March is Endometriosis awareness month and I get a lot of questions about what supplements can help to relieve Endometriosis symptoms.
The following are some of the symptoms and their causes that are often experienced by people who suffer from endometriosis:
Inflammation Excess estrogen Endometrial cells outside of the uterus
Inter-menstrual pain (usually mid-month)
Inflammation due to presence of excess endometrial tissue
Menstrual cramps that increase in severity
Inflammation due to presence of excess endometrial tissue
Painful bowel movements and urination
Endometrial tissue adhering to bowel/uterine tissue (excess estrogen and inflammation)
Painful intercourse (dyspareunia)
Endometrial tissue adhering to vaginal / cervical tissue
Pelvic pain that is all-encompassing
Spotting between periods
Excess estrogen / hormone imbalance
Supplements that could help with these symptoms and causes include:
1. DIM (diindolylmethane)
DIM is found in cruciferous vegetables (ie. cabbage, broccoli, kale, cauliflower, etc). DIM is anti-inflammatory in nature and is metabolized similarly to estrogen. This helps promote healthy estrogen breakdown and removal from the body. Women with endometriosis are estrogen dominant (meaning high levels of estrogen are present) and that is why proper estrogen metabolism is important.
A 2018 study looked at the clinical effects of DIM supplementation, DNG (Dienegist-*a prescribed medication) alone, and a combination of DNG and DIM in women with endometriosis (1).
DNG and DIM both inhibited the growth of endometrial cells. Endometrial tissues from women with and without endometriosis were exposed to DIM, DNG, or both. Endometrial cell life was decreased with DIM supplementation alone (25%) significantly more than with DNG alone (9%) and had a more improved effect when used in combination (40%) (1).
** NOTE: People who are trying to conceive should not use DNG because it inhibits ovulation. However, DIM on its own can be taken by people trying to conceive.
2. Curcumin (Turmeric)
Curcumin is an active component in turmeric and has proven anti-inflammatory properties as well as other potentially health-promoting characteristics, such as hormone-regulating abilities.
Research on curcumin for the treatment of endometriosis is limited, however, a 2013 study found that it can help reduce endometriosis epithelial cells (these are the cells that adhere to parts of the body outside of the uterus) by reducing excess estrogen production (2)
A 2020 review published by the Journal of Molecular Science suggests that curcumin may provide relief from endometriosis-related inflammation and directly act on decreasing adhesion and invasion of new lesions, shrinking existing lesions and stimulating angiogenesis (new blood vessel formation) to healthy cells (3). The authors do suggest that further research is needed to strengthen these findings.
3. Milk thistle
Milk thistle is a plant that contains silymarin, which decreases inflammation and supports healthy liver function.
The liver is important to help manage endometriosis, it’s responsible for filtering out toxins in the body, including excess hormones such as estrogen. As stated previously, endometriosis is an estrogen-dominant condition and endometrial lesions depend on estrogen for development and growth.
** NOTE: Milk thistle should not be taken if you are on certain medications for depression, diabetes, blood clotting disorders or to help lower cholesterol. Please speak to a qualified practitioner before taking milk thistle.
4. NAC (N-acetyl cysteine)
NAC is an amino acid derivative. It is a precursor to glutathione production in the liver, which is one of the body’s most important antioxidants.
NAC restores cellular ability to fight damage from oxidative stress, reduces inflammation, improves cellular detox, and helps regulate the gene that produces pro-inflammatory prostaglandins.
In a 2013 study of 92 women in Italy, 47 took NAC and 45 took a placebo. The study showed that NAC decreased abnormal cell growth, decreased inflammation and reduced inflammatory genes. Also, 24 patients in the NAC group cancelled their scheduled laparoscopies, due to a decrease or disappearance of endometriosis, improved pain reduction or because they had become pregnant! In the other group, only one patient cancelled surgery (4).
Omega-3 fatty acids from fish oil contain DHA (docosahexaenoic acid) and EPA (eicosapentaenoic acid). This combination can reduce the production of molecules and substances linked to inflammation, such as inflammatory eicosanoids and cytokines
A 2010 study published in Human Reproduction that took place over 12 years, showed that women who consume the highest amounts of omega -3 fatty acids were 22% less likely to be diagnosed with laparoscopically confirmed endometriosis when compared with women who had the lowest intake of Omega 3 fatty acids. Conversely, those that consumed high amounts of trans-unsaturated fat intake were 48% more likely to be diagnosed with endometriosis (5)
Furthermore, some small European studies have shown that omega-3 fatty acids reduce the symptoms of dysmenorrhea (painful periods). Researchers believe that prostaglandins (PGs) play a pathogenic part in both endometriosis and dysmenorrhea. Omega 3-fatty acids from fish act as anti-inflammatories in endometriosis and dysmenorrhea by reducing the pro-inflammatory PGs derived from omega-6 fatty acids (processed meat and red meat), and the associated symptoms of endometriosis and dysmenorrhea (6)
I know this list seems like a lot of pills to swallow (pardon my pun)!
Fortunately the first three supplements (DIM, Curcumin, and Milk Thistle) can be found in a single formulation. I recommend Estrovantage by BioClinic or EstroSmart by Lorna Vanderhaeghe.
NAC and Omega 3’s need to be taken separately.
I do want to stress that supplement intake should not replace the care of a medical doctor and the importance of consulting with a qualified health practitioner before taking any dietary supplements. Not all supplements are safe to take and there is no one-size-fits-all plan. Practitioners at Whole Family Health look at everyone individually and make decisions based on each person’s needs.
There are times when stress is completely unavoidable, such as a high demanding job, training for a competitive sport event, dispute with your partner or friends, or caring for a sick parent, etc. (more…)
If you’re a woman, your chance of getting a urinary tract infection is extremely high and many can lead into chronic infections that are recurrent, sometimes for years. There are two types are UTIs, bladder infections (BIs) and kidney infections (KIs). I will be specifically chatting about BIs, since KIs should be treated promptly with antibiotics.
UTIs are bacterial infections that are not to be taken lightly. If you have had the joy of experiencing one…you know how incredibly debilitating they are. Common symptoms of a UTI are:
Frequent and/or intense urge to urinate
Burning sensation when urinating
Pain or pressure in the lower back or abdomen
Cloudy, dark, bloody, or strange-smelling urine
Symptoms of shaky or feeling tired
Fever or chills, nausea and vomiting (likely a sign that the infection has gone to the kidneys)
If you suspect you have a UTI, it is imperative that you head to the medical doctor to get a urine sample to confirm. In younger, sexually active women, sudden onset of painful urination can also be due to chlamydia infection or gonorrhea (rarely), so getting a urine culture as well is beneficial. The majority of UTIs are bacterial in origin so medical doctor’s prescribe antibiotics during an acute episode. Some women who have chronic BIs are given long-term antibiotics for preventative measures. However, frequent antibiotic use, especially in women with chronic BIs, has been shown to alter intestinal and vaginal flora and increase the rate of antibiotic resistance.
Naturopathic approaches should be strongly considered in cases where chronic BIs are still a problem. Naturopathic doctors can treat acute, single episodes of BIs, but you want to be under the supervision of a doctor since these infections can quickly develop into kidney infections, which are very dangerous and can only be treated with antibiotics.
Housekeeping Rules for your lady parts:
If you were ever told to wipe from front to back after using the washroom, listen! This is a key factor in preventing recurrent BIs. Since the urethra (where you pee) is located close to the anus in women, bacteria from the large intestine are in perfect position to escape the anus and invade the urethra. Some women have shorter urethras allowing bacteria to ascend more easily to the bladder, making them more prone to BIs.
Another housekeeping tip is to urinate after sex. Having sex can introduce bacteria into the urinary tract, again causing an infection in the urethra.
Avoid vaginal hygiene products (ie. douches), which can be irritating to the urethral area and alter the vaginal flora.
Research has shown that wearing cotton underwear can reduce the chance of UTIs since it is more breathable.
Increase your intake of water to ensure you are peeing regularly to flush out bacteria and prevent their adherence to the urethra.
Add in some UNSWEETENED PURE cranberry juice (not the Welch’s cranberry or any “cranberry cocktail” drinks). It is a known anti-adhesion agent, meaning it can prevent the bacteria from setting up shop in your urethra. It can be found in different forms: juice, tablets or capsules. You want to be drinking about 250-300ml/day, which you can dilute in some water since the pure cranberry juice can be quite tart. Cranberry juice is also safe and effective for the prevention of UTI’s in pregnancy, which is important since they tend to be more common.
Your GUT and VAGINAL flora are key players in preventing recurrent BIs, therefore keep your diet low in sugar and high in fiber, specifically from dark leafy greens.
To reduce the susceptibility to bladder infections it may be necessary to address and remove food sensitivities.
Probiotics: can help keep the vaginal and gut flora balanced. You want to make sure the probiotics specifically contain the Lactobacillus species. One of my favorites is the UltraFlora’s Women’s by Metagenics that contains a 50:50 blend of Lactobacillus rhamnosus and Lactobacillus reuteri, once/day. This targets healthy vaginal flora by increasing the number of beneficial lactobacilli. Lactobacillus generates an acidic vaginal pH and interferes with the adhesion of common urinary bacteria. Vaginal probiotic suppositories have been used weekly and shown to reduce the incidence of UTIs after 12 months.
D-Mannose: a simple sugar that acts similarly to cranberry in that is prevents the adherence of bacteria. It can be used for treating acute BIs and for prophylaxis in women prone to recurrent infections. It has been shown to be more or just as effective as antibiotics when used for chronic BIs but with a much lower incidence of side effects. A general dose is around 2 grams of powder/day during an acute infection.
A healthy immune system can help the body resist infections. Specific vitamins I recommend are Vitamin C. Studies have shown that it increases the release of nitric oxide in the urine, which acts as a bacterial killing agent against the most common bacteria that causes UTIs, E.Coli. General dose is around 1-2grams/day. Vitamin A and Zinc are other common recommendations for supporting the immune system.
For acute bladder infections, berberine extracts (found in various plants – Hydrastis Canadensis and Berberis vulgaris) have significant antimicrobial activity. It inhibits the growth of several bacteria, including resistant E.Coli (common in chronic BI patients). Berberine can also act as an antimicrobial to treat dysbiosis (altered bacterial flora in the gut), which can indirectly reduce the occurrence of BIs since dysbiosis can increase the incidence of BIs.
Other great anti-septics used in acute cases are: Uva Ursi and Yarrow. Can be done as an infusion/tea so they can be flushed through the urinary tract. The addition of marshmallow root can be added if symptoms of burning are present. These preparations can also be taken in capsule form.
If stress is associated with your chronic BI, it is beneficial to incorporate herbs that specifically work at supporting your stress response while ensuring your immune system stays in check.
Just a note: recurrent bladder infections are common in postmenopausal women due to the decrease in estrogen and its role in maintaining healthy vaginal flora and mucosa. There are many herbal recommendations that can help support this hormone imbalance and important to address these changes to reduce the reoccurrence of UTIs.
This information given is not to discourage antibiotic use, since in some cases it is absolutely necessary. It is to provide you with more preventative strategies and other naturopathic alternatives for treating chronic UTIs, all of which have much lower side effects compared to long-term antibiotics.
If you have any questions or would like to schedule an appointment at Whole Family Health, please contact us today!
In this article series, I wanted to address how stress can greatly effect the functioning of the thyroid gland. My last article on hypothyroidism covered the anatomy of the thyroid gland and how routine lab testing may not be the most reliable indicator of thyroid status.
There are many factors that can lead to hypothyroidism but stress is one of the most important causes since it is something we all experience in our lives. The obvious stressors we encounter on a daily basis are situations like driving in traffic, rushing to an appointment, busy schedules, or losing a job. One thing I want to point out is other physiological stressor’s that people don’t really consider being an actual “stress,” but in fact they can trigger that same stress response. These include food sensitivities (intolerance), autoimmune issues, digestive issues, blood sugar swings, and underlying inflammation. All these conditions will alert your stress system to turn ON.
Specific hormones (cortisol, epinephrine and norepinephrine) are secreted from the adrenal glands (small glands that sit on our kidneys) to regulate our stress response. These hormones that are secreted play a crucial role in the proper functioning of the thyroid, therefore when stress becomes chronic, our adrenal glands become overworked and therefore throw off the proper functioning of the thyroid gland (explain later in more detail).
Some common symptoms and signs that indicate overworked adrenals:
Adrenal stress can mimic symptoms of hypothyroidism therefore it is important to consider your adrenal health. Typically it is a combination of both glands being involved, especially if stress is part of your case. This can occur commonly when patients do not improve with synthroid or other thyroid medications, since the adrenals themselves require some support in order to improve thyroid health.
How adrenal stress can directly impact thyroid function:
In my previous article on hypothyroidism I explained the importance of T3 and T4 (our thyroid hormones). The conversion from T4 to T3 is very important since T3 is the active form and the only form that can be used up by our cells.
When our stress response turns ON, inflammatory cytokines (immune factors that initiate responses against infections) interfere with the conversion of T4 to T3. These inflammatory cytokines have also shown to suppress thyroid receptor site sensitivity. This means the thyroid hormones are unable to be used by your cells properly resulting in hypothyroidism (in this case, lab markers TSH, T4, and T3 are usually normal).
Our hypothalamic-pituitary-adrenal (HPA) axis is what controls the body’s reaction to stress and as the name implies, it consists of a network of interactions between the hypothalamus, the pituitary and the adrenal glands. When chronic stress is present, it has been shown that the hypothalamus and pituitary gland function decreases. The hypothalamus and pituitary gland are also both involved in the synthesis of thyroid hormones therefore a disruption in the HPA axis will also cause a decrease in thyroid production, leading to hypothyroid symptoms. The inflammatory cytokines mentioned above also down-regulate the HPA axis and has shown to decrease TSH (thyroid stimulating hormone).
One of the most common causes of hormonal imbalance, seen in the clinic, is due to chronic stress. Cortisol (one of the stress hormones) can decrease the liver’s ability to clear excess estrogens from the body. This excess estrogen in the body increases levels of something called thyroid binding globulin (TBG), which attaches to the thyroid hormone making it inactive and not usable to activate any cellular processes. A high TBG can cause a low T3 and low T4/T3. Birth control pills and estrogen replacements (eg. Premarin) can cause an elevated TBG as well.
When stressed, you are likely more vulnerable to autoimmune thyroid conditions (Hashimoto’s thyroiditis or Grave’s disease). This autoimmune response can cause the thyroid to make too much thyroid hormone, especially after a sudden, stressful change (Grave’s disease). This is why you typically see significant weight loss after say a divorce or death in the family. Excessive, chronic stress can produce the opposite (Hashimoto’s thyroiditis). Adrenal stress can have a profound effect on the immune system regulation. Therefore, if regulation is out of whack, you become more prone to autoimmune diseases.
How to balance your adrenal glands?
Must address all the conditions that cause stress, not just the psychological and emotional stressors, but also the physiological stressors, such as: food intolerances, gut dysfunction, inflammation, blood sugar imbalances, fatty acid deficiencies and anemia.
Avoid dietary causes of inflammation (food sensitivities, refined sugars, etc)
Minimize any stimulants (caffeine)
Adequate DHA and EPA (Omega-3’s)
Adequate B vitamins (depleted with chronic stress)
Specific adaptogenic herbs and supplements are typically used to help modulate the stress response and support the adrenal glands. Some include Ashwagandha, Rhodiola, Ginseng, Holy Basil, and Schisandra. These herbs are potent and have a significant effect on the body therefore they should be taken under the supervision of a health care practitioner.
Adrenal Function Testing is also another tool typically used by naturopathic doctors to assess the stage of your adrenal stress. This can further specify what herbs/nutrients would be indicated since treatment does change based on what stage your at currently.
Eating healthy in the colder months isn’t just about swapping out some snacks for this year’s miracle food. Eating healthy is about making small changes and finding a balance of diet and exercise that fits your lifestyle and your metabolism. Acupuncture can also aid in finding that balance as it is a highly effective stress reliever for both mind and body. For finding balance in your diet we’ve put together a short guide to point you in that direction.
Change the way you shop
Think about the last time you visited the grocery store, did you stick mostly to the edges or did you find yourself spending most of your time in the aisles? Now look at what’s in your basket, is it mostly boxes or whole ingredients?
Small changes in your shopping habits can turn into big changes in the quantity and quality of calories you are consuming. Grocery stores tend to put the unprocessed foods along the outer edges of the store. Not only will these foods be lower in calories, they’ll also be lower in harmful additives, sugars and salts.
Aim for quality not quantity
Counting calories can be a helpful guide to losing weight, but it can also trick you into thinking you are eating healthier than you are. A low calorie yogurt may seem like a healthier choice than a high in fat Greek yogurt, however not only is that low calorie yogurt likely filled with artificial colors and sweeteners, you’re missing out on some important nutrients. Even though it is higher in fat, the combination of the fat, protein and probiotics in the Greek yogurt will help your body feel full longer and burn more calories.
However be cautious this rule isn’t cut and dry, there are many high fat, high protein foods that aren’t good for you. As a general rule aim for foods in their whole form or foods you’ve prepared from whole food items.
Take time to enjoy your food
This might be the hardest guideline to follow. Set aside time for food. That means taking the time to prepare meals, even if it means in advance on the weekends, eat as a family, eat your meals slowly and not in front of the TV.
Eating as a family will not only heighten the enjoyment of your meal, but also encourage you to be creative and dig out a cookbook. Not only is cooking from recipes fun, but they are more likely to call for whole ingredients. And family dinners can be one of the few times in an otherwise busy day that you get to spend time together as family and that can be another important step in achieving balance.