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Endometriosis: A Nutritional Approach

by Judith Price(more info)

listed in women's health, originally published in issue 62 - March 2001

The endometrial tissues line the uterus and respond to hormones during the menstrual cycle. In endometriosis, the endometrial tissue is found where it should not be, outside the uterus, where it still responds to hormonal instructions, bleeding into areas where there is no escape for the blood. Adhesions may form, binding tissues and organs together. Nutrition can alleviate this painful condition.

'I recall long nights of pain and crying, glad for the companionship of the television. One time, I paced up and down the room weeping miserably, alternately rolling on the bed. The pain was breathtaking and I felt on the verge of hysteria. Then a hot flush swept through my body, overwhelming me with nausea. I pulled off all my clothes and lay naked on the cold stone floor of the bathroom, with my head hung over the rim of the toilet to be sick. Then I had diarrhoea. Feeling faint, I held onto the bathroom sink, afraid and desperate for reprieve, thinking, 'Please God, help me'. Then a cold chill came over me. I shivered, put my clothes back on and went back to my bed, trying to calm myself. Several times I visited the doctor and later, two gynaecologists, who all said, 'It's just the way you are made.' By the time I was thirty I felt cheated and angry that I had lost many opportunities and days of my life to misery, pain and exhaustion. As I got older, the pain became worse. I had constant exhaustion and severe PMS. Then my period started to come over 3 weeks! Eventually, a laparoscopy revealed I had endometriosis.

'I knew that when I ate well and took my multivitamin, I generally felt better. I reasoned that my problems were the result of an imbalance in my body that was being partly alleviated by my efforts. I got nutritional advice and began to follow a nutritional plan, eliminating certain foods like wheat, dairy and coffee, eating fresh organic food and taking supplements. I also gradually altered my lifestyle; I had more sleep, tried to avoid alcohol and to relax more and reduce my work commitments. Gradually, I regained my vitality and enthusiasm for life. My PMS became less severe, my period pain reduced in intensity and duration. Then I had the first pain-free period of my life. I feel healthier now than I did when I was nineteen and that my health is getting better all the time!'

Mary, Brighton

Endometriosis and What Causes It

Some of the symptoms experienced are painful periods, intercourse, urination and/or defecation; PMS; infertility; and alteration to cycles. Endometriosis is a condition that affects each sufferer differently. Whilst one has pain during her period, another woman may have it throughout the month. Sexual relationships can be difficult because of internal pain. There are also associated health challenges such as irritable bowel syndrome and infertility. Endometriosis affects personal life, social life and career.

The endometrial tissues line the uterus and respond to hormones during the menstrual cycle. The endometrium thickens ands swells with blood and then, if conception does not occur, is shed during the menstrual bleed. In endometriosis, the endometrial tissue is found where it should not be, outside the uterus, where it still responds to hormonal instructions, bleeding into areas where there is no escape for the blood. Adhesions may form, binding tissues and organs together. Areas where endometriosis has been found include the outside of the uterus, ovaries, cervix, bowel, bladder, urethra, and fallopian tubes and, rarely, the lungs, pancreas or nose.

There are several theories on why endometriosis happens. The theory of retrograde menstruation holds that the menstrual blood flows back up through the fallopian tubes and into the peritoneal cavity where the endometrial cells take root and grow. Another theory suggests that endometrial cells are carried in the blood or lymph circulation to other areas of the body. Whilst these theories may explain the transportation mechanism, they do not explain why even though all women have retrograde menstruation at some time, not all develop endometriosis.

Another more recent theory is that the immune system has failed in some way, allowing these rogue cells to grow where they should not instead of recognizing and removing them. Some commentators believe in a genetic predisposition because 7-10% of sufferers have a close relative with the condition.[1] However, many sufferers are the only one in the family with the condition.

Perhaps the connection is more due to shared environment than shared genes. Indeed, there is strong evidence linking endometriosis with immune system damage caused by the environmental pollutant dioxin.[2] A clear dose-response relationship was shown between low levels of dioxin in the diet and development of endometriosis in rhesus monkeys. The more dioxin, the worse the endometriosis, according to experiments conducted at the University of Wisconsin.[3] Most of our exposure to dioxin comes from food, the biggest source being meat and dairy produce.

A Nutritional and Functional Approach

The four stages of endometriosis

Each woman is unique and requires a specialized approach according to her individual biochemistry. She responds differently to her environment, may be more or less able to deal with toxicity, and digests and assimilates food differently. My approach is outlined in Figure 1, 2 and 3.

Figure 1 – Overall Approach to Endometriosis Treatment:
What needs to be removed?
Environmental toxins Heavy metals Infections
Organochlorines (dioxins, PCBs, etc): food and water. Personal, household and gardening products Mercury, cadmium, lead aluminium, etc: dental amalgam, smoking, car fumes, etc. Bacteria, fungi, parasites viruses, etc.
What needs to be added?
Nutritional Physical Psychological/Spiritual

Vitamins
Minerals
Essential fatty acids
Amino acids
Enzymes
Beneficial bacteria
Other accessory nutrients and herbal supplements
Homeopathic remedies

Movement
Muscle tone
Aerobic capacity
Breathing
Postural adjustment
Hypnosis/visualization
Healing
EFT
Psychotherapy
Other support appropriate to individual beliefs
Creativity and expression of self: singing, dancing, art, writing, etc.
Mental calmness, physical relaxation

Figure 2: Suggested Diet for Endometriosis

Dietary Plan
• All food to be fresh, organic, and thoroughly washed before preparation.

Completely avoid:
• Sugar, in whatever form, including honey and dried fruit;
• Salt and high-salt products such as bouillon;
• Dairy produce including all milk, cheese etc. – beware of sodium caseinate or whey in some packaged foods;
• Wheat and rye;
• Tea, coffee and alcohol;
• Fried food, margarine and hydrogenated fats;
• Soya milks and manufactured soya products; tofu, miso and tamari may be used in small amounts;
• Tinned and frozen packaged foods;
• Manufactured meat products, sausages, burgers, luncheon meat, etc.;
• Aspartame, saccharine, monosodium glutamate, food additives, chemicals, preservatives, nitrites, etc.; invest in a good book on e-numbers and take to the supermarket; find out about shopping at your local organic farm shop.

Eat more:
• Wholegrains, excluding wheat and rye, e.g. brown rice, millet, quinoa, etc.;
• Peas, beans and pulses;
• Seeds and nuts, but not peanuts;
• Vegetables: carrot, parsnip, swede, celeriac, celery, beetroot, cabbage, Brussels sprout, broccoli, cauliflower, radish, lettuce, onion, leek, garlic, chicory, fennel, watercress, sprouted seeds, green bean, cucumber, courgette, yam, sweet potato etc.; vegetables to be used in moderation are pepper, aubergine, tomato and potato;
• Fruit: apple, lemon, red and purple berries, apricots. etc.;
• Fish, especially oily fish.

Other guidelines:
• All meat, poultry and eggs to be organic. Meat may be included at 2-3 meals per week. Choose fresh or frozen lamb, poultry or game, organic, free from hormones or antibiotics. Avoid beef and pork meat and all offal. Avoid all cured and smoked meats. Up to six eggs are allowed each week according to individual tolerance.
• Drink eight glasses of filtered water each day (four pints).

Figure 3: Example Supplement Plan

Good quality multivitamin
Colloidal mineral supplement (without mercury, lead, etc)
Vitamin B complex 50mg (containing P5P, folic acid and cyanocobalamin)
Flax oil 2 tablespoons or equivalent capsules
1000mg magnesium
500mg calcium
100iu selenium
50mg zinc citrate
1-3 grams magnesium ascorbate
Echinacea tincture according to instructions
Freeze-dried garlic, one a day
Antioxidant complex (vitamins E and C, carotenes, curcuminoids, pycnogenol)
Evening primrose oil 500-1500mg
Acidophilus, one capsule twice a day between meals
Digestive enzymes with each meal (if no gastric distress or history of gastric illness or ulceration)
Siberian ginseng for unrelenting stress
Silymarin or HEP194 to support liver function

With endometriosis there are possible underlying problems that could be contributing to a worsening of symptoms. These include:

Compromised digestion. Absorption depends on the breakdown of food into small enough particles. This depends on hydrochloric acid and digestive enzyme secretions. I frequently find that clients are not producing these in adequate amounts and are suffering from malabsorption as a consequence;

Bacterial dysbiosis, candidiasis or other bacterial or parasitic infection. Dr William Crook in Yeast Connection and the Woman comments on the Candida and endometriosis connection.[4] A stool test is useful to identify organisms and to assess digestive ability;

Food allergy and intolerance. Foreign proteins that have crossed the gut barrier lead to chronic stimulation of the immune system, which can lead to severe depletion of the lymph system.[5] Severe period pain can stop once antagonistic foods are removed from the diet.[6] There are blood tests available that identify immune reactions to specific foods or an elimination diet can be followed;

Heavy metal and other toxicity from dental amalgams, and other exogenous and endogenous toxins. Root canals can turn a tooth into a toxin-producing factory and dead infected teeth generate dimethyl sulphide, a carcinogen.[7] A hair mineral analysis is useful as an indicator of heavy metal load as well as mineral levels. Chlorella, MSM, garlic, zinc, selenium and coriander will help shift heavy metals from the body;

Liver overload. The liver may be stressed by heavy demands from oestrogen conjugation, elimination of toxins or pain-killing medication;

Thyroid antibodies are higher in women with endometriosis.[1] In my experience, hypothyroidism is prevalent. Severe period pain, weight gain, hair loss, cold hands and feet, low blood pressure, slow heart rate and low body temperature may indicate low thyroid function;

Worries, anxiety and stress from areas of life that need addressing and resolving because these undermine immune function;

Studies have found that some cancers, diabetes, thyroid and autoimmune disease were higher in endometriosis sufferers and their families than in the general population.[8] This should be considered and preventive diet and lifestyle protocols adopted;

Deficiencies of vitamins, minerals, essential fatty acids and amino acids should be identified and restored.

Nutritional Guidelines

Endometriosis involves an immune system deficit. It is therefore important to identify all immunosuppressant factors including toxic chemicals, heavy metals, harmful organisms, intolerances/allergies, stress and inadequate nutrition.

Then the diet needs to provide the vitamins, minerals, fatty acids and amino acids that are required for body processes such as hormone and prostaglandin function and to ensure that food and supplements can be broken down and assimilated via a healthy digestive system. This begins with a healthy diet (see Figure 3).

Then the immune system needs support. Taking lactobacilli results in improved immune function and garlic and aloe vera juice both help enhance immunity as well as acting against Candida.[7] Essiac tea may also be beneficial.

Other useful nutrients for the immune system: zinc, quercetin, bromelain, cysteine, vitamins A, C, E and B complex, sambucol, ginger, dried and aged garlic, bee propolis, goldenseal, echinacea, astragalus, panax ginseng and dandelion leaf (see Figure 3).

Endometriosis sufferers have a lower T cell count.[9] Echinacea stimulates T cells,[7] and natural killer cell activity is increased by selenium, germanium and vitamin C. Proteolytic enzymes also elevate T cells.[7]

T cells are also reduced by stress and illness. I find that hypnosis and visualization are useful for illnesses of immunity. A good hypnotherapist will help her client to feel more positive, confident, calm and relaxed, all of which will help the immune system. This is well illustrated in David Calof's excellent book The Couple Who became Each Other.[10]

Table 1: Foods with a beneficial effect on the immune system
Onions (contain quercetin) Green tea
Garlic (raw or lightly cooked) Pineapple (contains bromelain)
Carrots (contain beta-carotene) Fermented foods: miso, tamari, sauerkraut
Live yoghurt Seeds: sesame, pumpkin etc
Home-made chicken soup (high in cysteine) Red/purple berries
Rhubarb Ginger
Dandelion Elderberry
Chilli Beans, peas, lentils

Hormonal Rebalancing

Without oestrogen, there is no endometriosis because it is oestrogen to which the cells respond. However, the endometriosis sufferer tends to have a problem with oestrogen dominance. This can produce the unpleasant symptoms associated with PMS including anxiety, irritability, breast tenderness, weight gain and feeling nauseous. Foods containing natural plant sterols can be helpful. They are thought to block the oestrogen receptors, but are too weak to exert a very strong hormonal effect. See Table 2.

Table 2: Phytosterols
Peas, beans and pulses Brassicas: cabbage, cauliflower etc
Red and purple berries Nuts and seeds such as sesame and flax
Wholegrains such as oat and rye (unless intolerant) Tofu, miso and other natural soy products in moderation
Garlic Celery
Apples Carrots
Potato Brown rice
Parsley Rhubarb
Fennel Sage

A high-fibre diet and plenty of water are helpful because the fibre absorbs oestrogen and it is removed from the body preventing reabsorption. Fibre from fresh vegetables, fruits, beans, pulses and wholegrains is the answer, not wheat-based fibre supplements. Psyllium and linseeds can form part of a bowel-cleansing programme in conjunction with beneficial bacteria and herbs such as goldenseal. Frequent exercise is also thought to lower oestrogen[11] as well as reducing body fat if overweight.

Cruciferous vegetables such as broccoli, cauliflower and Brussels sprouts, have substances that activate liver enzymes and help the liver detoxify chemicals.7 This allows the liver to eliminate excess oestrogen more effectively. Raw cabbage juice contains indoles that affect oestrogen metabolism and decrease harmful hormones by as much as 50%. Cruciferous vegetables along with onion and carrot also contain sulphorophanes that increase anticancer activity within the cell.[7]

Progesterone levels are likely to be low. Increasing progesterone alleviates PMS and luteal phase deficit. Progesterone is lowered by stress because it can be transformed into adrenal hormones when there are excessive stress demands on the body,[12] again another good reason to find mental harmony. Agnus castus and Life Enhancer are helpful along with B6 in the form of pyridoxal-5-phosphate.

The salivary hormone assay is a useful tool to discover hormone levels before designing a protocol to alter hormone levels.

Supporting the Inflammatory Cascade

By altering the fat content of the diet, prostaglandin balance can be altered and this leads to a reduction in symptoms of endometriosis and PMT. Series 1 and 3 prostaglandins are generally thought of as anti-inflammatory. Series 2 are considered pro-inflammatory and an excess of them can cause pain and uterine contractions. They may also contribute to luteal phase deficit leading to shortened cycles and PMT,[13] and they paralyse the natural killer cells of the immune system. Increasing omega 3 fatty acids in the diet can reduce them, and thus immune function is enhanced, pain lessened, PMS alleviated and the natural length of the cycle restored.

Series 1 and 3 prostaglandins are increased when the beneficial fats from fish, flax, hemp, pumpkin, walnut, evening primrose and green leafy vegetables are consumed. Fish oils have been found to reduce endometrial implants in rabbits.[14] Meat, dairy and eggs promote the pro-inflammatory prostaglandins and should be restricted. Some clients are very sensitive to these and may have to avoid them altogether. A client reported her mid-period spotting stopped when she removed dairy from her diet. Avoid margarine, fried food, saturated fat, refined fats and oils (usually labelled 'pure'), and any fat that is hydrogenated or partially hydrogenated. Opt for extra virgin or cold pressed oils. Use olive for cooking because the other oils mentioned are too fragile and will be damaged by heat and lose their beneficial effect.

Poor nutrition will undermine the synthesis of fatty acids. For example, vitamins B6, B3 and C, magnesium, zinc and biotin are needed are needed for the conversion of fats to prostaglandins. Stress, saturated fats, trans fats, alcohol, smoking and sugar also affect this process adversely.

Integrity of cell membranes depends on essential fatty acids. It may be that endometrial cells can only attach to compromised tissue and that a strong cell membrane may prevent them from taking root. Having a strong cell membrane also helps protect the cell contents from harm such as free radical damage.

Free radicals are thought to be one of the causes of autoimmune disease and might be a contributing factor in endometriosis. Free radicals are destructive molecule that comes from UV light, pollution, illness and smoking. To quench these we need an appropriate level of antioxidants from vitamins A, C, E, selenium, super oxide dismutase, glutathione, CoQ10, vitamin B complex, and flavonoids, especially proanthocyanidins.

A nutritional programme to control pain should include fish or flax oil, evening primrose oil, vitamins C, E, K and B complex, zinc, selenium, magnesium, calcium, bioflavonoids and digestive enzymes. Fresh ginger tea is also effective against pain. Liquidize a two-inch piece, then pour boiling water over and leave to steep. Strain and add hot water to taste and a slice of lemon. Enterically-coated capsaicin tablets are also helpful if taken several days prior to the onset of the pain.

Water

I believe that one of the most important and overlooked contributions to good health is drinking adequate water. People are dehydrated because of central heating, dehydrated food, lack of fresh produce and diuretics like tea and coffee. Many people do not drink plain water at all. Water is required for the transportation of substances in the body, as well as the collection and elimination of toxins and debris. The policing by the immune system, via the blood, lymph and tissue fluids, relies on adequate hydration. I advise clients to drink eight glasses of filtered water each day. The water filter I use removes organophosphates, nitrates, fluoride, bacteria, heavy metals and other contaminants.

Case Studies

Case Study 1

Angela had severe period pain for four days every month, which meant she was unable to work, as well as fatigue that lasted through the month, becoming especially severe premenstrually. PMS took up two weeks, and then it took her a week to recover from the period by which time she was premenstrual again. She was taking a maximum dose of two prescribed painkillers; often they did not work and she felt these were making her recovery longer and affecting her liver. After following a diet and supplement plan for a month as well as bowel-cleansing, she felt much better and had more energy. She found it hard to avoid certain foods like wheat and milk but noticed that she felt better without them. Her period pain became less severe and the blood less clotted and dark and more red and free flowing. She stopped taking one of the painkillers and reduced the other considerably. Her energy level improved and her PMS gradually phased out. When she stopped smoking her health took a noticeable leap forward, especially her vitality. She continues to get healthier and just takes an occasional painkiller on the first day of her period.

Case Study 2

Surayah had greatly improved after reading and following a PMS diet book and taking supplements, but she still had severe period pain, constipation and fatigue. A stool test revealed she had some yeast and no lactobacilli were detected. Her hair analysis showed high levels of mercury. She followed an antifungal programme and I referred her to a competent dentist for mercury amalgam removal. An electrodermal skin test revealed benzene toxicity and an appropriate homeopathic remedy was made. During the year, she also had reflexology, hypnotherapy and healing and each month was slowly but noticeably getting better. She feels that everything she has done has played a part, but felt noticeably improved after amalgam removal, homeopathy and removing foods to which she was intolerant.

References

1. Mears Joe. Endometriosis: A Natural Approach. Ulysses Press. pp19-20. 1998.
2. McTaggart Lynne. Guide to Women's Health. What Doctors Don't Tell You. p33. 1995.
3. Rier Sherry E et al. Endometriosis in rhesus monkeys (Macaca mulatta) following chronic exposure to 2,3,7,8-tetrachlorodibenzo-P-dioxin. Fundamental and Applied Toxicology. 21: 433-41. 1993.
4. Crook William. Yeast Connection and the Woman. Jackson TN Professional Books. 1996.
5. Diamond W John, Cowden W Lee and Goldberg Burton. Alternative Medicine Definitive Guide to Cancer. Future Medicine Publishing Ltd. p591. 1997.
6. Mackarness Richard. Not All In The Mind. Thorsons. p88. 1994.
7. Moss Ralph W. Cancer Therapy: The Independent Consumers Guide to Non-toxic Treatment & Prevention. Equinox Press. 1996.
8. Hornstein H et al. Association between endometriosis, dysplastic nevi and history of melanoma in women of reproductive age. Human Reproduction. 12: 143-45. 1997.
9. Null Gary. Womens Encyclopaedia of Natural Healing. Seven Stones Press. p149. 1996.
10. David Calof. The Couple Who Became Each Other. Bantam. 1998.
11. Glenville Marilyn. Natural Alternatives to HRT. Kyle Cathie Ltd. p125. 1997.
12. Corsello Serafina. The Ageless Woman. Corsello Communications Ltd. p159. 1999.
13. Shannon Marilyn M. Fertility Cycles & Nutrition. CCL Inc. 1996.
14. Shepperson Mills Dian and Vernon Michael. Endometriosis: A Key to Healing Through Nutrition. Element. p56. 1999.

Comments:

  1. Lorna said..

    What is the Good quality multivitamin?


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About Judith Price

Judith Price R Cert NC, ITEC, RIPHH (Hons) trained in Nutrition at the Raworth Centre and Guildford College. She is a registered Foresight Preconception Clinician, and a qualified hypnotherapist, believing that the body and the mind need to be in balance before healing can be fully achieved. She can be reached on Tel: 01424 436587 jude@bodymind.org.uk

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