Last week I discussed endometriosis in detail. This condition should be taken seriously as it can lead to infertility and permanent damage of the Fallopian tubes and ovaries. It can also lead to cyst formation which puts you at risk for a ruptured cyst. If you want to learn more about Endometriosis and your risk, please read the article here.
If you have been struggling with Endometriosis, there’s a good chance you have been given little direction beyond surgery, birth control pills and pain killers.
I understand your frustration if you feel that these options are not right for you. Practitioners rarely discuss diet and lifestyle changes when it comes to this condition.
Thankfully, from a Functional Medicine prospective, there is a lot you can do to manage or even reverse your endometriosis. The first step to relief involves eating the right foods.
As you know, I generally recommend the Paleo diet as nutrition template for many hormone conditions. This recommendation mostly has to do with the fact that Paleo is a great tool for balancing blood sugar levels.
You can learn more about the Paleo diet and how it can help balance your hormones in this article.
Paleo isn’t your only option. Some women do better on different variations of Paleo (ie. less meat and more carbohydrates) or some women thrive with some gluten-free grains or beans and legumes in their diet. It really depends on your unique biochemistry, activity levels and carbohydrate tolerance.
The most important thing is that you eat real food. Your choices should be free-range, organic and local whenever possible. You food should not come from a box, bag or package. It should be chosen as you shop the perimeter of the grocery store, avoiding the nastiness of the isles in between.
Once you got the real food diet mastered, you can start being strategic with your food choices to optimize your body’s ability to prevent endometriosis from continuing to occur.
Cruciferous vegetables are a top choice when it comes to reversing endometriosis. The endometrial lining grows due to the effects of Estrogen (a potent growth hormone). Elevated estrogen is often at the root of Endometriosis.
Cruciferous vegetables like broccoli, cauliflower, kale, radish, cabbage, Brussel sprout, collard greens and bok choy contain Diindolylmethane (DIM). DIM is a powerful tool in lowering estrogen levels.
When estrogen is broken down, it can head down the 2-OH, 4-OH or 16-OH pathways. The 2-OH pathway is thought to be a protective pathway. 4-OH is thought to be a damaging pathway, causing DNA damage and a possible cause of estrogen dominant cancers. The 16-OH is not damaging like the 4-OH but can lead to symptoms of estrogen dominance (ie. endometriosis).
DIM consumption actually shifts these pathways and helps you break your estrogen down that protective 2-OH pathway and away from the 4-OH and 16-OH. It also has the effect of reducing estrogen levels overall.
I find DIM to be one of the most powerful tools when it comes to dealing with estrogen dominance and endometriosis.
I have heard that fermented cruciferous vegetables are even more powerful in these effects. So eat your sauerkraut!
One way that estrogen can become elevated is due to poor liver clearance. It is the liver’s responsibility to clear excess hormones from the blood. The liver is one of the areas where the estrogen metabolism mentioned above occurs. In fact, 50% of estrogen metabolism occurs in the liver.
This means if liver function is not optimal, you might have excess estrogen floating around your blood, leading to nasty symptoms.
Liver friendly foods include:
Approximately 50% estrogen metabolites that enter the liver, are then excreted in the bile, sent to the intestine and then hydrolyzed by intestinal microflora. Following this process, hydrolyzed estrogen is either excreted via poop or are entered back into portal circulation.
From here it goes back to the liver for further metabolization. They are either sent back to the bile or pushed back into circulation.
Enter the Estrobolome. The estrobolome is a set of gut microflora that produce beta- glucuronidase, an enzyme that influences this metabolization. Claudia Plottel, MD, a Clinical Associate Professor at N.Y.U., and her team looked at how intestinal flora affects estrogen circulation
Plottel believes your microbiota species can create beta-glucuronidase that increase estrogen– allowing it to re-enter circulation in the body.
This makes your intestinal flora crucial to healthy estrogen levels. Some unfavorable microflora carry this enzyme and thus creating not only a dysbiosis in the gut but elevates estrogen levels.
Fermented foods such as sauerkraut, kimchi, yogurt (if tolerated), pickles, kombucha and other fermented veggies contain a full spectrum of bacterial communities. Eating these foods on a regular basis can help repopulate your gut and increase the beneficial flora in your gut.
Another way your estrogen can become too high is due to something called aromatization. Aromatase is the enzyme which causes the conversion of testosterone into estrogen.
Inflammation can increase the presence of aromatase in the body leading to elevated estrogen levels. If you were to run a hormone panel and you had aromatization, you would see average DHEA with low testosterone and elevated estrogen.
Additionally, inflammation can negatively affect your adrenal glands leading to imbalanced hormones. It can also stress the immune system which is usually a reason excess endometrial tissue cannot be cleared from the body.
Top Anti-Inflammatory Foods:
If the immune system is strong and healthy, the body should be able to fight off the overgrowth of endometrial tissue. This is at least the thoughts of many of the practitioners I have spoken with.
It appears that many women with endometriosis also have reduced immunity. Most of the research suggests that low immunity is a result of endometriosis rather than a cause. Both ways, boosting immunity can likely help improve this condition.
Top Immune System Boosting Foods:
Have you been struggling with extremely painful periods, chronic pelvis pain or pain during sex? There are a number of reasons why periods can cause painful cramping, but endometriosis is a common culprit.
During the first half of the menstrual cycle, estrogen is the dominant hormone.Estrogen is a growth hormone and stimulates the growth of the uterine lining. Once an egg is released and not fertilized, estrogen starts to decline and progesterone becomes the dominant hormone in the second half of the menstrual cycle.
As the egg breaks down and becomes the corpus luteum, progesterone is given off. Both estrogen and progesterone reach their lowest levels just before the beginning of menstruation. This is what signals the start of bleeding where the lining of the uterus is shed for the next 3-7 days.
Endometriosis is a condition which tissue that normally grows inside the uterus instead grows outside it. The most common places in the body this tissue can grow is the abdominal cavity where it can land on the peritoneum, the thin layer that covers the inside of the abdomen, the ovaries, and fallopian tubes. This tissue has also been found in the knee and the nose, strangely enough. The body in it’s ultimate wisdom attempts to contain the growth by forming a cyst around the tissue. Then every time a woman has a period, this tissue proliferates and may lead to a ruptured cyst.
Like the lining of the uterus, the misplaced endometrial tissue is triggered by the same hormonal shift that begins the menstrual cycle (ie. low estrogen and progesterone). This tissue will then also shed and bleed. The blood, which is trapped in the abdomen, is irritating to the nerves in the abdomen, causing much of the pain associated with endometriosis. Some women experience chronic pelvic pain while others only experience pain during their periods. In certain cases, women experience no pain at all. The latter case can delay diagnosis and likely accounts for many undiagnosed cases. Statistics say 10% of women suffer from endometriosis but this is likely lower than the reality.
Over time the abnormal shedding can cause chronic inflammation and lead to scar tissue development. This abnormal cell growth will also instigate an immune response that can perpetuate the problem.
There is no concrete answer but there are many theories. In my experience, this condition is largely related to excess estrogen production. Since estrogen is involved in the growth of endometrial tissue, when it occurs in excess it can stimulate the over growth of the tissue.
Other factors that are likely involved in endometriosis are:
Dr, Stacey Roberts, natural fertility expert, mentioned that endometriosis may actually be an autoimmune process. According to this study, among 59 women who had a laparoscopy indicating endometriosis, 28.8% tested positive for antinuclear antibodies (a marker for autoimmunity).
The autoimmune connection is explored in detail in this scientific review. The authors conclude that endometriosis fits most of the criteria for autoimmune disease including blood markers of inflammatory cytokines and tissue specific autoantibodies. It seems endometriosis occurs with other autoimmune conditions such as Hashimoto’s Thyroiditis and inflammatory bowel disease.
Typically it is diagnosed through an ultrasound but this technique can often miss tissue growth that is hidden and lying deeper in the body. Some experienced physicians can find it using a physical examination, where they can pinpoint the adhesions and lesions in the abdomen. Laparoscopy, a surgical procedure, can also be used to identify lesions.
Unfortunately, endometriosis can lead to infertility issues. It can lead to scarring and damage of the filopian tubes which can make it incredibly difficult for a woman to become pregnant naturally.
If the fallopian tubes are damaged or altered in their function then this can set the stage for an atopic pregnancy. Up to 30-50% of women who have endometriosis may experience infertility, according to American Society for Reproductive Medicine.
In extreme situations it can perorate the bowel and lead to complications with digestion. This only occurs in very severe cases.
1. Surgerical Excision – This involves going in and removing overgrown tissue. This can be extremely helpful in removing adhesions and lesions but does little to address the root cause. If this is the only treatment used, adhesions may develop again. Surgery works best if it is used with natural therapies to prevent future tissue proliferation.
2. Progesterone Cream – Progesterone opposes estrogen and inhibits the growth of endometrial tissue growth. Lesions can be resistant to progesterone so typically high doses are needed. This treatment does not generally work on its own.
3. Hormonal Birth Control – This is the standard treatment as it suppresses ovulation and prevents the growth of the uterine lining. Again, this treatment fails to address the root cause and can mask other hormonal conditions. A woman cannot be on the pill indefinitely, so once she comes off it, she is likely to experience other hormone disorders that have been left untreated over the years.
4. NSAIDS OR Naproxen – This can help reduce pain associated with endometriosis but does nothing to deal with the problem. These drugs can cause many issues when used long term. They are known to stress the liver and thin the lining of the gut, even when only used once a month.
The good news is that there is a lot you can do to prevent endometriosis from continuing to occur. One of the most important starting points is to have your hormones tested via saliva or urine. I am not a huge fan of blood testing as it gives you a very limited piece of the overall picture.
In next few week’s blog posts, I will discuss some of the most effective diet, lifestyle and supplements therapies for dealing with endometriosis and preventing it from messing with your fertility. If you would like to learn more about the hormone testing I do and how it can help optimize your menstrual cycle and fertility, please book a free 20 minute consultation to speak with me directly. You can do that here.
Listen to me discuss this article in the video below!