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Endometriosis Management NEW Concepts

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22 Jul 2020 Women's Health

Endometriosis a sad and painful problem for many women

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Key Points


Endometriosis is defined as an estrogen-dependent, inflammatory disorder19. Research-based estimates show that around 40-60% of women with painful periods have endometriosis56.

> The Interventionist Medical Approach vs The Functional Medical Approach: 
Interventionsist (conventional) medicine will target the endometriosis cells directly and ignore the cellular terrain that feeds and drives the fudamental processes of endometriosis i.e. the estrogen level and inflammatory processes within the cellular terrain defined below. 

The 'Cellular Terrain' makes up all the factors that ultimately have an impact on the cells that in turn, makeup all our tissues and organ systems. It is the sum total of all the following - our nutritional status, our hormonal system, signalling molecule effects, macronutrient impacts, postprandial (after-eating) impacts, sufficiency of all vitamins - minerals- trace elements, sufficiency of essential fatty acids (Omega-3's), the vascular and lymphatic drainage systems working efficiently (exercise, activity), the efficiency of our immune system, our gut microbiome being healthy, toxic exposures (our exposome) minimised, toxic elements neutralised or excreted effectively by optimised biotransformation pathways. All of these have a powerful impact on the Cellular Terrain and if this is affected then all of our human cells will be affected making it difficult for our body to prevent cancer or to make it hostile to existing cancer cells. 

To view the differences between Integrative Medicine and Functional Medicine Functional Nutrition approaches - CLICK HERE 


> Modifying Estrogen: Thus, if this disease is driven by estrogen, then logically, estrogen modification will be our target in the treatment process.
Functional medicine used weight loss, specifically visceral fat loss which can drive estrogen producting by converting testosterone in females to estrogen by an enzyme called aromatase. This aromatase enzyme can be targed by many natural compounds to decrease estrogen and by inhibiting beta-glucuronidase an enzyme produced by gut mirobiome organisms this prevents bound estrogen destined for excretion being reabsorbed again. Glucomannan can markedly decrease beta-glucuronidase activity by over 30%76 and our Activ8Health practitioners can guide you in this regard. Lignans are natural compounds and dietary guidance can help you increase lignan intake and these lignans are converted to weak estrogens by the gut microbiome and these then compete with the stronger estrogens to dampen their effect on endometriosis tissue. 
This helps to optimise your cellular terrain through dietary manipulation to make the cellular terrain hostile to endometriosis cells preventing proliferation and spread. 
 
> Both estrogen and inflammation can be powerfully modified through an optimal diet, nutraceuticals (supplements) and lifestyle. Please view Activ8Health's 12+1 approach to nutrient intake. Learn more

> Fibre intake can actually decrease the absorption of gut estrogen: Your body can produce more hormone than is required, or perhaps the hormone has done its job and is not needed at that concentration anymore. The body has a mechanism called Biotransformation, which has two phases in the Liver (Phase-I and Phase-II). The Liver is a fantastic organ that is full of enzymes and compounds that can neutralise toxic compounds through the biotransformation processes. One of the molecules is estrogen that can have a powerful effect on tissues like the breast, prostate and diseases like Endometriosis that respond in a negative way to estrogen excess. The gut microbiome has organisms called the Estrobolome that unfortunately produce an enzyme called Beta-Glucuronidase that splits apart the bound estrogen that was destined for excretion, thus freeing it in the bowel and allowing that estrogen to recirculate once again to drive many disease states. As mentioned above, Glucommanna can markedly decrease beta-glucuronidase activity76. Fibre can also bind many toxic compounds within the bowel and assist their excretion. D-Calcium Glucarate can help inactivate Beta-Glucouronidase. See below. 

A diversity of fibre through diet and supplementation will help decrease this gut microbiome effect. An Alginate-Konjac-Xanthan soluble fibre mix and capsule is available and to add even more diversity of fibre intake, a Partially Hydrolysed Guar Gum (PHGG) is also available for daily use to enrich your gut microbiome and to decrease the absorption of estrogen. Remember, the gut microbiome uses fibre as food and that a strong and diverse gut microbiome will help to strengthen your immune system and help regulate some of the dangerous compounds we all are exposed to in the diet and environment. 

> Dietary and Supplemental Lignans blocking the effects of stronge estrogens:  Once again these are safe and natural compounds found in certain foods like flaxseed, sesame seeds and other plant-based sources. A diet rich in lignans can counteract the effects of the strong estrogens in the body. It is interesting that lignans are converted by the gut microbiome to enterolactone and enterodiol which are both weak estrogens. This may seem counterintuitive to use in Endometriosis or Breast and Prostate disease but these weak estrogens can competitively block the action of the stronger estrogens at the receptor thus protecting hormone-sensitive tissues. Our specialist Dietitians will guide you towards a lignan-rich dietary intake. 

> Natural Aromatase Inhibitors: Quercetin, Resveratrol, Grape Seed Extract: have been show to have potent effects on Estrogen sulfotransferase (EST)63 an enzyme that creates free estrogen in cells. Grape Seed Extracts, Resveratrol and Quercetin, are all natural compounds found in fruit and vegetables. They have all been shown to have aromatase inhibiting action. Aromatase is a troublesome enzyme found in the visceral (deep) abdominal fat of men and women that converts testosterone to estrogen. This enzyme action is an obvious disadvantage in endometriosis, breast tissue and prostate tissue that respond adversely to higher estrogen levels. Hopefully, you see that there are so many ways to decrease the effect of estrogen through dietary and supplement manipulation. 
 
> Endometriosis as an inflammatory processes18,19 can be managed by safe and natural compounds like Palmitoylethanolamide (PEA) which has a multi-targeted effect on inflammation and pain and mimics the action of an endocannabinoid molecule. A Pharmaceutical-Grade supplement created by a highly reputable Pharmacy is available to you through an Activ8Health practitioner as (see below). PEA may also have a significant effect on nerve and pelvic pain.
 
> Dampening inflammation through a full spectrum of Omega-3's - DHA, EPA, ALA, GLA: At the right doses can help to significantly dampen inflammation-driven disease processes. Use this to your advantage to fight inflammatory pathways that promote the spread of endometriosis. Testing can enure a far more targeted approach to Omega-3 supplementation. See Omega Lipid Assessment below. Ask a specialist Activ8Health Dietitian about a broad range of Omega-3 supplementation and the DHA + Choline formulation. 

> Stunning new research showing the way the brain controls inflammation: The Choline Connection
Exciting new research has shown a direct link between the brain and the Spleen (under the left rib cage) which is an important organ for the immune system. The Spleen may have activated immune system cells that produced pro-inflammatory chemicals called cytokines. What we have not known until recently is that the brain can send a signal to the Spleen to decrease the amount of inflammation in the body. This 'Inflammatory Reflex' as it is called, is a part of the parasympathetic nervous system that requires Acetylcholine, a form of neurotransmitter or signalling molecule, to function. As the name Acetylcholine suggests, Choline is vital to creating this neurotransmitter enabling the brain to do its job to dampen down inflammation. This link between nutrition and critical system functioning is obviously well known in medical science but poorly known and implemented at the level of medicine that actually treats individuals. A sad neglect of nutritional science and an indictment of medical training falling far behind the multibillion dollar strides in molecular nutritional concepts and precision nutrition. 
 
> Natural Palmitoylethanolamide (PEA) - Multi-Action Inflammation + Pain Control: PEA is a natural and safe biologically active lipid (fat molecule) used in many chronic pain states. Pain is often a significant factor with Endometriosis requiring numerous medical or surgical treatments which have their pros and cons. Palmitoylethanolamide (PEA) produced by your own body in response to pain can dampen down not only inflammatory pathways as discussed above, but can modify pain signalling. PEA can be used and has been used in conjunction with a variety of other medications safely and effectively and is a tool used by many pain specialists. This compound has been studied since the 1950's when it was discovered in egg yolk as having anti-inflammatory action. Most of the medical interventions will not have this long history of research but are far newer compounds with known side-effects. A paper published in the Journal of Pain Research states this compound is has been shown to very safe even when used in combination with other pharmaceutical compounds25,26. Always check with your treating medical practitioner who may or may not know about this compound. Avoid using this if you are planning to fall pregnant. 
 
> Optimising your diet: Is critical in the management of Endometriosis as food components such as Trans Fats, or Omega-6's can drive the disease. A 'Precision Nutrition' approach is vital to achieving positive outcomes (see below)
 
> Xenoestrogens can drive Endometriosis. All that smells good may be bad for you: Many compounds in the environment such as scents and perfumes, can have estrogenic effects (xenoestrogens). Perfumes should NEVER go on the skin but remember, inhaling it will have a hormonal effect in men and women. It is vital to modify your environment to avoid these factors that can drive Endometriosis (See below). Imagine young children as well being exposed to these estrogen-mimicking compounds. Is this a factor that is causing Endometriosis and perhaps producing hormonal effects in young girls and for that matter boys, that sets the scene for hormone-related conditions as they grow up? Avoid perfumes, avoid 24/7 plugged-in scents in the home, avoid scented candles that have a double-whammy effect of a xenoestrogen hit as well as aerosolised waxes that go into your lungs. 
 
> Antenatal supplements including DHA and Choline: If you are in your childbearing years and are wanting to have a child, it is important to consider using quality antenatal supplements, and this should include supplementing with a high level of DHA and Choline (see below). Discuss this with your specialist Activ8Health practitioner as you will want to use the safest and highest quality practitioner-only products at this critical time. These should be used by both the woman and the man!

 

Learn More Button: Click on the 'Learn More' button under the 'Supplement Panel' and discover what you can do to switch off inflammation by maximising Omega-3 intake. It is wise to get a full Omega-6, Omega-3 analysis as this can help us target management (discuss this with an Activ8Health practitioner). A large number of ignored yet powerful anti-inflammatory compounds also exist like N-Acetyl Cysteine (NAC). A full complement of essential fatty acids can help significantly to optimise cell membranes, with a higher intake of DHA and Choline that are great nutrient allies in the fight against inflammation. Ensuring you have all the essential micronutrients to 'fill in the gaps' is our target as this will give your body the best chance to overcome disease processes by functioning optimally in a biochemical, immune and molecular sense.


Medicine can be so much more if fundamental researched-based understandings of molecular micronutrient action can be used at the coalface of medicine as adjunctive treatment for common clinical conditions.  

 
  • Decreasing Weight & Waist Circumference:  Decreasing deep abdominal (visceral) fat needs to take priority. Please read how Activ8Health deals with this issue. Click Here 
    Deep abdominal (visceral) fat has an enzyme called aromatase that can convert Testosterone to Estrogen. Sad but true. This can decrease your libido because your body is 'chewing' up precious Testosterone that drives libido to create Estrogen that drives endometriosis. Losing weight through the guidance by a Specialist Activ8Health Dietitian + targeted supplements can decrease the impact of Estrogen on your Endometriosis. 
     
  • Cell Protection Nutrients. Modify Your Estrogen and Inflammation Profile: There are a multitude of nutrient factors that have specific effects that are well documented in the scientific literature. A formulation has been devised that works in multiple ways to decrease the effect of strong estrogens on endometriosis and to dampen inflammation in many ways that drives this disease. 
     
  • Alginate-Konjac-Xanthan Soluble Fibre Complex: Can help you shed weight. Simply take this multi-University researched fibre supplement and this includes the Glycaemic Index (GI) unit at Sydney University, which can be taken with each meal to decrease appetite and help shed deep abdominal (visceral) fat to decrease the impact of Estrogen on your endometriosis. Add fibre complexity to feed and nourish your gut microbiome by adding Partially Hydrolysed Guar Gum to this. PHGG should be taken morning and night 1 hour before meals. 
     
  • Use Magnesium Threonate a Practitioner-Only Product: Around 70% of people may be magnesium deficient44. Magnesium is critical for insulin to function through insulin receptor signalling32. Without enough magnesium in your body, you risk many things going wrong. Ensure you provide the insulin receptor with the magnesium it needs to function properly.  It is known that magnesium has an inverse relationship with the highly researched inflammatory markers, hs-CRP and IL-6 as shown in a large and very long 20-year study in young American adults43. In other words, the higher the magnesium level is in your body, the lower these inflammatory markers. A vicious cycle may develop between low magnesium levels and magnesium excretion in the kidneys32. In other words, if magnesium levels are low, the effect is to lower it even further through kidney magnesium excretion. A dangerous self-perpetuating effect in the body. Magnesium Threonate is a Massachusetts Institute of Technology (MIT) researched form of magnesium that can cross the Blood-Brain-Barrier (BBB) to help with brain health34,35. 
     
  • Get a Dietary Analysis Done: Don't Guess What Your Are Eating - Analyse It. One of our specialist Activ8Health Dietitians will organise this for you and provide you with a detailed report of any important nutrient weakness. Understanding exactly what you are eating will enable the Activ8Health practitioner to truly target what you are eating and to fix any dietary problems. 
     
  • Get a full Omega Analysis to optimise your Omega-3 Intake: Endometriosis is driven by inflammation. Don't guess if your body is inflamed - analyse It. Technology now allows you to measure your Omega-6 and Omega-3 levels. By analysing this in your body, you can fine-tune the amount of Omega-3 needed to truly dampen inflammatory processes in the body. Find an expert practitioner on this website to guide you. Click Here
     
  • DHA (Omega-3) + Choline For Cell Function and Inflammation: DHA a long-chain Omega-3 fatty acid along with choline are critial for cell membranes to function and to dampen inflammation. A practitioner-only product that has both DHA and Choline at effective doses may make a significant difference to inflammatory processes. These two compounds are vital during pregnancy especially when the foetal brain is being developed. There is compelling evidence that Choline may have a major impact on preventing mental health disorders developing including Schizophrenia12,20 and DHA in a Cochrane Collaboration study has shown unequivocally that premature birth can be greatly decreased through the adequate intake of this important Omega-355. 
     
  • Personalised Nutrtition: Consider a Full Personalised Nutrition Screen: Check the animation below. This includes 1) A Dietary Analysis to analyse your diet 2) Checking Omega-6, Omega-3 levels 3) Checking the Gut Microbiome, i.e. the organisms in your bowel as this affects the whole body 4) Genetics (Nutrigenomics) to look for genetic mutations that may indicate personalised dietary modifications to offset those mutations and their effect on on your body long-term
     
  • Multivitamin-Mineral Practitioner-Only Supplement: Will help ensure cell biochemistry functions at an optimal level. High quality, practitioner-only products chosen because of their quality, research, good manufacturing practices (GMP) and testing for safety. All your cell biochemical processes require vitamins and minerals to function. A multivitamin will not be needed by a woman taking comprehensive antenatal supplements. 

 

Targeting estrogen the driver of Endometriosis 

Estrogen is a driver of Endometriosis, so it is not surprising that this should be a target for both medical and diet-related ways of decreasing the impact of estrogen on metastatic endometrial tissue. We can look at the following mechanisms to minimise the effect of powerful estrogens on endometrosis tissue: 

1. The Estrobolome

The body gets rid of excess hormones by biotransformation. Often the hormone or toxic compound is bound to another molecule which makes it easier to excrete in the bile, through the kidneys or bowel.

However, we have organisms called the Estrobolome which are gut microorganisms that produce an enzyme called Beta-Glucuronidase that can zip apart that bound estrogen in the bowel lumen to release back into your body once again what your body has worked hard to excrete. Reabsorbing estrogen designed for excretion won't help your cause. 

Calcium-D-Glucarate can inhibit Beta-Glucuronidase and can be found in the comprehensive supplement recommended. 

2. Lignans and Competitive Inhibition of Estrogen

Certain compounds called lignans can be converted by the gut microbiome to weak estrogenic compounds. This fact may seem counterproductive when Endometriosis is driven by estrogen but, paradoxically, these weak estrogens compete for the more powerful forms of estrogen at the receptor level thus blocking their effects. 

Increasing lignans can be achieved through dietary and supplementary means. Our highly qualified Activ8Health Dietitians can guide you towards the consumption of a high-lignan diet and also have a look at the comprehensive supplement recommended below that has a powerful lignan compound. 

3. Converting Stronger Estrogens to Weaker Ones 

The body is constantly trying to balance or eliminate harmful compounds, and it does this through various mechanisms one being biotransformation which occurs mainly in the liver the so-called Phase-1 (CYP450) and Phase-2 (Conjugation) pathways. This is where the body uses biochemical processes in the liver to make toxic compounds into neutral and non-toxic compounds to excrete via the liver in the bile or through the gastrointestinal tract or excreted through the kidneys. 

Biotransformation pathways can be supported by ensuring you have all the vitamins, minerals and trace elements needed to support the enzyme systems involved and to have an optimal intake of cruciferous based vegetables or extracts such as Sulforaphane that helps the Phase-2 pathway function more efficiently. 

The Liver Biotransformation Pathways 

4. The Gut Microbiome and the GI360 Test: Finding out your Beta-Glucuronidase Activity

The GI360 test is a comprehensive analysis of your gut microbiome. This includes the assessment of the level of Beta-Glucuronidase activity that frees up estrogen destined for excretion being reabsorbed to worsen your Endometriosis condition. If this enzyme level is high, a far more targeted approach can be taken.

This Beta-Glucuronidase activity may be undermining your ability to control the Endometriosis process. 

Find a highly specialised Activ8Health Dietitian to help you organise an analysis of your gut microbiome.

 

5. Endometriosis is driven by inflammation19: How inflamed is your body? 

A big driver of inflammation in people is caused by a combination of the following: 

  • A big difference in the amount of Omega-6 fatty acids consumed relative to Omega-3's. This will prime all cell membranes for inflammatory responses.
  • High saturated and trans fat diets can powerfully alter the gut microbiome to allow Endotoxin (Lipopolysaccharide or LPS) to drive high levels of inflammation in the body
  • High-fat diets can also increase blood triglyceride levels after eating and these have been described as producing a 'soaring' inflammatory response in the body23.
  • A high protein diet that can markedly stimulate the mTOR cell synthesis pathway increasing cell multiplication and body fat stores as protein can easily be converted to fat in the body including highly inflammatory visceral fat and this protein to fat conversion is easy as stated by this highly respected biochemistry text22. Your protein intake needs to be calculated based on many variables, and a highly qualified Activ8Health Dietitian can do this for you. Adequate protein is critical to weight management, and this is known as 'Protein Leverage'24. With weight management concerns, a complete amino acid blend can be used instead of whole protein that can add excess calories to your diet. 
  • High starchy carbohydrate diets can lead to postprandial (after-eating) inflammatory surges in blood glucose that can also produce glycation to proteins damaging them to create Advanced Glycation Endproducts (AGEs), and these damaged proteins can lead to inflammation. 

 

6. Toxic Perfumes, Scents and Hormone Disruption and Xenoestrogens

Perfumes in the minds of most women will conjure up subconscious or conscious feelings of elegance, glamour and seduction with imagery driven by powerful and expensive advertising campaigns often using ultra-beautiful actors, models or simply famous people to sell this image. 

A Research and Markets report 2019 states that this is a $48 billion dollar industry with Hollywood A-Listers to Z-listers all scrambling to capture even a small amount of this vast market. 

So you start your day spraying 'Perfume-X' in copious amounts on your skin and perhaps clothes with the aim of creating a scented cloud that not only surrounds you but engulfs and embraces your current or potential partner in a heady sexual torment. Or so you think, but what seemed to be the realm of women in the past is now becoming commonplace for men as well who will also spray copious amounts of 'Manly-Cologne-Y' to also entice a woman. So here you both are, each drenched in a toxic scent with toxic clouds surrounding each of you and worse still, a poisonous mix of numerous chemicals when both scented clouds collide. 

You many be asking yourself why something so pleasant can be such a risk? The problem is that everything that smells nice has a Phthalate called diethyl phthalate, or DEP. These Phthalates can be found in perfumes, scented shampoos, conditioners, deodorants, detergents, soaps, toilet sanitizers, cosmetics, lotions, hair products, hairsprays and of concern is the growing number of products that are being promoted for the home where you can just plug in a scent reservoir that will provide a 24/7 toxic cloud in your home.

Scented candles are even worse as you not only have the hormone-disrupting scents filling the air but aerosolised waxes that are toxic to the lungs. 

There is a growing body of research that is showing that Phthalates have an affect on hormone function either producing an agonist (enhancing) effect and these are called xenoestrogens i.e. environmental chemicals that have estrogenic activity, or the Phthalate or other chemical disrupter may have an antagonistic effect where it blocks the action of hormones like estrogen or testosterone. These effects have been shown in studies on Phthalate activity to adversely affect sperm quantity, sperm quality and to increase sperm damage. Phthalates can potentially affect diseases like Endometriosis, Breast Disease, Prostate Disease in men or Polycystic Ovarian Syndrome (PCOS) in women, that are driven by or affected by hormonal activity or hormonal disruption. 

If you are trying to control your Endometriosis then it makes great sense to avoid perfumes and to make your home scent-free and to ask your partner to follow suit. 

 
 

 

 

 

Our Activ8Health team is here to support you  

Product & Micronutrient References
Highlighted Product References

 

Blog References
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