Functional Nutrition Coaching for Endometriosis
Endometriosis is a complex condition. While it is often treated as simply a “hormone imbalance”, there’s more going on, and therefore more that needs to be addressed. Healing from endometriosis requires a holistic approach, including an endometriosis nutrition plan.
We work with women that have complex chronic conditions, and we’re also endometriosis nutritionists practicing a functional medicine approach. So when we work with women with this condition, we address root drivers of endometriosis, like immune dysregulation, inflammation, gut microbiome issues, and nutrient deficiencies, through nutrition and lifestyle changes.
What Really is Endometriosis?
Endometriosis is an inflammatory condition in which the endometrial tissue is excessively forming more tissue & blood vessels outside of the uterus. Because the presence of endometrial tissue outside the uterus is unnatural for the body, the body begins to attack this “foreign” tissue, leading to the classic symptoms of inflammation & pain.
Is Endometriosis an Autoimmune Disease?
Endometriosis is similar to (or may very well be classified as) an autoimmune condition since it involves an overreaction of the immune system and gut dysfunction. Dr. Lara Briden discusses this more in a helpful article here. However, there is no scientific consensus yet on this. What we DO know about the immune system is that inflammation (an immune process) that occurs chronically can eventually lead to autoimmunity.
Root Causes of Endometriosis
While there still needs to be more research about endometriosis to confirm root causes, the root causes are likely multifactorial.
Metaplasia
Metaplasia is the abnormal conversion of one cell type into another. In endometriosis, metaplasia is a proposed explanation for the development of the disease. Metaplasia usually occurs in response to inflammation and enables cells to change to their surrounding circumstances to better adapt to their environment. Sources: Endometriosis News, Endometriosis UK
In endometriosis, normal abdominal cells and other cells change and become endometrial-like cells in places they should not. Hormonal or immunological factors are thought to stimulate the transformation of normal peritoneal tissue/cells into endometrium-like tissue. Sources: Hindawi article, Clinical Gate, ICPRM
The good news? Endometrial metaplasia is reversible once the stimulus is removed– the stimulus usually being inflammation. However, most women also benefit from surgical removal of current endometriosis lesions while simultaneously working on adjusting their diet and lifestyle to reduce inflammation. Since inflammation can be multifactorial, there may need to be various types of assessment to understand where inflammation is coming from (i.e. gut infections, diet, stress) and various methods for healing (i.e. gut healing protocol, dietary changes, stress management).
Gut Health
From current research thus far, the gut microbiome appears to play a major role. Gut bacterial imbalance, called dysbiosis, can play a role in creating inflammation & also changing the way the body regulates inflammation.
See this helpful article: How the gut might be the cause of the pathogenesis of Endometriosis. “Based on these findings, we hypothesize that the gut microbiota may be involved crucially in the onset and progression of endometriosis.”
Another helpful research article to read: The Gut Microbiome – A Double-Edged Sword in Endometriosis.
Food Sensitivities
Unaddressed food sensitivities can lead to more inflammation. Of note, food sensitivities may actually be caused by gut issues in the first place. So it’s important to address gut health first, and then possibly addressing food sensitivities in addition. Endometriosis nutrition, or a diet to heal endometriosis, will likely need to address a woman’s individual set of food sensitivities.
Oxidative Stress
Oxidative stress is a process that happens inside the cells, particularly in the mitochondria (energy production zone). It can occur from daily bodily processes that challenge the body like exercise as well as additional stressors like environmental toxins, injury, nutrient deficiencies, blood sugar imbalances, excess mental/emotional stress, an unhealthy diet, and lack of sleep. It is also a normal part of aging.
As a result of these processes, free radicals are formed. Free radicals, also called Reactive Oxygen Species (ROS), are natural byproducts of cellular processes that use oxygen to produce energy. Some free radical formation is actually healthy and essential for thriving functions in the body. Antioxidants, both from your diet as well as antioxidant enzyme systems in your body, can neutralize the free radicals (think “anti – oxidation”). However, when free radical formation outweighs antioxidant capacity, it can cause widespread havoc in the body, essentially imbalanced oxidative stress.
In endometriosis, certain checks and balances for keeping oxidative stress levels normal is impaired, and this is proposed to be a leading factor in endometriosis pathophysiology. Reducing oxidative stress from all angles is essential to mitigate endometriosis.
Hormone Imbalances, High Estrogen Levels, and Estrogen Dominance
Hormonal issues are often not the cause but rather an effect of inflammation already present. But hormonal dysregulation can lead to additional inflammation in a vicious cycle.
In many women with endometriosis, estrogen is often high or higher in comparison to progesterone, a process called “estrogen dominance”. High levels of estrogen is thought to lead to the advanced growth of endometrial tissue in endometriosis as well as the formation of fibroids.
For some women with endometriosis, however, estrogen is not high when tested. However, since estrogen likely plays a role, supporting proper estrogen metabolism should be considered regardless of estrogen levels on lab work. Overall estrogen levels can be normal while estrogen is not properly being metabolized in the body.
Medical Care for Endometriosis
Conventional Medicine for Endometriosis
If you’re reading this page, then you’re probably well aware that the first-line conventional medicine approach to endometriosis is birth control. According to the American College of OB/Gyns (ACOG), oral contraceptives and NSAIDs are standard initial treatment. Unfortunately, neither of these treatment options address the root drivers of endometriosis, leaving a woman without resolution to their symptoms, and potentially even progression of the disease.
Restorative Reproductive Medicine for Endometriosis
Restorative Reproductive Medicine (RRM), is a “medical discipline that looks to identify and treat the root cause of reproductive problems, aiming to treat, optimize and restore patient’s health”. Doesn’t this just sound like how ALL medical care should be?!?
RRM is often aligned with Functional Medicine. According to the Institute for Functional Medicine, “Functional medicine is a systems biology–based approach that focuses on identifying and addressing the root cause of disease. Each symptom or differential diagnosis may be one of many contributing to an individual’s illness.” It understands that there are often many root causes driving dysfunction. Therefore, the treatment process to enable a person to heal must be multifactorial as well, including nutrition and lifestyle therapy along with the efficient use of supplements and using comprehensive functional lab testing.
Seek a NaPro Doctor
We highly encourage you, if you haven’t already, to seek medical care from a NaPro-trained doctor. They can help you with a restorative reproductive medicine approach. From our experience working with clients, we have seen clients who have the best success when working with an excellent NaPro-trained doctor. Good medical care, along with functional nutrition & lifestyle therapy, is essential for restoration of health.
NaPro doctors qualified for surgical procedures are trained in restorative surgeries, particularly the type needed for endometriosis, and can help women to get the endometrial lesions fully removed (important to have it *fully* removed!).
Functional Medicine and Functional Endometriosis Nutrition Care
We partner with NaPro doctors to support patients with the nutrition, lifestyle, and supplement needs to restore the body back to optimal health. As stated, an effective surgery that fully removes endometrial lesions is often essential. And then functional nutrition & lifestyle treatments can help to address and reverse the root drivers of endometrial overgrowth in the first place. An endometriosis nutrition and lifestyle plan is essential.
Functional Lab Testing for Endometriosis
The functional lab tests we use more often to support our clients with endometriosis include:
GI MAP Test
A comprehensive stool analysis, including testing the levels of both health and inflammatory gut bacteria as well as marker of digestive sufficiency.
DUTCH Complete Test
A comprehensive analysis of reproductive and adrenal hormones (like cortisol), as well as melatonin and metabolites of the hormones, to identify symptoms of hormone imbalance.
MRT Food Sensitivity Test
Different than standard IgG testing, MRT is a more clinically accurate and comprehensive test for foods and food substances that may be contributing to immune & inflammatory dysfunction, and the foods that are well-tolerated.
HTMA Test (Hair Tissue Mineral Analysis Test)
Measures the mineral content of hair, representing the intracellular environment (different than standard bloodwork) to identify nutritional status and patterns of stress and dysfunction in the body. Best when also paired with comprehensive bloodwork.
Common Natural Treatment Options
Food Sensitivity Eliminations
While there is no clinical consensus on whether or not certain dietary eliminations are helpful in endometriosis, many functional medicine practitioners have seen success with certain eliminations in clients with endometriosis, given that many women may be producing more histamine or mast cells in response to certain foods, which may create more oxidative stress and inflammation. Of course, doing an MRT test as well as GI MAP testing can give us a more accurate understanding of a person’s current food sensitivities.
It is important to note that the need for dietary eliminations are often temporary, in order to allow the immune system to calm down inflammatory processes and to enable the gut to heal. Once those can happen sufficiently, oftentimes people can gradually reintroduce foods back into their routine!
Some of the more common potential food sensitivities often seen in women with endometriosis include dairy, gluten, and eggs. In addition, it is best to avoid highly processed foods and excess sugars.
Nutrient Repletion
A common denominator in the development of most chronic conditions is depletion of nutrients over time. This can occur due to common issues like:
- prolonged timeframes of suboptimal dietary intake, which obviously leads to reduced nutrient status over time
- chronic stress (mental/emotional and/or physical stressors, of which there are many), which actually increases nutrient needs and can also increase nutrient depletion.
When poor nutrition intake and chronic stress happen together, which is all too common, you can see that nutrient depletion is only a matter of time.
Nutrient status is so important in any chronic condition, as well as endometriosis, since many nutrients are needed for the immune system to function properly and to be able to appropriately manage inflammation.
Bringing the Diet Back to Optimum
Optimizing one’s diet must involve:
- Eating whole or minimally processed nutrient dense foods.
- Eating in a way to balance blood sugar and insulin levels (as I teach via my Protein, Fat, & Fiber Method).
- Replacing inflammatory industrial seed oils with healthy fats and oils and getting enough omega 3 fats.
- Including foods with specific key nutrients of need, including sufficient mineral and electrolyte intake.
Supplements for Endometriosis Nutrition: Supplements, Herbs, and Functional Foods that May Help
Note: supplements should always be personalized based on a woman’s individualized needs. The goal is to normalize immune function & reduce inflammation.
Some common supplements, herbs, and functional foods that can help with healing endometriosis include:
- Turmeric or curcumin
- Minerals such as sodium, potassium, magnesium, zinc, and selenium
- Vitamins A (especially in beef liver supplements), D, and E
- Berberine
- Resveratrol
- NAC
- Omega 3 (EPA + DHA types)
- Micronized Progesterone
- Adaptogens, like reishi mushroom and ashwagandha
Gut Support
In order to heal the gut, we help my clients follow a 5-part process called the 5R Gut Healing Protocol. This includes:
- Addressing any gut infections or dysbiosis, if present, through a proper herbal antimicrobial protocol.
- Supporting sufficient digestion and bowel motility.
- Utilizing probiotic supplements and/or foods for therapeutic effect followed by maintenance level support.
- Healing the gut lining.
- Rebalancing one’s lifestyle to support gut health moving forward.
Reduce Stress
Easier said than done, but managing stress and reducing excess stress is probably one of the most overlooked pieces of healing endometriosis. Stress biology feeds into the inflammatory process of the immune system. If excess stress occurs chronically, inflammation does too.
Some things we often help my clients do to manage stress:
- Incorporate supportive stress management practices daily and throughout the day.
- Audit one’s schedule to get honest with oneself and identify where they can make space for priority health practices.
- Add in appropriate adaptogen support.
- Seek expert help when additional support is needed.
Bottom Line
As you can see now, endometriosis is more complex than simply giving the birth control pill, or even doing just one natural treatment option. Healing endometriosis requires an integrative approach, ideally with the help of a NaPro doctor as well as a functional medicine practitioner like a functional nutritionist. That way, you can actually appropriately identify and then address the full scope of the root causes of endometriosis and what continues to drive the dysfunction.
As registered dietitians / functional nutritionists, we help women with endometriosis to address the root causes of their endometriosis through comprehensive nutrition and lifestyle therapies following a functional medicine approach.
If you’re finally ready to get the holistic care you need, book a FREE 30-minute nutrition strategy session. In this call, we’ll discuss:
- A brief overview of your health situation
- Your health goals
- If & how I might be able to help you
- My functional nutrition approach
- And answer any questions you have about what it would be like to work with me