Everything you should know about DIM and estrogen

Written By Sasha Bruno, LAc

As a Licensed Acupuncturist, women’s health is at the forefront of most of the cases I see in clinic. Whether it’s fertility issues, PMS, anxiety, depression, hormonal acne, hormonal migraines, peri-menopause, menopause, thyroid issues, or chronic fatigue, there seems to always be a connection to estrogen. But do we really understand estrogen? Do we know it can be so beneficial, yet also so harmful? Let’s talk about it, along with a deep dive into DIM.

About estrogen

Estrogen occurs in 3 major forms:

  1. Estradiol

  2. Estrone

  3. Estriol

Estradiol is most common in women of childbearing age/reproductive years. Estriol is produced by the placenta during pregnancy. Estrone is the only hormone your body produces after menopause (when you no longer get your period). These 3 forms of estrogen are naturally occurring in our body, produced by our ovaries and other organs. The liver then metabolizes the estrogen into metabolites, which is when things can become ‘good’ or ‘bad’ depending on the health of your liver.

This is why conditions of estrogen dominance, early menopause, PMS, heavy/painful periods, hormonal acne, and more evolve over time - the bad estrogen metabolites are outweighing the good estrogen metabolites. Acupuncture and Chinese Medicine is so helpful in helping the body detox, improving the Qi of the Liver to provide better support for natural detoxification of the body, and in regulating hormones.

What is good and bad estrogen?

Estrogen is a hormone produced primarily by the ovaries and secondarily by other organs in the body. It is then metabolized by the liver through three different pathways and then converted into estrogen metabolites: 16-alpha-hydroxyestrone, 4-hydroxyestrone and 2-hydroxyestrone. When estrogen is metabolized through the 2-hydroxy pathway, your body produces beneficial estrogen metabolites that support healthy mood, libido, breast tissue, and reproductive health. When your body converts estrogen using the 16-hydroxy and 4-hydroxy pathways, you experience estrogen dominant symptoms, such as irritability, vaginal dryness, and PMS. You are even at a higher risk of developing hormone related cancers, like breast cancer, down the road.

Therefore, the resulting estrogen metabolites from the 2-hydroxy metabolic pathway are considered ‘good’ since they yield the lowest risk for cancer and other imbalances. Meanwhile, the resulting metabolites from the 16-hydroxy and 4-hydroxy pathways are considered ‘bad’ because of their contribution to the high risk of breast cancer and other imbalances.

So it’s not about your total estrogens, it’s about your total estrogen metabolites. Nutrition, toxins, genetics, liver health, stress, diet, and sleep all determine which metabolic pathways are used. Since 16-hydroxy (the bad estrogen) is an unregulated form of estrogen prone to behave like “super-estrogen,” higher levels create a particularly unhealthy form of estrogen dominance. 16-hydroxy estrogens can result in mutations, abnormal growth (as in cervical dysplasia), and an increased risk of future breast cancer (see resources section below for links to this information).

Remember: bad estrogens are 16-alpha-hydroxyestrone and 4-hydroxyestrone, good estrogen is 2-hydroxyestrone

Levels of 16-alphy-hydroxy-estrone (16-OHE1), the “bad” estrogen, are elevated in women and research animals with breast cancer. Newer research takes it a step further, pointing out that it’s not the individual levels that matter — rather, it’s the ratio of good estrogen to bad estrogen. If your estrogen metabolism favors 2-OHE1, you’re less likely to experience the negative effects of estrogen, including pre-menopausal and post-menopausal breast cancer.

Although 4-hydroxyestrone (4-OHE1) gets far less research attention in estrogen studies, the research that is out there confirms it as a cancer-causing estrogen. It deserves more scrutiny for its influence on cancer because of its ability to alter DNA without even hooking up to an estrogen receptor. These estrogen metabolites are the ones responsible for all of the problems you may attribute to estrogen, including PMS, fibroids, endometriosis, water retention, acne, low sex drive and more.

What is DIM?

Diindolylmethane (DIM) is a metabolite of a compound found in cruciferous vegetables including broccoli, cabbage, and cauliflower. DIM supplements help to restore the healthy balance of hormones, specifically estrogen, by promoting the balance of estrogen metabolites. It does this by mimicking the metabolic pathways of naturally occurring estrogen. The connection between DIM and estrogen is due to similar characteristics between them at the molecular level. The special metabolic pathway for DIM, and the enzymes involved, precisely overlaps with the pathway needed for healthy estrogen metabolism.

It is not actual estrogen, but just the active compound in broccoli that helps to detox the liver of bad estrogen metabolites while ‘rerouting’ the incoming estrogens being processed. This increases beneficial estrogen metabolites and detoxes harmful estrogen metabolites. DIM also blocks the enzyme aromatase, which is responsible for converting testosterone into estrogen. This helps prevent estrogen dominance and allows the ‘good’ estrogen to flourish.

Stated simply, supplementing your diet with a high quality DIM supplement can promote beneficial estrogen metabolism and help restore a healthy hormonal balance. DIM supports estrogen balance by increasing beneficial 2-hydroxy estrogens and detoxing/reducing the unwanted 16-hydroxy variety. This improves estrogen metabolism and helps resolve all forms of estrogen dominance.

Not into supplements? Try increasing your intake of cruciferous vegetables daily and exercise for at least 30 minutes 5 days a week. These alone can help your body detox bad estrogens and improve production of beneficial estrogen.

What helps with estrogen metabolism?

Acupuncture treatments in conjunction with daily exercise, increased vegetable intake, and potential supplementation can help balance hormones. For some, acupuncture and herbs may provide enough support. For others, DIM supplementation may be recommended as well. This can help with the following common conditions related to ‘estrogen dominance’, or imbalanced ‘good and bad’ estrogen metabolites, when treated as a detox:

  • Hormonal acne

  • Preventing negative effects of testosterone supplementation (mostly for males)

  • Estrogen dominance

  • Weight loss

  • Potential therapy for hormone related cancers

  • Thyroid disorders

  • Menopause/Perimenopause

  • PMS

  • Heavy periods

  • PCOS symptoms, such as facial hair growth, weight gain, or painful / irregular periods

These conditions typically result from an imbalance of good estrogens, bad estrogens, and testosterone. When you focus on balancing estrogen through lifestyle changes, supplementing with DIM and a liver detox supplement allows you to balance these hormones and the estrogen metabolites.

Studies also suggest DIM has anti-inflammatory, antiproliferative and chemopreventive effects, and may also help increase bone mass. Healthy levels of 2-hydroxyestrone (2-OHE1) are associated with:

  • Lower body fat and more muscle

  • Higher quality collagen in the skin and joints

  • Healthy bone density

  • Proper cholesterol levels (in animal models)

2-OHE1 also serves as a strong antioxidant, protecting the body from damaging free radicals.

What are the side effects of DIM?

DIM is generally well-tolerated with a few mild symptoms for a few days. Side effects of DIM may include:

  • Headache

  • Fatigue

  • Brain fog

  • Dark urine (orange to brownish)

The consensus is that darkened urine is harmless and will return to normal once you stop taking your DIM supplement. It is also a good sign that the DIM is working on your liver to neutralize estrogen metabolites and detox the bad estrogen.

The rest of the side effects of DIM are short-lived and resemble the effects of general detox symptoms — because that’s precisely what’s happening. DIM pulls excess estrogens out of your cells and sends them out into the bloodstream for elimination. That’s why it’s crucial to support your body’s detox and elimination systems while you’re taking DIM.

The liver is a main mode of estrogen breakdown, and when you’re using DIM to usher it out, your liver starts to work overtime. You can support your liver with glutathione, calcium d-glucarate, vitamin C, and liver support herbs like dandelion, burdock, yellow dock, and milk thistle. A supplement from your practitioner is best. I like the Pure Encapsulations DIM Detox or Xymogen’s Hormone Protect with the Pure Encapsulations Liver GI Detox supplement.

Here are some more helpful tips:

  • Use charcoal on rough days. Activated charcoal binds to excess estrogen to prevent it from creating havoc on your cells. Use it on particularly miserable initial detox days — not throughout the entire time you take DIM. Reason being, it also binds nutrients, and you want to get the most out of the healthy food you eat.

  • Exercise to engage your muscles and aid in strength while detoxing.

  • Drink plenty of clean water. Get a good filter, and drink way more water than you think you need. Frequent urination is a good thing while you’re detoxing.

  • Explore detox biohacks. Saunas, IV therapy, cryotherapy (no chamber needed, you can toss some ice in your bath or take a cold shower), and other detox methods will help things along.

How does DIM help prevent breast cancer?

Studies suggest DIM may lead to changes in estrogen metabolism in postmenopausal women with a history of early stage breast cancer, induced apoptosis in pancreatic cancer cells, inhibits CDK activities in colon and prostate cancer cells, alters estrogen urinary metabolite profiles in women (4) and has androgen-antagonistic effects. Here are some helpful studies to look into if you are curious about using DIM in the context of hormone related cancers, such as breast cancer:


Blog Post Resources

  • https://www.mskcc.org/cancer-care/integrative-medicine/herbs/diindolylmethane#:~:text=Diindolylmethane%20(DIM)%20is%20a%20metabolite,and%20prostate%20cancer%20(3).

  • https://annarborholistichealth.com/2015-4-21-dim-diindoly-methan-for-natural-protection-from-estrogens-effect/#:~:text=Taking%20DIM%20in%20an%20absorbable,three%20forms%20of%20estrogen%20dominance.

  • https://daveasprey.com/benefits-diindolylmethane-dim-supplement/

  • https://www.drprestonnd.com/blog/when-estrogen-becomes-a-problem#:~:text=Depending%20on%20the%20pathway%2C%20estrogen,higher%20risks%20of%20breast%20cancer.


Sasha Bruno, LAc https://www.nuwaveacupuncture.com
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