Beer Phytoestrogens

Why do alcoholic men develop so-called man boobs and other feminine traits? We know estrogens produce feminization, and our liver clears estrogens from the body. As such, the original theory was that alcohol-induced liver damage led to the retention of excess estrogens. The problem was that when researchers measured estrogen levels, they weren’t elevated. What’s more, even those with cirrhosis of the liver appeared to clear estrogens from the body normally, and men’s testicles started shrinking even before serious liver disease developed.

So, alternative explanations were considered. If it’s not due to estrogens produced endogenously, meaning within the body, maybe alcoholics are being exposed to “exogenous estrogenic substances from dietary sources”—perhaps from phytoestrogens in the plants that alcoholic beverages are made from. The discovery that plants could contain hormonal compounds was made back in 1951 by two Australian chemists charged with finding out the cause of an “epidemic of infertility in sheep that was ravaging their nation’s wool industry.” It took them ten years, but they finally figured out the cause: a compound called genistein, present in a type of clover, and the same phytoestrogen found in soybeans.

You can read about the dreaded clover disease on scare-mongering websites, but you’ll note they never talk about the difference in dose. To get as much as the sheep were getting from clover, you’d have to drink more than 1,000 cartons of soymilk a day or eat more than 8,000 soy burgers or about 800 pounds of tofu a day.

This is not to say you can’t overdo it. There are two case reports in the medical literature that describe feminizing effects associated with eating as few as 14 to 20 servings of soy foods a day. But at reasonable doses, or even considerably higher than the one or two servings a day Asian men eat, soy phytoestrogens do not exert feminizing effects on men.

So, back in 1951, we realized plant compounds could be estrogenic. Two German researchers realized that perhaps that’s why women who handle hops start menstruating, and, indeed, they found estrogenic activity in hops, which is the bittering agent used to make beer. They found trace amounts of the soy phytoestrogens, but in such tiny quantities that beer would not be expected to have an estrogenic effect. In 1999, however, a potent phytoestrogen called 8-prenylnaringenin was discovered in hops, which I discuss in my video The Most Potent Phytoestrogen Is in Beer. In fact, it’s the most potent phytoestrogen found to date, fifty times more potent than the genistein in soy, “provid[ing] an obvious explanation for the menstrual disturbances in female hop workers in the past.” Today, we have machines to pick our hops, so our only exposure is likely via beer consumption, but the levels in beer were found to be so low that they shouldn’t cause any concern.

Then in 2001, a study on a hops-containing “dietary supplement for breast enhancement” raised the concern that another phytoestrogen in hops called isoxanthohumol might be biotransformed by our liver into the more potent 8-PN, which would greatly augment the estrogenic effect of hops. This study was conducted on mice, though. Thankfully, a study using human estrogen receptors found no such liver transformation, so all seemed fine…until 2005. “[T] he liver is not the only transformation site inside the human body.” The human colon contains trillions of microorganisms with enormous metabolic potential. It’s like a whole separate organ within our body, with a hundred livers’ worth of metabolizing power. So, let’s effectively mix some beer with some poop and see what happens.

Indeed, up to a 90 percent conversion was achieved. Up to then, “the concentration of 8-PN in beer was considered too low to affect human health. However, these results show that the activity of the intestinal microbial community could more than 10-fold increase the exposure concentration.” This can explain why you can detect 8-PN in the urine of beer-drinkers for days: Their gut bacteria keep churning it out. Obviously, the amount of straight 8-PN in beer is not the only source of estrogen effects given this conversion. So, a decade ago, the question remained: Might drinking too much beer cause estrogenic effects and feminize men? See my video What Are the Effects of the Hops Phytoestrogen in Beer? for the update.


Other videos on phytoestrogen include:

What about GMO soy? See GMO Soy and Breast Cancer.

For menstrual health videos, see:

In health,
Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live, year-in-review presentations:

How to Lower Phthalate Exposure Through Diet

Phthalates are hormone-disrupting plastics chemicals linked to a number of adverse health effects, such as disturbing infant and child development, and, in adults, may affect reproductive health in men and endometriosis in women, and is associated with increased abdominal fat in both. “Given the increasing scientific evidence base linking phthalate exposure with harmful health outcomes, it is important to understand major sources of exposure,” which I discuss in my video What Diet Best Lowers Phthalate Exposure?.

What is the most major exposure source? Diet. If you have people stop eating for a few days, you get a significant drop in the amount of phthalates spilling out in their urine. One can only fast for so long, though. Thankfully, we can see similar drops just from eating a plant-based diet for a few days, which gives us a clue as to where most phthalates are found.

The highest levels are found in meats, fats, and dairy. Poultry consistently comes out as being the most contaminated across the board with some of the highest levels ever reported, though there are geographic exceptions. In the United Kingdom, for example, fish came out worse than poultry, and, in Belgium, nothing appears to beat out reindeer meat in terms of contamination. In the United States, though, it is poultry, and the finding that egg consumption is also significantly associated with phthalate levels “suggests that chickens themselves may be contaminated” and not just arise from the plastic they’re wrapped in at the store.

The same might not be true with dairy, however. Realizing that these chemicals may be harmful, researchers in Seattle took ten families and randomized them into a five-day complete dietary replacement with fresh organic foods without any packaging. Nothing touched plastic. Organic milk was delivered in glass, and even the crates used to carry the food were wooden instead of plastic. This was like a fasting study to see what role eliminating processed foods would have on lowering phthalate levels because not everyone wants to switch to a plant-based diet—or stop eating completely. In my video, I show a chart depicting where the families started at baseline before changing their diet and where they were a week after the experiment, once again back on their baseline diet. What happened in the middle? When eating fresh and organic food, their phthalate levels went up, “a dramatic and unexpected increase in one of the most toxic phthalates—and not just by a little: It was like a 2000 percent increase. So the researchers tested all the foods. One of the spices was off the chart, and so was the dairy. Most of the phthalates apparently don’t come from the cow, however; they come from the tubing. If you milk cows by hand (which even the Amish don’t do anymore) the levels of phthalates in the milk are low, but if the same cows are milked by machine, the milk picks up phthalates from the tubing. As such, the final levels may depend more on the tubing than on what the cows are fed.

We’re not sure where the chickens are getting contaminated with phthalates, though. While that study was done on adults, we learned more recently where our kids may be getting it. Researchers found pretty much the same thing: mostly meat, including poultry and fish. Again, poultry appeared to be the worst, while soy consumption was associated with significantly lower levels. But what kind of exposure are we talking about? Researchers calculated what may be typical exposures for infants, teens, and women. How do these data compare with current guidelines? The U.S. Environmental Protection Agency’s reference dose, which is like the maximum acceptable threshold, is 20 µg/kg-day, based on liver risk. Europe places their maximum daily intake for testicular toxicity at 50 µg/kg-day. So a typical infant diet exceeds the EPA’s safety level, “while a diet high in meat and dairy was over this threshold by approximately four times. For adolescents, a diet high in meat and dairy also exceeded the EPA’s reference dose.” Indeed, diets high in meat and dairy consumption resulted in a two-fold increase in exposure. And “[a]ll diets for all groups exceeded the allowable daily intakes (ADI) derived by the US Consumer Product Safety Commission” for problems with sperm production, while diets high in meat and dairy consumption may exceed the allowable intake for risk of reproductive birth defects as well.


For more information on dietary sources of phthalates, I encourage you to watch both Chicken Consumption and the Feminization of Male Genitalia and Lowering Dietary Antibiotic Intake. Diet isn’t the only way one can be exposed internally, though. See my video Avoiding Adult Exposure to Phthalates, which discusses the risk in both children’s and adult toys.

In health,
Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live, year-in-review presentations:

Reversing Massive Obesity With Diet

Dr. Walter Kempner introduced the first comprehensive dietary program to treat chronic kidney disease and, in doing so, also revolutionized the treatment of other disorders, including obesity. Kempner was Professor Emeritus of Medicine at Duke, where he came up with the so-called rice diet, which basically consisted of rice, sugar, fruit, and fruit juices, was extremely low in sodium and fat, and included no animal fat, no cholesterol, and no animal protein. The sugar was added as a source of calories so people wouldn’t lose too much weight. But some people need to lose weight, so he started treating obese patients with a lower calorie version of the diet, which I discuss in my Can Morbid Obesity Be Reversed Through Diet? video.

He published an analysis of 106 patients who each lost at least 100 pounds. Why 106? Kempner simply picked the last 100 people who lost more than 100 pounds, and, by the time he finished reviewing their charts, 6 more had joined the so-called century club. Average weight loss among them was 141 pounds. “This study demonstrates that massively obese persons can achieve marked weight reduction, even normalization of weight, without hospitalization, surgery, or pharmacologic intervention…[O]ne important fact to be gained from this study is that, despite the misconception to the contrary, massive obesity is not an uncorrectable malady. Weight loss can be achieved, massive obesity can be corrected, and it can be done without drastic intervention.”

Well, Kempner’s rice diet is pretty drastic, so definitely don’t try this at home. In fact, the rice diet is dangerous. It’s so restrictive that it may cause serious electrolyte imbalances, unless the patient is carefully medically supervised with frequent blood and urine lab testing. Dangerous? Says who? Said the world’s number-one advocate for the rice diet: Dr. Kempner himself.

The best, safe approximation of the diet, meaning low in sodium and without fat, protein, or cholesterol from animals, would be a vitamin B12-fortified diet centered around whole, unprocessed plant foods. However, even a medically supervised rice diet could be considered un-drastic compared to procedures like getting one’s internal organs stapled or rearranged, wiring someone’s jaws shut, or even undergoing brain surgery.

Attempts have been made to destroy the parts of the brain associated with the sensation of hunger, by irradiation or going in through the skull and burning them out. “It shows how ineffective most simpler forms of treatment are that anyone should think it reasonable to produce irreversible intracranial lesions in very obese patients.” The surgeons defended these procedures, however, explaining that their “justification in attempting the operation is, of course, the very poor results of conventional therapy in gross obesity, and the dark prognosis, mental and physical, of the uncorrected condition.” In reply, a critic countered, “Such strong feelings [about how dark the prognosis is] run the risk of being conveyed to the patient, to the effect of masking the operative dangers and steam-rolling the patient’s approval.” The surgeon replied, “If any ‘steamrolling’ is taking place, it comes rather from obese patients who sometimes threaten suicide unless they are accepted for experimental surgical treatment.”

As of 2013, the American Medical Association officially declared obesity a disease, by identifying the enormous humanitarian impact of obesity as requiring the medical care and attention of other diseases. Yet the way we treat diseases these days involves drugs and surgery. Anti-obesity drugs have been pulled from the market again and again after they started killing people—an unrelenting fall of the pharmacological treatment of obesity.

The same has happened with obesity surgeries. The procedure Kempner wrote about was discontinued because of the complication of causing irreversible cirrhosis of the liver. Current procedures include various reconfigurations of the digestive tract. Complications of surgery appear to occur in about 20 percent of patients, and nearly one in ten of which may be death. In one of the largest studies, 1.9 percent of patients died within a month of the surgery. “Even if surgery proves sustainably effective, the need to rely on the rearrangement of [our] anatomy as an alternative to better use of feet and forks [that is, diet and exercise] seems a societal travesty.”


For more on Kempner and his rice diet, see my videos:

Learn more on the surgical approach in Reversing Diabetes with Surgery and Stomach Stapling Kids.

And, for more on weight, see:

In health,
Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live, year-in-review presentations: