Dr Ann Hathaway, MD has been successfully treating women and men with bioidentical hormones and other natural remedies since 1995. She is a member of the prestigious Institute for Functional Medicine and is a director of the Orthomolecular Health Medicine Board.

Tommy and I met Dr Hathaway at the Buck Institute for Research on Aging where she presented this excellent and incredibly well-referenced talk on the role of oestradiol in cognition for women.

Dr Hathaway is primarily using blood testing to assess hormone levels. However, urinary metabolites can be very helpful for mapping out the oestrogens. At around the twenty-minute mark, this interview gets quite technical, and I think you'll find it useful to look at this section of a DUTCH report while listening to the audio. Notice the enzyme names are written on the arrows indicating the direction of metabolism. The word "hydroxy" is abbreviated OH, so when you hear Ann say "four hydroxy E1," look for 4-OH-E1 on the map.

Here’s the outline of this interview with Dr Ann Hathaway, MD:

[00:01:35] Health problems not addressed well by the traditional system.

[00:03:13] A 1.5h first appointment in Functional Medicine is typical.

[00:04:25] Different types of practitioner.

[00:05:20] American Academy of Environmental Medicine.

[00:05:38] Jeffrey Bland, PhD.

[00:06:57] Buck Institute for Research on Aging.

[00:08:21] Principles for addressing hormone imbalance.

[00:09:41] Underlying root causes.

[00:10:40] Menopause and cognition.

[00:11:04] Oestradiol less than 20 pg/ml.

[00:13:11] The brain has oestradiol receptors.

[00:13:55] All of the neurotransmitter systems are favorably impacted by oestradiol. Acetylcholine, which is the neurotransmitter most associated with memory, serotonin, norepinephrine, dopamine. All are enhanced by oestradiol.

[00:14:30] Rasgon, Natalie L., et al. "Prospective randomized trial to assess effects of continuing hormone therapy on cerebral function in postmenopausal women at risk for dementia." PloS one 9.3 (2014): e89095.

[00:15:22] The odds ratio for women to develop Alzheimer's disease is 1.56.

[00:16:21] Balancing oestradiol with progesterone and other hormones.

[00:17:17] Endometrial hyperplasia which can turn into uterine cancer.

[00:17:32] Progesterone improves sleep

[00:18:27] Different types of testing.

[00:19:08] Never give oestrone.

[00:19:27] Metabolites of oestrogen (see the diagram above).

[00:21:13] Some of the things that you can do to increase the 2-hydroxy pathway are eating a high cruciferous diet, taking a supplement called diindolylmethane or indole-3-carbinol.

[00:21:32] Iodine sufficiency.

[00:21:39] Lignans in flaxseed.

[00:22:04] COMT enzyme and methylation.

[00:22:47] Genetic mutations.

[00:23:55] CYP1B1.

[00:24:14] Xenoestrogens.

[00:24:34] Eat organic!

[00:24:52] Pharmaceuticals.

[00:26:14] Glutathione. See Why You Should Manage Your Glutathione Status and How to Do It.

[00:26:34] Alpha lipoic acid.

[00:27:07] NutrEval and ION panel

[00:27:42] Eating a wide variety of veg

[00:28:52] Personal care products and makeup

[00:29:07] Environmental Working Group (EWG).

[00:30:01] The Women’s Health Initiative Study (WHI).

[00:31:21] Small differences matter in pharmacology.

[00:33:37] Oestradiol should only be used topically.

[00:34:19] Wharton, Whitney, et al. "Potential role of estrogen in the pathobiology and prevention of Alzheimer’s disease." American journal of translational research 1.2 (2009): 131-147.

[00:36:22] Oral oestrogen increases C-reactive protein and fibrinogen.

[00:38:28] Harman, S. M., et al. "KEEPS: the Kronos early estrogen prevention study." (2005): 3-12.

[00:44:08] APOE gene.

[00:45:05] What to do if you're taking something other than topical oestradiol.

[00:46:06] See Rasgon study linked above.

[00:46:46] Ann’s presentation at the Buck Institute: Bioidentical Hormones and Cognition.

[00:46:52] Ann Hathaway MD--Integrative Functional Medicine & Bio-identical Hormones

[00:47:06] This interview was recorded in January 2017, at that time Ann was scheduling new patients in April.