Is it possible that our gut microbes are not only linked to immunity, mental well-being and weight gain, but also play a role in endometriosis and the intense pain it can cause?
In endometriosis, uterus-like tissue grows elsewhere in the body, such as on the intestines, ovaries, or pelvic walls. This tissue responds every month as if it were in the uterus. It thickens, breaks off and often bleeds. But this blood has no easy way out and can get stuck, causing severe inflammation and pain.
Now it has been found that women with the condition often have a distinct composition in their gut microbiome, the community of microbes found there.
This suggests that having more or less specific bacteria could influence the risk of developing endometriosis – and raises the possibility that manipulating the composition of gut microbes could help alleviate some of the symptoms.
In fact, scientists are already conducting trials with endometriosis patients, exploring how probiotics (beneficial bacteria), prebiotics (food sources for beneficial bacteria), and dietary changes can rebalance the gut microbiome, reduce inflammation, and ease their pain.
The finding could ultimately lead to new treatments for this and other pain-related conditions – which would be a breakthrough.
Scientists now believe that the reason endometriosis pain can be so intense is that the immune system and hypersensitive nerve cells in the spinal cord amplify it.
But the gut microbiome may play a role here – by influencing how our nerves deal with pain.
Scientists are conducting trials with endometriosis patients and investigating how probiotics, prebiotics and dietary changes can reduce inflammation and relieve pain, writes DR. EMILY LEEMING
The intestines are packed with nerves that connect directly to the brain via the vagus nerve, an important nerve that runs from the brain to the intestines. The idea is that intestinal nerves help shape how we feel and respond to pain.
And this is where gut microbes come into the picture. This was highlighted in a 2017 study in mice published in the journal eLife, which found that changes in the gut microbiome impact areas of the brain linked to pain – essentially potentially aggravating the molecules produced by some gut microbes. pain, while molecules produced by others could improve it.
Findings like these have led to human trials of probiotics under conditions similar to endometriosis, which show modest but meaningful pain reduction.
The link between endometriosis and the gut has been suspected for some time – not least because women with endometriosis are three times more likely to develop IBS (another often painful condition) than women without endometriosis, according to a 2023 review in the journal Frontiers in Medicine.
This is likely due to the fact that some of the same genes are involved in both conditions, including the genes that control inflammation and hormones such as estrogen.
More and more scientists are investigating how diet can play a role in endometriosis. After all, diet can alter the gut microbiome by providing the nutrients that beneficial microbes need to thrive, which in turn supports a healthier immune response and can reduce pain signals.
It’s an emerging area and I’m not claiming that your diet will take away the pain – but there is a chance that it will reduce the severity somewhat. It can also reduce chronic inflammation, improve gut health, and promote overall well-being, which can help with other symptoms as well.
Here are some foods to include in your diet (if you have endometriosis or a chronic pain condition) – and what to avoid.
COOK WITH NATURE’S IBUPROFEN
Olive oil contains oleocanthal, a compound that reduces inflammation in a way similar to ibuprofen by blocking inflammatory enzymes, a 2005 study in the journal Nature reported.
Although endometriosis was not specifically targeted, these anti-inflammatory effects could help alleviate the inflammation-related pain associated with endometriosis. The study found that consuming about 50 grams (about four tablespoons) of extra-virgin olive oil daily would provide a small, regular dose of oleocanthal.
Extra virgin olive oil is expensive and if cost is an issue, you can alternate with other anti-inflammatory options such as canola, flaxseed or avocado oil.
FISHING FOR PAIN RELIEF
Women with endometriosis who took 2,000 mg of omega-3 fatty acids daily for two months experienced improvements in their pain levels and quality of life, the journal PLOS One reported in 2020.
This is probably due to the anti-inflammatory effect of omega-3 fatty acids; Inflammation can increase levels of prostaglandins, chemicals that can cause painful menstrual cramps and irritate the nerves, making pain worse.
Regularly eating fatty fish, such as salmon, mackerel and sardines, could provide similar benefits, with a serving of fatty fish two to three times a week providing similar levels of omega-3 fatty acids.
POP A PROBIOTICS?
There are many on the market, but one that has been specifically tested on people with endometriosis is Lactobacillus gasseri OLL2809. In a three-month study published in 2011 in the journal Cytotechnology, patients taking this experienced less menstrual pain and cramps than those taking a placebo, with no side effects.
Research (so far only in animals) suggests that this probiotic may also boost inflammation-fighting immune cells. Consult your doctor before starting, especially if you take medication regularly.
SIP PEPPERMINT TEA
A common symptom in women with endometriosis is bloating; according to a 2009 study in the Journal of Obstetrics and Gynecology Canada, about 96 percent experience it.
This is likely due to inflammation and irritation from the buildup of tissue in the abdominal area caused by the condition.
Peppermint oil capsules containing menthol – a natural antispasmodic – can be effective: menthol relaxes the intestinal muscles and helps relieve cramps, bloating and gas.
These capsules are available without a prescription; the usual recommendation is to take one capsule three times a day, about an hour before meals. Peppermint tea, although less menthol, can provide mild relief; two or three cups a day can provide mild relief from bloating.
AND DON’T FORGET FERMENTED FOODS
Fermented foods like yogurt and kimchi can help the gut grow more beneficial bacteria and can help reduce inflammation in the body in general, Cell magazine reported in 2021.
Although direct studies of endometriosis are lacking, this finding is promising because endometriosis is often associated with chronic inflammation.
Adding fermented foods such as yogurt, kefir, sauerkraut and kimchi to your diet can support gut health and potentially alleviate some symptoms of endometriosis.
Try stirring sauerkraut into brown rice; use kimchi as a topping for scrambled eggs or stir-fries; and enjoy yogurt or kefir for breakfast.
…BUT AVOID ONIONS
Avoiding certain FODMAPs – fermentable sugars found in foods such as onions, garlic, wheat, beans and certain fruits can help relieve the intestinal symptoms of endometriosis.
A low-FODMAP diet is a short-term plan to help identify personal triggers – by eliminating a range of foods and then gradually reintroducing them. A small 2023 study in the journal Human Reproduction found that following a FODMAP diet could significantly ease pain and improve the quality of life for women with endometriosis by reducing gut-related symptoms.
Many people think gluten is the main trigger for their endometriosis symptoms, but it is more likely to be FODMAPs and these are commonly found in gluten-containing foods. However, because some FODMAPs still support your gut microbiome, this approach is complex, so ideally seek the help of a dietitian before attempting this.