The gut microbiota and endometriosis: From pathogenesis to diagnosis and treatment: https://pmc.ncbi.nlm.nih.gov/articles/PMC9729346/

Estrogen dominance may lead to low progesterone levels – an imbalance between estrogen and progesterone. Progesteron is our “relaxing/chill pill” hormone. Balanced optimal levels means low levels of anxiety, calm mood, & better stress resilience due to interaction with GABA receptors.”

For estrogen dominance: Diindolylmethane (DIM) has shown to improve hormone health and metabolism by promoting the elimination of potentially harmful estrogen metabolites. (found in cruciferous vegetables)

Look at hormone and gut health since the estrobolome in the gut helps metabolizes estrogens (3).

Use DUTCH test to look at poor estrogen clearance, estrogen metabolism pathways (Phase I & II detox), estrogens (E1, E2, E3), estrogen metabolites (2-OH, 4-OH, 16-OH pathways), progesterone. Urine/saliva is more accurate than blood (serum) testing that is typically used in conventional medicine. Urine + saliva testing often give the clearest root-cause view.

All of the data that is shown above is put into dials which can seem overwhelming at first but should be read as a pathway that tells the functional practitioner how your hormones are metabolizing. In the middle of the graph, you will see the three phases of estrogen metabolism or estrogen detoxification. Phase 1 metabolism is shown above as 2-OH-E1 (low) , 4-OH-E1 (in range), and 16-OH-E1 (high). Deficiency in certain nutrients will lead to insufficient phase 2 of the estrogen detox phase or insufficient methylation of the estrogen metabolites (Phase 2 Metabolism) as seen towards the bottom left of the page. (2-Methoxy-E1 + COMT enzyme)

If you would like to further evaluate Phase 3 of estrogen detoxification, looking at stool testing using the GI-MAP stool test is necessary to evaluate the gut microbiome. You would need to look specifically towards the intestinal health markers page at GI Markers: β-Glucuronidase. Your functional practitioner will recommend dietary changes as well as targeted supplementation to help modulate these three pathways. (Phase one, two, and three of estrogen detox)

Use the GI-MAP to assess GI-MAP Stool Test: GI Markers:

β-Glucuronidase: elevated levels associated with gut dysbiosis (an imbalance in the gut microbiome), estrogen dominance, or poor detoxification.

High beta-glucuronidase levels can lead to estrogen being reabsorbed instead of eliminated → worsens estrogen dominance.

Support liver health: prioritize liver support since it helps detox and eliminate excess estrogen via the Phase 1 and Phase 2 liver detox pathways. This is to prevent estrogen recirculating.

Functional nutrition protocol: find the various root causes and nip the endo once and for all so no more surgeries and most importantly no more pain. Endo often linked with infertility.

Sluggish Phase 1/2 liver detox impairs hormone clearance & contributes to estrogen dominance + PMS symptoms.

• Reduce exposure to xenoestrogens (BPA, phthalates, plastic use)
• Increase dietary fiber and lignans (e.g., flax, leafy greens)
• Eat 2 tbsp ground flax daily
• Consume cruciferous vegetables or take DIM
• Maintain healthy body fat percentage
• Support insulin sensitivity (movement, blood sugar regulation)
• Incorporate omega-3s (EPA/DHA)
• Use phytoestrogens (e.g., flax, sesame, soy in moderation)
• Avoid excessive alcohol intake
• Ensure daily bowel movements
• Support liver detox with B vitamins, magnesium, and glutathione
• Explore supplements that lower aromatase (e.g., green tea, citrus flavones)

Understanding the phases of detoxification and how to support them using food, lifestyle, and supplementation.

There are 2 main phases of detoxification that happen mainly in the liver as well as the gut mucosa (+other places):

Phase 1 Detox (Liver)

Cytochrome p450 enzymes are the 1st place detox occurs. Cytochrome P450 enzymes oxidize/reduce compounds to make them more water soluble for kidney excretion.

Phase 2 Detox (Conjugation)

Toxic metabolites from Phase 1 are conjugated/attached with other molecules to reduce toxicity and prepare for elimination. Metabolites start attaching to any toxic molecules that come out of phase 1 to make them less toxic so they can be eliminated safely.

Phase 3 Detox (Excretion)

Involves active transport systems that that can pump certain toxins out of the cytoplasm of the cell.

Key Genes

• Cytochrome P450 SNPs: gives insight into how well the body detoxes things in the liver.
• NRF2 pathway: tumeric, coffee, & green tea can enhance this pathway. This genetic pathway is amplified by oxidative stress (like when you exercise). The body produces more antioxidants to combat the free radicals during exercise.

Key Labs

• D-glucaric acid (Phase 1 marker): high levels = potential phase 1 issues. If levels are high, prob an issue with the phase 1 pathway.
• Mercapturic acids (Phase 2 marker): high levels = potential phase 2 issues. Mercapturic acids: breakdown product of glutathione. If levels are high, prob an issue with phase 2 pathway.

Action Steps

• Regular exercise and sweating helps support elimination
• Avoid carcinogens
• Daily BMs (magnesium + water)
• Sauna/steam use can increase sweating
• Adequate fiber intake (30g+) (soluble + insoluble)
• Legumes (beans) & fermented foods to support the gut microbiome

Supportive Foods

Consume foods that support biotransformation: cabbage, broccoli, kale, brussels (1-2c per day), garlic, vegetable juices (not too much fruit), herbal teas, burdock, dandelion, ginger, licorice

• Cruciferous veggies (broccoli, kale, brussels (1-2c per day), cabbage)
• Vegetable juices (not too much fruit)
• Herbal teas (burdock, dandelion, ginger, licorice)
• Sulfur foods: egg, whey, garlic, onion, etc
• Turmeric: better absorbed with fats or in its natural food form (it contains essential oils that increase absorption) If supplementing turmeric — it should have essential oils, pepperine, black pepper extract, cyclodextrin to increase absorption.
• Chlorophyll from dark leafy vegetables (Chlorophyll-rich leafy greens)

Targeted Supplements

• Vitamin C (1–4g/day)
• Milk thistle: (600mg silymarin – active ingredient in milk thistle) — protects the liver
• B-vitamins to help with detox
• Liposomal glutathione (master antioxidant: precursor to NAC)
• Folate (active/reduced form – methylfolate)
• Omega-3s
• NAC (500mg–1g/day)
• Alpha-lipoic acid
• Bioflavonoids: quercetin, rutin, hesperidin. Plant-based compounds like quercetin (found in apples and onions), rutin (found in buckwheat and citrus fruits), and hesperidin (found in citrus fruits).

Toxins to Excrete (Carcinogens)

• Glyphosate
• Xenoestrogens (endocrine disrupters)
• Mycotoxins
• Pesticides/Herbicides (foods sprayed with)
• Heavy metals

Dietary Trends

Nutrient density in the foods have been reduced: english spinach > baby spinach. We have bred much of the bitterness out of our foods, but the bitter taste comes from phytochemicals that are needed for proper biotransformation of toxins for excretion! Reduced phytochemicals due to breeding out bitterness (e.g., baby spinach vs. English spinach)

Low plant food diversity: we are eating less diversity of plant foods.

Energy-dense but nutrient-poor diets: we are eating energy-dense foods but not nutrient-dense foods.

Referrals: