones are still, you know, vilified to some extent. But it was like if you ever put anyone on hormones, if you have a client that comes in who’s on hormones and their doctor isn’t supporting their metabolism, it’s almost like this must. Like if someone’s on hormones,

Dr. Carrie (32:04.034)

Mm-hmm.

Inna Topiler CNS MS (32:15.206)

They need to be on dim and possibly calcium deglucurate. And, you know, I I really kind of took that in. And it wasn’t until more recently that, you know, talking with our mutual friend Emily Saji, who’s been on the show, and Dr. Gersh and the people. And it’s that, you know, until estrogen is optimized, you really don’t know because DIM has that ability to lower overall estrogen. So if you’re not at where you need to be, you’re kind of pedaling backwards with that. And I thought that was really interesting.

Dr. Carrie (32:44.64)

And if you have high levels of estrogen, so people will, let’s say you are a candidate, you’re working with a practitioner, you’re totally a candidate for DIMM, you have really high levels of estrogen, it’s part of your detox plan. Sometimes, I’ve seen the before and after results, the studies, I’ve heard it, where people will just stay on DIMM, or they’ll double their dose, and they’re like, I’m feeling so much better, my PMS is better, my periods aren’t as heavy, my breasts aren’t as tender, but then they keep staying on it, and now they’re like,

I’m getting hot flashes. This is weird. Like I’m having joint pain. Like I’m feeling menopausal. I’m like, ooh, you’ve dropped your estrogens too much. The DIM is working. DIM is potent. You got to be careful.

Inna Topiler CNS MS (33:26.394)

Yeah, I’m so glad you’re saying that. Yeah. Cause I think we’ve all had people where, you know, typically we see people on a regular basis, but sometimes people come and then they drop off, right? They feel so what happens is they feel so good. Like you said, they’re like, my god, it’s great. And then they cancel their next appointment because they feel so good, but then they stay on it too long. Yeah. Yeah, absolutely. Okay. So then what’s next after that? So they go through these three pathways, the 16, the four. And actually, let’s talk about the we talked about the four and the things that people can shift there.

Dr. Carrie (33:34.05)

Yeah. Yeah. Yeah. Yes.

Inna Topiler CNS MS (33:56.221)

But what about the 16? You mentioned it a little bit before, but let’s talk about that a little bit more. Let’s just say someone’s four is normal, their two is good, but their 16 is a little high. You mentioned that that could be if they’re potentially in a flare. And but if they’re not in the flare, what can cause that and what can people do to support that?

Dr. Carrie (33:59.15)

Hmm.

Dr. Carrie (34:07.15)

Mm-hmm.

Dr. Carrie (34:12.952)

So that same pathway, that CYP3A4, again, it’s your big detoxification superhighway. So usually it’s a signal to me of like, you must have come in contact with something. I wonder if you started to do medication. Maybe you took something over the counter that is causing that pathway to increase. Maybe you’ve come in counter with an endocrine disrupting chemical. You don’t even realize it. And so that pathway is increased because it increases on itself to get things out of the body.

Now again, DIMM helps shift towards the two pathway. So we from a 216 ratio, let’s say if you’re a lot more 16, even if you’re two is in range, but relatively your 16 is higher, DIMM helps shift away from the 16. But what I tell people is I like to slow down the 3A4 pathway because it doesn’t just clear estrogens. It clears everything else. So I’m like, let’s just go back to the basics. Let’s eat clean and healthy. Let’s support just general liver detoxification.

ease up or completely cut out the alcohol for a while. Let’s hydrate. Let’s make sure you have enough electrolytes and minerals. Maybe do a multivitamin. Your liver requires a lot of B vitamins. Maybe you need more glutathione or other antioxidants. Maybe we need to add in a lot more colorful fruits and vegetables. Get the polyphenols in there. There’s some great herbs that are helpful for the liver. Even things like milk thistle. I’m like, maybe we need…

to add in a little milk thistle. Maybe you need, you you see the detox teas and I don’t mean the weight loss teas. I mean the true herbal blends of tea that support detox. When you read the label, you’re like, these, these are, it has milk thistle in it. This is great. Maybe we need to incorporate a couple cups of that a day because I just want to support that pathway. And then look around. Has there been forest fires around you? Have you been drinking out of water bottles because you’re on vacation and that’s, it is what it is. That’s what’s available. You’re at the airport or.

You’re traveling and they’re plastic water bottles. Have you been adding fragrance into your life and you forgot? Like dang it, I’m kind of sensitive. I probably shouldn’t do this. Did you buy a new detergent? Any of these little things can cause the 3A4 to increase. I’m not saying you need to micromanage. I’m just saying thankfully there’s a lot we can do to help just completely support that pathway and get out what we need to get out.

Inna Topiler CNS MS (36:29.318)

Now, when people are looking at the two and the four and the sixteen, how does it differ in terms of what phase they’re in? Meaning, like at twenty-five, they’re gonna have naturally more estrogen. So they’re gonna see things shift down those pathways. But let’s say someone is 53 and maybe they’re not on hormones and maybe they wanna go on, maybe not, but they just wanna see where they are maybe before they start hormones. But naturally,

Dr. Carrie (36:41.742)

Mm-hmm.

Dr. Carrie (36:47.169)

Mm-hmm.

Inna Topiler CNS MS (36:55.004)

their estrogen is going to be low. You know, they might be very close to menopause already in menopause. So when it’s low, the whole the metabolites of course going to be lower, right? Because there’s less substrate. But are you then able to extrapolate what their metabolism is because everything else is low? Most of the time

Dr. Carrie (37:11.15)

Most of the time, yes. So the testing is only looking at the metabolites of the estrogen you have coming through. if you think of it like you’re looking at a river. So when you’re 25, the river is full, and you can see how high the river naturally is and how the river flows. But if you’re 53, maybe the river is a little bit more dried up. It’s lower, but it’s still flowing. So you can still get the gist. You can still see where it’s going. And you can still see that on

with estrogen metabolites. Now, if your riverbed is completely dried up, meaning you literally are scraping the bottom of the barrel with your estrogen, then these test companies like the Dutch will often put a disclaimer on there that says, hey, you hardly have any estrogen. Like it’s near zero. And that means it’s harder for us to really determine which direction your estrogen is going, the 2, 4, or 16. Because we’re staring at a dried up riverbed going, I’m not

totally sure how high it gets. I’m not really sure how much the rapids are. We’re kind of taking a guess here based on what we know. So until you add estrogen to it, for example, if you’re going to go on hormones, then it becomes harder. But if you’re just lower in estrogens, you’re just sort of naturally post-menopausally low, we can still tell on the 2, 4, and 16 what’s going on.

Inna Topiler CNS MS (38:32.11)

great yeah and then we’re looking at the percentages of it versus the actual number and so this way people can see that in relativity yeah okay so then what happens after ideally we have most of it going to the two because we’re not done yet there’s more and this is for everyone listening this is important because again this is literally what happens to your hormones and we have to you know you may not need to understand it you know obviously you may have a provider you don’t need to understand every di detail but I think you need to understand

Dr. Carrie (38:43.176)

Yes. We’re not done.

Dr. Carrie (38:52.907)

Mm-hmm.

Inna Topiler CNS MS (39:00.912)

The overall of what happens because the way I look at things is, you know, I don’t need you to become a scientist, but if you understand what is going on and for the most part, how it’s working, you’re gonna feel so much more empowered to be your own advocate and to take the steps. And then you can also see how food and nutrients and lifestyle are going to affect all those pieces versus like, there’s this weird thing that’s over here and it just looks like this big black hole.

Dr. Carrie (39:26.784)

Exactly. So the next phase is called conjugation and conjugation is phase two detoxification. And this is where we make it neutral and then water soluble. So estrogen, estrone and estradiol are fat soluble. They are zippy little hormones that can move in and out of our cell membrane because our cell membranes are fatty. So, they’re fat, they’re fat soluble. So they’re like, woohoo, I don’t need to carry your protein. I don’t need an Uber. I don’t need anything. I can just slide through a cell membrane, get to the receptor and do my job.

Well, that’s not how we get rid of it because our urine is liquid in our stool, by and large, bile and everything in our intestines is liquid. So it has to be water soluble. So that’s why we need phase two. So phase two options, they’re all asians. So we have conjugation. That’s the umbrella term. We can go through methylation, sulfation, glucuronidation. And all these fancy terms mean I add an extra molecule or two on, and I’m going to make it water soluble and or.

neutral, excuse me, and or water soluble. So let’s start with methylation. So methylation is where the two and the four that we just talked about have to get a little put on them. That’s methylation. And to get a little put on them, we use the nutrient magnesium, is the major cofactor. Everyone knows magnesium. And we use an enzyme called SAM, S-adenosyl methionine.

But we know it is a supplement called SAMe. Like you can actually take this as a product. And SAM donates its using magnesium and makes those estrogens neutral. So now they can’t cause any problems in the body, which is a great thing. That’s ultimately what we’re going for. Now to make SAM, it’s this whole cycle called the methylation cycle. And it starts with a marker that some people are quite familiar with. It’s called homocysteine. And homocysteine goes up in a loop

In a cycle up around is something called methionine. Methionine becomes SAM and the whole thing starts over again. It’s just round and round and round. Make SAM, SAM gives its it goes right back around the cycle again. Now to make this cycle work though requires a lot of B vitamins. B12, B2, B3, B6. It requires folate. It can use choline. It can use something called trimethylglycine. Glycine is helpful for the liver. Glycine is helpful here.

Dr. Carrie (41:49.315)

So right away, you can hear like, nutrients. these nutrients, I can take as supplements. I can get them in foods. I can make sure I’m digesting and absorbing them well. So that’s the whole methylation cycle just to get methylation to occur to start the neutralization process. But then we have to keep going through sulfation or glucuronidation. So it’s a whole, it’s a lot of big words, but nutrients are at the core.

Inna Topiler CNS MS (42:12.666)

Yeah. And I love that you bring up magnesium because many people know magnesium, but what do people think about? Sleep, calm. Important for sure, but like the magnesium helps with methylation. And I don’t think people realize that part. And I think sometimes people say, like, well, I don’t need magnesium because I don’t have lec cramps or I sleep fine or I don’t have constipation. But there’s so much more that we need it for. It’s important. It’s just a cofactor in so many different things.

Dr. Carrie (42:20.588)

Yeah.

Dr. Carrie (42:42.24)

In fact, magnesium is the cofactor that activates ATP. So when we think of our mitochondria and our cellular energy, the battery power of our cells, ATP, we talk about ATP all the time. ATP, ATP, do you have enough ATP to power the cell? ATP can’t be powered unless it’s attached to a magnesium. So even from a cellular battery powerhouse discussion, we need magnesium there too. Huge.

Inna Topiler CNS MS (43:06.064)

Yeah, it’s so important. Yeah. Now, then as we go into glucarondation and sulfation, a supplement that people may be familiar with that they may have taken and it’s been recommended to them is calcium deglucrate. And oftentimes, if people have PMS or they have, you know, estrogen dominance, that’s a supplement that’s recommended. Or sometimes they may do a stool test and they see a marker in there that’s elevated. And so they may be recommended calcium deglucurate. Can you talk a little bit about that and how that works?

Dr. Carrie (43:27.256)

Mm-hmm.

Dr. Carrie (43:34.221)

Yep. Yes, so once the hormones go through sulfation or glucuronidation, that’s phase two, another water soluble. So now I can put it in bile and flush it out through stool or put it into the kidney and of course flush it out through urine. And it’s completely inert. It can’t bind to things, it can’t do anything. It has a little S for sulfation or a little G for glucuronidation on there and out it moves. So once the estrogen metabolite with the glucuronidation,

goes through your intestines, it’s like, goodbye, goodbye, thank you, goodbye, it’s on its way out. What I joke about, I say it’s like it’s in a box with a lid and a bow on it. But it goes right through your microbiome. You have a part of your microbiome called the estrobalome, which is the estrogen microbiome squished together. But actually it’s bigger than that. It’s the endobalome. It’s your endocrine microbiome squished together because all your hormones, progesterone, testosterone, cortisol, they all can go through this whole microbiome route.

So estrogen’s in its box, it’s being sent out in your stool. And if your microbiome isn’t so great, it’s not so healthy, it’s not doing well, you’ll have an elevated level of that enzyme you mentioned, it’s called beta-glucuronidase, and it acts like scissors. And it comes around and it snips off the bow and it opens the lid and it cuts off the little G, and now estrogen can fly free and it can get reabsorbed back in the body. So some people have a lot of estrogen, not because they don’t

make too much. It’s because they keep reabsorbing out of their intestines estrogen that was tagged for trash. So the supplement calcium deglucarate says, I’m anti-scissors. I am going to keep the lid on and the bow on so estrogen can get eliminated in your stool. Now, you still have to address your microbiome. What’s going on? Do have an infection? Do you have a leaky gut? Is it from foods? Is it age? Is it hormones? Because hormones, the declining hormones in perimenopause,

can play a negative role in our microbiome. Like, what’s happening here? So we still have to address that, but calcium deglucurate is an anti-scissors that allows estrogen to leave the body in the trash, essentially.

Inna Topiler CNS MS (45:40.176)

Yeah, that’s great. Now, can that lower estrogen the way DIM can?

Dr. Carrie (45:44.143)

So it doesn’t lower dim like dim as in dim will kind of pull estrogen out of circulation, but calcium deglucurate keeps it from getting reabsorbed. So it doesn’t pull out of circulation, but it stops it from going back in. So if you’ve had high levels because it just keeps getting reabsorbed out of the intestines, then yes, it can drop those levels. But if you have low levels of estrogen and then just some of it’s flying free, getting back reabsorbed,

It’s not necessarily gonna like drop it as low as DIMM does. I don’t tend to see that.

Inna Topiler CNS MS (46:20.178)

That’s good to know. Yeah. So if someone wants to know where there’s a break in their pathways, whether it’s in the metabolism or the glue carundation or sulfation, if they do the Dutch test, are they able to see that or do they need other testing to see the full picture?

Dr. Carrie (46:35.416)

So here’s where it’s a little like clinical pearl next level. So sulfation and glucuronidation aren’t necessarily shown on the Dutch test, but because that’s what comes through urine, because even in the kidney, sulfation and glucuronidation have to occur. So what happens on the Dutch test is when it comes through, they break the S and the G off, and then they report it just back a step. They report it as the methylation version.

or they report it as estrone or estradiol or estriol. So we can see it inadvertently on the Dutch test. But from a genetic point of view, if you’re into genetics, I can also run your salt SNPs, S-U-L-T, or I can check your glucuronidation SNPs, which are called UGT or UDT. And then I can see, like, ooh, do you have a higher propensity to a problem in these areas, which can be really helpful.

Now, sulfation for estrogen and sulfation for other hormones is not the same SNP, but sometimes they run in the same family, meaning if I run other hormone markers on you, DHEA S, that little S stands for sulfate, sulfation. If I run Estrone S on you, so I can get those in, well, I can get DHEA S in the Dutch test, but blood test, Estrone S in a blood test. If those markers are really low, I’m like, ooh.

I bet in general you have a sulfation issue. And one of the biggest, biggest, biggest inhibitors of sulfation, the ability of phase two to do its job, is inflammation. So if you’re a very inflamed person, you’re struggling with inflammation, you’re in a flare right now and inflamed, automatically I know it’s going to impact your ability to sulfate just because unfortunately inflammatory cytokines are naughty nasty little messengers and they get in the way of the ability to put the sulfation.

S on.

Inna Topiler CNS MS (48:28.998)

Yeah. Yeah. Now what if someone has an elevated DHES? I mean, it doesn’t happen as often, but there is a whole group of people that no matter what they do, and they don’t they’re not taking DHA as a supplement, but they just have this elevated DHES. What does that mean?

Dr. Carrie (48:45.89)

Couple things, one, all DHEA-S is made in the adrenal glands, so it can be very adrenally related. If they’re under a lot of stress, the body can put out a whole lot of DHEA-S, because it’s like, sound the alarm, we’re in a fight or flight situation, let’s go. Now, the scissors that cuts the S off of DHEA is called steroid sulfatase, and it’s also possible that genetically, they have a variant in their snips.

So their scissors are broken. They actually can’t get the S off of their DHEA, and they tend to maintain it as DHEA. So those are the two things that I tend to see probably the most common. Look at the adrenals first. Because you’ve already said they’re not taking it. So I’m like, well, let’s look at the adrenals. What’s going on in the stress system? And then it’s possible they’ve broken scissors. They can’t cut the S off.

Inna Topiler CNS MS (49:33.543)

Yeah, yeah, that makes sense. there is a lot here, but I just think it’s so important. I know we’re getting into the nitty-gritty, but I think it’s so important for people to understand. And thank you so much for explaining all of this because really like it doesn’t matter how old you are, right? Whether you’re twenty-five or forty-five or fifty-five or seventy-five, whether you’re on hormones or not, like this is something that’s going to affect you because even with low hormones, you’re still gonna have that metabolism.

Dr. Carrie (49:37.792)

All good.

Dr. Carrie (50:00.729)

Mm-hmm.

Inna Topiler CNS MS (50:00.964)

issue or potential issue, right? And then it determines so many things downstream. And I think so often, you know, people are excited about hormones, but then this other part of them is also scared about hormones. Right. And I think that when you look at this together with whether it’s your own hormones or repl hormone replacement, then you’ll actually be able to see what’s happening. And I just I love giving people these tools and this understanding so that they really feel in control. And of course it’s so important to work with a provider who

Dr. Carrie (50:10.999)

Mm-hmm.

Inna Topiler CNS MS (50:28.602)

understands this, but then you can ask for that, right? You can look for that. So you don’t feel stuck. You know, and especially there’s if so many people are like, well, you know, I have a certain cancer risk in my family, or when I was younger, I had very, very heavy periods and I’m actually happy not to have periods anymore because it was so awful. Right. But then there’s all of these other inflammatory things that are affecting with having no hormones, right? So there’s a way to figure out that balance.

Dr. Carrie (50:44.974)

you

Dr. Carrie (50:54.572)

Yeah, absolutely. And I love that because it just empowers people and just really helps. Like, it’s your health, you can take control. You’re listening to this right now. now you’re in fact listening to this right now, you probably know more than 80 % of what your conventional practitioner knows. Most conventional practitioners have no idea about this. Like they get the gist of detoxification, but not the fine pathways, the enzymes, the nutrients that goes into it.

to make it a healthy process from start to finish.

Inna Topiler CNS MS (51:27.994)

Yeah. And you have so much control over the process. That’s the thing because so often we think, well, I have the SNP. well, I guess that is what it is, right? But it’s like, yeah, you the SNP, but you can circumvent that and you can do all of these lifestyle things, which is really important to know.

Dr. Carrie (51:30.349)

Mm-hmm.

Dr. Carrie (51:34.372)

well.

Dr. Carrie (51:43.66)

Yeah, and sometimes that snip doesn’t manifest, right? Sometimes, you know, even when we talked about methylation, the big snip there is called COMT, catechol-O-methyltransferase. And sometimes people go, I have that, or they’ll, know, MTHFR, methyl tetrahydrofolate reductase, which plays a role, and they’ll freak out, but it’s not manifesting at all. They’ll get the results back, and I’m like, your results look great. It’s not showing up for you. Don’t panic, it’s okay.

Inna Topiler CNS MS (51:45.967)

Right.

Inna Topiler CNS MS (52:07.698)

Yeah, yeah, exactly. Okay, how can people connect with you? How can people learn more? Because I think they’re excited about all the information, but they’re gonna want more. So where can people find you?

Dr. Carrie (52:17.838)

Mm-hmm.

Absolutely. I love it. If you go to my website, drkaryjones.com, I actually have a free ebook all about estrogen detoxification where I explain it, break it down. So if you need it in written form, that may be helpful. So drkaryjones.com slash estrogen detox. I am on Instagram at dr.karyjones. I’m on YouTube at drkaryjones. And then I have a podcast, Hello Hormones with Dr. Kary Jones. Basically, if you search my name, you’ll find me.

Inna Topiler CNS MS (52:42.276)

Inna Topiler CNS MS (52:49.522)

And we’ll put everything in the show notes. Thank you so much for being here and for sharing all of this with us. I think it’s such important information that people are just not getting elsewhere. So thank you, thank you for all of this. Yeah. I look forward to staying connected.

Dr. Carrie (52:49.705)

Because everything is that

Dr. Carrie (53:03.534)

Thank you. I appreciate it too.

Likewise.

Inna Topiler CNS MS (00:01.432)

There’s a lot here, isn’t there? And I know we went a little heavy on the science in this episode, but I know that you want to know this information and I know you want to understand it. And I know that you want to be your own health advocate, which is why I wanted you to have this general sense of what happens, and even more so for you to understand not just what happens, but all of the different things that you can do and how much control you actually have. I really think that that is so empowering. And if you know someone that can use this information.

Can you please share this episode with them? And be sure, of course, that you’re subscribed to the show so that you never miss a health and thyroid mystery. And if you’re enjoying this episode or any of our other episodes, can you please rate and review the podcast? I would appreciate that so much. And that really helps the podcast because it helps the podcasts to go up in the ranks. And then more people can discover it and more people can see that they also can be in control. And there’s so much that they can do.

about their thyroid, about their immune system and health overall. And remember, no matter what you are dealing with, the answers are out there and there is hope. I’m Ina Toppler. Thank you so much for listening and I will see next time on thyroid mystery solved, Hashimoto’s and hypothyroidism revealed.