Many thanks for your question regarding your client with Endometriosis and suffering with ongoing fatigue. You have also noted she is highly stressed and feeling anxious. Certainly, her recent adrenal results do indicate hyper cortisol reaction in the morning. We have written about endometriosis on linked in before, but I will summarise some key points before discussing your client in more detail.
Endometriosis describes a condition in which tissue that normally resides in the inner lining of the uterus, the endometrium, emerges elsewhere in the body, usually in the pelvic area. The growth of this misplaced (ectopic) endometrial tissue can cause significant pelvic pain, pain during menstruation or sexual intercourse, fertility problems, and in some cases gastrointestinal or urinary problems and abnormal vaginal bleeding.
Endometriosis is oestrogen-dependent and often progressive, resulting in worsening pain and other symptoms over time.
Simoens S, Hummelshoj L, et al. Endometriosis: cost estimates and methodological perspective. Human Reproduction Update, 2007; 13(4): 395-404 http://tinyurl.com/ydxb6afg
There are many suggestions as to the cause but common is the fact that there is ongoing systemic inflammation.
Endometriotic tissue produces excess inflammatory mediators such as prostaglandin E2 and prostaglandin F2α
Bulun SE. Endometriosis. The New England journal of medicine. Jan 15 2009;360(3):268-279. http://tinyurl.com/y8b4mup3
Hormonal imbalance may contribute to endometriosis as well. During a woman’s menstrual cycle, endometrial tissue grows and then regresses. Oestrogen is responsible for the proliferation of the endometrial lining.
The growth and progression of endometriosis is also dependent on oestrogen and can be treated by suppressing oestrogen levels. Conversely, progesterone can help stop the growth of normal and ectopic endometrial tissue.
As your client experiences a lot of pain a focus on lowering inflammation and addressing hormone imbalance would be recommended. As diet may play a role it is recommended you follow a diet rich in vegetables and omega-3 fatty acids and reducing or avoiding red meat and processed meats.
Parazzini F, Vigano P, et al. Diet and endometriosis risk: A literature review. Reproductive BioMedicine Online (2013) 26, 323– 336 http://tinyurl.com/yde9dzbp
Other foods may also play a role. Interestingly increased dairy consumption was associated with a reduced risk of endometriosis in one study – this may in part be linked to vitamin D levels.
Harris HR, Chavarro JE, et al. Dairy-Food, Calcium, Magnesium, and Vitamin D Intake and Endometriosis: A Prospective Cohort Study. American Journal of Epidemiology, 2013; 177(5). http://tinyurl.com/y82dtedo
Your client may also wish to look at acupuncture. Acupuncture may be a viable intervention for women suffering from endometriosis. Acupuncture is increasingly used in the United States and other countries for chronic pain and gynecologic conditions
Wayne PM, Kerr CE, et al. Japanese-Style Acupuncture for Endometriosis-Related Pelvic Pain in Adolescents and Young Women: Results of a Randomized Sham-Controlled Trial. J Pediatr Adolesc Gynecol. 2008 October; 21(5): 247–257. http://tinyurl.com/y88b2h3m
There are certain key nutrients that may be helpful for your client.
Omega 3 fats. Omega-3 fatty acids have generated interest because of their anti-inflammatory abilities. A large study found that women who ate greater amounts of long-chain omega-3 fatty acids were also less likely to develop endometriosis.
Hansen SO, Knudsen UB. Endometriosis, dysmenorrhoea and diet. European Journal of Obstetrics & Gynecology and Reproductive Biology, 2013. http://tinyurl.com/y8usmbv5
Many lines of evidence suggest that oxidative stress, which is caused by reactive oxygen species, contributes to several aspects of endometriosis. Therefore, increasing consumption of antioxidants may benefit women with endometriosis. One study with 1200 IU of vitamin E along with 1000 mg of vitamin C or a placebo each day for 8 weeks. showed significant reduction in pain.
Santanam N, Kavtaradze N, Murphy A, et al. Antioxidant supplementation reduces endometriosis-related pelvic pain in humans. Transl Res. 2013; 161(3):189-95 http://tinyurl.com/y7jemvcu
Several animal and human studies have shown that NAC may be an effective treatment option for endometriosis. It may also be helpful for reducing cysts. One study 600 mg 3 times daily on 3 consecutive days per week. After the 3-month study period, endometriotic cysts were slightly reduced in size among women who took NAC, while a significant increase in cyst size was observed in the women who received no treatment.
Porpora MG, Brunelli R, Costa G, et al. A Promise in the Treatment of Endometriosis: An Observational Cohort Study on Ovarian Endometrioma Reduction by N-Acetylcysteine. Evid Based Complement Alternat Med. 2013;2013:240702. http://tinyurl.com/yb5u48xd
Other considerations are anti-inflammatory nutrients such as green tea, resveratrol and turmeric.
In view of her fatigue and high morning cortisol attention should be given to supporting blood sugar levels overnight and through the morning. Keeping the protein high at breakfast and lunch and avoiding known allergens would be recommended. In view of her previous antibiotic use you may wish to consider whether there are any gut infections or bacterial dysbiosis present which is further aggravating her symptoms. If the fatigue is ongoing then consider using a supplement to provide more resilience for your client in the morning and check iron and ferritin, B vitamins and thyroid function as well. It may be the case that inflammation is also contributing to fatigue and raised cortisol levels.
I would consider a gluten free diet to see if this is aggravating her symptoms. In view of lack of compliance it is important to keep meal suggestions very simple and making use of prepared foods at supermarkets if needed too. A protein shake that supports blood sugar balance may be a helpful aid when she is struggling with energy to make meals. You may also wish to consider using a high strength B vitamin formula with NT factor to support overall energy levels.
Additional dietary considerations would be supporting detox of oestrogen – soluble fibre, fermented soy such as miso, natto, tempeh, supporting healthy gut flora, beans and pulses as well as flaxseed could be recommended.
The following supplements are suggested for you to consider in light of your relevant expertise and intimate understanding of the needs of your client or patient. They may be used in isolation or as part of a multi supplement strategy, but at all times the consideration of their use should be tied into the specific needs of the individual you are responsible for.
Energy and Stress
Stabilium 200 (ARG) – take 4 first thing in the morning – http://tinyurl.com/hhz7228
NT Factor Advanced Physicians Formula (NT) – take 3 at breakfast & 2 at lunch – http://tinyurl.com/ybsppz4g
Whey Protein Concentrate (BRC) – take 1-2 servings as needed – http://tinyurl.com/hslmdzg
Antioxidant support and gut health / detox support
NAC Enhanced Antioxidant Formula (ARG) – take 1 twice daily – http://tinyurl.com/c96mjpy
Pro Greens (ARG) – take 1 scoop daily – http://tinyurl.com/gtqgbyo
Lowering Inflammation / supporting energy and stress
Wholly Immune (ARG) – take 1 scoop daily – http://tinyurl.com/gwqzxya
Fatty Acids / lowering inflammation
EFA-Sirt Supreme (BRC) – take 2 three times daily – http://tinyurl.com/h3czc9x
I hope this helps answer your question
Registered Nutritional Therapist Helen Perks is collaborating with Clinical Education to bring you the first-ever Functional Medicine book club for Practitioners.
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