Endo Empowerment: modern research and natural health strategies to reduce the impact of endometriosis.
Guest contribution by Kirsty Eng Fertility
In my 20 years of working in the field of women’s natural health and fertility, I have witnessed the full impact of endometriosis on countless numbers of women. Not only can it produce debilitating pain and a myriad of other documented symptoms, but it can also be a hidden cause of infertility. As endometriosis may be silent in its presentation, it may often be overlooked in a diagnosis for infertility, and as a result it is often assumed egg quality issues or age are to blame. It is common for women to try to conceive for years, or go through multiple rounds of IVF, without ever suspecting that endometriosis is the reason they are struggling with fertility. Failing to conceive, multiple failed IVF rounds or recurrent miscarriage should be seen as red flags to the possibility that silent endometriosis may be present.
In this blog, I’ll explore a newly discovered potential cause of endometriosis and dive into how learning into this emerging research may guide us toward reducing endometriosis’s impact on health and fertility. I’ll share practical insights through the lens of diet and nutrition, alongside the wisdom of traditional Chinese medicine.
New research surrounding a potential cause
There have been many promising leads in recent research to what causes endometriosis. One of the most notable being the work of Japanese researchers in 2023, demonstrating that a specific bacterium in the gut, called Fusobacterium Nucleatum, could contribute to the development of endometriosis. This bacterium was found in endometrial lesions (patches of endometrial lining tissue in places other than the endometrium) and endometria of over half of the patients suffering from endometriosis but was only present in 7% of the control samples. The researchers found that the bacteria increased the size and count of endometriosis lesions.[1]
Fusobacterium nucleatum is a part of the normal, healthy oral, gastrointestinal and genital flora. Though normally harmless in a balanced microbiome, dysbiosis (an imbalance in microbiome) can allow F.nucleatum to proliferate and contribute to disease.[2] When dysbiosis occurs, an overgrowth of F.nucleatum bacteria causes it to transform from a neutral resident in the microbiome, to an opportunistic pathogen capable of producing the toxin LPS (lipopolysaccharide). LPS stimulates immune cells to release pro-inflammatory proteins, called ‘cytokines’, that trigger chronic inflammation. It is this cascade of inflammatory pathways, initiating from a state of dysbiosis, that has led some researchers to believe that dysbiosis may ultimately be responsible for the onset and development of endometriosis.[3]
Inflammatory cytokines play a significant role in the development and progression of pain associated with endometriosis. They stimulate nerve growth into lesions and amplifying pain pathways and receptors.[4] Cytokines have a toxic effect on both egg and embryo development, resulting in lower fertilisation rates, poorer embryo quality, and higher miscarriage rates.[5] They deal another blow to fertility by interfering with the functioning of reproductive organs, as they are linked to the formation and growth of endometriosis lesions and adhesions (bands of scar tissue from previous lesions), which may cause abnormal attachments, structural changes and blockages that interfere with fertility processes.[6]
Restoring balance to the gut microbiome could be the key to mitigating the impacts of endometriosis on health and fertility. When a microbiome is healthy it is supportive of the immune system, and it is only through dysbiosis that this support breaks down and microbes can translocate to other places within the body such as the uterus or peritoneal fluid, setting off the inflammatory immune response mentioned above.
Other than endometriosis, F.nucleatum has been linked with a wide range of diseases including inflammatory bowel disease, irritable bowel syndrome (IBS), colorectal cancer (CRC), rheumatoid arthritis, metabolic disease, psoriasis, neurological disorders, angina, lung diseases and periodontal diseases. Research has shown the prevalence of F.nucleatum increases with the severity of the disease.[7] In fact, research focused on CRC, is recommending high levels of F.nucleatum should be seen as a biomarker of the disease. [8]
Natural strategies for managing the impact of endometriosis
Now that we have acknowledged the connection between microbiome dysbiosis, increased levels of F.nucleatum and endometriosis, let's focus on natural ways to reduce this impact.
In order to do this we need to focus on:
1. Reducing F.nucleatum bacteria
2. Reducing overall inflammation
3. Restoring the gut microbiome
1.Reducing F.nucleatum bacteria:
Due to the F.nucleatum bacteria being implicated in other diseases, research from those spheres has allowed us to better understand what specific natural substances can be used in the treatment of endometriosis.
· Fermented foods especially raw, unpasteurised, naturally fermented kimchi. The probiotics they contain, provide a 6-fold decrease to F.nucleatum levels. [9]
· Cold-pressed virgin coconut oil’s antibacterial effect kills off F.nucleatum – add it to spreads or put it through your cooked vegetables. [10]
· Polyphenols, flavonoids & pterostilbene – natural plant compounds found in many vegetables and fruits, especially those dark or red in colouring, have antibacterial and anti-inflammatory propertied that inhibit F.nucleatum. Berries, red/purple grapes, red onions, dark leafy greens.
· Anti-inflammatory and anti-bacterial superstars – To further inhibit F.nucleatum, regularly include in your diet: cloves, star anise, cinnamon, ginger, turmeric and raw or tinctured propolis. [11]
2.Reducing overall inflammation:
To reduce inflammation, it is recommended to adhere to a whole food diet with a high percentage of organic, fresh vegetables and fruits. As mentioned above, dark leafy greens, dark or red vegetables and fruits, turmeric and ginger are standouts in reducing inflammation.
Unfortunately, there is quite a long list of foods that we need to avoid in order to reduce inflammation:
· Processed food and fast food
· Fried food
· Meats cooked on high heat such as barbequing
· Commercial biscuits and bakery items due to trans-fats
· Refined carbs, sugar and soft drinks
· Alcohol, caffeine, nicotine and vapes
· Plastic is highly inflammatory so avoid plastic food packaging, tinned foods (due to their plastic resin lining), takeaway food containers and plastic cooking utensils.
· PFAS (synthetic ‘forever’ chemicals valued for being water-, grease- and stain- resistant) found in non-stick cookware, water-repellent clothing, stain resistant or moisture wicking fabrics, food packaging such as pizza boxes and microwave popcorn bags, and long wear or waterproof cosmetics.
· Synthetic fragrances in any products (perfumes, body wash & lotions, candles, laundry detergents and fabric softeners) should be avoided as the phthalates they contain, contribute to inflammation.
· Gluten in even small amounts should be avoided as it has been shown to trigger inflammation. [12]
· Regular dairy should also be avoided as the A1 casein dairy protein is highly inflammatory. [13]
In traditional Chinese medicine, the concept of inflammation is known as Damp Heat, and is a condition where excess moisture (damp – similar to phlegm or mucous) combines with internal heat, leading to symptoms like fluid retention, digestive issues, skin problems, or infections. To avoid creating Damp Heat it is recommended to avoid excess ‘damp’ foods: sugar, dairy, fried and greasy foods. Spicy food and stimulants such as caffeine, alcohol and nicotine are all heating in nature so should also be avoided. Regular acupuncture is a powerful way to clear Damp Heat. For a Damp Heat clearing diet, aim to regularly consume asparagus, celery, Chinese cabbage, kidney beans, blueberries, cranberries, fresh peppermint tea or fresh ginger and lemon tea.
3.Restoring the gut microbiome:
As we have ascertained, the key to reducing the impact of endometriosis may very well be held in the restoration of gut microbiome. The health of the microbiome will improve from the reduction in inflammatory food and F.nucleatum mentioned above, there are however further ways we can work on bringing it into balance.
To do this we need to:
· Regularly increase the variety of fruit and vegetables in our diets to increase the diversity of gut bacteria.
· Increase the intake of high fibre foods to feed good gut bacteria. Choose low FODMAPS options if you struggle with digestion issues: quinoa, green beans, chia seeds, flax seeds, pumpkin seeds and polenta.
· Increase the intake of polyphenols as these are specific micronutrients rich in antioxidants that also feed the good bacteria: berries, kiwis, grapes, oranges (especially the peel and zest), unripe bananas, dark leafy greens, zucchini, carrots, red bell peppers, basil, oregano, parsley, ginger, turmeric, star anise, cloves, cinnamon, thyme, quinoa, walnuts and macadamia nuts.
In traditional Chinese medicine, the concept of ‘Spleen Qi deficiency’ correlates with dysbiosis of the gut microbiome. Research has shown that acupuncture and Chinese herbal medicine focused on building Spleen Qi, enables restoration of the gut microbiome, regulates the immune system and decreases inflammation. [14-17]
In traditional Chinese medicine, the qi of the spleen needs to be adequate for the process of digestion to function efficiently. When spleen qi is deficient. Issues with digestion prevail e.g diarrhoea, constipation, irritable bowel syndrome, bloating and flatulence. Low energy and fatigue are also common.
Building on the Spleen Qi and restoring the gut microbiome involves these dietary and lifestyle strategies:
· Eat warm, cooked foods – favour warm, easy-to-digest meals like soups, broths, stews and casseroles. Avoid chilled drinks and foods. Reduce raw foods as it is harder to digest these with a weak spleen.
· Choose spleen nourishing foods – specifically orange coloured root vegetables such as pumpkin, sweet potatoes and carrots. Warming spices such as ginger and cinnamon build the spleen and support digestion.
· Avoid skipping meals (especially breakfast) – creating a routine with meals improves Spleen Qi.
· Get adequate rest – overwork and lack of rest, sleep and downtime deplete Spleen Qi.
· Exercise regularly – gentle to moderate exercise helps to build on the energy of the spleen.
· Have regular acupuncture sessions focused on spleen building acupuncture points.
· Strengthen your spleen with a Chinese herbal tea – making a tea of goji berries and grated ginger is an effective way to support your spleen. Add in some turmeric, cloves and star anise to aid in reducing inflammation. To increase the spleen boosting benefits of your tea add in astragalus and Chinese red dates. You can find these at an Asian grocery store in the dried herb section.
In traditional Chinese medicine, maintaining health is all about striving for balance. The microbiome is a lot like that too. Dysbiosis triggering a chronic inflammatory state, like endometriosis, is a body’s cry for balance to be restored. Be patient with your body when attempting to reclaim this balance and make diet and lifestyle changes gradually so they are easier to maintain. It takes time for your body to heal and repair, trust that slowly your body is getting closer to a healthier state of wellness. In Chinese medicine there is a saying ‘know your body’s weakness, and continue to work on it’, understand that this will be a lifetime’s focus just as the yin yang symbol represent the continual state of always striving for balance. It is important to remember that the inflammatory state your body is in, is not just created by your diet but unfortunately also due to the toxic world we live in. Plastics in our food packaging, phthalates and PFAS are all a major threat to our health and fertility and are unfortunately ubiquitous. We can do our best as individuals but ultimately their critical impact on health needs to be handled on a national and global level.
For further endometriosis health and wellness advice follow @kirstyengfertility.
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