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Women’s Health

IS DIET HELPFUL IN ENDOMETRIOSIS?

Endometriosis occurs when non-cancerous tissues that resemble the ones lining your uterus , begin to grow outside of the uterus in places like the ovaries, the fallopian tube, pelvis and bowel. 

It is a hormone dependent type of condition (especially steroid based hormone estrogen).

The tissues in the uterus becomes  thicker than normal, breaks down and leave the body during menstruation, but these tissues that grow outside of the uterus also thicken and break down but cant leave the body thereby leading to pain, inflammation, formation of scar tissue and most likely, potential fertility problems. 

According to a study, about 70 million women all over the world  are affected by endometriosis. Surprisingly, the disease is even more common than breast cancer and diabetes.

Endometriosis usually occurs during active menstruation when there is still much release of estrogen (i.e it is hormone dependent), it rarely occurs after menstruation. 

WHAT ARE THE SYMPTOMS? 

Symptoms always vary from one woman to another, might come in as mild or moderate or severe.

The degree of pain doesn’t always equate the severity of the condition; you might have very excruciating pains and it’s a mild condition. 

Symptoms involved in endometriosis include: 

  • excruciating pains during period
  • pain experienced in the lower abdomen and back either before or during menstruation 
  • cramps around menstruation week
  • heavy bleeding 
  • infertility problems 
  • pain after sexual intercourse
  • Diarrhea or constipation 
  • Bloating 

WHAT EXACTLY CAUSES ENDOMETRIOSIS? 

The etiology behind endometriosis is not known yet, but according to some theories put forward, these suggested causes might be linked to the condition: 

  • Genetics: the condition most likely runs in families and affects people of some ethnic groups more
  • Retrograde menstruation: this happens when some of the womb lining flows up back through the fallopian tubes and hangs on to some organs of the pelvis instead of leaving the body as period.
  • When the immune system is malfunctioning 

These suggested theories don’t fully explain the causes of endometriosis; it is a condition caused by many factors put together.  

RISK FACTORS 

Some other factors include: 

  • AGE: usually affects women from the ages of 25-40, symptoms can be seen from puberty though. 
  • FAMILY HISTORY
  • PREGNANCY HISTORY: pregnancy might have the tendency of decreasing the risk of endometriosis, those who haven’t had children might have higher risks of endometriosis.
  • MENSTRUATION HISTORY:  issues associated with this can include shorter cycles, heavier and longer periods and might place the individual at higher risks. 

HOW CAN I PREVENT ENDOMETRIOSIS?

Sadly, there is no known way to prevent endometriosis. The possible ways are to create awareness, ensure early diagnosis and management to help slow down or halt the natural progression of the disease. 

HOW IS IT DIAGNOSED? 

Endometriosis can be suspected from history; tender masses might be visible on the vagina and cervix during pelvic examination. 

TREATMENT OPTIONS 

Even though there is no known treatment option for endometriosis, it can be managed to help reduce symptoms. Possible ways to help manage endometriosis includes: 

  • nutritional therapy
  • exercise
  • pain medication
  • hormone therapy
  • surgery

These options totally depend on the severity of the condition. 

HOW ENDOMETRIOSIS MAY BE LINKED TO DIET 

Diet may have a potential role in the cause of endometriosis through its influence on hormones derived from cholesterol. Hormones like oestrogen which are cholesterol based are the major culprit in endometriosis. So, studies have shown that a plant-based and high fibre diet increase oestrogen secretion and reduce the availability of oestrogen, and this might help reduce endometriosis progression. This diet would help to modify the risk of endometriosis by altering the metabolism of cholesterol based hormones. 

FOODS THAT MAY NEGATIVELY AFFECT ENDOMETRIOSIS 

Endometriosis can be influenced by your lifestyle, and this determines the severity of the condition and the pain experienced. 

The following factors might negatively influence the condition: 

  • High intake of transfat : research has it that women who consumed high amounts of transfat especially from fried and processed foods had a higher rate of diagnoses. 
  • Red meat consumption
  • Gluten: A study showed that most women experienced a decreased pain while they went on a gluten free diet
  • High FODMAP diet: low FODMAP diets are majorly prescribed to people who has irritable bowel syndrome (IBS). A research found out that those with IBS and endometriosis that followed a low FODMAP diet had reduced symptoms

Alcohol, caffeine, gluten, red meat, saturated and trans fat can negatively affect hormone regulation in people with endometriosis as they lead to progression of the disorder. So, they should be totally avoided 

FOODS THAT MAY POSITIVELY AFFECT ENDOMETRIOSIS 

A nutrient dense and well adequate diet can help to reduce symptoms from endometriosis. you should consider: 

  • A high fibre diet: a diet high in fibre helps reduce the production of oestrogen which is implicated in the mechanism of endometriosis, and also helps to reduce insulin production, which relates to the progression of endometriosis. foods high in fibre includes green leafy vegetables, legumes and whole grains. 
  • iron-rich foods, such as dark leafy greens, broccoli, beans, fortified grains, nuts, and seeds
  • foods rich in essential fatty acids, such as salmon, sardines, walnuts, chia, and flax seeds
  • antioxidant-rich foods found in colorful fruits and vegetables, such as oranges, berries, dark chocolate, spinach, and beets. Studies has linked oxidative stress to the progression of the disease, so its important to also consider these antioxidant rich food sources. 

SUPPLEMENTS ALSO HAVE A ROLE TO PLAY

Apart from an adequate diet, nutritional supplements also have unique roles to play while managing endometriosis. 

For example, supplementing with 1200 IU of vitamin E and 1000 IU of vitamin C was shown to reduce pelvic pain in some women with endometriosis after a clinical trial. 

Also, curcumin, vitamins A and D proved to help in the management of endometriosis

EXERCISE AND OTHER ALTERNATIVES 

 Exercise could help to manage endometriosis as it reduces the production of estrogen and helps in the release of serotonin “the feel good hormone”. Some relaxation techniques can be explored

  • meditation
  • yoga
  • accupunture
  • massage

SUMMARY 

Lifestyle changes and dietary patterns could help to reduce the symptoms associated with endometriosis, you can speak to a dietitian and a doctor to help you through this condition as everyone’s body’s are different and should be handled individually.

 

SOURCES

  1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3941414/
  2. https://nutritionguide.pcrm.org/nutritionguide/view/Nutrition_Guide_for_Clinicians/1342065/all/Endometriosis
  3. Zondervan KT, Becker CM, Missmer SA. Endometriosis. N Engl J Med 2020; 382:1244-56.
  4. Agarwal SK, Chapron C, Giudice LC, et al. Clinical diagnosis of endometriosis: a call to action. Am J Obstet Gynecol 2019(4):354-64.
  5. https://www.researchgate.net/publication/247770015_Diet_-_A_New_Approach_To_Treating_Endometriosis_-_What_Is_The_Evidence
  6. Harris, H. R., Chavarro, J. E., Malspeis, S., Willett, W. C., & Missmer, S. A. (2013). Dairy-food, calcium, magnesium, and vitamin D intake and endometriosis: a prospective cohort study. American Journal Of Epidemiology, 177(5), 420-430.
  7. Missmer, S. A., Chavarro, J. E., Malspeis, S., Bertone-Johnson, E. R., Hornstein, M. D., Spiegelman, D.,  Hankinson, S. E. (2010). 
  8. A prospective study of dietary fat consumption and endometriosis risk. Hum Reprod, 25(6), 1528-1535.

 

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FERTILITY : DOES DIET PLAY A ROLE?

Generally, one major factor considered to affect fertility is age. As you grow older, your organs, hormones and system seem to deteriorate.

But apart from this, there are other external and non-modifiable lifestyle factors that also affects the fertility of a woman and they include smoking, elevated consumption of caffeine and alcohol, stress, agonist sports, chronic exposure to environmental pollutants and other nutritional related issues.

In addition to the aforementioned, other metabolic disorders like diabetes, obesity, and hyperlipidaemia which are associated to an intake of high caloric diet could also interfere with a woman’s fertility.

Infertility is defined as the inability to conceive after one year of unprotected intercourse.
Infertility has really become a thing of concern in the modern society and its recurrence affects about 20-30% of the female population globally.

In Nigeria, about 10-30% of couples are saddled with the burden of infertility
The World Health Organization (WHO) reporting up to 80 million women world-wide having been affected by this disease to date, with a prevalence of ~50% of all women in developing countries.

There are possible gynaecological issues or systemic diseases that poses a threat female fertility, but asides these, unbalanced nutrition and unhealthy diet also interfere with reproduction processes in women.
Gradually, inadequate weight gain due abnormal energy supply, extreme restrictions, and inadequate intake of nutrients (both macro and micro), have a detrimental impact on the normal functioning of the ovaries.
Taking a proactive approach could help curb emotional stress and even cut financial costs attached to infertility problems.
Your odds at getting pregnant might just be improved by being intentional about your diet, effectively dealing with stress and being more active.

POSSIBLE LIFESTYLE FACTORS THAT AFFECTS FERTILITY
1. SMOKING: Smoking, be it first or second-hand smoke, can have a negative impact on the reproductive process for women. Cadmium and cotinine are two specific toxins found in tobacco smoke which can reduce egg production.
2. ALCOHOL: there are no safe levels for alcohol if you’re planning to conceive
3. BMI: for females wanting to conceive, body weight is of the essence and should not be overlooked. A BMI higher than 30 could impact hormonal imbalances and affect fertility processes.
4. RECREATIONAL DRUGS: use of some illicit drugs could have a great impact on fertility for women. Women who are expectant shouldn’t use heroin, ecstasy, marijuana and other illicit drugs.

WHAT ARE SOME POSSIBLE CAUSES OF INFERTILITY?
Unexplained Infertility: reason of infertility is unknown and can’t be linked to any external or internal factors. Most times, more than a year of trying to conceive.
Endocrine Disorders (PCOS (Polycystic Ovary Syndrome): these sort of disorders leads to an alteration of sex hormones in the female body thereby leading to elevated insulin levels and overproduction of testosterone (male hormone).
Anatomical Abnormalities & Anomalies (Endometriosis, Uterine Irregularities): conditions where similar tissues to the ones inside your uterus, grows outside of the uterus. These conditions subject the uterus to be shaped in abnormal ways; heart shaped, unicorn shaped etc. (fibroids and polyps also included)

HOW DOES DIET AFFECT FERTILIY?
A number of dietary considerations should be considered in order to curtail hormonal fluctuations in females. The adequacy of a diet totally influences the functionality of hormones in the female body, especially fertility related hormones,
Let’s see some dietary considerations that directly affects hormonal response in the female body.
1. WHOLE GRAINS: whole grains are lower in glycemic index (their ability to increase blood glucose per time), and help increase chances of reduced insulin resistance in females. Insulin resistance poses a huge threat of inflammatory disorders and weight gain which directly affects hormonal balances in the female body. Whole grains include oatmeal, millet, bulgur, corn etc.
2. PROTEINS: getting most of your proteins from plant sources could help women with ovulatory issues. Isoflavones contained in soy products have been shown to positively affect ovulation and also helps women undergoing ART (assisted reproductive technology). Also, a higher intake of dairy products has been linked to decreased risk of endometriosis. Successful incorporation of dairy products into the diet of females, would have a great impact on fertility.
3. HEALTY FATS: trans-fat negatively affects fertility, enhance inflammation, and also play a role in egg quality and implantation. It’s very important to know the types of fats which are healthy and take out the unhealthy ones. Fats from nuts, avocado, seeds and fatty fish are healthy fats.
Also, supplementation with omega-3 fatty (500-1000mg) acid may help reduce the amount of male hormones circulating in the system (testosterone), thereby reducing risks of developing PCOS and regulating menstrual cycle.
4. SUPPLEMENTATION: supplementing with vitamins like folate, vitamin D, and vitamin B12 has been shown to improve better embryo quality and reduce risks of ovulatory infertility. Antioxidants also has shown to support and provide the eggs with adequate nutrition. Other supplements of importance include glutathione and CoQ10.

SUMMARY
A correct balance of proteins, fats, carbohydrates and vitamins in the daily diet helps provide optimum female reproductive health and reduce risk of infertility possibly caused by inflammation and hormonal imbalances.

SOURCES:

Does diet really affect fertility? – A few useful tips from Fertifa’s nutrition expert


https://www.todaysdietitian.com/marketing/webinars/fertility/TDFinalRecorded.pdf
https://www.insider.com/how-healthy-and-unhealthy-diets-can-impact-fertility-2018-4

Nutrition and Fertility: 5 Things to Know


https://www.todaysdietitian.com/newarchives/050113p38.shtml

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