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From the Townsend Letter
February / March 2013

Environmental Medicine Update
Detoxification as a Treatment for Endometriosis: Clinical Cases Report
by Marianne Marchese, ND
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Endometriosis is a common condition affecting around 10% of women. It is characterized by the presence and growth of endometrial cells outside the uterus, called implants.  Endometriosis is a hormonally responsive condition and is a common cause of dysmenorrhea and infertility. Endometriotic implants contain estrogen, progesterone, and androgen receptors.1 Risk of endometriosis seems related to the amount of menstrual flow. Women with a short menstrual cycle (<27 days), longer menstrual flow (>7 days), and spotting before the onset of menses are at greater risk for developing endometriosis.2

The exact cause of endometriosis is unclear. A common theory is retrograde menstruation. This is where endometrial cells flow backwards through the fallopian tubes and land on pelvic organs, where they start to grow.3 Another theory is metaplasia, or the changing from one type of tissue to another.4 There appears to be a genetic link as well. Women with first-degree relatives with endometriosis are predisposed to develop the disease, develop symptoms earlier, and have more severe manifestations.5 Inflammatory cytokines are elevated in women with endometriosis, suggesting immune dysfunction plays a role in the pathogenesis.6 Other causes of endometriosis include iatrogenic, where endometriosis develops after gynecological procedures, abdominal surgery, or cesarean sections. Diet is linked to endometriosis. One study found that there was a 40% decreased risk of endometriosis in women with higher consumption of green vegetables and fresh fruit and an 80% increased risk in women who ate high amounts of beef and other red meats.7
Environmental Factors
The influence of environmental factors on endometriosis has been an area of great interest and research of late. Chemicals in the environment that women are exposed to through diet, cosmetic and grooming products, plastics, and other common sources are known to alter hormones in the body. These compounds are called hormone-disrupting or endocrine-disrupting compounds. Many chemicals have hormone-disrupting properties, including bisphenol A found in canned foods and plastic bottles, organochlorines found in food and water, phthalates found in plastic food storage containers and cling wrap, pesticides and polycyclic aromatic hydrocarbons found in food, solvents found in paint, and chemicals found in some household cleaning products. Even heavy metals such as cadmium and mercury are shown to have endocrine-disrupting properties.8

The role of hormones in the pathogenesis of endometriosis is clear, and new evidence has directly linked hormone-disrupting chemicals to endometriosis. Organochlorine compounds such as dioxin and polychlorinated biphenols (PCBs) contaminate our food and water, and women are exposed to low doses on a daily basis. Deep endometriotic nodules are associated with high blood levels of dioxin and PCBs.9 Phthalates are used in the plastic industry and are in everything from plastic water bottles with the #3 on the bottom to plastic food storage containers. A recent study showed that 55 women with endometriosis had elevated blood levels of phthalates compared with controls.10

Phthalates are not the only chemicals in plastic products linked to endometriosis. A study found that over 63% of women participants with endometriosis had BPA in their blood compared with healthy women.11 Using data from the National Health and Nutrition Examination Survey (NHANES), researchers found that women with endometriosis had higher blood levels of cadmium than women without endometriosis.12 Cadmium is common contaminate of non-organic vegetables and fish. Plants absorb cadmium from soil, and fish from the water that they live in.

Endometriosis Treatment
As the evidence grows linking hormone-disrupting compounds to endometriosis, the question is, what can be offered patients in terms of treatment? Conventional treatment for endometriosis typically begins with medications such as oral contraceptives and Lupron. Nonsteriodal anti-inflammatory drugs (NSAIDS) are used to decrease inflammation and pain, as well as other analgesics. Laparoscopic surgery is the main treatment to remove the endometrial lesions from the pelvic area. Typical alternative or natural treatments for endometrisois include diet and nutritional changes, anti-inflammatory and analgesic botanicals, herbs to decrease inflammatory cytokines, and hormone balancing herbs. However, none of these common conventional or alternative treatments address the exposure to chemicals from the environment. It is clear that women are exposed to chemicals that get stored in the body and cause hormone disruption. Several state and federal agencies have conducted studies to determine the amount of chemicals stored in the average person in the US. In 2010 the Centers for Disease Control (CDC) released the Fourth Report on Human Exposure to Environmental Chemicals ( The report outlines information collected from 2005 to 2006. Around 212 chemicals were tested for in over 2400 people living in the US. This reflected low-dose exposure from everyday living in the US. One chemical linked to endometrisois, BPA, was found in over 90% of participants. Removing these chemicals from the body is a critical part of endometriosis treatment.

Detoxification is a treatment used by physicians to remove chemicals from the body. This is done by mobilizing chemicals from storage sites such as fat tissue, organs, and cells. Once they are released, they will reenter the blood stream and are metabolized through the liver with proper support for liver phase 1 and phase 2 detoxification pathways. Next, the organs of elimination are supported to get the toxic byproducts out of the body. Detoxification has been used for years by both conventional and alternative physicians to address a plethora of health conditions. Recent studies have shown a positive effect of using detoxification for patients with multiple chemical sensitivity and for reversing the many health problems of the first responders to the September 11 attacks on the World Trade Center.13,14 Detoxification is an option for treating endometriosis as well. Endometriosis is a hormonal responsive condition linked to several known hormone disrupting compounds. By removing chemicals from the body and decreasing body burden, patients can improve symptoms of endometriosis.

Clinical Cases
This is a review of 10 women with endometriosis treated in an outpatient clinical setting using detoxification. Six of the women had laproscopic confirmed endometriosis and presented with dysmenorrhea. The remaining 4 women had a diagnosis of endometriosis from their OB/GYN or primary care doctor, without laproscopic surgery, and presented with dysmenorrhea. All 10 women were prescribed the same 8-week detoxification plan and 4 to 5 sessions of frequency specific microcurrent for endometriosis. Frequency specific microcurrent is an electrical modality wherein frequencies of microampere-level electrical stimulation are applied to particular places on the skin of a patient via conductive graphite gloves. The detoxification plan consisted of a detox diet, hydrotherapy, and several supplements to assist the liver with detoxification.

Detox Diet
1.  Take 2 Tbsp ground flax seeds/meal a day on food.
2.  Take 2 tsp a day of psyllium husk powder in water.
3.  Drink 3 to 4 cups of rooibos or green tea.
4.  Increase legumes, fruits, veggies – organic only.
5.  Fish low in mercury, organic chicken, and turkey are OK to eat.
6.  Eat 3 to 4 servings of organic cruciferous vegetables a day.
7.  Do not eat refined carbohydrates, white flour, or sugar.
8.  Do not drink coffee or alcohol, and do not smoke.
9.  Do not eat dairy products or red meat.
10. Complex carbohydrates are OK to eat.

1.  Infrared sauna therapy twice a week. Patients start with 10 minutes hot sauna, 30-second cold shower rinse. Repeat 5 times and end on cold. 2 times a week. Then build up amount of time in the heat each week, alternating with cold shower rinse.

2.  Colon hydrotherapy: once a week for 4 weeks the last 4 weeks of the 8-week plan

Supplementation/Detoxification Support
1.  A product to provide detoxification cofactors: specifically designed high dose vitamin and mineral complex with turmeric and green tea.

2.  A product to support estrogen metabolism: ingredients included a variation of the following; calcium-D-glucarate, alpha-lipoic acid, methyl B12, methyl folate, N-acetylcysteine, diindolylmethane.

3.  An herbal product to support liver and gallbladder function – ingredients included a variation of the following: milk thistle, burdock, dandelion root, artichoke, beetroot.

A survey was sent to the 10 women asking what parts of the treatment plan prescribed were followed and what parts were not, along with a symptom survey to track the results/outcome of the plan. All women followed the detoxification diet. Nine of the 10 women completed 4 to 5 frequency specific microcurrent treatments; one did not do the microcurrent. Six of the 10 women did the sauna therapy ranging from 6 to 24 sessions, and 4 women did not do the sauna therapy. Six of the 10 women completed the colon hydrotherapy ranging from 2 to 10 sessions. All 10 women took the supplements as prescribed for the 8 weeks.

Patient    Supplements     Sauna     Colonic     Microcurrent     Diet
     1                 yes                  8             no                   4         yes
     2                 yes                  6              2                    5         yes
     3                 yes                20              7                    5         yes
     4                 yes                24            10                    4         yes
     5                 yes                  6             no                   5          yes
     6                 yes                no              4                    5          yes
     7                 yes                no             no                   6          yes
     8                 yes                no             no                  no          yes
     9                 yes                no             no                   5           yes
    10                yes                12              2                    5           yes
The number represents the number of sessions completed
No means that the patient did not complete that part of the plan

Part of the survey sent to the 10 women included a symptom scale to rate the improvement in dysmenorrhea following the 8-week plan. They were asked to rate the degree of improvement immediately after the treatment plan, 3 to 6 months afterwards, and at 1 year. The survey asked to what degree the menstrual cycle pain/cramps improved, got worse, no change, somewhat improved, good improvement, great improvement. 80% (8/10) had somewhat to great improvement in the endometriosis symptom of dysmenorrhea. 10% (1/10) had no change and 10% (1/10) got worse.

Patient................. Improvement        Patient................. Improvement
1..............................great >1 yr worse
2..............................great >1 yr        7................................great >1yr
3..............................great >1yr         8............................... somewhat
4..............................somewhat          9................................great> 1yr change        10............................... great>1yr

Although this is a small study using detoxification for the treatment of endometriosis, it shows a positive effect in the symptom of dysmenorrhea. Detoxification can not only improve symptoms of disease but also lower blood levels of chemicals. A study done on 7 rescue workers from the September 11 attacks showed that detoxification reduced blood levels of chemicals. The seven rescue workers had health complaints since working at Ground Zero that included headaches, breathing problems, muscle and joint pain, and skin rashes. The study measured their blood for levels of PCBs, dioxins, and polychlorinated dibenzofurans. After undergoing a detoxification plan similar to the one outlined above, all 7 had a reversal in symptoms and PCB levels declined by 65%, and dioxins and dibenzofurans were below detection limits.15 A larger study on detoxification for endometriosis with pre- and posttesting of chemicals in the body is recommended to further show the positive effects of detoxification.

Endometriosis is a common condition affecting thousands of women. Many factors contribute to the development and disease process, including chemicals in the environment that are known hormone disruptors. One of the main symptoms of endometriosis is dysmenorrhea, which can be often challenging to manage. Detoxification is a way to decrease levels of hormone-disrupting chemicals in the body and manage dysmenorrhea.

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