Why Eating Turmeric will treat your Condition, and why you shouldn’t believe what I Just Said

If you’ve ever read a newspaper or watched the news over the last decade, chances are you’ve come across stories declaring that some everyday food has been elevated to the status of ‘superfood’. This is then quickly proceeded by a number of celebrity endorsements, fad diets and a sharp incline in the price of said foodstuff. Some such superfoods include: blueberries, tomatoes, spinach, broccoli, hemp seeds, onions, salmons, the list goes on and on, but what exactly has exalted these mere pedestrian groceries to the level of godlike, divine ambrosias?

It’s usually that some journalist has gotten wind of a scientific study that has shown a component of a particular foodstuff has been shown to have a beneficial effect on a certain disease or condition and, rather than wait for more evidence to come to light about the true value of this research, said journalist now declares this food to be hewn directly from the allotment of Zeus himself, a panacea to cure all the world’s ills. It doesn’t matter that these journalists never have any scientific training and lack the skills required to properly appraise scientific data because there are papers to sell dammit!

Mostly news outlets like to make a song and dance about superfoods treating cancer, but endometriosis is no exception to the journalist’s flights of fancy. A prime example came back in 2008 when UK newspapers the Daily Mail and the Times proudly honked ‘Eating tomatoes could help fight a painful womb condition that affects 2 million women in the UK’. Wow! You must be thinking, let’s all go out and stuff our faces with tomatoes until we are literally red in the face. That’s the impression the headline gives, but if you actually read the article it becomes quickly apparent what they actually mean is that there is some evidence that suggests a component of tomatoes (lycopene) reduces some of the factors found in adhesion tissue grown in the lab. Ok so that’s nothing like what the headline was claiming, but let’s have a look at the original research to see what they found. According to the Mail this research was carried out by “Dr Tarek Dbouk, a researcher at Wayne State University in Detroit, Michigan”, being as this research was conducted in 2008 the subsequent publication should now be easy to find on one of the main professional citation databases, except it isn’t, in fact it doesn’t seem to exist. The only reference to this research I can find comes from the very newspapers that claimed it existed in the first place!

So what happened? Did the newspapers simply invent the story? Probably not, this was likely based on some real research that was being carried out, but that research was either found to be flawed (and hence never professionally published), or abandoned because, on closer inspect, the results weren’t as good as they previously thought. Either way, because the journalist responsible for this article was incapable of doing proper scientific investigation, thousands of people reading this story were given completely false information and false hope.

You may be wondering why I’m venting my spleen about a story that happened in 2008, well it’s because I can see something similar happening soon, and I’d like to pre-empt the media’s slash and burn attitude to science this time. Here’s what I’m talking about – there’s been some evidence recently in the scientific literature concerning the potential effect of curcumin, a compound that can be extracted from the spice turmeric and how it could have positive effects on endometriosis.

This stuff

So, before someone decides to write, in a national newspaper, about how turmeric is a wonder spice and if you eat enough of it your symptoms will magically disappear, I thought I would interject and get to the truth of the matter. There have been three studies investigating the effect of curcumin on endometriosis last year, and here’s what they found.

The first study was published in January 2011, from a research team in China. This team was looking at the effect of curcumin on the development of blood vessels in endometriotic implants. To do this they took several rats and surgically induced some to develop endometriosis. They then divided the rats into groups. One group would receive no treatment, the other three groups would receive either a low dose (50mg/Kg), medium dose (100mg/Kg), or high dose (150mg/Kg) of curcumin injected directly into the gut. After a while the rats were killed and the development of blood vessels around their endometriotic lesions was measured. Interestingly, rats which received the higher doses of curcumin had significantly less blood vessel development around their implants than those who had a lower dose or who were untreated. So does this mean you should all go out and start putting turmeric on your cereal? Hopefully not, especially when we consider the doses involved. Consider the following; in the study rats were given doses of 150mg per Kg max. If you were an average sized human female (about 60Kg) that would mean you’d need 9000mg of curcumin for an effective dose. Now, turmeric only contains 3.14% curcumin, so you would need to eat 286,624mg (287g approx) of turmeric in one go. That is a lot of spice and would probably make you very ill, but of course I’m being facetious, you can buy curcumin tablets however the amount you would need to take every day would leave you rattling like a bag of coins (and probably put you in the poor house).

The second study, published in December 2011, by a research team in India was looking at the effect of curcumin on the invasive potential and survival of endometriosis. This research used methods very similar to the one mentioned above, except this study used mice instead of rats and injected the curcumin directly into the peritoneum in doses of 12, 24 and 48mg/Kg. Another difference in this study was that they injected the curcumin before surgically inducing endometriosis in the mice. This was to show whether or not the curcumin doses had any effect on the survival and invasion of the endometrial tissue. The results of this study showed that curcumin appeared to cause regression of the endometriotic implants. However, an issue here is that the curcumin was administered before the endometriosis developed. Whether or not curcumin has any affect on well established endometriosis is an issue that needs to be addressed. Nevertheless, this study does make me wonder whether some sort of curcumin treatment could be used to prevent the recurrence of endometriosis after surgery.

Another issue is that of using rats and mice as ‘models’ for human endometriosis. The problem is mice and rats don’t spontaneously develop endometriosis like apes and monkeys so the disease may behave very differently in these creatures compared to humans, particularly as rodents have an oestrus cycle rather than a menstrual cycle. Women with endometriosis also have alterations to their immune system that probably go hand in hand with endometriosis, modelling this in the rodents would be extremely difficult. Whilst there are drawbacks to using animals, they are the best method we have to study the disease in a living creature, which offers so many more insights into endometriosis than any other method we currently have (other than experimenting on humans, which, quite frankly, probably wouldn’t go down well!).

The last study, also published in December 2011, was from a research team based in Korea and examined how curcumin affected the release of different factors from endometriotic cells. This study used endometriotic cells, surgically removed from women with endometriosis, and grew them in a lab, then added the curcumin and watched what happened. This method is more simplistic than the other studies mentioned above, but it gives a better idea about what curcumin does at the cellular level. The results of this study showed that curcumin hindered the ability of endometriotic cells to produce several factors known to be involved in inflammation. Previous studies have shown that curcumin is effective as an anti-inflammatory agent and this may be good news for women with endometriosis because inflammation is thought to play a significant role in how the disease causes pain.

So what can we say about curcumin and endometriosis? Well, nothing really conclusive at the moment. The studies that have been done so far are definitely encouraging but there are still the problems of dosage, cost and effectiveness in humans. If more research is done along this avenue then maybe curcumin therapies would be beneficial for women with endometriosis, but it would be nice if someone proved it before promoting it.

The ENDOCUL Study

Well it’s the first post of 2012, so first off I’d like to wish all my readers a very happy new year despite it being two weeks late. I’ll also start off the New Year with a post about a study that took place in my university last year. This study was carried out with women in the UK and aimed to investigate the different experiences of endometriosis of women from different ethnic backgrounds.

You can read all about the way in which the study was conducted and the key findings, here. It makes a quite interesting read to see how women from other cultures view the disease and its treatment. Of course the study could only look at a small subset of women from a handful of cultures, so it would be very interesting to expand this study to more women from an even more diverse set of backgrounds.

One of the outcomes of this study was that it led to the creation of tailored resources for women of different ethnic backgrounds, specifically several videos especially for women from Afro-Caribbean, Indian, Pakistani, Chinese and Greek backgrounds with narration in their native language. I’ve actually spoken to the leader of this study from my university and discussed the possibility of expanding these resources for even more languages (e.g. Arabic, Nigerian, Spanish, Portuguese, etc) so watch this space!

A presentation was also produced aimed at healthcare providers, but I would highly recommend it to anyone interested in seeing endometriosis from another viewpoint.

Making these resources available online is essential in our information age. The advent of the internet has allowed dissemination of our knowledge at a speed hitherto unknown throughout all of human history; and whilst this has led to some remarkable leaps forward in technology and science, it also means that inaccurate and potentially harmful information can be spread faster than ever before. This is increasingly true for women in third world countries or from underprivileged backgrounds that may not have access to reliable information in their own language.

I know even in developed countries women are fed a whole heap of misinformation about endometriosis, often from health professionals, but for English speakers doing your own research, finding and joining support networks has never been easier. It must be even more difficult for women in poorer countries, where health care is basic, misunderstanding is common and support is impossible to find. Therefore, if you happen to know someone who is a native speaker of one of the languages included in this study and you think they would benefit from hearing what the video has to say, forward it to them and let’s erode the misunderstanding about endometriosis, one person at a time.

Endometriosis in an 18 month old infant

This month appears to be the month for rarities, a few days ago I was reporting on the case of endometriosis in a man and just today a case report from Hong Kong was published on something even rarer, ovarian endometriosis in an 18 month old girl. This alone would be enough to raise an eyebrow, but what made both my eyebrows almost fly off my forehead was that this girl also had an endometriosis-associated ovarian tumour.

It has been known for ovarian endometriosis to be associated with an increase risk of developing tumours of the ovary, but this in itself is a rare event and to find this occurring in an infant means the odds of this occurring must be astronomical.

This isn’t the first case of endometriosis in a pre-pubertal girl I’ve heard of; there have been documented occurrences of endometriosis in girls aged as young as 8 years old and I’ve wrote about several publications from Italy concerning the discovery of endometriotic tissue in unborn human foetuses. But ovarian endometriosis associated with ovarian tumours is something which is more often reported in older women with advanced stage endometriosis.

So it concerns me greatly how this could have occurred in an 18 month old infant. The authors of the case report state that the girl’s hormone levels were normal for someone he age and there was no evidence of precocious puberty or genital abnormality. Perhaps this girl had a particularly disproportionate genetic or epigenetic susceptibility to endometriosis, in which case further investigation along this line may answer some of our most long standing questions about which genes (or gene variants) make someone more at risk of developing endometriosis.

It could be hat this girl had been exposed to high concentrations of some environmental pollutant, either whilst still in the womb or during early development which triggered onset of the disease. Hong Kong is a heavily industrialised urban area with a serious pollution problem, so exposure to pollutants could be a contributor to this rare occurrence; it really is very hard to draw any definite conclusions though.

Whatever the cause of this particularly peculiar event, it highlights how little we know for certain about endometriosis. With the growing body of research on the disease, scientists involved in endometriosis need to take a step back and have a long hard look at the current state of our understanding because, personally, I think a radical shift in our thinking is needed.

The Art of Endometriosis

They say that suffering inspires creativity, after all some of the most notable artists from any time period you care to mention have drawn on their own personal tragedy when composing some of the greatest works to grace the halls of our museums and galleries. Of course, if it were true that suffering is indeed the well from which creative genius is drawn, then women with endometriosis would have contributed more to the cultural development of humanity than all the other artists, philosophers, musicians and playwrights combined.

Nevertheless, endometriosis can be a source of inspiration for people of all walks of life; for instance, I can say that personally the disease has inspired me to research and understand it in as greater depth as possible (because the first rule of war is “know your enemy”).

Some have used their experience with endometriosis to generate creative works; for example, poetry like that by Belle Browne and Roberta Speyer, paintings such as those by Adelaide Damoah and even organising events based around art to raise money for endometriosis research and awareness, like the ‘Art for Endometriosis’ event in 2009.

Some have even suggested that art therapy may be of use to women with endometriosis. Mostly as a means of expressing how you feel about the disease or even helping to work through anxiety, fear and even grief associated with the disease. Whatever your feelings may be I would still encourage you to embrace your inner artist, be it through writing down how you feel or expressing it with a pencil, paintbrush or digital media. Even if, like me, you’re not going to be invited to repaint the ceiling of the Sistine Chapel anytime soon, you still might surprise yourself (in a good way!).

So in the spirit of joining in I fired up my newly acquired version of Photoshop and did a few bits of official Endometriosis Update artwork. (Click on the thumbnails below for the full version)

Happy creating! And if you do decide to make some endo art (or any other art for that matter) and want to share it, feel free to post a link to it in the comments.

There’s something you don’t see everyday

Endometriosis in a man. Yep, thats right, it is an incredibly rare occurrence but it has been known to happen. This, particularly detailed, report comes from Japan and concerns a 69 year old man who had been undergoing estrogen therapy for 9 years to treat prostate cancer. In the abstract no account of the symptoms are given, but it does state that the man was found to have a series of endometriotic cysts measuring approximately 5x3cm in the left paratestis (the region just above the testicle).

The authors state that this may have occurred due to, what is known as, endometriotic metaplasia or stromal hyperplasia. Basically, what both of these terms mean is that, under the influence of increased estrogen levels, the normal tissue has undergone a change into a different tissue type.

This case report isn’t the first to observe endometriosis in a man; it’s not even the first report of it occurring in this area of the body.

Other than that there have only been six other cases of male endometriosis reported in locations such as the bladder, prostate and lower abdominal wall. However, if we look at all of these cases, most of them have one thing in common; they have been undergoing long term estrogen therapy for the treatment of prostate cancer. This is quite important, as unusual presentations of a disease can often give us clues as to how it arises in women.

One of the reports of male endometriosis was from a young man aged 27 who was otherwise completely healthy, very different to the other reports which are mostly much older men with prostate cancer. So not only was this an unusual presentation of endometriosis, it was an unusual, unusual presentation, if that makes sense. So what can this tell us about the disease as a whole?

The authors of this report looked to the very beginning of the development of the reproductive organs. Whilst still only a developing embryo, there are different structures that will form the male and female reproductive systems (there’s a nice illustration here). The female organs develop from the müllerian duct which in male embryos regresses because the embryo produces the imaginatively named müllerian inhibiting substance (MIS). The authors of this report suggest that exposure to certain environmental toxicants (such as diethylstilbestrol or other hormone disrupters) whilst the embryo is still developing, may lead to abnormal production of MIS which in turn stops the müllerian duct regressing properly, leaving small remnant patches of tissue that could, given the right stimulus, develop into endometrial like tissue, which would appear as endometriosis.

Could something similar explain endometriosis in women? Well there could be if this ties in with the theory of mullerian rest. This theory states that during normal foetal development, tiny parts of the mullerian duct, perhaps only a few cells, get displaced and deposited on other organs. Once there, the displaced deposits do nothing until stimulated to transform into endometriotic tissue later in life. What these exact stimuli are, or why some women experience this displacement are mysteries, as yet, unsolved, but answering these questions may be a defining moment in the history of endometriosis.

Thinking outside the box

When you look back at the history of science, you'll notice that it is heavily punctuated by radical ideas to solve complex problems. Some of these radical ideas have lead to changes that shaped and changed the world, others not so much. For example, American doctor Jonas Salk saved the lives of millions and practically eradicated the disease polio in the 1950s by injecting people (including himself and his own family) with ‘inactive’ versions of the polio virus; a hefty risk that paid off. Other medical cures haven’t proved quite so successful. For example, there is the sad case of Alan Turing, a brilliant British scientist without whom you would not have the computer you are reading this on now. Around the same time Salk was developing his polio vaccine Turing was convicted of being a homosexual (a custodial offence in the UK at the time) and rather than face prison he was forced to undergo estrogen injections to ‘cure’ his homosexual urges. The side effects were, of course, horrific and not long after he committed suicide by taking a bite from an apple laced with deadly cyanide (some people speculate the logo for Apple computers pays homage to Turing).

Obviously those are two very extreme examples, but they set the scene for the topic of this post, which is radical thinking in science, especially in relation to endometriosis.

Endometriosis is complicated, no matter what your views on the origin, treatment or mechanism of the disease; we can all agree it is complicated. In order to solve a complex problem, no matter what it is, people have come up with many different possible solutions and endometriosis is a shining example of that. There are so very many different types of treatment for the disease, from established treatments like the multitude of hormonal therapies and surgeries, through alternative medicine all the way to cutting edge technology like gene therapy.

But the field is always progressing, as scientists we are always researching and doing experiments to try and solve complex problems and sometimes the ideas that are borne of these experiments can seem a little different or unusual at first.

Take, for example, this piece of research by a group from Turkey. This group induced endometriosis in rats and then divided them into two groups. One group of rats were left to get on with their business without any interventions (a control group), whilst the other group was placed in hyperbaric oxygen therapy (HBO) for two hours a day over 6 weeks. So what is hyperbaric oxygen therapy? Basically it involves the subject being placed in a chamber which contains pure oxygen which they breathe for a period of time. This isn’t a new treatment either; it’s been used for a long time to treat all sorts of conditions, from sports injuries to carbon monoxide poisoning and even alleviate the side effects of radiotherapy, but never as a possible treatment for endometriosis (for more on HBO follow this link). Below is a picture of a HBO system used for humans.

Source: http://mdmedicine.wordpress.com/2011/04/10/what-is-hyperbaric-oxygen-therapy-hbot/

Anyway, back to our original study. The results of this study showed that endometriotic implants of rats receiving HBO had decreased in size compared to the implants from the control group. There was also a marked decrease in markers of inflammation in the HBO rats. Essentially endometriosis in the HBO rats had gone into remission. So why might his be the case and where do we go from here? Well, HBO is used for the purposes I mentioned above because it encourages wound healing and also helps boost the immune system, so it could be that the HBO therapy is helping the body destroy the endometriotic implants. Despite this being an animal based study (which means it may not work the same in humans) this is still an encouraging result as HBO therapy has no serious side effects and is overall very safe. Because of this, in the future it would be easy to test HBO therapy on human subjects with endometriosis to see if it could help recovery from surgery or reduce symptoms.

Whilst I’m not anticipating hyperbaric oxygen therapy will be a cure for endometriosis, the type of thinking that the authors of this study were doing will eventually lead to a cure. By that I mean in science it is important to step out of one’s comfort zone occasionally, take risks, think of the radical ideas no-one has thought of before but be prepared to be proved wrong and always be held accountable. It is only by embracing what is new and being fearless in our approach that means we will, one day, find a cure for endometriosis.