Endometriosis is a disorder in which tissue that normally lines the uterus grows outside the uterus. With endometriosis, the tissue can be found on the ovaries, fallopian tubes, rectum, bladder, and intestines. 10% of women in the world have endometriosis. Because getting a diagnosis can be difficult since it requires exploratory surgery, this number is likely much higher.
The typical solution for endometriosis is to prescribe hormonal birth control. Some women are offered excision surgery to remove the endometrial tissue and then recommended to use hormonal birth control to prevent the regrowth of the tissue. While some forms of hormonal birth control suppress hormones, which in theory suppress endo lesion growth, this doesn’t work for all women. Especially those who eventually want to conceive and are concerned with fertility or those whose bodies do not react well to hormonal birth control.
So what are the other options? Taking a deeper look at the root issues of endometriosis and how you can support the different systems in your body that can minimize growth and symptoms.
The hallmarks of endometriosis outlines four areas that specifically impact how endometriosis develops and grows in the body. They are immune system dysfunction, progesterone resistance, estrogen dominance, and inflammation.
When it comes to endometriosis and the immune system, we have to consider both our innate immune system and our adaptive immune system. Our innate immune system contains macrophages and natural killer cells that are supposed to eat up & destroy endometriosis lesions. Those with endometriosis have lower natural killer cell activity and reduced phagocytosis by macrophages, which means more lesions and inflammation AKA more pain. Our adaptive immune system contains T cells and B cells whose job is to respond to antigens and make antibodies. Those with endometriosis have more B cells, T cells, and antibodies. The adaptive immune system also contains T-reg cells that are typically immunosuppressive; however, they appear to not be working properly in those with endometriosis, despite having more.
A common concern with endometriosis is high estrogen, which we will discuss next and impacts the severity of the disease, but what’s often left out is how some women with endometriosis struggle with progesterone resistance. Progesterone resistance is when the tissue has a decreased response to progesterone. So even if a woman with endometriosis is making enough progesterone, if she has progesterone resistance, her body will not use that progesterone properly.
Endometriosis is an estrogen-dependent condition, and even the endometrial tissue can be a source of local estrogen. Women with endometriosis are more likely to have genetic mutations that can also lead to a build-up of estrogen, such as poor methylation, which is important for getting rid of estrogen. Another important one is aromatase. Women with endometriosis are more likely to have high aromatase activity that converts androgens (male hormones) to estrogens, further exacerbating excess estrogen. Those struggling with progesterone resistance are more likely to deal with an imbalance of estrogen and progesterone as well.
There are many sources of inflammation for those with endometriosis. Immune system dysfunction can contribute, especially when endometrial lesions are not destroyed and cause more inflammation. High estrogen can also contribute to inflammation and can down-regulate the DAO enzyme leading to histamine build-up and more inflammation. Compromised digestion, which is very common with endometriosis, can lead to more inflammation in the digestive tract. Women with endometriosis are more likely to have an imbalance of gut bacteria that exacerbates inflammation. These all feed into and impact one another, and inflammation is more of a result than a cause of endometriosis.
If you do any web search for nutrition for endometriosis, you will likely come up with many resources that tell you to eliminate a long list of foods. This can be overwhelming, especially for those struggling with fatigue and chronic pain from the condition, and I also find it very unnecessary. This is something I go into more detail about within this week’s podcast episode with endometriosis dietitian Cindy Drabrowska. Most food restrictions are a bandaid and do not guarantee that your symptoms will resolve. They can also lead to more issues down the road, both in the form of nutrient deficiencies and mental/emotional stress, and food fear.
Let’s dig into the most commonly recommended foods to cut out with endometriosis:
Some research shows that removing gluten improved endometriosis symptoms in 80% of women over a year. This is great, but the question is, what foods did they add in to replace gluten, and did that have a more significant impact on overall health? For example, if they added in more fruit, starchy carbs, etc., in place of gluten, this would also add more potassium and nutrients in general that were responsible for reducing symptoms rather than just the elimination of gluten. This is not accounted for in the study. Do I think it’s worth experimenting with? Yes. You aren’t necessarily missing out on any nutrients when you remove gluten, but I think it can be challenging to deal with in some social settings or leave some women feeling too restricted. For this reason, you’d want to focus more on what you’re adding in.
I do not recommend eliminating dairy for women with endometriosis for a few reasons. It’s often one of the few sources of vitamin A, which is essential for balancing iron, supporting the immune system and thyroid function. Women with endometriosis have a genetic predisposition that lowers the conversion of beta carotene to active vitamin A (retinol). Dairy is also a great source of calcium, which is helpful for blood sugar balance and cramping. Lastly, dairy can be a convenient protein source and allow women with endometriosis to eat more regularly throughout the day, supporting healthy digestion and metabolism.
Caffeine can be helpful to reduce for many women with endometriosis, but it doesn’t mean removing this will solve all of your problems. If someone is drinking caffeine before eating breakfast, then yes, that can contribute to cortisol and blood sugar imbalances and eventually burnout. Having caffeine with food or after a meal will greatly reduce this. Not overdoing caffeine and making sure you’re regularly eating throughout the day and not depending on caffeine for energy is also key. Some women find it helpful to reduce or remove caffeine leading up to their period to help reduce cramps. I think this is worth experimenting with, but again, not a cure-all. Learn more about how to enjoy coffee without impacting your hormones here.
This is a very common recommendation that often leaves many women with endometriosis feeling confused and frustrated since red meat can be something their body is craving. Red meat is a great source of zinc, which is important for the immune system and high-quality protein to support the liver and estrogen removal, and other minerals that support our metabolism.
Alcohol is one where I will say that I do agree reducing or eliminating altogether (depending on the person) can be helpful for many women. The main reason is that it increases estrogen, which can exacerbate endometriosis lesion growth. Alcohol also puts a significant burden on the liver. If a woman with endometriosis also has genetic predispositions that lead to higher estrogen and difficulty removing estrogen, alcohol will worsen this. This is one where you want to think about your personal experience and figure out when alcohol is worth it and how it impacts your body and condition.
Digestion is often compromised in those with endometriosis. This happens for a few different reasons. A major one is related to the balance of beneficial and non-beneficial bacteria. Women with endometriosis are predisposed to having higher amounts of bacterial imbalance in their gut. This can lead to inflammation and dysfunction as far as making digestive juices go. Another big one is how fatigue and chronic pain can impact eating habits. It can be difficult to eat regularly throughout the day, leading to a higher risk of slow metabolism and sluggish thyroid, leading to low stomach acid production. This slow motility puts the person at higher risk of small intestinal bacteria overgrowth (SIBO) and IBS. The other thing to consider is whether or not the woman has endometrial lesions on her intestines. When that is the case, bowel obstructions and constipation can occur.
This is why supporting digestion is a great place to start for those struggling with endometriosis. One of the best ways to do this is to use digestive bitters before meals, and this helps your body make more of its own digestive juices and improves how well you break down and absorb your food. When we break down our food better, we move it through the intestines more efficiently, supporting healthy bowel movements. Our bowel movements are how we eliminate estrogen from the body, so we want to prioritize this in women with endometriosis.
Hydration is also key for digestion. When I say hydration, I’m not talking about drinking a gallon of water a day. That’s not true hydration. I mean adding minerals to your water as well as including adrenal cocktails on a daily basis. I typically recommend 1-2 adrenal cocktails a day for women with endometriosis. The more stress you have, the more you would want to include. Learn more about adrenal cocktails here.
One of the most powerful things you can do to support digestion is to eat regularly. This can be difficult for those struggling with fatigue. Keep in mind it doesn’t have to be a full meal. Even including something like bone broth between meals is helpful. Eating regularly will support your energy, blood sugar balance, and metabolism.
Overall, you can see that endometriosis is a complex condition involving many body systems. This is why it is essential to keep these areas in mind when approaching and healing endometriosis for a sound approach that isn’t centered around food elimination. You can reduce your symptoms and balance your hormones with endometriosis–healing is possible!
Here is a great podcast episode to listen to that digs deeper into nutrition for endometriosis!
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