Thank you for your question about DIM and testosterone metabolism and PCOS.
In women with Hirsutism related to PCOS, there is a link pointing to excessive androgenic hormones. PCOS is associated with enhanced androgen and cortisol metabolite excretion and increased 5 alpha-reductase activity that cannot be explained by obesity alone.
Increased adrenal corticosteroid production represents an important pathogenic pathway in PCOS too. These androgenic hormones include testosterone, androstenedione, and DHEA. Testosterone present in excessive levels, as found in some women with PCOS, is converted to the much stronger dihydrotestosterone (DHT) by the enzyme 5 alpha-reductase.
A study performed in 2009 by the Centre for Endocrinology, Diabetes & Metabolism, at the University of Birmingham, UK, found that both obese and normal weight women with PCOS had higher levels of 5 alpha-reductase than women with the same BMI’s that do not have PCOS: http://www.ncbi.nlm.nih.gov/pubmed/19567518.
The study shows that women with PCOS have the ability to convert testosterone to DHT more easily than women who do not have PCOS. This creates excessive levels of DHT in women with PCOS. This is why women with PCOS often have hirsutism and DHT is thought to be responsible for male pattern baldness in men, but also thinning hair in women. This may also cause excessive hair growth in unwanted areas in women, especially on the face. DIM suppresses cell proliferation of LNCaP cells and inhibits dihydrotestosterone (DHT) stimulation of DNA synthesis: http://www.ncbi.nlm.nih.gov/pubmed/12665522.
Interestingly, Antony did have a case where DIM resolved a lady’s facial hair completely in a relatively short period of time (one month) which supports the potential role that DIM may have on testosterone metabolism!
Diindolylmethane (DIM) is a natural compound formed during the autolytic breakdown of glucobrassicin present in food plants of the Brassica genus, including broccoli, cabbage, Brussels sprouts, cauliflower and kale. The autolytic breakdown of glucobrassicin requires the catalytic reaction of the enzyme myrosinase which is endogenous to these plants and released upon rupture of the cell wall.
Information about DIM® – http://tinyurl.com/3xv4ycm
DIM® (Enhanced Delivery) (AR) is indicated in PMT where it is suspected that the balance of oestrogens is awry (i.e. too many unfavourable 16-OH oestrones) and there is good clinical evidence of improvements in women with PMT.
DIM® helps to improve the metabolism of improves the metabolism of oestrogens promoting more of the protective 2-OH oestrone and less of the 16-OH oestrone.
Cruciferous vegetable phytonutrients include natural substances whose supplemental use has great potential for the prevention of human cancer. The additional discovery that the cruciferous indoles, diindolylmethane (DIM®), also promote healthy estrogen metabolism has expanded their usefulness as dietary supplements for many estrogen-related conditions. Beyond cancer prevention, effective uses of absorbable DIM® have included benefits for perimenopausal women, in premenstrual syndrome (PMS), in endometriosis, and in cervical dysplasia. Also benefited from supplementation are women on estrogen replacement (HRT), as well as men with estrogen-related conditions including prostate hypertrophy.
Benefits of Diindolylmethane (DIM®)
• Cancer-preventive phytonutrient
• Reduce prostate cancer by half
• Reduces risk of breast cancer
• Causes the regression and disappearance of advanced cervical dysplasia (e.g. abnormal smear test) – DIM has improved cervical health as documented by normalised Pap Smears.
• Reduce symptoms of peri-menopause including depressed mood, loss of libido, and weight gain.
• Reduces hot flushes
• Reduces PMT
• DIM has been associated with improvement in premenstrual breast pain
• DIM has been associated with a resolution of breast cysts
• DIM can reduce menstrual pain
• DIM can benefit some women with PCOS by improving estrogen metabolism.
• In both women and men, facilitated weight loss has been noted on lower carbohydrate diets at higher doses of absorbable DIM.
• Protects male prostate against accumulation of estrogens, associated with aging
• Improves functioning of prostate
• Very safe for long term use
Actions of Diindolylmethane (DIM®)
• Promotes beneficial shift in estrogen metabolism: to reliably increase the 2-hydroxylation of estrogen, increasing the 2/16 ratio of estrogen metabolites. This ratio (also known as the “good to bad” balance of estrogen) has now been shown to be a predictor of future breast cancer in a prospective study of 5,000 Italian women.
• The 2-hydroxylation of estrogen which is associated with a cancer-resistant estrogen metabolism.
• DIM supports testosterone and progesterone levels.
• DIM can predictably and safely increase 2-hydroxy estrogen metabolites. These unique estrogen metabolites stimulate progesterone production, and compete with testosterone for protein binding. This helps to maintain testosterone in its active, free form, specifically shown to be support healthy mood and libido in women with PMS.
• It is well documented that estrogen accumulates in the prostate gland starting at age 50, and that estrogen is associated with the degree of prostate enlargement. Using DIM in men avoids accelerating testosterone metabolism, especially regarding unwanted conversion of testosterone into estrogen. Supplementation with absorbable DIM has resulted in reports of improved prostate function based on reduced nighttime urination in symptomatic older men.
• The use of this patented formulation of DIM effectively provides an absorbable amount of DIM equal to or above that found in two pounds of raw cabbage.
Contraindication: Due to the theoretical potential for DIM to improve synthetic and natural estrogen metabolism and detoxification, it is advised for women taking the contraceptive pill, NOT to take DIM, since it may reduce the efficacy of the contraceptive.
DIM offers improved benefits to isoflavones, red clover, black cohosh
While phytoestrogens (SORMs – selective oestrogen receptor modulators) like the isoflavones found in soy and those found in red clover and black cohosh can be used in conjunction with DIM, they do not offer the same advantage in terms of beneficial modulation of oestrogen action seen with DIM.
There is also a product called DIM Palmetto Prostate Formula (AR) which combines DIM with Saw Palmetto and nutrients to support testosterone metabolism. Research suggests that supplementation with saw palmetto may prove useful in preventing and managing hair loss through the inhibition of the conversion of testosterone to DHT via the 5-alpha-reductase enzyme also. http://www.ncbi.nlm.nih.gov/pubmed/12006122
In clinical practice, we have found using extract of Saw Palmetto (serenoa repens) can prove to be the deciding factor in resolving acne for many women. It’s role in inhibiting the conversion of testosterone to DHT in the skin can be vital. The combination of DIM with Saw Palmetto in the product DIM Palmetto Prostate Formula (AR) has been the single most helpful supplement in addressing acne in many of our patients compared to any other product.
I hope this helps with your patient
Registered Nutritional Therapist Helen Perks is collaborating with Clinical Education to bring you the first-ever Functional Medicine book club for Practitioners.
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