Endometriosis: A Key to Healing Through Nutrition. Michael Vernon

the release of testosterone. The high testosterone then triggers high LH release from the pituitary. When the thyroid hormone thyroxine and the sex hormones oestrogen and progesterone do not work effectively, then blood sugar levels may rise. Severe shock may cause the pituitary and thyroid glands to function below par. Insulin is zinc dependent, and glucose tolerance factor (GTF), another hormone, depends upon chromium and vitamin B3. Both insulin and GTF are produced in the pancreas, an endocrine gland, and they work alongside other hormones in balancing the blood sugar levels in the body.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

      To date, there is not enough information on how all these hormones ‘talk’ to one another normally. Much is known of the effects of IVF drugs on hormone levels, but too few studies have been carried out on what is normal in women. The problem is that most women are or have been on the oral contraceptive pill (80 per cent of all American women) or steroid hormones as