Читать книгу Endometriosis: A Key to Healing Through Nutrition - Michael Vernon - Страница 10

To be surprised, to wonder, is to begin to understand.

Jose Ortega y Gasset

The ovary is a complex organ that works on a cyclic pattern to secrete hormones and mature existing ova, ripening them ready for release at ovulation. They react to the monthly hormone cycle that is dependent upon the release of hormones in the brain – from the hypothalamus and pituitary glands. In most women, this cycle just continues normally month in and month out, year in and year out, from teen years to the early 50s. Puberty usually begins at around the age of 13 to 14. In the 19th century, this was around the age of 17 years. In modern Western society, the onset is becoming earlier and earlier – many girls appear to begin their menstruation at age 11 or 12. Occasionally even children aged four to five years begin precocious puberty.

Research reported in the Journal of Pediatrics in 1999 noted that girls with the highest prenatal polychlorinated biphenyl (PCB) – oestrogenic pesticide – exposure tended to hit the first stages of puberty a bit earlier than others. In one study, 15 per cent of white girls were showing outward signs of puberty (breast buds and pubic hair growth) by the age of eight. Other research shows that overweight girls tend to mature earlier while very underweight girls mature later.

Early development may be caused by a protein hormone called leptin, produced by fat cells and known to be necessary for the progression of puberty. It functions in a lipostatic pathway and mediates energy production. The presence of leptin reduces appetite and increases energy production. It is possible that leptin and insulin work in a way to balance one another. Those girls who are overweight also have more insulin circulating in their blood, and high levels of insulin stimulates the production of sex hormones from the ovary and adrenal glands. No one has looked at the effects of growth hormones fed to beef and dairy cattle and their breakdown in the human body, so their effects in this area are unknown. But some research suggests that the chemicals used in plastics, like phthalates and bisphenol A – ‘chemical cousins’ to oestrogen – can affect the reproductive systems in animal experiments.¹

Of course, such early development can bring endometriosis into the realm of adolescents. Already, one girl of 17 has reported to the author that she has undergone seven laser laparoscopies, and has been on the oral contraceptive pill once, and gonadotrophin-releasing hormone (GnRH) antagonists twice, to put her into a state of menopause, and had a Marina coil inserted – to no avail. A nine-year-old when operated on had her womb and ovaries stuck together with adhesions and active endometriotic implants, having begun her periods at the age of eight. We all have to find a less harsh approach than this for young girls.

There are four kinds of people in the world:

People who watch things happen,

People to whom things happen,

People who don’t know what is happening,

And people who make things happen.

Anon

For some women and young girls, the normal hormone balance becomes disrupted, and ovarian tissue responds by developing abnormally; cysts and tumours may form. This may also be due to chemicals that pollute our world. Cysts appear and disappear all the time. Normal physiological cysts, such as follicular cysts and luteal cysts, are the only ones that are meant to be present and are discussed in chapter 2. The follicular cyst appears from day 1 to day 14 to ripen the ova and release it into the Fallopian tube. The luteal cyst (corpus luteum) appears from day 15 to day 28 and produces progesterone to maintain any possible pregnancy. They are usually 1cm in diameter, appear and are reabsorbed monthly.

When the follicular cyst bursts and releases the ova, it may spew out a small amount of blood, which gives rise to some short sharp pains and inflammation for a few minutes in some women midcycle (known as Mittleschmertz); this is normal. But if the pain is extreme, then something is wrong, and anti-inflammatory agents are needed to reduce the pain and immune support to clear away the debris. If a luteal cyst grows abnormally, it may cause hormonal problems. The excess progesterone may cause an irregularity of the menstrual cycle and stimulate the endometrium, thus altering blood loss.

ABNORMAL CYSTS

Endometrial cysts begin when the follicle does not burst and release an ova, or maybe a corpus luteum fills with blood and continues to grow and fill as the monthly bleed continues, trapping endometrium tissue inside. Endometriomas lie within the ovary or may grow from their surface. They have a wall around them not unlike moss on a stone. The term ‘chocolate cyst’ comes from the stale brown blood that they contain. They may be removed by laser or by aspiration (rupturing with a long needle), but they have been known to return within a few days unless their core has been removed by ovarian resection. Large ones up to 45cm diameter have been known, though most are 4–9cm in size. Strangely, gynaecologists always liken their sizes to fruits such as grapefruit, tangerine, orange or plum. These cysts produce oestrogen and, as such, can ‘feed’ the development of endometriosis. Ovulation can still occur with smaller cysts, though it may be erratic in the presence of excess oestrogen. It has been suggested that the presence of endometriomas alters the ova and may disrupt fertility.

Polycystic ovary cysts, on the other hand, produce more androgen hormones, such as testosterone, and do disrupt ovulation (see pp).

Mucoid cysts are filled with clear mucus not unlike that of the nose, and can come and go within the ovary or be joined to it by a stalk. They are most often benign, but some can become malignant. They show up on scans as being full of dense matter and can grow alongside endometriomas.

Dermatoid cysts are bizarre, as they contain hair, nails and teeth. They can cause pain and need to be removed surgically. They are more unusual and develop if the cells that produce the ovum behave abnormally.²

When any of these cysts goes into torsion – where it twists on its stalk and cuts off the blood supply – great pain may be caused. Large cysts may also rupture, spewing out hot sticky blood or mucus all over the intestines. As bowel tissue is very sensitive and moves away if lightly touched during an operation, this shock of hot inflammatory blood causes the intestinal muscles to go into spasms.

The pain is so intense and terrifying that one wonders how the body can live through such pain. People who have not experienced this can have no idea of the severity of this pain. If we consider that most health professionals may have only ever experienced a severe toothache, it becomes understandable why they may have no idea of what we are talking about. Kidneystone pain may be the nearest agony the pelvic cavity can undergo. Often the body goes into shock and shakes violently, and there may be vomiting and cold sweats rather like standing under a waterfall. The immune system then has to work hard to clear up all the inflammatory debris that has been flung around the peritoneal cavity. Extra macrophages and polymorphs may be found in the fluid as they attempt to clear up the mess.

Some ovarian cysts are symptom-free and may only be found by chance on pelvic examination. Indeed, many women with endometriosis are asymptomatic and their cysts have only been discovered during an operation for sterilization. Sometimes women feel pain during intercourse, and the abdomen may become enlarged and uncomfortable if the cyst is large. The bladder may also be affected by the extra pressure, and urination may become more frequent. The vast majority of cysts are benign and the body is able to reabsorb those that are below 4–5cm in diameter (normal-sized). Larger cysts may require surgery to remove them, though they can recur within a few days in some cases.

New research suggests that cysts may be triggered by a variety of factors. Excess dairy foods, yoghurt and eggs are thought to be involved in cyst formation in some studies using Mormon women as controls. Another study found high copper levels when ovarian cysts are present. The latest research suggests an association with a high intake of refined carbohydrates and sugars. Research shows that B-complex vitamins aid the body in control of excess oestrogen, but excess sugars reduce their ability to work. Reduction of sugars and dairy foods, and an improved intake of B vitamin-rich foods, may help.

SYNDROME X OR INSULIN RESISTANCE

Syndrome X or insulin resistance is hidden and may be life-threatening. It affects body metabolism, and the evidence grows daily that many of us are inflicting it upon ourselves through chronic food intoxification. In the early stages it often goes unnoticed, the symptoms are silent and remain hidden – high blood pressure, raised levels of triglyceride fats in the blood, and insulin resistance (as the body struggles and acquires resistance to the insulin hormone, which normally enables the body to control glucose levels). Insulin is a hormone produced in the pancreas, an endocrine gland, and acts as a messenger between cells. It can affect the follicle of the ovary because it balances the effects of other hormones, including oestrogen, testosterone and glucose tolerance factor.

Insulin receptors are found in the ovaries, skin, brain, kidney and blood vessels. Insulin normally controls the enzymes involved in carbohydrate metabolism. It stimulates the storage of glucose in muscle and fat, and glycogen storage in the liver.

Insulin resistance is very complex. When extreme insulin reactions occur, it affects other steroid hormones. Too much insulin, and other hormones react badly; too little insulin, and hormones react poorly. The body always requires balance.

The liver holds the secret of syndrome X or insulin resistance. It deals with the products from digestion. Cell biochemistry research has shown that sugar can be as bad for the heart as saturated fats. The liver can flood the bloodstream with saturated fats as it deals with digestion. Since the 1960s, people have begun to shun the regular eating pattern of three meals a day and are now more likely to graze throughout the day. It is felt that this change in eating patterns may be why syndrome X is on the increase. Eating too frequently makes the liver continue to churn out digestive enzymes with no rest whereas eating three regular meals a day allows the liver a period of respite between each meal. Grazing or snacking all day long means that the overworked liver has to churn out fats, enzymes and hormones all the time. Every time we eat, the pancreas has to release insulin hormone into the bloodstream. Insulin encourages our body cells and organs to use up the glucose that surges through the bloodstream. Any glucose left in the blood for too long is dangerous as it sticks to proteins and leads to kidney damage or blindness. Insulin can also stop the liver from releasing excess fat. Excess fats in the bloodstream are dangerous as there they are altered biochemically and stick to the walls of the arteries, thus narrowing the blood channel. This can lead to heart attacks and strokes.³

Research suggests that when people munch on snacks – grazing throughout the day – instead of eating regular meals, the liver has to deal with insulin being around for long periods of time. This prevents the liver from withholding fats such as triglycerides and instead causes the opposite to happen. The liver releases an excess of triglycerides, which may lead to heart disease and other problems related to ovarian function. This excess of fatty triglycerides makes muscle cells insulin-resistant which, in turn, makes the liver secrete even more insulin. Even the fat cells, with all the extra triglycerides and glucose hurled at them to store, finally give in to insulin resistance. As the fat cells become overloaded, they push an excess of fatty acids into the bloodstream, and this overload kills off the important cells in the pancreas that produce insulin. What happens next is that insulin levels fall and glucose builds up in the blood to dangerous levels.⁴

As there is insufficient insulin left to maintain the normal balance of two teaspoons of glucose to eight pints of blood, type II adult-onset diabetes may then be diagnosed. (This may also be related to high dairy intake which, nutrition research suggests, may trigger an immune system reaction against cells in the pancreas.) If you eat a bar of chocolate containing eight teaspoons of sugar, the body has to react immediately to restore balance. The pancreas has to produce insulin and glucose tolerance factor in order to maintain normal blood sugar levels; doing this too often creates mayhem. The pancreas struggles to respond as sugar washes through the system. Eventually the pancreas cells reduce their response and are unable to cope with the demand, leaving these cells to die off.

How does this all relate to endometriosis and polycystic ovaries?

1 It affects liver function, and we need the liver to be extra efficient so that oestrogen is dealt with correctly and excreted from the body if in excess. If we eat too much sugar and saturated fats, we are tying up the liver to deal with sugar and triglycerides, leaving it too weary to balance oestrogen correctly.

2 Insulin affects ovarian function. The ovaries are very sensitive to insulin, as it has a steroidal action and makes the ovary produce an excess of the male hormone testosterone. This causes too many follicles to be stimulated, causing the ovary to have six or more follicles trying to ripen at any one time instead of the usual two or three. It may also have a relationship to the build up of ovarian ‘chocolate’ cysts.

POLYCYSTIC OVARY SYNDROME (PCOS)

Polycystic ovary syndrome is a common endocrine disorder affecting 5 to 10 per cent of women of reproductive age all around the world. Many women with endometriosis are also diagnosed with PCOS. Symptoms vary from irregular menstrual cycles with months in between, hirsutism, acne, frontal hair loss, skin tags and acanthosis nigrans (a velvet-like skin patch often found in the groin, neck, and under the breasts and arms). Weight accumulates on the stomach, thighs and hips. Though PCOS is independent of obesity, skinny and overweight women show signs of decreased insulin sensitivity. Obese women in general may exhibit insulin resistance. (Women with regular menstrual cycles do not show signs of insulin resistance.)⁵

In PCOS, hormone messengers from the pituitary gland to the ovary seem to be at abnormal levels, which in turn has a domino effect and creates havoc with the normal hormone balance. Lutenizing hormone (LH) levels are often abnormally raised, which stimulates the ovarian follicle, but the follicle is unable to mature fully as follicle-stimulating hormone (FSH) measurements are then at the wrong levels. High LH causes the ovarian follicle to produce more testosterone than is normal. This testosterone changes the oestrogen level and triggers menstrual dysfunction.⁶

These scrabbled hormones lead to the ovary’s ending up with many small cysts – having between six to ten cysts constitutes a diagnosis of PCOS. Some contain eggs, others are dormant and the rest may secrete hormones. Unlike endometriotic (chocolate) cysts, which may grow as large as a five-month-old fetus, these PCOS cysts remain small and do not grow (8mm in diameter is maximum). They appear, are reabsorbed and others come to take their place, all due to receiving the wrong hormonal messages.⁷

Some women with endometriosis also appear to develop PCOS, but not every woman. PCOS tends to run in families, with evidence suggesting that there may be a genetic link.⁸

• CASE STUDY •

Lou C of Buenos Aires, Argentina

I would like to express my utmost gratitude to you for all your help and advice regarding my PCOS. After years of being pushed from doctor to doctor with no real answers being given, I decided to turn my back on conventional medicine and focus on dietary change. I am now a firm believer that ‘you are what you eat’.

My symptoms started four years ago with hirsutism, weight gain, acne, severe mood swings, insomnia and depression, all of which pointed to PCOS. It took two years before I was diagnosed correctly. The only help offered was to go on the contraceptive pill Dianette. Purely by chance several years later, I saw a television programme on the Hale Clinic, offering alternative and complementary therapies. After my first consultation with you, it was clear that my condition could be greatly helped by dietary changes and food supplements. The main change in my diet was to reduce wheat products, avoid dairy products, eat less meat and drink less alcohol, and increase my intake of fish, vegetables and fruit.

The difference was amazing. Within two weeks, there was a noticeable 99 per cent improvement in all my symptoms. My husband said it was like having a new wife. My life has totally changed for the better and I feel like a totally new woman, full of energy and life. I am now nearly 99 per cent symptom-free – a change due completely to my new way of eating.

If you want something different for tomorrow, you have to do something different today! I cannot express my gratitude to you enough for all you have done for me. Many thanks!

PCOS AND ENDOMETRIOSIS

PCOS may or may not be found alongside endometriosis. With endometriosis, the link may be related to insulin resistance due to erratic hormone levels, liver dysfunction and poor food choice. When periods are erratic, and acne, hirsutism and weight gain are present, women may suffer from both conditions. Many sufferers of both PCOS and endometriosis may share the hyperinsulinism, high insulin secretion disorder. High insulin triggers the higher levels of testosterone and LH that give rise to these extra symptoms, and this can lead to anovulation, where the ovaries fail to produce a viable egg. It is the pituitary gland that produces growth hormone, stimulating the release of glucagons and insulin from the pancreas. This insulin acts on the outer layer of the ovary and stimulates the release of testosterone. The high testosterone then triggers high LH release from the pituitary. When the thyroid hormone thyroxine and the sex hormones oestrogen and progesterone do not work effectively, then blood sugar levels may rise. Severe shock may cause the pituitary and thyroid glands to function below par. Insulin is zinc dependent, and glucose tolerance factor (GTF), another hormone, depends upon chromium and vitamin B3. Both insulin and GTF are produced in the pancreas, an endocrine gland, and they work alongside other hormones in balancing the blood sugar levels in the body.

Insulin targets tissues to initiate the uptake of glucose and, of course, each cell requires glucose for energy production. Insulin binds to the cell’s insulin receptors and this triggers a cascade of events. The amino acid tyrosine is involved in this process. Tyrosine is vital to the formation of thyroxine – the hormone from the thyroid gland in the neck that controls metabolism and temperature. How much everything in the body is interlinked! Once the target cells have received sufficient insulin, they can take up glucose and produce energy, and we feel well. When insulin stimulates fat cells in PCOS women, the binding levels of insulin appear normal, but further down the line, the uptake of glucose into cells becomes impaired. Insulin resistance causes hyperinsulinism and hyperandrogenism in ways that are not yet fully understood. One may trigger the other. An excessive intake of refined carbohydrates is, however, the true culprit.

It is felt by researchers that insulin somehow interacts with LH, and this interaction causes the ovaries to increase production of androgen hormones such as testosterone. High insulin stimulates testosterone while low insulin decreases testosterone. Zinc balances testosterone levels along with vitamin E. Insulin-like growth factors (IGFs) in the ovary promote insulin-like metabolic effects. It is felt that insulin and LH may halt the maturation of the dominant follicle at 5–8mm. This, of course, makes the woman become anovulatory – there is no ovulation and egg release cannot occur, so no pregnancy can happen. Fertility is thus compromised in women with PCOS.

Another mechanism may occur in women with endometriosis who eat an excess of refined carbohydrates, and have poorly functioning liver and pancreas cells. We know that many of the drugs given to women with endometriosis can lead to liver enzyme problems so these levels should always be checked; the GP should always run blood hormone level and fasting glucose tolerance tests.

Once again, we come into the realm of tests that all GPs should be offering to women with reproductive disorders. At present, most women have to fight for adequate treatment when it should be de rigeur. The moral of the story is that, if you are trying to achieve a pregnancy, too many sugary and starchy foods are bad news for the ovary, and an excess may even prevent ovulation.

Orthodox treatments use the oral contraceptive Dianette tricyclically, but new research suggests that antidiabetic drugs, such as metformin, also help to reduce androgen levels. These work by reducing both insulin resistance and circulating insulin levels; they also lower androgen levels, which reduces the hirsutism and male pattern baldness. They regulate the menstrual cycle back to normal and support fertility. However, they do come with side effects, such as nausea, diarrhoea, appetite suppression and reduced uptake of vitamin B12.^{9, 10}

Obesity is thought to be related to insulin resistance and hyperinsulinism. Some 50 to 60 per cent of women with PCOS are overweight and weight loss in these women can be extremely difficult whatever they do. Conversely, 40 to 50 per cent of women with PCOS have a normal body build.¹¹

In classical PCOS, the woman is overweight with severe androgenism (hirsutism, male pattern baldness and acne). Insulin suppresses sex hormone binding globulin (SHBG) in the liver and gut, which leads to increased testosterone. Concentrations of SHBG are low and periods are wildly erratic, being months or years apart. These women may develop acanthosis nigrans. Other women with PCOS are of normal weight, often have regular menstrual cycles and very little androgenism. This may be a result of the beginnings of insulin resistance and not true PCOS, and will respond well to nutritional treatment.

Increased levels of leptin, the protein hormone produced in fat cells that reduces appetite, can trigger an increase in LH and FSH, a Japanese study has shown. The theory is that if leptin can be decreased, it will affect the receptors on mRNA which help to decrease body weight and improve reproduction. GALP (galanin), a peptide, can target the leptin and cause levels to decrease.¹²

PCOS may well be a genetic ‘strength’ that has developed over the ages in times of famine. A slow metabolic rate is very economical in its use of energy. In hunter–gatherer communities when food was scarce, extra abdominal fat was protective of fertility and survival. It may have developed as a step towards sustaining human survival. Researchers always refer to genetic PCOS as ‘the thrifty gene’.¹³ The higher androgen levels would have provided more strength to gather food, and subfertile periods would have prevented the birth of extra mouths to feed in times of famine.

The milder form of PCOS may be common, but the more severe form associated with obesity may be a reaction to triggers in the environment and heightened unnatural stressors. Extra abdominal fat seems to be related to higher levels of LH, oestrone and androstenedione, and also higher fasting glucose-stimulated insulin. Hirsutism appears to be worse when these hormones are higher. Research suggests that women who opt for a vegetarian diet rich in soluble fibre show lower levels of blood androgen hormones than those on normal Western diets. This is probably because soluble fibre is much better at binding to oestrogen and helping it be escorted from the body.

In endometriosis, it is essential to have any excess oestrogen removed efficiently from the body, so the choice of rich soluble-fibre foods is important. These include green leafy and red vegetables, fresh fruits and oats, with a selection of legumes, nuts and seeds. This is really only going back to a more Stone Age-type diet, one that is full of natural foods as opposed to preprepared and processed foods that contain hidden additives, colourings and preservatives which may, in combination, interfere with normal hormone levels. In addition, exercise has been shown to reduce levels of LH and FSH and bring them back to normal.

The cysts in PCOS produce testosterone that is converted by the body into oestrone. Elevated levels of LH are seen when testosterone is high. If FSH is low, this gives rise to elevated oestrogen and stops the cells in the follicle from producing testosterone from the oestrogen. When that happens, ovulation does not occur. The balance is very fine and depends very much on foods in the diet, such as good oils and proteins, on which the steroid hormones are based. High FSH in turn gives rise to low oestrogen, a condition that is more usual in menopause or after IVF treatment, when the ovaries have been repeatedly overstimulated.¹⁴

Another theory suggests that PCOS might be triggered by adrenal androgens being produced in excess at times of stress. The adrenal glands produce adrenaline to give us extra energy at times of stress. Androgens (such as testosterone) are converted to oestrone in fatty tissue, which causes the blood levels of oestrone to rise. Raised oestrone causes excess LH and a deficiency of FSH. As high LH triggers the ovary to produce androgens within the follicle, a cycle begins which may continue for too long. This in turn alters the delicate relationship of the steroid hormone balance.

Increased adrenal activity mobilizes the fatty acids that depress glucose uptake by peripheral tissues, thereby reducing insulin sensitivity. Stress can also decrease chromium stores, which may lead to hyperinsulinaemia; the body compensates by releasing extra insulin to get blood levels back into balance.^{15, 16} It is therefore essential to keep stress to a minimum. Assess what things are causing stress in your life and write them down on the left side of a sheet of paper. Then, on the right side, list the stressors that you can rid yourself of and take steps to remove some stress from your life.

The hypothalamus and pituitary glands in the brain control the ovarian hormones. If the hypothalamus secretes the wrong level of GnRH, the pituitary may increase LH production, which can trigger an increase in testosterone production in the ovary.

To date, there is not enough information on how all these hormones ‘talk’ to one another normally. Much is known of the effects of IVF drugs on hormone levels, but too few studies have been carried out on what is normal in women. The problem is that most women are or have been on the oral contraceptive pill (80 per cent of all American women) or steroid hormones as treatment for gynaecological conditions, or on hormone replacement therapy (HRT). Only a university department or institution with unbiased funding could take this type of research on board and, as most researchers are paid by pharmaceutical companies, funding for such pure research will be difficult to find, unless a wealthy benefactor who is without bias comes along.

It is a sad state of affairs that so little is understood of the normal hormonal balance of a normal reproduction system that has never been initiated into the use of drugs like oral contraceptives, steroids, GnRH analogues or HRT.

• CASE STUDY •

Emily F of London

I hope my story will encourage others to look beyond conventional medicine and discover that there are alternatives that work.

I have suffered from painful periods since I was 17 and must have seen at least 15 doctors, who all prescribed various, increasingly strong painkillers over eight years. I was told that it was quite normal to have painful periods – it was part of being a woman. By age 25, I was living in London and had joined another group practice of doctors, and was working my way through the insensitive ones. My periods were becoming more and more painful, and painkillers less and less effective.

I then met my friend Debs, who told me about the condition she suffered from – endometriosis – I had never heard of it, and none of the countless doctors I had seen over the years had ever mentioned that having painful periods could be a symptom of a medical condition. I made an appointment to see one of the doctors and suggested that I might have endometriosis. She agreed that it was a possibility and referred me to a consultant. Within a month I had had a laparoscopy and had been diagnosed as suffering from moderate endo and polycystic ovaries.

My consultant talked the options through with me and suggested that the best course of treatment would be Zoladex. While at the time I was happy with the way he dealt with me, and his suggested approach, I wish he had mentioned that there were non-medical avenues I could have explored. My experience with Zoladex was not one that I would wish to repeat – I had dreadful mood swings and was regularly depressed and inconsolable; I gained two stone in weight and suffered from hourly hot flushes. At the end of it, my periods were just as painful as they had been before the treatment.

The subsequent treatment prescribed was Dianette (an oral contraceptive) on a continuous basis – two or three packets, then a break. The periods were still very painful, but at least I could control when I had them, and the Dianette helped with the acne, which I had because of the polycystic ovaries. By the age of 30 I was still taking Dianette and various combinations of painkillers, but the pain was getting worse – to the point where I was seriously considering laser surgery (something I considered a last resort). I had also started to develop other health problems such as eczema, IBS and fatigue.

I then received details of the National Endo Society’s 1999 AGM, where the speakers were to give talks on various complementary therapies; I decided to attend. The speakers were extremely informative and I came away determined to find a complementary approach that would help me. Soon after the AGM, my mother read an article in the Daily Telegraph, which focused on a nutritional approach to relieving the symptoms of endometriosis. The interview was with Dian Mills and gave details of her book Endometriosis: A Guide to Healing Through Nutrition. My mother ordered the book and gave it to me for Christmas. I read the book from cover to cover – delighted that many of the other problems I was suffering from seemed to be related to the endometriosis and that I wasn’t becoming a hypochondriac, as my doctor was making me feel.

I made an appointment to see Dian in February 2000. Before the appointment I had to fill in a lengthy questionnaire about all aspects of my health, and I was embarrassed at how sickly I appeared. The first appointment was amazing – for once I could talk at length about how I felt without feeling that I was wasting someone’s time. And Dian understood what I was talking about! Her suggested approach was to tackle my health goals one by one, dealing with my digestive problems initially (I was suffering from very sudden, violent and unpredictable attacks of diarrhoea), then focusing on the period pain and finally on my concerns about whether or not I was fertile. She suggested that I cut out dairy and wheat from my diet and prescribed what seemed like a long list of vitamins, minerals and supplements.

At first it was a struggle to find alternatives to dairy and wheat, but it soon becomes second-nature. It very soon emerged (via making mistakes when ordering from menus) that I was intolerant of dairy products. Knowing this made such a difference to my life – I had become scared of eating out or leaving the house too soon after a meal, just in case I had an attack of diarrhoea.

The first period I had after seeing Dian (I was still taking Dianette continously) was 50 per cent less painful than the last. By August of that year I had a pain-free period. It was incredible – after 14 years of pain. My energy levels had returned; my skin was better than I can ever remember it being and I had lost some weight.

Being concerned about fertility, my partner and I decided that we would start trying for a baby in September. I was expecting to be infertile, given my combination of endo and polycystic ovaries, and we decided that we couldn’t afford to wait much longer as it could take a minimum of two years. To my shock and delight, I conceived in October and I am expecting a baby in four weeks’ time!

So many people I have spoken to, especially those in the medical profession, have dismissed the benefit of a nutritional approach to dealing with endometriosis, but I would urge anyone who feels that conventional medicine has failed them to pursue it. In fact, I would encourage anyone who has just been diagnosed to try a nutritional approach before embarking on any medical treatment. It can be difficult to change your diet after years of eating whatever you wanted, but the benefits far outweigh the sacrifices you might think you are making.

Menstruation should occur at least three times each year with PCOS; otherwise there may be cellular changes in the endometrium due to the unrelenting levels of elevated oestrogen which could lead to cancer. Normal menstruation is once each month. Excessive bleeding at menstruation is usually due to an imbalance of iron levels, and iron EAP2 is the best-absorbed form which, if taken for two months, may help to stop heavy menstrual bleeding.

OVARIAN CANCER

Ovarian cancer is rare, thankfully. However, it is extremely serious as there are no symptoms until it is very advanced. By having ultrasound scans and internal examinations with a Pap smear, or with a CA125 antigen blood test, checks can be kept on anyone with a family history of ovarian cancer.

PREMATURE OVARIAN FAILURE (POF)

Approximately 4 per cent of the female population has premature ovarian failure, an endocrine disorder. For some unknown reason, these women suffer a loss of ova from the ovary. Suggested causes are endless. As the ova are produced while the baby girl is still within her mother’s womb, so the problem may begin very early on. Clearly, the diet and environment of the mother during pregnancy is crucial to her daughter’s health throughout her life. The ova may be dysfunctional, or there may be a chromosomal defect, Turner’s syndrome, fragile X, metabolic dysfunction or viral infection damage. Autoimmune disorders may also affect ovarian function, or the ovaries may be removed at an early age.

Loss of ovarian function in this way may give rise to premature menopause if the hormone balance of the ovary is affected. We have seen how the follicle and corpus luteum produce the steroid hormones as a natural part of the menstrual cycle. With POF, this cycle is lost, so that the hormones do not function as they should. Periods often stop and hot flushes or night sweats may be commonplace. Sleep may become fractious, giving rise to mood swings, a low sex drive and bladder-control problems. Energy may be low and, of course, fertility is affected.

Two tests on the blood for FSH levels should be done one month apart. Normal FSH levels are 10–15mU/ml and under; women with POF often have FSH levels above 40mU/ml, which is in the postmenopausal range. Health concerns are as in menopause – with the risks of osteoporosis, heart disease, thyroid problems, adrenal problems or diabetes.

Infertility for a young girl as a diagnosis can be utterly soul-destroying. However, 6–8 per cent of women with POF do become pregnant. Sound nutrition may aid the function of the ovary, endometrium and endocrine glands, and otherwise do no harm. Medical treatments include HRT and the oral contraceptive pill. Women’s support groups can provide helpful advice (see p).

KEYS TO COMBATING INSULIN RESISTANCE

1 Return to eating three regular meals each day. This is vital in order to allow the liver to rest and renew its hormone-releasing cells.

2 Reducing the levels of saturated fats, refined sugars, starches and alcohol is also crucial in combating insulin resistance.

3 Limit fresh fruit to two pieces each day to control fructose intake as the fruit sugar also travels through the liver to be processed.

4 Changing from fatty meat and dairy foods to oily fish and nuts and seeds can help to suppress the liver’s release of saturated fatty acids.

5 Use only complex forms of carbohydrates such as oats, corn and rye, brown rice and legumes.

6 Forget high-sugar fizzy drinks and use filtered water or diluted fruit juices.

7 Try to cook many of your meals from fresh and keep convenience foods to a minimum to reduce intake of hidden sugars and saturated and trans fats.

8 Avoid all bovine dairy products (from cows), and use dairy alternatives from goat’s and ewe’s milk products to maintain calcium levels. Some soya milk has added calcium.

9 Eat more oily fish, nuts and seeds, and legumes to obtain protein foods.

10 Exercise is a very important tool to prevent the dangerous overload of fat build up in the blood. Even a moderate amount of exercise can help to prevent this build up. Getting off the bus or parking the car further away from work in order to have a brisk, 20-minute walk each day may be just the thing. This will reduce the fatty build up in the blood.

COMPLEMENTARY TREATMENTS FOR PCOS

The important thing is not to stop questioning.

Albert Einstein

The herb Vitex agnus castus has been used since Egyptian times to normalize pituitary release of FSH and LH, and regulate menstrual cycles. It needs to be taken for four to six months to have an effect. The tincture form is the most potent, but tablets are also beneficial. These should only be taken under the guidance of a herbalist or nutritionist. Women with a pituitary adenoma or who are attempting pregnancy should not take agnus castus. You may take it in the three or four months before you wish to get pregnant, and then stop when you decide to try for conception.¹⁷

Vitamin E and zinc are known to balance testosterone, and pectin and guar gum are also thought to be helpful. Aromatherapy oils – geranium, bergamot, clary sage – may be used in the bath, and in base oil to massage the abdomen.

SUPPLEMENT REQUIREMENTS

These may be taken for three to four months to try and improve and correct menstrual function:

 Multivitamins/minerals

 Chromium polynicotinate

 Zinc citrate or methionine

 Digestive enzymes

 Bioacidophilus

 Evening primrose and fish oils

SUMMARY

1 Syndrome X or insulin resistance is related to refined carbohydrate consumption, and affects pancreatic production of the hormones insulin and glucose tolerance factor. All hormones work in relation to one another, and these hormones have a knock-on effect, leading to an imbalance of the steroid hormones of the ovary.

2 Hyperinsulinism triggers the follicle of the ovary to produce testosterone in excess. This stops the follicle from working properly. Women may become anovulatory.

3 Return to eating three regular meals each day, as this enables the liver to rest and renew its hormone-releasing cells.

4 Reducing the levels of saturated fats, refined sugars and alcohol is also crucial in combating insulin resistance.

5 Limit fresh fruit to two pieces each day to control fructose intake, as the fruit sugar also travels through the liver to be processed.

6 Change from fatty meat to oily fish, nuts and seeds to help suppress the liver’s release of saturated fatty acids. Avoid bovine dairy foods. Research done in Florida suggests that the protein isomer in milk and that in the pancreas may have the same shape, and could lead to the immune system targeting the pancreas tissue if milk intolerance occurs. This may be harmful in the long term to insulin-producing cells.

7 Use only complex forms of carbohydrates, such as oats and rye, brown rice and legumes.

8 Forget high-sugar fizzy drinks and use filtered water or diluted fruit juices. Avoid all aspartame-containing foods.

9 Try to cook many of your meals from fresh ingredients and keep convenience foods to a bare minimum to reduce intake of hidden sugars, and saturated and trans fats.

10 Follow the supplement and diet programme for three to four months, combined with a 10-minute exercise regime before breakfast. Insulin levels are low on waking and this enables easier metabolism of fat cells during exercise. Ten minutes of aerobics or yoga before breakfast is equivalent to 30 minutes of exercise later in the day.