Dr. Amy Nett: So if you’re doing a complete hormone profile, like the DUTCH complete hormone profile, there is a marker there that looks at the conversion of 2-hydroxy-E1 or 2-hydroxyestrone to converted to 2-methoxy-estrone. So again, conversion of 2-hydroxy- to 2-methoxyestrone and that’s a COMT-dependent conversion. COMT is one of the genes that we talk about in the setting of methylation. There are a few different COMT genes.
So if I see an indication that there is low conversion of the 2-hydroxy- to 2-methoxyestrone, I’m going to think something’s going on with COMT; at least some steps in methylation are impaired. In that case I’m going to do two things. If I have a hormone panel, that means I also have blood work on a patient. So I’m going to look again as I just mentioned, look for anemia. What’s their hemoglobin, hematocrit, and what’s the mean corpuscular volume? Because if it’s in an MCV that’s large, maybe you know 94 to 97, I’ve seen an MCV of I think hundred in a vegan, then functional B12 or folate deficiency depending on finances, how interested someone is in testing, I may or may not just start some B12 and folate support at that point. Or I may run the HDRI functional methylation panels. So HDRI is a Health Diagnostics and Research Institute functional methylation panel, and that’s really the one we use to test functional methylation.
I believe it’s expensive, I mean all the tests are, but I think it’s like $400, something like that for their basic. And maybe $500 or $600 if you add on some of the other markers like nitrotyrosine, nitric oxide, and catalase. So have a discussion with people about the pros and cons of doing that test versus just starting some basic B vitamin support. I always prefer to test, but I also get the financial restrictions. So yeah, so that’s where I would start. Start with the blood work and consider an HDRI functional methylation panel.