Endometriosis: A Key to Healing Through Nutrition. Michael Vernon

daily, fresh supplies of linoleic and alpha-linolenic acids from vegetable and fish oils as it cannot make series one and three vital fatty acids. If the daily diet is poor, the body supplies of these essential fatty acids will be extremely low.

      • CASE STUDY •

       Jane W J of Kent

       I remember that the nutritional programme did make me feel much better. I still rely on the evening primrose oil. I really feel the difference in pain and PMT if I run out or forget to take it before a period. I take 1,000mg a day, upping it to 2,000mg a day in the immediate days before the period.

       I conceived straightaway after the nutrition programme and, since then, my endometriosis has been in remission.

       Essential fatty acids – the precursors to prostaglandins

      Prostaglandins (PGs) are lipid (oil-based) hormones that have very important effects upon such body tissues as cell membranes in the reproductive system. The precursors to prostaglandins are the essential fatty acids (EFAs), arachidonic, linoleic acid and alpha-linolenic acid. Cis fatty acids should be the preferred source of oils in our diet.

      The conversion of prostaglandins from EFAs depends upon enzymes, which are in turn nutrient dependent. If an excess of the wrong types of prostaglandins are produced by our tissues, this may lead to internal inflammation. Often the actions of one group of the PG system are in direct opposition to those of another.

      There are three types of prostaglandins (see figures 4.3 and 4.4):

      1 Series 1 prostaglandins are derived from vegetable oils and they have anti-inflammatory properties (linoleic acid).

      2 Series 2 prostaglandins from dairy foods and fats within meat can cause inflammation to occur (arachidonic acid).

      3 Series 3 prostaglandins are metabolized from fish and linseed oils and have anti-inflammatory properties (alpha-linolenic acid).

      Figure 4.3

      Metabolic pathway of the prostaglandin pathways for series 1 and series 2 prostaglandins.

      Linoleic acid, which the body cannot make, comes from safflower, sunflower, hemp, soya bean, walnut, pumpkin seed, sesame seed and flax (linseed) oils. You need a fresh daily supply of this cold-pressed oil. Linoleic acid is the precursor of series 1 and series 2 prostaglandins. In your body, linoleic acid is changed, using nutrients, into gamma-linolenic acid (evening primrose oil). This is then changed again to dihomogamma-linolenic acid, which is the anti-inflammatory form, and also to arachidonic acid, which is proinflammatory. The vitamins and minerals which are required for their formation are listed.

      The three different types of PGs need to be kept in balance (see figure 4.3), because they have a role in maintaining body homeostasis. (Homeo means same; stasis means standing still; homeostasis is the harmony within the body.) The body has an internal environment which has to be maintained within certain limits, for example, temperature control and the acid/alkaline balance, and it is constantly making adjustments to maintain this stable state. The body requires a rich mixture of gases, nutrients and water to control the temperature balance (here the thyroid gland in the neck is involved). It also needs fresh water to maintain health within cells. Health can deteriorate rapidly when this homeostatic balancing act is disturbed.

      Thus, PGs possess both proinflammatory and anti-inflammatory properties. It has been suggested that more evidence ‘appears to indicate that PGs from series 1 conceivably dominantly have an anti-inflammatory property, whereas the series 2 PGs may have mainly pro-inflammatory qualities depending on their local concentrations’.⁶ Series 3 PGs are also anti-inflammatory. If you absorb enough linoleic and alpha-linolenic series 1 and 3 groups from good quality cis oils, you should be able to produce sufficient prostaglandin PGE1 which reduces the production of series 2 arachidonic acid (arachidonic triggers inflammation and pain in the body). Thus you can help to control internal inflammation just by eating the right sorts of oils. Evening primrose oil can be beneficial for some people; it tips the balance.

      ‘Only the natural horseshoe shape cis form of linoleic and linolenic acids are able to contribute to the formation of PGs.’⁷ Trans fatty acids which have been changed by chemical processing known as hydrogenation form a kink shape are not as effective in the formation of prostaglandins. Macrophages, often the predominant immune cells present during chronic inflammatory conditions, release PGs in response to inflammatory stimuli. In women with endometriosis the macrophage count is often higher than normal. If they release PGE2 more inflammation may occur (see chapter 9).

      As an added bonus, PGE1 is able to stop blood cells becoming sticky; it can help to remove fluid from the body and can improve the functioning of nerves. It also has been shown to help immune cells in their work of clearing up cell debris in the abdominal cavity. These immune cells also need vitamin B6, iron and selenium.

      Researchers think that an imbalance in the three different types of prostaglandins may be one of the causes of premenstrual syndrome and endometriosis pain. One piece of research shows that women with severe period pain, infertility and endometriosis had raised levels of prostaglandins series 2 (from arachidonic acid) in their peritoneal fluid, which could be the trigger for the inflammation.^{8, 9} Therefore making the effort to ensure these oils are balanced in the diet is a good practical step to take.

       Daily oil intake

      How can you assess the daily intake of good quality oils in your diet and improve it where necessary? If your diet is very low in the oils from fresh nuts, seeds, good quality cold-pressed oils and oily fish, and very high in dairy foods and fatty meats, then the series 2 prostaglandins will outweigh those from series 1 and 3. The result may be internal inflammation and pain. A change in your eating pattern may be able to reduce this effect. Standard prostaglandin inhibitors (such as Ibroprufen) reduce all three types of prostaglandin, thus stopping the beneficial anti-inflammatory ones from working effectively.

      Figure 4.4

      Metabolic pathway of the series 3 fatty acids down to prostaglandins.

      Alpha-linolenic acid is found in flax seeds, hemp seeds, pumpkin seeds, dark-green leafy vegetables, soya bean, walnut and fish oils. The body cannot make this fatty acid so fresh supplies are required daily. Alpha-linolenic acid is the precursor of series 3 prostaglandins, which are anti-inflammatory. It is changed in the body to eicosapentaenoic acid (EPA). The enzymes require zinc, B6, magnesium and biotin to make series 3 prostaglandins. These are known to decrease blood pressure, reduce blood clotting, lower cholesterols and reduce internal inflammation. The vitamins and minerals involved in the process are listed.

      Your body cannot take the steps to convert linoleic acid into gamma-linolenic acid (GLA) unless zinc, magnesium, vitamin B6, folic acid and biotin are absorbed from your diet. Vitamin C and calcium are then necessary for the final change into series 1 PGE1 and series 2 arachidonic acid. Evening primrose oil is very useful for some people as it bypasses the second stage of conversion, if the five nutrients are missing from the diet or being malabsorbed. Taken as a supplement, evening primrose oil can help to rebalance the three types of prostaglandins. The usual dose is four 500mg capsules per day. Too much stress, saturated animal fats, trans fatty acids and alcohol, can prevent the enzymes being able to change linoleic acid into a form the body can use to dampen down inflammation.

      Practical steps you can take include:

      1 Increase your intake of oily fish to twice a week.

      2 Use one tablespoon of cis olive and walnut oils in, for example, salad dressing or soup once a day.

      3 Reduce your intake of bovine dairy and red meat.