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​Endometriosis

Endometriosis is an invisible but crippling condition that 1 in 10 women of reproductive age suffer from here in the UK.  
Startlingly, the time it takes for a diagnosis of endometriosis is around 8 years.  That`s 8 years of suffering and being passed around the medical system without answers. 

Most people with the condition understand the gynaecological nature of the disease, but are not so aware of the relationship of the condition with immune system dysfunction.

The Immune response

It is thought that the retrograde flow of menstrual blood is responsible for the lesions spreading in the peritoneal cavity and often beyond.  This is something that is not just unique to endometriosis sufferers though.  Most women will experience retrograde menstrual flow at times but their immune system will "clean up" any endometrial tissue that has migrated outside of the Fallopian tubes and uterus.  In endometriosis, this immune function is depressed and the lesions begin to take hold. Once these lesions are allowed to implant onto neighbouring tissue, interestingly the process of angiogenesis begins to form blood vessels to feed the lesions and sustain them.  

A holistic approach

In Naturopathic medicine, it is therefor essential that an understanding of the sufferer`s immune system is thoroughly assessed.  It is not an adequate approach to merely mask the symptoms with pain relief or birth control pills.  It is essential to try to broach the care of an endometriosis individual more holistically and understand why their immune system is not doing as it should be. 

Endometriosis does indeed have a genetic predisposition to the condition, meaning that it can commonly run in families, due to a polymorphism on a specific gene.  However, epigenetics means that these faulty genes are either switched on, or turned off in response to our diets, lifestyles and emotions.  A naturopath will therefor try to educate an endometriosis sufferer in the ways of minimising this gene expression with dietary and lifestyle measures. 

An inflammatory condition

Endometriosis is a very inflammatory condition.  An endo sufferer has extreme inflammation which needs to be calmed from several angles.  Inflammation is a natural response to an acute problem to help the body to heal.  In the short term, it is helpful and necessary.  The problem with inflammation lies when it becomes chronic (long-term).

Chronic inflammation floods the body with inflammatory chemicals that can be damaging. It can also heighten the sensation of pain. 
Endometrial lesions release inflammatory chemicals. One of which that is found in excess in the peritoneal fluid is prostoglandin E2 (PGE2). This chemical causes high amounts of inflammatory pain.  


The endo diet

One of the best ways of nurturing the immune system and reducing inflammation is eating in a particular way known as the anti-inflammatory Diet. Certain foods and drinks deplete the immune system and depress it from working as it should do, whilst other foods really boost it`s strength and nourish it into balance once more. 

Similarly, certain foods are highly inflammatory and can create more PGE2. Conversely, other foods soothe inflammation and calm the inflammatory response. We also know that endometriosis sufferers have more oxidation in their bodies, which causes cellular damage.  It is therefor vital to increase antioxidant -rich foods to calm the oxidation that occurs with the disease. 

Following the endometriosis diet is going to improve more than just your endometriosis symptoms. It will likely improve your overall health and vitality as well. And research has found that women who do try dietary interventions to manage their endo, most often report feeling better – and not just in reducing their pain.  A 2019 study found that women who made changes to their diet reported feeling more connected to their bodies, felt less endo symptoms, felt more healthy overall, and had more energy to live a full life.  


Foods to avoid


  • Avoid Alcohol

Studies have found that women who consume alcohol have up to a 50% increased risk of developing endometriosis.  Drinking alcohol depletes B vitamins that are necessary for hormone detoxification. It also has estrogen-like effects on the body and can worsen endometriosis symptoms.  Alcohol depresses the immune system, increases inflammation and causes oxidation.  It also inhibits the microbiome, allowing oestrogen to re-circulate rather than being excreted in your bowel movements.  When this happens, oestrogen rises and your endometriosis can worsen.  

  • Avoid Refined Sugar

Sugar is another major culprit in messing up our hormone balance.  When we have refined sugars it causes a spike in insulin and insulin-like growth factor production.  These cause a reduction in sex hormone binding globulin, which causes more estrogen to be free and active in our bodies.  In animal studies this has been shown to cause a proliferation in endometrial tissue and a potential concern for development and worsening of endometriosis. In short, sugar is fuel for endometriosis. 
​
  • Avoid Caffeine

It is known that the consumption of caffeinated beverages can increase the availability of estrogen during the peak estrogen phases of our cycle.  We also know that there is some research showing women consuming two cups of coffee per day have twice the risk of developing endometriosis. Caffeine is also present in Tea.  Caffeine alters our blood sugar balance and is disruptive in this respect to hormonal balance.  There`s so many other delicous hot drinks that you can explore, it really isn`t worth that 20 minutes of enjoying a caffeinated drink. 

  • Avoid Red Meat

Unfortunately for women with endometriosis the research is quite well established that red meat can promote the production of inflammatory prostaglandins, increasing inflammation and pain. Another major issue is that  cattle and pigs fed grains treated with pesticides tend to concentrate these hormone-disrupting chemicals (such as dioxin) in their fat and muscle tissues. Consumption of these meats is a leading source of human exposure to organochlorines – which are disastrous for hormonal balance and for endo sufferers. 

  • Avoid Gluten
 
In a notable 2012 study, 75% of the women in the study reported an improvement in pain when following a gluten -free diet, and none reported an increase in pain. There are thousands, if not hundreds of thousands of women who have shared their experience of improving their endo symptoms with avoiding gluten. From a naturopathic perspective, we always look to support the liver with endometriosis.  Gluten is known to inhibit the liver from functioning optimally.  It is an absolute definite recommendation that I make with my patients, and I often see remarkable results. Being gluten-free means entirely that - checking ingredients on packaging for wheat and barley and avoiding it totally.  Having the odd bit here and there is a no-no.  Gluten takes many weeks to leave the body and has a cumulative effect.  You will never get the full effect of removing gluten if you have the odd bit here and there.  Just go for it and remove it completely. 


  • Avoid Dairy

Dairy is one of the most inflammatory foods and one of the first areas that I explore when working with a client who has endometriosis. Casein is a protein in milk, and there are two types: A1 and A2. A1 casein is mainly from Holstein and Friesian cows (the primary cows used for dairy operations in North America, the UK, and Australia), meaning if you go to the store and buy regular ‘ol dairy products, they’re full of A1. Bummer, because when it comes to many of the worst inflammatory symptoms of dairy we hear about, A1 is the biggest culprit. Like, really. By far.
The problem with A1 casein is that, for many people, the body turns it into a product called casomorphin. Casomorphin is an opioid-like substance that can cross the intestinal barrier and enter your circulation and causing problems for your immune system. 
Casomorphin is also a potent histamine liberator (6)- something directly tied to endometriosis pain and many endometriosis-related symptoms. The problem is that endometriosis lesions have more mast cells in them than normal tissue, mast cells being those which produce histamines, meaning consumption of A1 dairy may cause the endo in your pelvis to inflame




  • Avoiding Bad Fats

Fats are one of the most important macronutrients for hormone balance and human health.  However, the type of fat really matters.  For women with endo the biggest concerns come from saturated fats – found mostly in red meats and butter (and other dairy products).  Women with higher saturated fat intake are typically found to have higher estrogen levels and are a higher risk for developing endo.  Trans fats, found in highly processed “foods” such as pastries, biscuits and cakes, are associated with higher levels of inflammatory mediators like PGE2,  interleukin 6 and C-reactive protein. 
It`s best to cut out all "bad" fats and counter balance them with essential fats (we`ll come on to those shortly). 


  • Avoid any foods you are intolerant to

An intolerance test can reveal foods that you should avoid.  Some food groups can be identified just through talking through your history in your consultation.When you consume a food that you are intolerant  to it is like setting little fires off in your body each time.  You have a huge inflammatory response (known as an IgG response) each time you consume them, adding more fuel to your endometriosis fire of inflammation.  Common food intolerances are dairy, wheat, soy, eggs and peanuts. In clinic, from experience, many endo sufferers have a dairy intolerance. 

  • Processed foods

If it comes in a packet with ingredients that are man-made then don`t eat it.  If you don`t recognise the food in it`s original form, don`t eat it.  Processed foods have an array of chemicals added to them which are inflammatory and will add to your problems.  Keep your food as close to how it grew on earth as possible.


Foods to Enjoy



  • Organic Fruits and Vegetables

Fruits and vegetables provide fibre that support healthy digestive function as well as nutrients to support immune function, detoxification and decrease inflammation. Women who consume two servings of fruit per day have a 20% decreased risk of endometriosis. There is research that shows women who eat one citrus fruit per day are at a lower risk for developing endo compared to women who ate citrus infrequently. Fruits and veggies are high in antioxidants to help fight the oxidation that endo sufferers display.  Aim for at least 5 vegetable portions and two fruits per day.  With fruits - try to stick to berries, apples, pears and citrus fruits whilst you bring your body into balance and avoid high G.I fruits such as bananas, mangos, pineapples, grapes etc.
Selecting organic fruits and vegetables whenever possible will minimise your intake of pesticides that further disrupt hormone function. Don`t forget... to get enough antioxidants to support your endometriosis, you need to eat a rainbow of veggies each day. 


  • Eat Vegetable Protein Daily

Women who eat a vegetarian diet excrete 2-3 times more estrogen in their feces and have half as much estrogen in their blood as meat-eaters. While estrogen doesn’t cause endometriosis, we know that supporting estrogen detoxification is important in managing the spread and severity of endo. 
Aim for two or three meat -free days at least each week but make sure every meal or snack that you have has a healthy portion of vegetable protein. Focus on eating soy, almonds and nuts and nut butters, beans, lentils and legumes.  When you do consume animal protein, stick to chicken, turkey, eggs and fish.


  • Fish

Fish, especially cold-water fish like salmon and mackerel, are a rich source of anti-inflammatory omega 3 fatty acids. These fats are essential fats and will help to balance out the bad fats that are so problematic to endo sufferers.   While supplements of omega 3s are often necessary to achieve the optimal anti-inflammatory benefits, consuming fish as a protein is a good recommendation.  Two servings per week is ideal. Not only will you be getting your essential fats by consuming fish such as salmon, mackerel, herring and sardines but you will also be getting a healthy source of protein.  You should be aiming to eat protein with every single meal of the day. 

  • Cabbage Family Vegetables

The Brassica (cabbage) family of vegetables support detoxification and encourage a healthy estrogen balance by favouring production of the less active form of estrogen. Consume broccoli, brussel sprouts, cabbage, kale, kohl rabi and cauliflower regularly to reap these benefits. Make sure you have at least one serving per day.  


  • Other Leafy Green Vegetables

Leafy green vegetables provide key minerals for detoxification and support liver function. They contain magnesium, a vital mineral for hormonal balance and blood sugar homeostasis.  Frequent consumption of leafy greens (two servings per day) has been shown to significantly decrease the incidence of endometriosis.  Greens such as spinach are excellent in smoothies and give a good dose of much-needed iron at the same time. 


  • Onions, Garlic and Leeks

These vegetables contain organosulfur compounds that enhance immune function and induce enzymes that detoxify the liver. They are also rich sources of quercetin, a bioflavonoid that stimulates the immune system and decreases inflammation.


  • High Fibre Foods

High fiber foods are incredibly important for endometriosis because they support the optimal balance of friendly bacteria in the digestive tract. Friendly bacteria support the elimination of estrogen in the feces. Focus on fiber in the form of vegetables, fruits and whole grains such as barley, quinoa, millet, brown, red and wild rice.


  • Flax Seeds

Ground flax seeds are a rich source of omega 3 and also contain lignans that provide an ideal source of fiber to support digestion and healthy bacteria balance.  We also know that lignans are great for balancing hormone levels. People with oestrogen dominance often find great relief with consuming flax seeds regularly.  
Aim for 1 - 2 TBSP of ground flax seeds per day.  Make sure they are ground - the goodness is inside the husk and the digestive system just can`t get to it unless it is ground.  
You can add them to smoothies, sprinkle on granola, add to stews or do what I do and drink them in a pint of boiling water each day.  


  • Other items that help

Seaweed - If your thyroid is functioning well then sea vegetables can become your ally.  Nori, dulse, Seaweed sheets, furikake seasoning... there`s lots of tasty ways of bringing this iodine -rich food source into your diet.  

​Green tea - Green tea will help to stop the angiogenesis supply of blood to the endometriosis lesions.  It is also a powerful antioxidant. 

Turmeric/Curcumin - this bright yellow nutrient is one of the finest things to help lower inflammation

Dandelion coffee - naturally caffeine free, this tasty drink is extremely nourishing to the liver



Lifestyle 

Diet is just one key part of supporting your endometriosis.  In addition, you really have to assess your lifestyle.  Stress, whether physical - (lack of sleep, working night`s, over-training, injury, illness etc) or emotional causes huge hormonal imbalances and inflammation.  
It is imperative to assess your life and see what measure you can introduce to help get a little headspace from anything that is causing you to be less than your happy self. 

Rest and Restore

Time each day undertaking activities that really put you into a restful state are hugely beneficial.  Simply watching TV isn`t good enough.  You need time to switch your brainwaves to an altered state of consciousness.  Activities like listening to guided meditations, T`ai Chi, Qigong and restorative yoga (not the type that ties you in knots and has you panting for breath!) all help do this, as does walking in nature.  When you enter this state your nervous system switches from fight or flight to rest and restore mode.  In this state you are more able to achieve homeostasis and regulate your body`s chemical processes. 
Even if it is just 10 minutes per day where you take yourself away and just be.  Do your best to try to bring this head-space time into your day. 

Grief and Trauma 

Often, under-processed traumatic events can also cause a constant drip - feeding of stress hormones that interfere with hormonal balance.  This is something I see so regularly in clinic.   If there`s something you need to work on from your past, seek out a therapist and take some time to work on addressing your emotions.  This in itself can be transformative to your health. 

Laughter

Lastly, bring laughter into your life.  Watch comedies, funny films, even those silly cat videos that pop up on your socials, go out with the girls, do something that makes you laugh.  Laughter really is therapeutic for your health and studies have proven that contentment and happiness raises your immune system.  Actively bring laughter into your weekly routine, even if it just sitting once a week and watching a funny film.  





Thrive 
Clinical Nutrition and Naturopathic Health
​Eve Morley NT
FNTP.  AMNNA. Soc Nat. 
07809 432028
​​hello@shesthriving.com​

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