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
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.
- All food to be fresh, organic, and thoroughly washed before preparation.
- Sugar, in whatever form, including honey and dried fruit;
- Salt and high-salt products such as bouillon;
- Dairy products 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.
- 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.
- 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).
Supplement to Consider:
- Good quality multivitamin/mineral supplement (without mercury, lead, etc)
- Vitamin B complex 50mg (containing P5P, folic acid and cyanocobalamin)
- Flax oil 2/3 tablespoons or equivalent capsules
- l000mg 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.
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.
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.
Endometriosis sufferers have a lower T cell count. Echinacea stimulates T cells and natural killer cell activity is increased by selenium, germanium and vitamin C. Proteolytic enzymes also elevate T cells
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.
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 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. 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.
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, 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,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. 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.
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. We should drink a minimum of eight glasses of filtered water each day.