Medical research and diet for Endometriosis and the Immune System

From the website of the Physicians Committee for Responsible Medicine


Founded in 1985, the Physicians Committee for Responsible Medicine (PCRM) is a nonprofit organization that promotes preventive medicine, conducts clinical research, and encourages higher standards for ethics and effectiveness in research.


Extract from an article by Neal Barnard, M.D.


Diet for Endometriosis Article

Certain foods appear to make endometriosis more likely. According to researchers at the Harvard School of Public Health, women who have two or more cups of caffeinated coffee (or four cans of cola) per day were found to be twice as likely to develop endometriosis as other women. The reason why caffeine has this effect is unknown. (Grodstein 1993)

Foods tainted with certain chemicals appear to encourage the implantation of cells in the abdomen. Polychorinated biphenyls (PCBs) were commonly used in electrical equipment, hydraulic fluid and carbonless carbon paper, and organochlorine pesticides have been commonly used in agriculture. In 1992, German researchers found that women with high blood levels of PCBs had a higher prevalence of endometriosis. (Holloway 1994)

These chemicals presumably do their dirty work by impairing your immune defenses against abnormal cells. Indeed, the natural killer cells and other white blood cells that are supposed to maintain a constant look-out for any abnormal cells have been shown to be weakened in women with endometriosis. (Dmowski 1995) In addition, some organochlorines mimic the effects of estrogens. (Koninckx 1994, Ahlborg 1995)

These toxins tend to accumulate in animal fat, and the major route of human exposure is through food, particularly fish. They also show up in meats and dairy products. (Ahlborg 1995) Chickens, cattle, pigs, and other animals are fed grains treated with pesticides and sometimes contaminated with other organochlorines, and they tend to concentrate these compounds in their muscle tissues and milk. While there may also be organochlorine pesticide residues on non-organic fruits or vegetables, they are less concentrated and are easier to remove. Organic produce is grown without chemical pesticides.

To measure the concentration of organochlorines in a woman's body, researchers sometimes check samples of breast milk. Breast tissue is a natural target for chemicals that dissolve into fat, and, in fact, during breast-feeding, a woman can excrete up to half of all the dioxin she has accumulated in her body tissues. (Koninckx 1994) Unfortunately, the recipient of these chemicals is the nursing baby. (Ahlborg 1995)

A vegetarian diet has obvious advantages. By avoiding fish, other meats, and cow's milk, you avoid the foods that harbor most organochlorines. Indeed, researchers have found that vegetarian women have much lower levels of pollutants in their breast milk, compared to other women. (Hergenrather 1981) The earlier in life that a plant-based diet is begun, the better.

Happily, bans on some of these compounds have caused exposures to decrease since the 1970s, although the amount in your body drops only very slowly.


Foods as a Treatment for Endometriosis

Some women with endometriosis improve spontaneously, (i.e. with onset of menopause) although most find that their symptoms continue or gradually worsen. Medical treatments rely on anti-inflammatory pain-killers and hormone treatments designed to shrink endometrial tissues: danazol, gestrinone, GnRH agonist analogs, progesterone derivatives, and progesterone-estrogen combinations.

Surgical treatments include removing cell clumps, severing pain nerves, and even hysterectomy, sometimes with removal of the ovaries. Surgery to remove endometrial cells has about the same effectiveness as drug treatments, but both are usually temporary measures, as they do not reliably eliminate all of the troublesome cells. (Dawood 1993, Revelli 1995)

The dietary treatment is based on the fact that, whatever causes endometriosis to start, it is estrogen that keeps it going. Without estrogen, the clumps of cells do not grow each month; they soon wither away.

That means that the dietary approach that reduces estrogens can also be used for endometriosis. In my discussions with gynecologists who have tried this approach, it is clear that, for some patients at least, it can make a big difference.

Ronald Burmeister, M.D., a gynecologist in Rockford, Illinois, describes the case of a 24 year-old woman who had had terrible menstrual pain every month since her periods began. She had had laparoscopic surgery twice, but her pain continued. She had tried birth control pills, but they caused depression and other side effects. Hormone-blocking medications were helpful, but the medicine was very expensive and, in any case, could only be prescribed for six months without an increased risk of osteoporosis. After it was stopped, her pain returned. A progesterone derivative helped some but did not abolish the pain. One of her doctors recommended hysterectomy, but she wanted to avoid such a drastic solution.

Dr. Burmeister suggested trying a hormone-balancing diet. Using low-fat, purely vegetarian foods, she could reduce her hormone shifts, and, unlike medicines or a hysterectomy, it would not interfere with her efforts to get pregnant. He gave her a set of recipes and recommended several books for further information.

Within three months she was noticeably better, and at six months her pain was gone. She stopped the progesterone derivative, and set about seeing if she could become pregnant.

Based on this success, Dr. Burmeister made the same recommendation in three other cases, and found that it was helpful in reducing pain. One patient reported that if she deviated at all from the diet, by having some dairy products or a bit of chicken, her pain came right back, just as skipping one or two pills can make a prescription fail.

No one has yet done a clinical study on the use of a low-fat vegetarian diet for endometriosis. That should change, because, unlike hormone treatments, it does not interfere with efforts to conceive. It is also cheap and safe, and it brings many other health benefits, too.

Aerobic exercise also helps. Women who run, jog, or work out for two hours per week have only half the risk of endometriosis, compared to other women. The reason, presumably, is the well-established ability of exercise to reduce hormone activity. In fact, women who exercise very strenuously and consistently sometimes miss periods altogether. (Mangtani 1993) Exercise also strengthens the immune system, making you better able to eliminate errant cells.

Natural progesterone can also be used to oppose estrogen in endometriosis. It is typically used from day 8 to day 26 of the monthly cycle (counting the first day of bleeding as day 1), using up a two-ounce jar each month. This delivers about 40 to 50 milligrams per day. Normally, this dose is continued for about four months, then the dose is reduced as the pain diminishes.


Immune-Boosting Foods

If endometriosis is caused by an immune system failure to recognize and eliminate out-of-place cells, it may be that immune-boosting foods might help prevent it.

You already want to reduce the amount of fat you eat in order to keep your estrogen level lower. Getting away from fat also helps your immunity. (Barone 1989) Researchers have found that fatty foods impair the function of white blood cells. This is true for any kind of fat—animal fat or vegetable oil. It is also true of cholesterol. When researchers add cholesterol to white blood cells in the test tube, they find that their immune strength is diminished. (Cuthbert 1984, Pepe 1986, Traill 1990) A low-fat, zero-cholesterol diet simply means getting your nutrition from plant sources, rather than animal sources, and keeping the added oils to a minimum.

Researchers have studied the effect of different diets on the natural killer cells that seek out and destroy abnormal cells, and it is clear that getting away from fat and cholesterol makes a big difference. When blood samples are taken from volunteers and the ability of their natural killer cells to destroy abnormal cells is tested, vegetarians do twice as well as their omnivorous counterparts. (Malter 1989)

You can get an extra immune boost from beta-carotene, found in orange vegetables, such as carrots and sweet potatoes, from vitamin E, found in grains and beans, and from vitamin C, which is in many fruits and vegetables.


Adenomyosis

Adenomyosis is a condition in which the cells that normally line the uterus are found in pockets within the muscle layer of the uterus. This occurs to some extent in up to 40 percent of women, and it probably causes no symptoms at all unless it is fairly deep into the muscle layer.

As in the case of endometriosis, the stimulus for the growth of these cells is probably estrogen, (Yamamoto 1993) which again means that reducing estrogen production through diet changes makes good sense. Unfortunately, these diet steps have never been put to the test. One complicating feature may be that the endometrial cells make their own estrogen, and the extent to which diet changes can influence this local production is unknown. (Yamamoto 1993)

We have good evidence that diet changes can help women with common menstrual pain, and time will tell if these same changes help women with specific causes of pain, including endometriosis and adenomyosis.

There are many other approaches to menstrual pain. Some researchers are beginning to test whether ginger's anti-inflammatory effect helps reduce menstrual pain, when used in doses of one-half to one teaspoon (one to two grams) each day. Unfortunately, unlike motion sickness and arthritis where we have good evidence of its efficacy, tests of ginger for menstrual pain have been limited to individuals. (Srivastava 1993) More and more herbal supplements are also available. It helps to keep an open mind, and to see what they might do for you.



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