naturopathydigest.com -- An Intricate Symphony

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An Intricate Symphony

By Patricia Kim, ND, LAc

The complexity of the human endocrine system can be likened to an intricate and massive symphony. One might even compare the level of complexity to one enormous global symphony, in which every person on this planet is responsible for a different instrument.

There are numerous manifestations of female hormonal imbalance, ranging from premenstrual syndrome to cancer, and everything in between. As many disorders as there are, there are just about as many treatments available, ranging from allopathic medications to numerous naturopathic therapies. Two treatments in particular, evening primrose oil and flaxseed, have been shown to greatly influence and affect proper hormonal regulation.
History of Evening Primrose Oil

Native Americans have used the evening primrose plant for hundreds of years. According to ancient folklore, a tribe called Flambeau Ojibwe was the first to realize the medicinal properties of the evening primrose and used to make poultices out of the plant to treat bruises, skin problems and asthma.
Although the plant accidentally was brought to Europe from North America in 1614, it wasn't until 1917 that scientists discovered the seeds contained 15 percent oil. In 1919, scientists extracted a new fatty acid, gammalinolenic acid (GLA), in addition to the normal oleic and linoleic acids (LA). By the 1960s, studies revealed that GLA was more efficiently taken up by cells of important tissues and organs of the body than linoleic acid.
Essential Fatty Acids

Essential fatty acids are a vital part of nutrition and perform a variety of crucial functions within the body: They give energy, help maintain body temperature, insulate nerves and protect tissues, to name a few. Fatty acids are a part of the structure of every cell in the body and are vital for metabolism. Further, they are the precursors of the all-important regulating molecules, the prostaglandins.
Essential fatty acids also play a fundamental role in all cell membranes of the body. The amount of fatty acids in a cell determines how fluid and flexible the cell membrane is. This fluidity has a huge impact on lymphocytes, whose job it is to rid the body of foreign invaders. Thus, there is a clear link between fatty acids and the immune system.
There is no shortage of foods rich in linoleic acid and they are readily available. However, a deficiency might occur because the essential fatty acids in food may not be getting through to the places they are needed, due to some metabolic defect. The metabolic pathway from linoleic acid contains several hurdles from start to finish. In some people, the obstacles are so great the pathway is never completed. On its own, linoleic acid has no biological activity. In order to be of any use, the body must convert it to other products that are biologically active. Briefly, the metabolic pathway is as such:
Linoleic acid -> Gammalinolenic acid -> Dihomo-gammalinolenic acid -> Prostaglandin E1

The key to understanding the importance of supplementing with oils rich in GLA, such as evening primrose oil, is that many patients cannot convert LA to GLA efficiently. A common site for blocking agents to interfere is the conversion step from LA to GLA. Common blocking agents include sugar consumption, saturated fats, trans fatty acids, alcohol, viruses, chronic disease conditions, zinc deficiencies, radiation and cancer. With so many blocking agents around, it's not surprising there might be difficulty metabolizing essential fatty acids, even though there are plenty available.
In addition to the widespread blocking agents, cis-linoleic acid needs cofactors in order to complete its pathway to prostaglandin E1. The conversion from cis-linoleic acid to gammalinolenic acid requires an enzyme, delta-6-desaturase, that needs to function properly for the conversion to occur. Necessary cofactors include vitamins and minerals such as vitamin B6, vitamin B3, vitamin C, biotin, zinc and magnesium. A shortage of any of these cofactors can cause problems in the pathway. Evening primrose oil has an enormous head start in the metabolic process because it bypasses the easily impeded first step from cis-linoleic acid to gammalinolenic acid.
Prostaglandins

Evening primrose oil is a precursor of prostaglandin E1, and a much more reliable precursor than linoleic acid. Prostaglandins act more locally than hormones and have very specific effects on tissues. Specifically, women with PMS may have a deficiency of PGE1 in the central nervous system and in other tissues, such as breast tissue. Additionally, it has been confirmed that women with PMS are low in essential fatty acids, which can lead to an apparent excess in the hormone prolactin. Body tissues might be abnormally sensitive to normal levels of prolactin when they are low in essential fatty acids and prostaglandin E1. PGE1 has complex interactions with steroids and the net effect of this is that PGE1 helps to smooth out the actions of the rapidly changing hormone levels in the second half of a woman's cycle. Therefore, evening primrose oil can be given in the second half of a woman's cycle to help balance these changes.
Flax

Flaxseed is a concentrated source of dietary fiber and lignans, which are substances formed from plant precursors by the actions of intestinal bacteria. Flaxseed is the most concentrated food source of the plant lignan secoisolariciresinol, which then is converted to the mammalian lignan enterodiol, and its oxidation product enterolactone. Enterodiol and enterolactone, along with their plant lignan precursors, are absorbed by the colon, undergo enterohepatic circulation and are excreted in the urine and feces. It has been proposed that lignans offer estrogenic, antiestrogenic, and antioxidative properties. Similar in structure to endogenous sex steroid hormones, lignans are diphenolic compounds hypothesized to act in vivo to alter hormone metabolism and subsequent risk for hormone-dependent cancers. Lignans have been implicated in diet-induced changes in the actions of sex steroids, such as estradiol, estrone and testosterone, in women. Some experts propose that the common Western diet, which is low in fiber and, consequently, low in lignan content, predisposes women to ovarian dysfunction, marked by chronic anovulation and/or luteal inadequacy. In turn, ovarian dysfunction can be related to an increased risk of breast and other cancers.
One of the theories behind hormonal dysfunction includes the concept of "estrogen dominance," whereby women's hormonal scales have been tipped more toward estrogen relative to progesterone. Estrogen dominance also is due to the high number of chemical substances in our modern environment that have estrogenic effects in the body.
Lignans have both estrogenic and antiestrogenic properties. Because of their estrogenic properties, lignans can compete with estradiol and estrone for their high-affinity binding sites with inhibitory potencies. Enterolactone also exhibits antiestrogenic properties by stimulating synthesis of sex hormone-binding globulin (SHBG), thus decreasing free-estradiol concentrations and increasing clearance of estradiol. Further, enterolactone inhibits the estradiol-stimulated cell growth of estrogen-dependent breast cancer cells. Mammalian lignans competitively inhibit aromatase enzyme, the rate-limiting enzyme in estrogen synthesis.
Because of the adaptogenic estrogenic and antiestrogenic effects of flaxseed, it might make sense to use flaxseed in the first half of a woman's menstrual cycle, when estrogen is dominant. Using flaxseed in the first half of a woman's cycle might lay the necessary foundation for the upcoming luteal phase.
It's important to make note that the natural aspect of naturopathic medicine is not just about using natural substances. As naturopathic medicine becomes more and more integrated into the mainstream world of medicine, it's a double-edged sword. Increased recognition and research, as well as the nature (so to speak) of our modern society, often bring us further away from naturopathic roots and principles. We must remember that naturopathic medicine is about bringing physiology as close to the rhythms of Nature as possible. It's truly about guiding our bodies and our lives into true homeostasis so we can allow the innate wisdom of bodies to work.

About the Author: After graduating from the University of Notre Dame, Dr. Patricia Kim attended National College of Naturopathic Medicine, receiving a Doctorate in Naturopathic Medicine and a Master of Science in Oriental Medicine. Currently, she practices at the Acumen Health Centers in Hollywood, Calif.