BPA and Endometriosis

One of the most troubling questions that still looms large over the heads of all of those affected by endometriosis is, where does the condition come from? More specifically, what causes endometriosis? We know that there are genetic factors that influence the risk of developing endo, so if your mother had the disease, you are more likely to have it, but if that is the case, where did your mother get it from? From her mother probably, but there has to be a point where it originated because there are many women who have no family history of endometriosis yet still develop the condition.

If we look at other complex conditions like cancer, for example, there are the familial risk factors but there are also external factors that influence the risk. For cancer there is, well, quite a lot of things really, the worst of these you can avoid simply by living a healthy lifestyle, but if you want to escape all potentially harmful substances you’ll have to seal yourself in a vacuum chamber and get buried 2000miles under the earth. So it is a reasonable question to ask whether there are any external factors that influence the development of endometriosis.

The first aspect we need to consider, when trying to answer this question, is the issue of timing of exposure. I’ve put a few posts on here that provide evidence suggesting endometriosis is something you are born with, therefore there is not much point in looking for influencing factors in grown women with well established disease. If endometriosis is indeed a condition you are born with, then exposure during the development of the foetus is probably the most important time to consider the influence of external factors.

Where do you start though when looking for potential environmental nasties? As we know endometriosis is an estrogen dependant disease, so it would make sense to look at pollutants in the environment that have the potential to mimic estrogen, one such chemical, which is known to have weak estrogenic activity, is Bisphenol-A (BPA). Before we go any further I should probably address the question of what is BPA. BPA is a chemical that is mostly used in the manufacture of plastics, so if you’ve ever used or handled or cooked with something plastic, you’ve been exposed to BPA. But is it dangerous and does exposure to BPA have any relation to endometriosis?

The trouble is it’s very difficult to measure the exposure of unborn children to environmental factors without putting the foetus at risk and I very much doubt pregnant women would be happy about being injected with a potentially harmful substance. One way around this is to perform experiments on animals, which is what one research team in Italy have done.

This study took pregnant mice and gave them, throughout their pregnancy, BPA in various doses. After the mice gave birth the pups were kept for 3 months then their ovaries were analysed to see what effect the BPA had. The results showed that mice exposed to BPA in the womb were more likely to develop damage to their ovaries. Not only that but some mice developed an endometriosis like condition.

That pretty worrying, right? Well let’s look a bit closer before we go off and start building our subterranean vacuum chamber. One of the issues with this study is the dose of BPA given; the mice in question received doses of BPA ranging from 100 to 1000 micrograms per kilogram per day. Although it sounds small, this is in fact a huge dose, likely exceeding anything any human would ever be exposed to. It’s a bit like trying to test the effect of microwaves on a potato by dropping a nuclear bomb on a farm (ok I’m exaggerating a bit there).

Then we have the age old problem of using mice as an analogue for humans. Whilst mice are surprisingly similar to humans, in a physiological respect, there are of course major differences, particularly in the reproductive systems. But there is also the difference in metabolism to take into consideration. Humans and mice metabolise BPA in different ways and this is important when considering the effect BPA has on the body. A study conducted at the Institute for Toxicology, Wurzburg University, Germany, found that humans metabolised and excreted BPA much quicker than rodents, meaning there is a much smaller chance of BPA having a harmful effect on the human body.

So is that the end of it? No need to worry about BPA? Maybe, but maybe not; there have been other studies showing that BPA levels are elevated in the blood of women with endometriosis, so perhaps women with endometriosis have a deficiency in the enzymes that metabolise BPA? Whilst that sounds like a fascinating hypothesis, other studies have shown that not to be the case and furthermore, there is no difference in the levels of urinary BPA between infertile women with endo and healthy controls, oh well so much for that idea. However, there is still no evidence concerning the effect of foetal exposure to BPA in humans and how this might relate to endometriosis risk. There have been other studies suggesting foetal BPA exposure affects childhood behaviour and brain function, however there are those that say no such association exists, so it is really difficult to come to any real conclusion here, the jury is still out on BPA.

As usual I would always encourage you to do your own research if you’re concerned about any topic, but be cautious when searching out there on the vastness of the internet. There are plenty of reactionary idiots with agendas to push and no evidence to back up their claims, a good rule of thumb I have is; if it sounds sensationalist, it’s probably not true.

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.