Читать книгу Endometriosis: A Key to Healing Through Nutrition - Michael Vernon - Страница 9

All is flux, nothing stays still.

Heraclitus, 540–480 BC

OH NO! MY PERIOD HAS STARTED AGAIN – SO SOON?

How many times have these words been uttered by women? The menstrual period has a way of appearing at the most awkward time and interfering with daily life. With endometriosis, menstruation may worsen, leading to severe, sometimes excruciating, pain and possible subfertility. It can interfere with normal daily activity, and we can shy away from learning about endometriosis when the cycle provokes such distress. When the monthly cycle includes pain or lack of a hoped-for pregnancy time after time, it becomes physically and emotionally draining. Other women seem to have no period pain and to fall pregnant so easily – it all seems so unfair. We stand aghast and become angry with our own body and its failings.

The reproductive system is the core of our feminine identity and its many subtleties and biological intricacies could be better understood. It should be celebrated as the focus of the origin of new life and menstruation should NEVER be painful. By understanding the reproductive system, you will be better able to understand endometriosis and how proper nutrition may help your body biochemistry to stay in balance and help you in your fight against this disease.

Our bodies are wondrous things, and understanding the amazing ways in which they work will help us to see more clearly what should be happening and just how endometriosis affects our whole body. Understanding can place us more in touch with the miracles going on within our cells each day. Endometriosis has the ability to mess up what should be a perfectly normal reproductive system, causing the wrong hormonal messages to be sent. The body always tries to get things right, so we have to enhance what it is attempting to do by natural means wherever possible.

THE REPRODUCTIVE SYSTEM

The menstrual or reproductive cycle of women is a complex process that involves many different endocrine glands and the hormones they secrete. These hormones all work together in a 28-day menstrual cycle that prepares the uterus for a possible pregnancy.

Women menstruate for about 40 years of their life. It is during this stage of their life that the symptoms of endometriosis will appear. The normal age for a girl’s first period (menarche) occurs between 9.1 and 17.7 years with a median age of 12.8, while a woman’s last period (menopause) occurs between 48 to 55 years with a median age of 51.4.

What is fascinating is that when women are assembled together, such as in schools, colleges and hospitals, their menstrual cycles align so that they all have a period at the same time. This is felt to be due to pheromones and an olfactory link to the pituitary gland.

The major organs of the reproductive system are the hypothalamus, pituitary gland, thyroid, ovary, uterus (womb), endometrium and Fallopian tubes. To understand how the menstrual cycle works, we need to look at where the various endocrine glands are located (figure 2.1). The glands control the whole reproductive cycle. People often assume that only the uterus and ovaries are involved. However, several endocrine glands control the system and they trigger the menstrual cycle. After we have familiarized ourselves with the reproductive system, this chapter will discuss how the glands and the hormones they produce interact during the reproductive cycle, and how endometriosis interferes with this cycle.

THE ENDOCRINE SYSTEM

It is the correct balance of hormones that controls this whole system. The endocrine system is scattered throughout the body and usually works perfectly, sending hormone messages from one gland to another via the bloodstream. Occasionally this system may go wrong and a polyendocrine disorder, where one or more glands are affected, can lead to illness. The thyroid, pancreas, adrenals and ovaries may all malfunction under stress.

HYPOTHALAMUS AND PITUITARY GLAND

The control centre for the reproductive cycle is the hypothalamus and the pituitary gland in the brain. The hypothalamus secretes hormones (chemical messengers) which control the timing and the amount of hormone produced by the pituitary gland in the brain (figure 2.1). The pituitary gland can be viewed as the ‘master gland’ of the endocrine system, since its hormones orchestrate the activity of most of the other endocrine glands of the body, including the ovaries in women and testes in men. Think of the pituitary gland as the conductor of the orchestra, wielding the baton, telling the other glands what to do and when.

The pea-sized pituitary gland nestles in a bony cavity at the base of the skull (figure 2.2). It has a rich blood supply that allows it to distribute its hormones rapidly throughout the body. The pituitary gland is divided into two parts: the anterior and posterior pituitary.

1 The anterior pituitary secretes several protein hormones which affect a variety of glands and tissues of the body. However, the two major hormones of the anterior pituitary that affect the reproductive system are follicle-stimulating hormone (FSH) and luteinizing hormone (LH). These two hormones control the activity of the ovaries, and are very important controls for fertility.

2 The posterior pituitary also secretes several protein hormones. Oxytocin is the hormone that most directly affects the reproductive system. Oxytocin causes the smooth muscle of the uterus to contract during the birthing process. Oxytocin production is dependent on sufficient levels of the mineral manganese. It is thought to be important for bonding at birth and oxytocin levels are known to be increased in the brain when we fall in love.

Figure 2.1

Diagram of the major endocrine organs involved in endometriosis, infertility and the menstrual cycle.

THE THYROID GLAND

The thyroid is dealt with in detail in chapter 10. This gland can have an effect upon fertility; and lower than normal thyroid hormone levels (hypothyroid) cause infertility in both men and women. Indeed, auto-antibodies to the thyroid are used to predict which women are at risk from miscarriage.

Oestrogen acutely inhibits the rate of thyroid hormone release in adults.¹ In subclinical hypothyroidism, abnormal circadian TSH rhythm, elevated basal serum TSH concentrations and elevated titres of antithyroid antibodies are frequently seen.² Women with mild hypothyrodism have prolonged and heavy menstrual bleeding with a shorter menstrual cycle.³ The thyroid enlarges in pregnancy and takes up more iodine as it makes more thyroxine.

THE OVARIES

The ovaries contain the female sex cells, also known as oocytes or eggs (see figures 2.2 and 2.3). All of the eggs that a woman has in her ovaries were produced while she was developing as a fetus in her mother’s womb. The health of each egg inside a baby girl is therefore dependent upon the health of the mother. When a female fetus develops in her mother’s uterus, her eggs increase in numbers until the seventh month of pregnancy, and then their numbers decline throughout the remainder of the pregnancy and throughout her life. As many as seven million eggs are present in a female fetus by the seventh month of pregnancy, but there are fewer than one million eggs at birth.⁴

From birth to puberty, the number of eggs declines further, from one million to about 400,000, which is the total number of eggs available to a woman during her reproductive years. During the reproductive years one egg is selected every month to develop to a stage that allows for ovulation, fertilization and conception. When a woman reaches 50 to 55 years of age, the supply of eggs is exhausted and the reproductive cycle stops. This is, of course, the time of natural menopause.

At any given time, two major structures, each about 1cm in diameter, can be seen within the ovary – the follicle and the corpus luteum (figures 2.2 and 2.3). Each follicle contains an egg surrounded by granulosa cells or ‘nurse cells’. During the menstrual cycle the follicle becomes filled with follicular fluid and looks like a small cyst, about one centimetre in diameter. The granulosa cells of the follicle secrete the steroid hormone oestrogen; the corpus luteum produces the hormone progesterone.

Oestrogen has several roles:

1 It stimulates the endometrium to grow from day 1 to 14 of the cycle and replace the endometrial cells that were shed during menstruation. It is produced in the follicle of the ovary and in fat cells, and by the adrenal glands.

2 It enhances the contractions of the uterus and is required during the birthing process.

3 Too much oestrogen acts as an abortant. Too much produced very early in the pregnancy and not balanced by sufficient progesterone from the corpus luteum could trigger the loss of the pregnancy, as it is an abortive in high doses.

4 It increases the levels of neurotransmitters in the brain, improving mood and memory. If oestrogen is out of balance, it can trigger mood swings.

5 It is synthesized in the ovary from cholesterol, and secreted from the granulosa cells inside the follicles, the corpus luteum and the placenta.

6 It causes the liver to produce hormones.

7 It increases cholesterol production, produces weight gain and determines fat distribution.

8 It causes cell proliferation.

9 It deposits calcium into bones.

10 When its levels are high, women show greater verbal fluency.

11 When its levels are low, women use their hands more skilfully, and spatial ability is stronger.

12 Excess oestrogen may increase the level of antithrombin III, which increases the risk of blood clots.

13 Normal levels in the follicular phase are 30–150ng/ml. In menopause, oestrogen levels are 40–200ng/ml.

Progesterone, on the other hand, has different roles from oestrogen:

1 Stimulate the endometrium to become nutrient-rich in preparation for a pregnancy, from day 14 to 28 of the cycle.

2 Enhance relaxation of the uterus and prevent contractions of the uterine smooth muscle to prevent miscarriages.

3 Inhibit oestrogen from stimulating contractions of the uterus, maintain a pregnancy and prevent further ovulation.

4 Reduce the effect of the immune system to prevent the body from rejecting the embryo.

5 Raise the basal metabolic rate.

6 As a thermogenic, adjust body temperature, which rises from 97.8 degrees C to 98.3 degrees C just before ovulation.

7 It is synthesized from cholesterol in the corpus luteum and in the placenta from months three to nine during pregnancy.

8  Normal levels of progesterone are greater than 10ng/ml during the mid- to late luteal cycle.

Figure 2.2

Diagram of the endocrine (hormone) relationships between the anterior pituitary and ovary. The pituitary secretes FSH (follicle-stimulating hormone) to stimulate the growth of the follicle which contains the egg. When the egg is ripe and the follicle large, the pituitary secretes LH (luteinizing hormone) and the egg is expelled (ovulated). After ovulation, the follicle becomes the corpus luteum. The follicle produces oestrogen and the corpus luteum progesterone [(+) means stimulates and (-) means inhibits].

The follicle granulosa cells produce oestrogen from day 1 to day 14 of the cycle; then the corpus luteum produces progesterone from day 15 to day 28 of the cycle. As these steroid hormones are both oil-based, the health of these hormones depends upon the quality of the oils you eat. Both are synthesized from cholesterol.

Androgens play a role in fertility:

1 They are precursors to oestrogen and come from the ovary and adrenal glands.

2 Testosterone is the male hormone produced in the testes, ovaries and adrenals. In women, excess may be produced if insulin levels are too high.

3 In women, testosterone levels are normally 35–50ng/ml. It is felt that there is a slight surge at the time of ovulation that increases the sex drive.

OVARIAN CYSTS

Often, women with endometriosis develop cysts on the ovaries. There are four main types of cyst:

1 Dermatoid cysts are rather bizarre and contain tissue that has developed into hair, nails and teeth. They are unusual.

2 Mucoid cysts are filled with a clear mucus and may grow to be very large.

3 Endometrial, or ‘chocolate’, cysts are related to endometriosis and appear to be unruptured follicles that fill with blood and become larger and larger. Size is usually given in terms of a fruit (tangerine-sized to grapefruit-sized), or up to the size of a five-month-old fetus in one case.

4 Polycystic ovaries, where six or more small cysts develop at the same time (see chapter 3).

The ovary is able to reabsorb cyst material and research suggests that a diet rich in B-complex vitamins aids this process. Cysts may grow within the ovary but, more often, they are attached to the ovary by a stalk. Pain ensues when this stalk becomes twisted or the ovary ruptures, spurting out hot stale, sticky blood onto the intestines. This pain is unbearable as the whole of the bowel muscles go into spasm and the body goes into shock. It is known that some cysts produce their own hormones, upsetting the hormonal balance. Small cysts can be reabsorbed, but those over 5cm in diameter are best removed surgically with a laser.

Figure 2.3

Cross-section of the uterus and Fallopian tube, and diagrams of the development of the egg to embryo. (A) Fertilization of ovum. (B) Fertilized egg with pronuclei. (C) Two-cell embryo. (D) Four-cell embryo. (E) Multicellular embryo (100 cells) – a morula. (F) Early blastocyst embryo. (G) Blastocyst invading the endometrium.

THE UTERUS

The uterus or womb is a little smaller than a woman’s clenched fist, but during pregnancy, it can expand to over 45cm (18in) in length (see figures 2.1 and 2.3). It consists of a well-developed muscular wall (the myometrium) and an inner mucus-like membrane (the endometrium). The smooth muscle wall of the myometrium expel the baby during the birthing process, and it is the contractions of these muscles that also cause menstrual cramps. These muscles require a balance of calcium and magnesium to help them function correctly. Calcium tenses muscles while magnesium allows them to relax. Magnesium-rich foods should be eaten when muscular cramps are a problem.

The uterus retains its full capacity to sustain implantation for up to 60 years of age. It clearly does not age in the same way as the ovary, as postmenopausal women can maintain a pregnancy after egg donation. ‘The uterus is the main site for the production of the hormone prostacyclin, which protects women from heart disease and unwanted blood clotting. Since prostacyclin cannot be synthetically made in a laboratory, the removal of the uterus will ensure its production will cease forever.’⁵ It also produces 60 different prostaglandins and enzymes.

THE ENDOMETRIUM

The endometrium (tissue lining the womb) plays a vital role in the reproductive process (see figures 2.3 and 2.4). The endometrium is brownish-red in colour with a fluffy appearance and slimy texture. The brownish-red colour is due to its nutrient-rich blood supply, and the slimy texture is due to the large amount of protein contained in its secretions. For a woman to conceive, the embryo must physically implant into this ‘lush’ endometrium. The endometrium is the sole source of nutrients and oxygen for the newly formed embryo. If nutrients are in poor supply, the womb lining will be unable to support the embryo’s development. The growth of the embryo places a heavy nutrient demand on the endometrium, and this tissue needs to develop a rich blood supply. As we will see later, the quality of food eaten greatly influences the nutrients available to the endometrium. Pregnancy is rare if the endometrium thickness is less than 7mm. The chances of pregnancy are optimized if the endometrium is 9–14mm in thickness.⁶

The endometrium is also an important endocrine gland and secretes a family of hormones called prostaglandins (PG). Prostaglandin F (PGF) can stimulate strong uterine contractions (cramps) and prostaglandin E (PGE) can cause pain. These prostaglandins are the hormones directly responsible for most of the cramps and pain associated with endometriosis and menstruation. PGF also inhibits the development of the corpus luteum in the ovary and therefore reduces progesterone production. Therefore PGF has been used clinically to initiate abortions. If higher levels than normal of PGF are produced, miscarriages may occur.

As an endocrine gland, the endometrium is very responsive to the levels of hormones circulating in the blood. The balance of oestrogen and progesterone greatly affects the growth and activity of the endometrium. In chapter 11, the effects on the balance of what you eat will be clearly explained.

FALLOPIAN TUBES

The womb has two tube-like extensions called the oviducts or Fallopian tubes, which are the transport system (rather like a highway) for the sperm to reach the egg and for the embryo to reach the uterus (see figure 2.3). The process of fertilization takes place in the upper third of the Fallopian tubes, so the sperm have to be robust enough to be propelled from the uterus up two-thirds of the Fallopian tube to fertilize the egg. Contractions in the uterine muscle during orgasm are believed to assist this process.

The Fallopian tube enlarges at ovulation and secretes fluids as it responds to oestrogens. At midcycle, the fluid is copious, alkaline and contains nutrients, gases, proteins, electrolytes and steroids.⁷

ENDOCRINE COMMUNICATION

How does the body know when the embryo is entering the womb? The womb must have a precise line of communication to the ovary, where the eggs are manufactured and released. This is accomplished by endocrine communication. The pituitary and ovaries communicate with each other by sending ‘chemical messengers’ (hormones) through the blood system to tell each other what to do and when. Light hitting the retina of the eye stimulates the pituitary and hypothalamus, which releases GnRH, a hormone that triggers the release of LH from the pituitary. The LH surge causes the follicle membrane to rupture, releasing the egg. Ovulation occurs if the ovum meets a sperm in the Fallopian tube, and the follicle seals up to form a corpus luteum. This begins to produce progesterone to make the endometrium ready for implantation of the fertilized egg. Progesterone is produced by the corpus luteum until the third month of pregnancy, when the placenta is sufficiently mature to take over. If no fertilized embryo is implanted, the corpus luteum is reabsorbed into the ovary and the whole process begins all over again.⁸ The major hormones involved in the reproductive system are listed in table 2.1.

Table 2.1

The major reproductive hormones of the menstrual cycle

ORGAN	HORMONE	ACTION
Hypothalamus	Gonadotrophin-releasing hormone (GnRH)	Stimulates the pituitary gland to produce FSH and LH
Anterior pituitary	Follicle-stimulating hormone (FSH)	Stimulates ovarian follicles
	Luteinizing hormone (LH)	Initiates ovulation
	Prolactin	Stimulates lactation
Posterior pituitary	Oxytocin	Stimulates uterine contraction
Ovary	Oestrogen	Stimulates endometrial growth and uterine contractions
	Progesterone	Maintains pregnancy
Uterus	Prostaglandins (PGE/PGF)	Stimulates uterine contractions, menstrual pain and birth

Establishing the correct levels of these hormones is the key to getting the right message to the right place at the right time. When we say that the hormones are ‘out of balance’, the wrong messages are being sent and received, and things can begin to go awry.

FOLLICLE-STIMULATING HORMONE (FSH)

1 FSH is responsible for maturation of the ova in the follicle. Once a dominant follicle emerges with a diameter of 6.5–14mm, the rest will subside.

2 FSH production is inhibited by excess oestrogen and inhibin.

3 FSH causes granulosa cells to multiply rapidly and produce oestradiol.

4 Normal levels of FSH are 5–20mU/ml, depending on the day of the test.

5 When FSH levels are over 20mU/ml, menopause may be due within five years. Women with elevated FSH can still get pregnant as other factors, such as stress, can raise levels. After IVF treatments, where the ovaries have been hyperstimulated, many women find they have abnormal FSH levels for a time. Menopause is usually indicated with FSH levels of 40–200mU/ml.

LUTEINIZING HORMONE (LH)

1 LH secretion precedes ovulation and completes the maturation of the ovarian follicle.

2 LH stimulates androgen (testosterone) production.

3 LH is inhibited by oestrogen except just before ovulation, when it surges.

4 Progesterone may block LH secretion as it decreases the rate at which LH is pulsed from the pituitary gland.

5 LH receptors inside the granulosa cells develop as a result of FSH and oestrogen build up.

6 When LH surges, the dominant follicle grows between 1.4–2.2mm per day, reaching a maximum diameter of 18–22mm, and is ready for ovulation. It should be fully mature on day 14–16 of the menstrual cycle.

7 The interval between the LH surge and ovulation is 37–38 hours. Ovulation occurs randomly from left to right ovaries during natural cycles.

8 The Fallopian tubes enlarge at ovulation and secrete fluids as they respond to oestrogen and the LH surge.

9 Normal levels of LH are 7–14U/ml. While LH remains normal, ovulation is possible. FSH tests alone are not indicative of perimenopause as they can fluctuate wildly at this time. As LH levels rise abruptly at menopause, they should be tested with FSH.

PROLACTIN

1 This hormone inhibits ovulation.

2 Elevated prolactin can also be caused by high melatonin levels, resulting in decreased fertility (melatonin from the pineal gland increases when the eye registers darkness).

3 Excess prolactin can be caused by drugs such as tranquillisers, anti-ulcer drugs, high-dose oestrogen oral contraceptive pills, alcohol and street drugs.

4 Hypothyroidism and breast stimulation may also increase prolactin levels.

5 When prolactin is high, GnRH and LH are lowered. This can cause menstruation and ovulation to stop.

RELAXIN

1 This protein-based hormone, produced by the corpus luteum of the ovary, is similar to insulin and growth hormone.

2 It softens tissues and muscles, and may be responsible for morning sickness during pregnancy.

THE REPRODUCTIVE CYCLE

The bottom line of the reproductive system is to make a healthy bouncing baby through the processes of sexual intercourse, conception and pregnancy. One of the more formidable tasks of the female reproductive system is to prepare the lining of the womb (the endometrium) to feed and nurture the embryo. However, it is not possible for the body to maintain the endometrium in a continuous, heightened ‘ready state’ for pregnancy. Thus the body follows a monthly cycle of slowly building up the endometrium so that it will be in a nutrient-rich state only when a fertilized embryo may be around. Think of the endometrium as fresh food for the embryo; if it gets old (past its sell-by date) it is less nutritious and is less likely to sustain the pregnancy. This ‘food for the fetus’ is renewed each month, so the quality of food you eat is crucial to the health of this tissue. If a fertilized egg fails to appear, then the body flushes away the existing endometrium, and starts all over again. This flushing away of the endometrium is, of course, the menstrual period.

THE MENSTRUAL CYCLE

The menstrual cycle in most women lasts approximately 28 days, with the first day of blood flow (the menstrual period) usually designated as day 1 of the cycle (see figures 2.2 and 2.4). Around day 1 the hypothalamus secretes gonadotrophin-releasing hormone (GnRH) and, in response to this hormone, the pituitary gland secretes increasing amounts of FSH (follicle-stimulating hormone). FSH stimulates the granulosa cells (helper cells) in each follicle to ensure that each ova is ‘fed’ nutrients to help it produce oestrogen and to stimulate the egg to mature.⁹ Oestrogen also sends a message to the womb to tell it to produce more endometrial cells, so that a healthy thickened endometrium will be present to accept the egg should it be fertilized by a sperm in the Fallopian tubes. Unfortunately, oestrogen also has some bad effects. It is responsible for the water retention between cells, which is why some women can feel bloated before a period, and for stimulating uterine contractions (menstrual cramps).

When the follicle reaches 15–17mm in diameter (around day 14–15 of the cycle), the pituitary produces a surge of luteinizing hormone (LH). This surge stimulates the egg to grow to 18–28mm in diameter and also signals the ovary to expel the mature egg (ovulate) out towards the Fallopian tubes. The mature egg is then sucked up by the Fallopian tube so that the sperm can fertilize it. Ovulation usually occurs on the 15th day of the cycle. If the body does not ovulate, then the LH surge may not be happening as it should, implying that the hypothalamus is not functioning efficiently. The hypothalamus requires vitamin B6 and zinc to produce GnRH. If it is not working efficiently, the right message is not passed to the pituitary gland for the LH release. All these hormones and the health of the egg are nutrient-dependent, and good blood flow is essential during this stage of growth.

After ovulation, the empty follicle undergoes a dramatic physical change. It turns a yellow colour (because of its oil-rich tissue) and is called the corpus luteum (which means ‘yellow body’). The corpus luteum is very important as it secretes the hormones progesterone and relaxin, which send the message to the endometrium of the uterus to become receptive for a possible pregnancy (see figure 2.4). As its names implies, progesterone (which means ‘for gestation’) is required for the pregnancy to be maintained. In response to the progesterone, the endometrium starts to produce the nutrients the embryo will need for its development, and the myometrium (muscle) layer of the uterus relaxes. Without sufficient levels of progesterone, relaxin and magnesium, the uterus would start to contract and expel the developing embryo. Therefore, if the corpus luteum is poorly developed, a pregnancy may fail. Again, oils are implicated here. Studies show that ‘Vitamin B6 (pyridoxine 5 phosphate) is necessary for the formation of the hormone progesterone’ and the same source indicates that ‘vitamin B6 is also required after ovulation when the body has a high level of oestrogen. B6 acts as a natural diuretic and helps alleviate some of the bloating associated with PMS. It is a precursor to progesterone’.¹⁰ Moreover, ‘the action of steroid hormones is balanced by B6 – it has an effect on endocrine diseases’.¹¹

The fate of the egg is dependent upon whether or not it will meet up with a sperm in the Fallopian tube (see figure 2.3). If no sperm are present, both the unfertilized egg and the corpus luteum will degenerate (die) and be reabsorbed. The slow destruction of the corpus luteum leads to a decrease in progesterone and oestrogen secretion (see figure 2.4). Without these steroids, blood flow to the endometrium decreases and the lush endometrium cannot be maintained. The endometrium starts to degenerate from a lack of oxygen and nutrients, and it begins to separate physically from the uterus and is shed. This withdrawal of oestrogen and progesterone is the cause of the menstrual period (blood flow). With the onset of the menstrual period, a new menstrual cycle starts all over again and a new lining of endometrium is made for another attempt at pregnancy.

Figure 2.4

Graph of the day-to-day changes in the reproductive hormones during the menstrual cycle and the appearance of the endometrium during these changes. Note the endometrium becomes thick, and develops numerous blood vessels and glands because of the increase in oestrogen. The progesterone continues this build-up and makes the glands secretory, and prepares the endometrium for pregnancy. When the steroids decline at the end of the cycle, the endometrium sloughs off (menstrual period) and the cycle starts over again at day 1.

Women often accept a very heavy menstrual flow as the norm because that is what they have come to expect. Dr Casmir Funk, the man who isolated vitamin B1 in 1912, described the effect of vitamin B-complex in reducing a woman’s menstrual flow from five or six days to three or four days. He reported that menstruation came on ‘completely without warning’ (i.e. with no symptoms of premenstrual syndrome, or PMS) while these women were on B-complex vitamin therapy. He treated PMS successfully through nutrition, rather than drugs.¹² Large blood clots may be prevented when vitamins C and E are used together with evening primrose and fish oils as ‘these all have oestrogenic properties, and certain oestrogens produce changes in blood clotting’.¹³

The amount of blood lost is usually about 60ml (2 fl oz).¹⁴ At the beginning of the menstrual cycle, rich red blood should be the norm, whereas brown granular blood with chopped-liver-like clots implies poor nutrient uptake. The nutrients used to improve periods include iron EAP2, vitamin B6, B-complex vitamins, magnesium, chromium, vitamins C and E, and evening primrose and fish oils. If blood loss is excessive to the point of flooding, then a well-absorbed iron supplement such as EAP2 or citrate may be used for 1–2 months to normalize the flow.

• CASE STUDY •

Gabi B of London

I’m 34, married with no children and live in London. I work as an IT consultant.

My periods were never a problem, more a slight inconvenience really. My story starts nine years ago, when I was around 25. My periods had become very heavy and painful. I thought this was how periods should be and that I’d been lucky up until then. So I put up with the pain, cramps, headaches and general grotty feeling for about a year. I then saw my GP, who referred me to a gynaecologist. My first visit was disappointing, to say the least. I was told that periods can be pretty unpleasant, and to come and see them again if the symptoms persisted. Well, after about two years, a laparoscopy confirmed that I had moderate endometriosis. I was put on a course of tablets to reduce the pain and inflammation. These tablets didn’t really help with the symptoms, but added side effects to my list of complaints. After about a year, I was put on a course of Zoladex injections, very painful injections into the abdomen once a month. Now, at no time had I been told that there is no cure for endometriosis. The drug treatments can only ease the symptoms. Zoladex in effect makes you menopausal, thus stopping your periods. The lack of bleeding causes the endo-sites to decrease in size and shrivel up. This seemed to make sense to me and so I put up with the side effects – hot flushes, night sweats, headaches, nausea, exhaustion, mood swings and depression – because I genuinely thought this treatment would cure me. How naïve.

All was well for about a year, then the symptoms came back. So another laparoscopy confirmed endometriosis was still present. I was put on the pill to ease the bleeding and pain, and given Coproximal as needed, which I’m afraid I did.

About two years ago, I was finally given laser surgery to burn away the endo-sites. My condition was moderate-to-severe, my left ovary had become stuck to the cavity wall and there were a lot of adhesions. The surgery was a success, and I was skipping about with joy I felt so well. But then, nine months later, it was back with a vengeance.

I returned to my gynaecologist to discuss my options. I understood this was not going to go away, but wanted to know if there was anything I could do to help myself. I was told that surgery was not an option so soon, but they could prescribe a contraceptive pill which can be taken constantly, thus stopping my periods for six to nine months, which might decrease the size of the endo-sites. That sounded like good news to me. But when I read the booklet that came with the pills, the side effects sounded so severe that I decided to put up with the pain.

By this time I was a very unwell bunny. I felt ill for three weeks a month. Before my period, I felt like I was about to give birth to triplets. There were many different symptoms:

constant severe ache in the abdomen

shooting and throbbing pain on my left side

shooting pains in my bottom

headaches

extreme bloating most of the time

exhaustion

nausea when the pain was really bad

ovulation was like a full-blown period

I couldn’t use tampons and the pads just made me feel even bigger

the blood was very dark and smelly, as if I was rotting from the inside out

on top of these symptoms, my periods made me feel dirty.

I had managed to programme my periods to start on a Saturday, so I was able to spend the weekends in bed. Intercourse was impossible, and although my husband was very understanding, it was difficult not to be depressed. We had sex, but not intercourse. Sometimes I would demand intercourse, but would be in so much pain for days afterwards, it really wasn’t worth it. I had a hot water bottle at work and used to spend a lot of time hanging onto the radiator in my office. I couldn’t walk any distance and was exhausted all the time. We had to plan our life around my monthly cycle. I used to retire to bed most of the time. I think this was more depressing than anything. I hated having to cancel social events or even visiting my parents. People were very sympathetic, but I felt very pathetic. Life was not good.

I’d read a lot of books, many of which touched on nutrition, and I felt that maybe it was time to seek alternative help. I read Dian’s book from cover to cover. It all made so much sense. I got her number from a friend of a friend, but I delayed making the call. I think I was afraid of another treatment not working, as what would I do then? I know this was the wrong attitude, but it wasn’t until later that I realized that.

My life changed over a year ago. My period had come a day early and I had to take a day off work. As an IT manager, my work involved a lot of stress, running up and down stairs and humping heavy equipment from place to place. There is no way I could function with my period. It was like a battle and my endometriosis seemed to be winning. I finally made the call to the clinic from my bed. I was in tears and the receptionist was really sympathetic. I was amazed as, over the years, I have seen many medical people and I can’t say that any of them were sympathetic. I wasn’t expecting sympathy, but it would have been nice on occasions.

I saw Dian; we discussed my condition, lifestyle and diet. She prescribed multivitamins, minerals and fish oils. These were to give me a booster as I was so low. I was to give up wheat, citrus, chocolate and coffee, and to reduce dairy, increase fruit, vegetables and oily fish, drink more water and generally avoid very processed foods. I decided to make a real effort and stick to the guidelines for a month to see what happened. I celebrated this with a cappuccino and a large piece of cheesecake followed by an orange.

I kept a diary, recording what I ate and how I felt. It was a very useful process as I could refer back and see how well I was doing – or not. I thought about what I ate and ate regularly. I’d never had such exotic breakfasts! I knew that we ate food because our bodies needed it; I knew I should eat more fruit regularly, but just never fancied it.

After about three days, I felt fantastic, had loads of energy and didn’t look so drawn. My husband said he could always tell the level of pain I was in by my eyes, and my eyes seemed bigger and brighter. I looked forward to food, and ENJOYED fruit. I had my period 10 days later. It was amazing. It hurt but was manageable. I almost enjoyed it (that was weird). The blood was bright red and, because of a major systems failure at work, I had to work on the weekend. I couldn’t believe it. Not only was I standing up during my period, but I was working too.

It’s been over a year now since I first met Dian and I am a different person. I wonder how much I have cost the NHS over the years in drugs, surgery and consultations, which weren’t as successful as nutritional awareness has been.

It seems that wheat is my real problem, but because I now eat so well, my body can tolerate the occasional accidental wheat consumption. I am now very finely tuned so that if I do eat something that upsets me, I pretty much know immediately. I usually drink lots of water and cranberry juice, which seems to ease symptoms.

I had an amazing experience recently that confirmed my intolerance. I had a piece of chocolate cake – a real treat – which I was told was gluten-free. After a few mouthfuls, I found it physically hard to swallow. Within 10 minutes, I felt very tired and withdrawn. Later that afternoon, I had a pain in my left side and found it difficult to speak coherently. I knew something was wrong. I remembered I’d had some quiche at lunch and thought maybe the flour used was the problem. It turned out to be coeliac wheat flour but with the gluten removed. It is the wheat that affects me. I was very ill the next day and amazed by the severity of my reaction. I felt ill and tired the following week as well. It wasn’t nice feeling ill again, but it confirmed to me how well I maintain my diet.

The point I want to get across is that I am an ordinary girl and lead an ordinary life. I sometimes stay out late and drink beer! But now I think about what I eat and I’ve got my life back. It isn’t hard to change your diet because the rewards are immediate and your body takes control. Your body will let you know what vitamins and minerals you are lacking through cravings for different foods.

In a way I’m glad I was so ill when I first saw Dian because the change in me was immediate and immense. You don’t have to live a miserable and painful life. There is help out there. I hope you are able to change your life like I have, and wish you a long good health.

FERTILIZATION

In women, the ovum lives for approximately 72 hours after it is expelled from the follicle. It may be fertile for less than half this time. Sperm survive in the female genital tract for 48 hours. Sperm have been seen to survive for one week after intercourse.¹⁵ If sperm are present in the Fallopian tube, then the egg may be fertilized (see figure 2.3).

A fertilized egg, called a zygote, sends a hormonal message to the reproductive system that conception has occurred and the corpus luteum is prevented from degenerating. The corpus luteum of pregnancy continues to produce progesterone and the endometrium gets even more lush. As the zygote passes down the Fallopian tube its cells begin to divide to form the embryo. It keeps dividing, first into a two-cell embryo, then a four-cell embryo and then an eight-cell embryo, up to about 100 cells, at which point it is called a ‘morula’ (see figure 2.3).

At this stage of development, the cells of the embryo begin to develop into specific different types of body cells, and a fluid-filled area forms in the middle of the embryo. The embryo, now called a blastocyst, implants itself in the endometrium, a process dependent on enzymes rich in vitamin E and zinc. It takes about seven days for a fertilized egg to develop into a blastocyst and implant into the endometrium. Blastocysts may have 1,000 to 10,000 cells by day 8; by day 9 or 10, it should be firmly attached. On day 10, the placenta is formed when cells invade the maternal blood vessels. By day 19, the placenta has developed its own blood vessels.¹⁶

A woman is totally unaware of these important events. She will not know that she is pregnant for another week, when she misses her period.

Once the sperm has entered the egg, how does the body recognize that a conception has occurred? A message comes from the embryo that prevents the shedding of the endometrium. Within two weeks of conception the level of progesterone produced by the corpus luteum is maintained, and this protects the pregnancy. This progesterone enhances the ability of the endometrium to produce nutritious fluids that the embryo will need during its very early development.

Just imagine, from the tiny egg in the ovary and the minute sperm from the testes a whole new person can grow. The beauty of it is that each egg and sperm contain totally unique blueprints so that the baby developed from them will be a totally unique individual. We all began from this miracle of nature; we are indeed the stuff that stars are made of.

As complicated as the reproductive process is, it is easy to see that human procreation is a miracle. In fact, the incidence of subfertility in human beings is high, and as many as 15 to 20 per cent of all couples may be subfertile. Some of this subfertility may be the result of ‘hiccups’ in the reproductive process or a result of anatomical deformities in the reproductive system. As you will see in chapter 4, endometriosis may adversely affect many parts of the reproductive processes. What we have to do is make the body less tolerant of endometriosis, and get the right messages to the right place at the right time, to enhance the reproductive and immune systems. The correct choice of food will help our bodies to work efficiently as the nutrients help to trigger the correct hormonal messages.

CERVICAL MUCUS

The uterus is connected to the vagina through a small opening called the cervix, which acts as a physical barrier to protect the female reproductive organs from germs in the external environment. The state of the cervical mucus within the vagina is very important in achieving fertilization, and is also dependent on the correct hormonal messages.

Oestrogen makes the mucus runny and slippery, like egg white, making it easy for the sperm to swim through it and for conception to take place, rather like a superhighway for sperm. By watching for a clear mucus coming from the vagina, you will have a good indication as to when ovulation takes place. Mid-cycle (at ovulation) cervical fluid is copious and watery, and secreted at a rate of 600mg per day. It contains salts, amino acids, proteins, peptides and lipids.¹⁷

Progesterone, on the other hand, reduces the secretion rate to 20–60mg per day and thickens the mucus to stop sperm or bacteria from entering the womb during the second half of the cycle, when the uterus could contain a pregnancy that needs protection from the external environment. (See Appendix D, for natural fertility guidance.)

ENDOMETRIOSIS

ENDOMETRIUM VERSUS ENDOMETRIOTIC IMPLANTS

The endometrium of the womb plays a vital role in the reproductive process. It is a dynamic tissue that undergoes continuous changes in the preparation for and maintenance of pregnancy. But although the endometrium is required for normal reproduction, it is also the major culprit in endometriosis. In this disease, pieces of endometrium grow and develop in areas outside the uterus. These rogue pieces of the normal endometrium are called ‘endometriotic implants’ by gynaecologists and scientists, and they can be found throughout the body. In general, however, endometriotic implants are usually found in the lower abdomen with the greatest number occurring in the base of the pelvis or the cul-de-sac/Pouch of Douglas and on the outer surface of the womb, ovary and the bowel, bladder and intestines (figure 2.5).

To a lesser extent endometriotic implants are found in the upper parts of the abdomen, including the small intestine, stomach, liver, gall bladder, kidney, pancreas and diaphragm, and also in the vagina and on the external genitalia. Implants have also been noted in lungs, skin spots, joints, the brain, gums and in the lining of the nose, but these locations are, thank goodness, fairly rare. They have even been observed in the scar tissue in women who have had hysterectomies or Caesarean sections. A bizarre location for endometriotic implants is in the joints of elderly men.¹⁸ Three men in Australia were found to have endometriotic implants on their bladder as a result of taking oestrogenic drugs for cancer of the prostate.^{19, 20} As men do not have a uterus, this is a true medical curiosity. Some scientists believe that we are born with a potential to develop endometriosis because, as a fetus develops, some of the endometrial cells migrate to the wrong place and are triggered by a hormonal message at some later date. Endometriosis is so curious and very difficult to live with, but fascinating in its bizarre behaviour.

WHAT CAUSES ENDOMETRIOSIS?

Although we do not have definitive proof of the true origin of this disease, several theories have been proposed as to what causes endometriosis. Dr Sampson in the early 1920s developed the theory of ‘retrograde menstruation’.²¹ He reported that endometrial tissues, in addition to flowing out of the vagina at the time of menstruation, also move up into the Fallopian tubes, from where they pour into the peritoneal cavity (abdomen). These backward-flowing fragments of endometrium then attach to the cells lining the abdomen and grow in a similar fashion to the uterine endometrium.

Sampson’s theory has received the most support from the scientific community, since it agrees with the observation that the numbers of endometriotic implants increase with proximity to the opening of the Fallopian tube. As the endometriotic tissue flows out of the tubes, it would bathe the outer surface of the ovary and uterus, and large amounts would settle at the base of the pelvis in the cul-de-sac/Pouch of Douglas area. As mentioned above, these are the areas of highest occurrence of the disease. Recent research by Dr Jouko Halme of North Carolina University, USA, also supports Sampson’s theory. Dr Halme examined the abdomen of his patients at the time of their menstrual flow. He observed the presence of endometrial fragments in the peritoneal (abdominal) fluid of 90 per cent of those who had normal, open tubes, compared with no endometrial fragments in the peritoneal cavity of the patients who had their tubes tied.²²

These studies confirm that endometrial tissue can make its way through the tubes into the abdomen. Research performed by Dr Michael Vernon on monkeys has also shown that endometrial tissue placed on the surface of the cells lining the abdomen readily supports the growth and development of endometriotic implants.²³

Thus it seems that Sampson’s theory of retrograde menstruation provides a workable explanation of how endometriosis starts. However, it does not explain how endometriosis can develop in the bladder of men, so some additional theories have been suggested over the past 60 years. A second theory proposes that endometrial fragments work their way into the blood circulation or lymphatic system at the time of the menstrual period. The uterus has a rich supply of blood and lymphatic vessels (see figure 9.1). As the endometrium is sloughed off, some pieces may enter open blood vessels or the lymphatic system and travel around the body. The lymphatic system is a part of the immune system and is explained in detail in chapter 9. It is similar to the blood circulation system, except that there is no heart to act as a pump. The body’s movements aid the flow of the lymph, which is an oil-like fluid through which the white blood cells can flow. This theory offers an explanation for endometriosis in lungs, since endometrial fragments entering the circulatory system at the uterus would flow freely until they reach the small blood vessels in the lungs. It also may explain the presence of endometriosis in joints.

Figure 2.5

Cross-section of the female torso showing the areas of the body where endometriosis is most frequently found.

Another theory, noted by Meyer in 1927, proposed that epithelial tissue (the cells on the surface of most tissues) has the ability to transform into different types of epithelial tissue. Meyer proposed that some epithelial tissue (for example, joint epithelial cells) is converted into endometrial cells, thus explaining how men may develop endometriosis.²⁴ Quite perplexing, isn’t it? The important question is ‘Why does this happen in some women, but not in others?’ Once we can find the answer to this, we will be nearer the cure. It is felt that a healthy immune system is the key to the removal of the endometriotic implants.

As the endometriotic implants are composed of a tissue very like that of the endometrium, the implants behave like the endometrium, and they respond to the same endocrine hormone messages. In fact, when Sampson first described the disease in the 1920s, endometriotic implants were sometimes referred to as ‘mini-uteri’. Using microscopic observations, Dr Deborah Metzger of Yale University has closely examined the response of the endometriotic implant to ovarian hormones. She noted ‘a correlation between morphological features (physical appearance) and the ability of endometriotic implants to respond to endogenous gonadal hormones (oestrogen and progesterone) in a manner similar to intrauterine endometrium’.²⁵ So the two tissues behave in an almost identical manner, one having a life-giving function and the other causing misery and pain.

Women with endometriosis in their noses actually have nosebleeds at the same time as their menstrual period. When the oestrogen of the ovary stimulates the cells of the uterine endometrium to proliferate, the cells of the endometriotic implant also increase. Therefore, endometriosis may ‘spread’ in response to the oestrogen produced during the menstrual cycle.

It has also been suggested that endometriotic implants may be fuelling their own growth by producing their own supply of oestrogen.²⁶ Such an ‘intracellular’ source of oestrogen could help to explain why some women’s endometriosis does not respond to the standard drugs which reduce oestrogen production from the ovaries. It could be said that endometriotic tissue is very devious. It could be perpetuating its own growth by making its own home-grown supply of oestrogen.²⁷ Remember too that every fat cell as well as the adrenal glands and the ovaries also produce oestrogen. The key is how the digestive system excretes the oestrogen.

When the progesterone produced by the corpus luteum in the ovary stimulates the cells of the womb endometrium to become more secretory, the endometriotic implants also start to secrete large amounts of proteins, carbohydrates, fats and oils (lipids) and hormones. However, the big difference with endometriotic implants is that its secretions are not contained safely within the womb and excreted out of the vagina, but dumped into the abdomen or other areas of the body. The delicate organs and tissue inside the abdomen do not normally come in contact with these inflammatory secretions.

Some of these chemical secretions can be quite harmful to abdominal function and possibly to the ova and sperm. For instance, large amounts of prostaglandin E (PGE) and prostaglandin F (PGF) are produced by the endometrium and the endometriotic implant. PGE stimulates excruciating pain. Laboratory technicians who accidentally expose a cut or the mucous membrane of their nose to prostaglandin E feel severe pain for hours, and sometimes days, after the contact. Prostaglandin F can cause increased gut motility (causing irritable bowel syndrome) and stimulate diarrhoea. Prostaglandin F can also shut down the function of the corpus luteum and interfere with the reproductive cycle by reducing progesterone output. Thus, the pregnancy would fail. Balancing the anti-inflammatory and pro-inflammatory prostaglandins seems to be another of the keys on the road to reducing inflammation and pain. This balance is dependent on the quality of fats and oils which we take into our body, and on our absorption of zinc, magnesium, vitamin B6 and biotin, as these four nutrients are all involved in the metabolism of oils.

There is no medical cure for endometriosis. The primary reason for this is owing to the fact that the cells of the endometriotic implant respond to the same cues and chemical messengers as the uterine endometrium. If researchers developed a chemical or physical agent that destroyed the cells of the endometriotic implant, it would also destroy the endometrium lining the womb which would have very serious consequences for fertility. What we need to do is find the differences between womb endometrium and endometriotic implants so that we can destroy the endometriotic implants without harming the endometrium.

APPEARANCE OF ENDOMETRIOSIS

Not only does endometriosis appear in multiple sites within the body, it can also have a different physical appearance depending on its biochemical status. Several researchers have attempted to classify endometriosis by the appearance of the implant and some classification systems list over 30 types of endometriosis! Dr M W Vernon of the Woman’s Hospital of Baton Rouge, Louisiana, USA, has developed a simplified classification system of endometriosis to explain the different physical appearance and biochemical status of the endometriotic implants.²⁸ In this system the implants are divided into three types:

1 Red or petechial implants. The first type owe their bright red appearance to a rich blood supply and look rather like a blood blister. These implants are the most biochemically active implants and may be the major culprit in the symptoms of endometriosis (i.e., pain and infertility), as they appear to secrete proinflammatory prostaglandins and the hormone oestrogen.

2 Brown or intermediate implants. These endometriotic implants look exactly like the fluffy, reddish-brown endometrium of the womb. They are less biochemically active than the red implants and are therefore called intermediate implants.

3 Black or powder-burn implants. These implants are virtually biochemically inactive. They have a poor capacity to secrete hormones, and they are associated with the formation of connective tissue that causes adjacent organs to become attached to each other (i.e., adhesion formation).

Adhesions can literally tie up organs, like the intestine, and cause serious gastrointestinal problems. Stretching these adhesions may also stimulate pain receptors on nerve endings. Adhesions are usually formed from sticky blood strands that set and harden between organs. The organs can then be pulled out of alignment. This tugging may cause sharp pain. The triggering of pain impulses and the production of the PGE proinflammatory series two prostaglandins directly by the implants may be the major cause of the pain associated with endometriosis, especially where the bowel may be attached to the ovary or uterus. Many women reading this book will understand exactly how excruciating that pain can be.

When a woman has endometriosis, the endometriotic implants are usually found in multiple locations in the body and all three types of endometriotic implants can be present at the same time. To help physicians determine the relative severity of the disease, the American Society for Reproductive Medicine (ASRM) has developed a classification system for endometriosis that has been used worldwide. This classification is based upon a scoring system that reflects the size, number and location of the endometriotic implants. Dependent upon the final score, the severity of a patient’s disease is classified into one of four stages (see Appendix A):

 Stage I or minimal disease

 Stage II or mild disease

 Stage III or moderate disease

 Stage IV or severe disease

The ASRM classification system has recently been revised by a group of international scientists, and the new revised system also incorporates the three types of endometriotic implants into disease assessment (see Appendix A). It also records the percentage of the three types of implants, as well as the size, number and location of the implants.

In the future, most physicians who directly examine endometriosis through surgery will be able to classify the severity of the disease by ascertaining the stage of disease and the percentage of the incidence of the various types. Your gynaecologist should be able to tell you exactly what your implants look like. Ask about this! It is important that this information is in your notes if you change consultants.

The question arises as to how can such an important tissue as the endometrium turn into such a villain when it grows outside the womb and what can we do about it. The best way to elicit change is by helping the endocrine glands to send the right message, and to ensure that the immune system is working effectively to remove the rogue endometriotic implants and that the digestive system is excreting oestrogen correctly.

DIAGNOSING ENDOMETRIOSIS

The two major symptoms of endometriosis are pain and infertility. Unfortunately, to many doctors these symptoms sound vague and in themselves do not present definitive evidence of the presence of endometriosis. The pain that most women with endometriosis feel may be similar to the pain from a long list of medical problems, including extreme uterine cramps, gastrointestinal bloating (causing painful distention), childbirth contractions, stomach ulcers, pelvic inflammatory disease, kidney dysfunction, irritable bowel disease, diverticulitis, vulvadynia, cystitis and bladder infections and many others. Similarly, it is difficult to determine from a physical examination whether a patient is infertile due to endometriosis or some other reproductive problem (unless large lumps of endometriosis are palpable, but these could also be mistaken for fibroids or ovarian cysts). The only definitive proof of the presence of endometriosis is through direct observation, which means surgery.

To diagnose endometriosis, a doctor can look surgically for the disease via laparoscopy or laparotomy (see also chapter 6 for information on these procedures).

LAPAROTOMY

Laparotomy is a surgical procedure involving a 10–12cm (4–5in) abdominal incision and exposure of the peritoneal cavity. This is a very invasive procedure and is often unnecessary.

LAPAROSCOPY

Laparoscopy or ‘belly-button surgery’ is the second and preferred surgery (see figure 6.1). In this procedure a fibre-optic device, called a laparoscope, is inserted through a small incision in the navel and the abdomen is examined and photographed or videoed. This procedure requires anaesthesia, but can be done in one day as an outpatient service. In the USA and Europe, some general practitioners can perform a mini-laparoscopy in their surgeries. As we will see in chapter 6, laparoscopy has the added advantage of allowing the consultant not only to diagnose the disease, but also to perform a simultaneous laser treatment, to ‘burn’ away visible endometriotic implants. If a woman consents to having a laparoscopic examination, she should confirm with the physician that in addition to diagnosing her disease, the endometriosis will be classified and photographed, and removed (by ablation, cauterization or laser). This spares her from a second operation and more anaesthetics, and the information will be very helpful in determining subsequent treatments. It would also prevent repeating the procedure if the patient changes doctors. Chapter 6 will discuss consent issues and medical ethics.

During laparoscopy, gases are pumped into the peritoneal cavity to increase the viewing area and to enable the consultant to move organs around in order to locate the endometriotic implants. Usually this form of surgery is successful in locating and ablating troublesome implants. The gases may dissipate to the four corners of the body, causing aching shoulders. Very occasionally the spine may need correcting by a chiropractitioner or osteopath as, when the body is tilted, unconscious, for several hours, the lumbar and cervical vertebrae may become misaligned. In order to speed up the healing of wounds after operations it has been shown that vitamin C and zinc supplements are helpful, as they are essential to the formation of collagen. Homeopathic Arnica 6X taken three days before and three days after an operation may reduce bruising. (Both Guy’s and St Thomas’s Hospitals in London, England, use this treatment for their patients after operations.)

CELLULAR BIOLOGY AND ENDOMETRIOSIS

Endometriosis happens at a cellular level; the implant attaches to the cell wall and hangs on for dear life. The important questions to ask are: Is something in the body weakening the cell membrane so that the endometriotic implants can take hold? How can we maintain the integrity of our cell membrane? If the cell membrane can remain strong, will it prevent the endometriotic implants from taking hold? Is a ‘balanced’ diet sufficient when we are so ill, or do we need nutritional supplements to help our bodies ‘kick start’ the healing process? Knowing how our cells work helps us understand why this may be essential in the short term.

Johannas Evers of Maastricht University in the Netherlands is ‘looking at the behaviour of endometrium and peritoneum, and at how the endometrial fragments contact the peritoneal lining, how it apposes and attaches to cell membranes. How it subsequently invades organs remains enigmatic’. Somehow, it is felt that these fragments of rogue tissue are damaging the peritoneal membrane. Evers has shown that normal peritoneal tissue has ‘Teflon’-like characteristics, which should be a defence against the endometriotic implants. But something secreted by the implants or immune cells may be disrupting this defence mechanism so that the peritoneal membrane behaves more like ‘Velcro’ and allows the endometriotic implants to stick fast to it.²⁹

Research by Professor George Gray CBE has shown that cell membranes behave like liquid crystals. Liposomes (oils) give cell membranes integrity so that they act as a barrier to stop harmful chemicals from entering. Liquid crytals are rod-shaped molecules that are sensitive to light and heat. Local environmental conditions can affect the biology of these crytals. By increasing our knowledge of the dynamics involved, we can begin to understand why the cell membrane changes from ‘Teflon’ to ‘Velcro’.

Nutritionally we know that magnesium and essential fatty acids enhance cell membrane integrity.

CELL STRUCTURE AND FUNCTION

There are many different types of cell in the human body – sperm cells in semen, bone-forming cells, red and white blood cells, cells forming connective tissue to hold us together, cells secreting acid in the stomach to help us digest food, cells storing fat in adipose tissue so that we are ready to survive a famine or drought, and the germ cells which form the ova. The list is endless. The basic structure is the same, but the function is very different for each cell. Together, cells make up the body in which we live. Each type of cell relies upon the nutrients in our diet to be fully functional. Low levels of essential nutrients cause cellular function to begin to fail.

Our bodies are about 70 per cent water. The cells also contain many minerals, trace elements and vitamins, often linked with sugars, fats or proteins. You are made up from what you eat.

Figure 2.6

Cell diagram which shows all the major organelles within each cell. Rather like a small industrial centre, they take nutrients and process them to form new tissues and chemicals for our body to rebuild itself and stay healthy.

The basic cell structure (figure 2.6) consists of the outer layer or cell membrane, and the inner area which contains a fluid called cytoplasm. Within the latter are mini-organs rather like factories where proteins, fats, enzymes and hormones can be built. The centre of the cell contains the nucleus. This is the brain of the cell which controls how the cell behaves and how it will pass on its code to a new cell. The nucleus contains deoxyribonucleic acid (DNA), the genetically coded information that we have inherited from our parents. Cells chatter to one another and, if the message is disrupted, it becomes like a country trying to work without a postal service.

The cell membrane consists of phospholipids (compounds made up of cis-oils and phosphorus). In chapter 4, we look at the role of prostaglandins (which are oil-based hormones), and how the quality of the oils we eat is very important for fertility and pain reduction. The cis-fats found in natural oils can keep the cell membrane strong, whereas the trans-fats from manufactured or processed oils cannot lock into the membrane very well and leave the cell wall more likely to be breached by harmful substances. (Trans-fats may be made within the body or they could be from the environment.) The cell membrane is permeable, to allow nutrients and substances used for rebuilding the body cells to pass in and out.

A cell is rather like a little powerhouse, or production line. There are factories making proteins from amino acids, phospholipids from fats and oils, and glycoproteins from sugars and proteins. The structures called mitochondria take from your diet iron, vitamins C, Bl, B2, B3 and B5, magnesium and coenzyme Q10, and with glucose, water and oxygen make all the energy the body needs. Magical stuff goes on in the twinkling of an eye.

We know that the amount of magnesium in the body is important for the integrity of the cell membrane. Research has shown that magnesium on the cell membrane can prevent the changes that cause cancer. Research shows that: ‘Magnesium on the cell membrane helps cells stick together in a normal fashion. Magnesium is required in more than 30 enzyme systems that deal with cell growth and division, which are disordered in cancers.’³⁰ Endometriosis cells appear to mimic the way cancer cells grow and this may be important to understanding the disease. Endometriosis is thought to have nothing to do with cancer, but the way in which the endometrial cells can implant themselves in other tissues and travel all over the body has some resemblance to the attachment and movement of cancers. By understanding more about the mechanism of transport, it may help us understand better how we can prevent the disease from taking hold. As magnesium is required for DNA replication and is involved with the enzymes affecting cell growth and division, we know that this mineral could be vital for reproduction and possibly for prevention of endometriotic implants. More research is necessary to show how magnesium levels affect the ability of endometriosis implants to attach to the cell membrane.

Production of skin, mucous membranes, cell membranes and tissue renewal are dependent on vitamins A, C and E, zinc, manganese, choline and essential oils (fatty acids). The mitochondria are protected by manganese and choline. Deficiency of manganese leads to alterations in cell tissues. So our nutrient intake can make the skin, mucous membranes and cell membranes throughout our body much stronger. Our bodies can only use what we put into them. If we are stressed, take in too many anti-nutrients (such as coffee, chocolate, alcohol, refined sugars, fizzy pop and cigarettes), if we are surrounded by pollution (lead, cadmium, mercury, aluminium, food additives, pesticides and fungicides), or eat processed foods low in essential minerals (such as zinc, magnesium, manganese, chromium and selenium) and essential fatty acids, then it becomes more difficult for our poor bodies to cope.

FREE OXIDIZING RADICALS

Alex Comfort, the gerontologist, says ‘FoRs are highly reactive chemical agents that will combine with anything that is around – like conference delegates.’ To add insult to injury, ‘free radical damage’ to the cell membrane could be another problem. Free oxidizing radicals (FoRs) occur naturally in the body and are formed when glucose is burned to produce energy. Free oxidizing radical means that the molecules are incomplete; they have an electron missing, giving them an uneven, negative electric charge. As a result, the FoRs will rush around the body like mad things trying to steal an electron from an already complete molecule in order to make themselves whole.

However, changes in our diets and the environment have also caused an increase in the number of free radicals produced. FoRs are present in burnt food, fried food, sunshine, smog, industrial factory fumes, pesticides, tobacco smoke, upholstery and carpet treatments, barbecued food, and chemicals used in the building and paint trade. The high levels of FoRs can cause the body to become overwhelmed so that it can no longer make them all safe.

FoRs can cause injury, inflammation and mayhem to cell membranes, collagen (the building block of all human tissue) and to the DNA in the nucleus. Wherever they have been, they leave behind a compound which has been denatured and can no longer function as it should. For example, proteins are rather like tight curly hair; once they have been denatured, the proteins uncurl and lose their power. Protein-based hormones, such as oxytocin and prolactin, can be damaged in this way. The FoRs also damage the fats and oils in our bodies, including those oils making up the cell membrane, the steroid hormones, prostaglandins and the immune cells of the lymphatic system. All this thieving of electrons causes a domino effect, cascading through localized tissues and causing untold damage, as the cell loses control of its internal and external biochemistry.

FoRs cause damage in four main areas:

1 Double bonds and DNA. FoRs love the double bonds of DNA molecules and are attracted to them because of the electrons they contain. If DNA function is impaired it can no longer reproduce itself faithfully. Cellular mutations may occur, and the production of new enzymes, hormones and proteins can become faulty.

2 Immune cells. Because immune cells are so complex, they are susceptible to FoR damage. If the immune cells are damaged by FoRs they can no longer identify and attack invading ‘aliens’ effectively, thus leaving our body tissues open to more damage than would normally have taken place. This damage may lead cells to attack ‘self’ tissue as in auto-immune diseases, which could be the case in endometriosis.

3 Cell membranes. The cell membrane is made up of lipids (oils) and the FoRs attack the lipids’ double bonds allowing harmful chemicals into the cell that may damage its working. Arachodonic acid from animal fats may trigger the cell walls to secrete prostaglandins which cause a proinflammatory reaction in the surrounding area, as happens with endometriotic implants.

4 Proteins. These are most susceptible to free radical damage. Once the electrons have been stolen from proteins they lose all their normal activity. This is very serious as all protein-based hormones, such as oxytocin, relaxin, inhibin and prolactin, and enzymes suffer irreparable damage. Collagen (the substance which holds cells together) is affected and wrinkles in skin can result. Skin and internal mucous membranes age more rapidly.

The question is, therefore, how to reduce the amount of damage caused by FoRs?

There are several enzymes in the body which exist in order to ‘mop up’ FoRs:

1 Super oxide dismutase (SOD) releases an electron to neutralize the FoR. For SOD to work, it needs regular supplies of copper, zinc and manganese from the diet. SOD forms part of a vital collection of genes which influence the repair of damaged DNA.

2 Glutathione peroxidase neutralizes FoRs by giving them an electron and stopping the damage before it begins. The amount of glutathione peroxidase present in the body is entirely dependent upon our absorption of selenium and vitamin B2 (riboflavin).

3 Catalase can only work when iron is present in sufficient quantity. It is an enzyme which plays an important role in the body’s metabolism and it also neutralizes the effects of FoRs.

Antioxidants

Antioxidants are specific nutrients which can disarm the FoRs by adding an electron to the FoR and balancing the electric charge. The best-known antioxidants are vitamins A, C and E, and the mineral selenium. But coenzyme Q10, Quercetin (a flavinoid, see Glossary), and the amino acids taurine, glutathione and cysteine are also involved. Other substances which help support antioxidant activity are copper, manganese, iron, sodium and the vitamins B1, B2, B3, B5, B6, para-amino benzoic acid, choline and inositol. If our digestive systems are poor at absorbing these vital nutrients or our diets do not contain them in sufficient quantities, then we will sustain more FoR damage to our cells.

Does this mean that the damaged cell membranes may be prone to developing endometriosis? We don’t know. More research is needed, but we can try to protect ourselves through our diet.

SUMMARY

1 The menstrual cycle is a complex mixture of interactions between the pituitary, the ovaries and the uterus.

2 The pituitary secretes the hormones FSH and LH which stimulate the ovary to produce mature eggs and steroid hormones (oestrogen and progesterone). The ovarian steroids, in turn, prepare the uterus for a possible pregnancy by stimulating the uterine endometrium to become a lush tissue that secretes the nutrients required by a developing embryo.

3 Endometriosis is a disease that is characterized by the presence of uterine endometrium in areas outside of the uterus, primarily within the abdomen. These rogue patches of endometrial tissue are known as endometriotic implants.

4 Endometriotic implants interfere with the menstrual cycle in a subtle fashion that is not fully understood. But they can lead to pain and infertility in some women. The hormonal messages get mixed up in endometriosis.

5 Weakened cell membranes may make it easier for endometriotic implants to take hold.

6 Magnesium and natural cis-vegetable and fish oils are known to improve the integrity of cell membranes, which may prevent the endometriotic implants from sticking like ‘Velcro’.

7 By reducing free radical damage the cell membrane may sustain less injury. Antioxidants such as selenium and vitamins A, C and E help to disarm free radicals. (A daily portion of fruit and vegetables will help to improve the dietary intake of these.)

8 Optimum nutrition and a healthy digestive system help to ensure that all cells work efficiently.

You must be the change you wish to see in the world.

Mahatma Mohandas Karamchand Ghandi, 1869–1948