Although no conclusive data exists yet, many doctors and nutritionists feel they are going in the right direction by recommending limited intake of arachidonic add and supplements of gamma-linolenic add, or GLA, to women with endometriosis.

Arachidonic add is an essential fatty acid that is linked to inflammatory conditions, as is the case with endometriosis. What does this mean to you? Inflammation is often mediated by prostaglandins. Knowing this, many doctors are suggesting to patients that they eliminate foods containing this add, which is found in dietary sources of saturated fat, such as butter, animal and organ meats, and lard. It is also possible to alter the balance of arachidonic add by taking another oil to counteract its effect. This is where linolenic acid comes in.

Found in sources as diverse as mother’s milk and cold-pressed safflower oil, gamma-linolenic add, or GLA, is one of the body’s more essential fatty adds. It is most important for the woman with endometriosis, both as a possible pain inhibitor and as an immune system strengthener.

GLA is made in the body from a conversion of vitamin F, or linolenic add, which is the basis of prostaglandins. Prostaglandins E2 and F2 Alpha have been linked to uterine contractions producing menstrual cramps, while GLA, called prostaglandin El, may offset some of the worse symptoms of the opposing prostaglandins. In a number of studies, it was also found to oppose the constriction of blood vessels, prevent blood dots, and prevent cholesterol buildup in the arteries. It has also been tried experimentally to help alcoholics over their addiction and to reduce some of the irritation of eczema.

Suggestions for daily intake: Take one to two tablespoons of safflower, walnut, or nutritional linseed oil (not the commercial variety used for varnishes) a day, preferably on a fresh tossed salad, flavored with herbs. Follow with a tablet of vitamin E to help absorption. GLA is also available as evening primrose oil—cither the essence of oil or in 500-mg tablets. You should be aware that this oil is very costly (approximately thirty dollars tor 180 tablets) and may not be much more effective than a daily salad with the above-mentioned oils.

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Infections and surgical procedures are common causes of adhesions, which are filmy or thick strands of scar tissue that bind organs together. Adhesions can develop between the uterus, ovaries, bowel, bladder and rectum because of their proximity in the abdomen. Pain can occur any time that adhesions are stretched, for example during movement, a pelvic examination, sexual intercourse, passing urine or a bowel motion. If adhesions are constricting the ovary, pain may occur only, or mainly, during ovulation; if constricting the bladder, the pain may be intense when the bladder is full, easing as the bladder empties. Adhesions can also result in infertility by constricting the Fallopian tubes, covering or displacing the ovaries, or impeding the movement of sperm and egg or interfering with the growth of embryos. Ironically, while hysterectomy is sometimes successful in overcoming pain caused by adhesions, hysterectomy itself may be responsible for severe adhesions that result in long-term pain and intestinal obstruction.

The diagnosis of pelvic adhesions in a woman relies mainly on her history of infections or surgery and the nature of her pain. The diagnosis is usually confirmed by laparoscope although ultrasound can be useful in revealing adhesions surrounding the ovaries or bowel. If laparoscopy is performed in the presence of extensive adhesions it can result in puncture of the bowel, so great care must be taken with this technique and alternative methods (such as a mini-laparotomy) may have to be considered. (A mini-laparotomy entails a small incision through the abdominal wall to allow inspection of the internal organs. It is like a mini-Caesarean section.)

It is possible to remove adhesions without going to the lengths of hysterectomy in most women, and one of the most useful techniques is laparoscopic surgery. The laparoscope or viewing tube (for inspecting the internal organs) is used in conjunction with fine forceps which can hold the adhesions steady or break them with a blunt action, scissors to cut the adhesions, lasers to vaporise them, or high frequency electrical currents that produce heat and destroy them. In order to minimise adhesion formation, it is important that your surgeon is gentle and careful in his or her handling of the tissues, that techniques are used to prevent bleeding, and that solutions or

special membranes to reduce adhesion formation and other complications are used in the abdomen.

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Breads

Organic whole meal bread is best and health food shops and supermarkets stock some good ones such as Shipton Mill. Some breads contain either sugar or dextrose and/or flour improvers, so read the labels carefully. If the flour improver is ascorbic acid, that’s OK as it is a form of vitamin C. Whole meal pitta bread makes a nice change but do check the label for undesirable ingredients.

Flavourings

Avoid over-processed, commercially-produced flavourings. Instead, choose from ginger, garlic, fresh and dried herbs, lemon juice, sea salt, Lo-salt, miso (soya bean paste), mustard (check for added sugar, chemicals, etc), and arrowroot for thickening to make gravies and sauces.

Soya sauce is good on rice, in salad dressings and sauces, as well as Chinese stir-fries. Choose organic where possible and avoid any makes which contain monosodium glutamate. There are also a number of ready-made salad dressings with no sugar or chemicals, but do check the labels.

Sweeteners

It is better to rely on the natural sweetness in foods rather than using artificial sweeteners. For example, if you are making cakes, try carrot and raisin or banana cake. However, if you do want to add a sweetener, use maple syrup, concentrated apple juice, barley malt, date syrup and honey.

When buying honey, avoid those which are ‘blended’ or the ‘produce of more than one country’, as they are often heated to temperatures as high as 71°C (160°F) which destroys their goodness. With maple syrup, if the label says ‘flavoured’ beware: if it is not the real thing it could contain sugar and chemical flavouring.

Beans/Pulses

Beans make a good base for many healthy dishes, especially if you are trying to stay off meat to improve your fertility. They are great added to salads, soups and casseroles, and you’ll find them a useful and economical addition to your culinary repertoire.

Most beans (not lentils) need to be soaked, some overnight, before cooking. Alternatively, you can buy organic beans in tins from most supermarkets which have a little salt added to them but no sugar.

Houmous, which is made from chickpeas, can be bought ready-made from most supermarkets and is a good source of protein and essential fatty acids.

Meat

Meat is high in saturated fat so you should try to cut down on it. Of all meat, poultry is the healthiest choice and several supermarkets now sell organic, free-range or corn-fed birds, all of which are preferable to the usual mass-produced birds. However, apart from saturated fat, meat also contains growth hormones, antibiotics and other chemicals given to many animals reared for human consumption.

In addition to its adverse effects on fertility, these is also a possible link between the consumption of red meat and bowel cancer. The Government has therefore suggested that our intake of red meat should be less than 90g (3.2oz) a day.

Fish

Fish has low saturated fat levels and is very nutritious. It’s best to grill or poach fish, rather than fry it. Oily fish is particularly good, as it contains high levels of essential fatty acids, so you can enjoy mackerel, tuna, salmon (eat the bones), sardines and anchovies. Fresh is best but frozen or tinned are acceptable.

Eggs

Buy organic free-range eggs. You want organic as well as free-range. ‘Free-range’ only implies that the hens, unlike their battery cousins, have been given a certain amount of freedom but they can still be fed on ‘junk’.

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