Microbiome Diet for Endometriosis
Researched by:
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Karen Pendergrass
ID
Karen Pendergrass
Karen Pendergrass is a microbiome researcher specializing in microbiome-targeted interventions (MBTIs). She systematically analyzes scientific literature to identify microbial patterns, develop hypotheses, and validate interventions. As the founder of the Microbiome Signatures Database, she bridges microbiome research with clinical practice. In 2012, based on her own investigative research, she became the first documented case of FMT for Celiac Disease—four years before the first published case study.
Endometriosis is a chronic, inflammatory condition affecting approximately 10% of women of reproductive age, marked by debilitating and chronic pelvic pain, infertility, and systemic inflammation. Emerging research reveals that endometriosis is closely linked to disruptions in the gut microbiome, with cross-signature overlap with irritable bowel syndrome (BS), highlighting the potential of targeted dietary interventions to […]
Research feed Researched by:
-
Karen Pendergrass
ID
Karen Pendergrass
Microbiome Signatures identifies and validates condition-specific microbiome shifts and interventions to accelerate clinical translation. Our multidisciplinary team supports clinicians, researchers, and innovators in turning microbiome science into actionable medicine.
Karen Pendergrass
Overview 
Research Feed 
References Overview
Endometriosis is a chronic, inflammatory condition affecting approximately 10% of women of reproductive age, marked by debilitating and chronic pelvic pain, infertility, and systemic inflammation. Emerging research reveals that endometriosis is closely linked to disruptions in the gut microbiome, with cross-signature overlap with irritable bowel syndrome (IBS), highlighting the potential of targeted dietary interventions to modulate these imbalances and support symptom management. [1][2]
The Microbiome Diet for Endometriosis is a precision nutrition approach tailored to address the specific microbial and inflammatory pathways associated with the condition. Unlike generalized “microbiome diets” that promote gut health broadly, this evidence-based diet targets the clinical features of dysbiosis characteristic of endometriosis to reduce inflammation and support long-term health.
By aligning dietary strategies with the unique microbiome signature of endometriosis, this diet represents a paradigm shift in managing the condition. It emphasizes highly specific, research-driven recommendations that prioritize safety and efficacy, ensuring that dietary choices meet the specific needs of individuals with endometriosis rather than following one-size-fits-all guidelines.
The Risks of Generic Microbiome Diets
Generalized “microbiome diets” have become popular for promoting gut health, often emphasizing increased fiber intake and fermented foods. While these approaches may benefit the general population, they can be harmful to individuals with conditions like endometriosis. These diets fail to consider individual differences in microbiome composition, physiology, and disease-specific microbial shifts.
For instance, green leafy vegetables, though widely recommended, can exacerbate gastrointestinal symptoms that are common in endometriosis. Similarly, fermented foods may aggravate inflammation by worsening imbalances in specific microbial taxa. Fruits are often suggested to be kept to a minimum for fear of excess sugar, but they are inversely associated with the condition. [3] Additionally, sensitivities like nickel allergy—frequently overlooked in dietary patterns—can intensify symptoms and contribute to further dysbiosis. Nickel allergy has been identified as a risk factor for endometriosis, and elevated nickel levels in the blood have even been suggested as a causal factor in endometriosis development, with 90.3% of women experiencing allergic contact mucositis (ACM). [4][5] Research also suggests that this figure may actually be much higher, as certain phases of the menstrual cycle reduce the allergic response, and this factor was not accounted for in the previous studies. [6]
Even foods considered universally “microbiome-friendly,” such as cruciferous vegetables, appear to increase the risk of endometriosis.[7] Research suggests that broccoli, cauliflower, and Brussels sprouts, while rich in fiber and antioxidants, are associated with an increased risk of the condition. Therefore, to truly support patients with endometriosis, dietary recommendations must be tailored to the unique microbial and metabolic disruptions associated with the condition.
Why the Microbiome Diet for Endometriosis Stands Apart
The Microbiome Diet for Endometriosis diet is built upon the foundation of microbiome signature-specific alignment, which focuses on correcting microbial imbalances identified in endometriosis. Research reveals that women with endometriosis often experience a depletion of beneficial bacteria such as Faecalibacterium and Lactobacillus alongside an overgrowth of pathogenic taxa like Escherichia coli, Streptococcus agalactiae, and Prevotella. These imbalances not only exacerbate inflammation but also interfere with hormonal regulation and immune function, two critical factors in endometriosis pathogenesis.
The Microbiome Diet for Endometriosis goes beyond surface-level dietary recommendations to tailor nutrient intake to modulate specific microbial taxa, address individual differences in microbiome composition and physiology, and incorporate emerging evidence on the role of trace elements, metalloestrogens, and immune modulation in the disease.
A Precision Approach for Better Outcomes
The Microbiome Diet for Endometriosis represents a significant shift in how we think about nutrition and health. It leverages the latest research to align dietary choices with microbiome-signatures and microbiome-targeted goals, offering a powerful tool to improve quality of life for individuals managing this challenging condition. By embracing a personalized, evidence-based approach, we aim to empower patients and clinicians with a dietary framework that delivers tangible results. This diet is not just a list of foods to eat or avoid; it is a scientifically grounded intervention designed to restore balance, reduce symptoms, and ultimately validate the role of the microbiome in endometriosis management. As we deepen our understanding of the microbiome’s role in health, this approach sets the standard for future condition-specific microbiome diets.
The Role of Metalloestrogens in Endometriosis
Metalloestrogens represent a class of endocrine-disrupting metals that mimic the activity of estrogen by binding to estrogen receptors. This ability to hijack the body’s hormonal signaling pathways has profound implications for estrogen-dependent conditions like endometriosis. Given that endometriosis thrives in an estrogen-dominant environment, the presence of these metals can exacerbate the condition by promoting the proliferation and survival of ectopic endometrial tissue. Metalloestrogens such as cadmium, lead, mercury, aluminum, and nickel have been implicated in the etiology of endometriosis through their contributions to oxidative stress, inflammation, and hormonal dysregulation.
The link between metalloestrogens and endometriosis becomes clearer when examining their role in oxidative stress and inflammation. These metals can induce the production of reactive oxygen species (ROS), tipping the balance toward a pro-oxidative state. Excess ROS not only damages cellular structures but also promotes the adhesion and invasion of endometrial-like lesions. For example, cadmium and lead have been shown to inhibit antioxidant defense enzymes, further amplifying oxidative damage. Additionally, these metals can alter immune function, impairing the body’s ability to recognize and eliminate ectopic tissue, which is a hallmark of endometriosis.
Epidemiological studies have revealed elevated levels of certain metalloestrogens, such as cadmium and nickel, in the blood, urine, and even peritoneal fluid of women with endometriosis. While the precise mechanisms are still under investigation, some findings suggest that these metals may act synergistically with other environmental toxins to aggravate the disease. For instance, nickel has been associated with increased prevalence of endometriosis and symptom severity, likely due to its ability to disrupt hormonal signaling and contribute to chronic inflammation.
Given their pervasive presence in the environment—from industrial pollutants to everyday consumer products—metalloestrogens are difficult to avoid entirely. However, their role in endometriosis underscores the importance of reducing exposure to these harmful metals. Transitioning into dietary strategies, it becomes essential to identify foods, water sources, and lifestyle factors that can help minimize the accumulation of metalloestrogens. Additionally, incorporating specific nutrients that support detoxification pathways and bolster the body’s natural antioxidant defenses can mitigate the impact of these metals.
The next section will explore practical dietary and environmental strategies to reduce exposure to metalloestrogens and support the body’s ability to counteract their harmful effects. By understanding and addressing the role of these endocrine-disrupting metals, it is possible to develop a more targeted approach to managing endometriosis through the microbiome diet.
Heavy Metals Implicated in Endometriosis
The role of heavy metals in the pathogenesis of endometriosis is becoming increasingly evident. These metals, through their oxidative, endocrine-disrupting, and inflammatory effects, contribute to the development and progression of endometriotic lesions. The microbiome diet for endometriosis must focus on reducing exposure to these metals while supporting the body’s natural detoxification pathways and maintaining microbial balance. Below are the specific heavy metals implicated in endometriosis and the rationale for targeting them in the microbiome diet:
Iron
Iron is a paradoxical player in endometriosis. While essential for cellular function, its accumulation in the pelvic cavity due to retrograde menstruation fuels oxidative stress, inflammation, and microbial dysbiosis. Endometriosis lesions are known to have abnormally high iron levels, and iron chelation therapy has shown promise in reducing lesion growth and symptom severity. The microbiome component comes into play as pathogenic bacteria in the pelvic environment exhibit robust iron acquisition mechanisms, further exacerbating iron-driven inflammation. [8][9] Therefore, a microbiome diet for endometriosis must address iron overload by avoiding excessive iron supplementation and instead focus on incorporating iron-chelating nutrients like polyphenols, or lactoferrin supplementation, which can modulate iron bioavailability.
Nickel
Nickel’s role as a metalloestrogen makes it a critical target in endometriosis management. Its estrogen-mimicking effects disrupt hormonal balance, while its strong association with nickel allergy and allergic contact mucositis (ACM) highlights its ability to provoke chronic inflammation. Elevated nickel levels are also linked to gastrointestinal symptoms, often mistaken for irritable bowel syndrome (IBS), which frequently co-occurs with endometriosis. [10][11][12] A low-nickel diet, featuring foods that naturally contain minimal nickel levels, and screening for nickel sensitivity are integral to reducing its impact. This dietary intervention can alleviate both gastrointestinal and systemic symptoms of endometriosis.
Cadmium
Cadmium is a potent metalloestrogen that contributes to the oxidative stress central to endometriosis pathogenesis. It induces reactive oxygen species (ROS) production, damages cellular components, and compromises antioxidant defenses. The potential synergistic effects of cadmium with other heavy metals, such as lead, may amplify its impact on oxidative stress and disease progression. While some studies show elevated cadmium levels in women with endometriosis, findings remain inconsistent, underscoring the need for more research. [13][14][15] Nevertheless, cadmium exposure, often stemming from contaminated food, water, and smoking, should be minimized. Diets rich in antioxidant foods can mitigate cadmium-induced oxidative stress, while limiting sources of cadmium, such as certain leafy greens and shellfish, can help reduce exposure.
Lead
Lead disrupts hormonal function and amplifies oxidative stress, particularly when combined with other metals like cadmium. Even low levels of lead have been associated with a higher prevalence of endometriosis, with occupational exposure posing additional risks. In the context of the microbiome, lead’s effects may also influence microbial imbalances, further compounding disease progression. [16][17][18] Reducing lead exposure involves ensuring clean water sources, avoiding lead-contaminated food, and supporting detoxification pathways.
Zinc
Although zinc plays a pivotal role in immune modulation, antioxidative processes, and MMP regulation, recent evidence indicates that excessive dietary zinc intake is associated with a significant increase in the risk of endometriosis. Zinc’s influence on matrix metalloproteinases (MMP-2 and MMP-9), which facilitate lesion invasion, may explain its counterproductive effects when consumed in excess. Therefore, zinc supplementation should be approached cautiously, and dietary zinc intake should be moderated, avoiding over-reliance on zinc-fortified foods or supplements. [19][x] Foods naturally containing zinc, such as nuts, seeds, and legumes, should be consumed in moderation to maintain optimal levels without exceeding the recommended daily intake.
The Microbiome Diet for Endometriosis
The results from the reviewed studies strongly support the dietary strategies incorporated into the microbiome diet for endometriosis. Consistently, low-fat diets, including those rich in fruits and vegetables, were associated with a decreased risk of developing endometriosis and with improved symptom management. Notably, citrus fruits, such as oranges, which are included in the diet due to their low nickel, cadmium, zinc, and lead content, were linked to a reduced risk of the condition, in alignment with the findings from the tables.
Additionally, the correlation between low nickel diets and successful clinical outcomes in managing endometriosis further validates the exclusion of high-nickel foods such as chocolate. The dietary patterns that emphasize omega-3 fatty acids, olive oil, and lean meats, as well as higher fruit intake, were associated with less pain in endometriosis patients, supporting the inclusion of these foods in the diet.
Conversely, the exclusion of foods high in nickel, zinc, and red meat—consistently shown to exacerbate endometriosis—aligns with clinical recommendations. The exclusion of cruciferous vegetables, often linked with an increased risk of endometriosis, corroborates the diet’s alignment with observational studies. Furthermore, the role of dietary zinc in promoting IBS-like symptoms in endometriosis patients highlights the potential benefit of eliminating zinc-rich foods.
In summary, the dietary recommendations detailed in our tables are well-supported by clinical evidence, emphasizing a tailored approach to mitigating symptoms and reducing disease risk in endometriosis through targeted food choices. These findings reinforce the importance of a carefully curated diet in managing endometriosis, with clear evidence linking the exclusion of certain metals and foods to improved clinical outcomes.
Research Feed
Elevated Lead, Nickel, and Bismuth Levels in the Peritoneal Fluid of a Peritoneal Endometriosis Patient without Toxic Habits or Occupational Exposure following a Vegetarian Diet
December 10, 2023
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Endometriosis •
Endometriosis
Did you know?
Gut microbiota predict endometriosis better than vaginal microbiota.
Metals •
Metals
Lorem ipsum dolor sit amet, consectetur adipiscing elit. Proin ut laoreet tortor. Donec euismod fermentum pharetra. Nullam at tristique enim. In sit amet molestie
A case study links elevated lead, nickel, and bismuth in peritoneal fluid with endometriosis, highlighting potential dietary and environmental exposures as contributors. Further research may identify these potentially toxic elements (PTEs) as diagnostic biomarkers and therapeutic targets.
What Was Studied?
This case report investigated the multielemental profile of peritoneal fluid (PF) in a 22-year-old woman diagnosed with peritoneal endometriosis. The study aimed to evaluate the concentrations of potentially toxic elements (PTEs), including lead (Pb), nickel (Ni), bismuth (Bi), and cobalt (Co), and to compare them with levels in an age-matched control without endometriosis. The patient had no toxic habits, occupational exposure, or documented environmental exposure, and adhered to a vegetarian diet, raising questions about the dietary and environmental sources of PTEs and their role in the pathogenesis of endometriosis.
Who Was Studied?
The primary subject was a 22-year-old woman diagnosed with peritoneal endometriosis during laparoscopic surgery, where her PF was analyzed. The comparison group included an age-matched control and a reference cohort of ten women diagnosed with non-hormonally dependent benign ovarian cysts.
Most Important Findings
The study revealed significantly elevated levels of Pb (75 µg/L, 90:1 ratio), Ni (40.4 µg/L, 4:1 ratio), Bi (33.3 µg/L, 1.5:1 ratio), and Co (1.39 µg/L, 5:1 ratio) in the PF of the endometriosis patient compared to the control. These findings suggest potential contributions of dietary and environmental exposures to PTEs. Nickel, a cofactor for metalloenzymes, was noted to be higher potentially due to the patient’s vegetarian diet, which is associated with increased nickel intake from plant-based foods such as nuts and legumes. Elevated Pb levels were striking, with concentrations much higher than typical dietary or environmental exposures in industrialized settings. While cobalt and bismuth also showed elevated levels, their specific roles in endometriosis remain unclear. The findings support the hypothesis that environmental and dietary PTE exposure may contribute to the pathogenesis of endometriosis by inducing oxidative stress or endocrine disruption.
Greatest Implications
This study highlights the need to explore PTEs as potential biomarkers for endometriosis diagnosis and as contributors to its etiology. Elevated PTE levels in PF may result from dietary habits, such as a vegetarian diet, or unidentified environmental exposures. This study emphasizes the importance of further investigations into environmental toxicology and dietary patterns in endometriosis patients. Understanding these associations could inform preventative strategies, dietary guidelines, and therapeutic interventions for endometriosis management.
Elevated levels of whole blood nickel in a group of Sri Lankan women with endometriosis: a case control study
January 14, 2013
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Endometriosis •
Endometriosis
Did you know?
Gut microbiota predict endometriosis better than vaginal microbiota.
Metals •
Metals
Lorem ipsum dolor sit amet, consectetur adipiscing elit. Proin ut laoreet tortor. Donec euismod fermentum pharetra. Nullam at tristique enim. In sit amet molestie
This study identified elevated blood nickel levels in women with endometriosis, suggesting a potential role of nickel as a metalloestrogen in its pathogenesis.
What Was Studied?
This study investigated the association between whole blood levels of nickel, cadmium, and lead in women with and without endometriosis. Specifically, it aimed to determine whether these heavy metals, known to have estrogenic properties, could be linked to the pathogenesis of endometriosis. The research involved analyzing the whole blood levels of these metals in 50 women with endometriosis and 50 age-matched controls who were confirmed to be free of the condition via laparoscopy or laparotomy.
Who Was Studied?
The study focused on a group of Sri Lankan women of reproductive age who underwent laparotomy or laparoscopy. The participants were divided into two groups: cases (women diagnosed with endometriosis, n=50) and controls (women without endometriosis, n=50). None of the participants were current smokers, and the groups were matched for age and body mass index.
Most Important Findings
The study revealed significantly elevated levels of nickel in the whole blood of women with endometriosis compared to controls (2.6 μg/L vs. 0.8 μg/L, p=0.016). This finding aligns with previous evidence that nickel, a potent metalloestrogen, can activate estrogen receptors and may contribute to the persistence of ectopic endometrial tissue. In contrast, the blood levels of cadmium and lead did not show statistically significant differences between the two groups. The presence of nickel in ectopic endometrial tissue, previously demonstrated by the researchers, supports the hypothesis that hematogenous routes could transport nickel to ectopic sites. Despite these findings, the study's small sample size limits the ability to conclude definitively that nickel is an etiological factor for endometriosis.
Greatest Implications
The discovery of higher nickel levels in women with endometriosis introduces a novel avenue for understanding the role of environmental pollutants, particularly metalloestrogens, in the condition's pathogenesis. It emphasizes the need for larger-scale studies to explore nickel's potential as a biomarker or contributor to endometriosis. Furthermore, this research underscores the importance of addressing environmental and occupational exposures to nickel, especially for women of reproductive age, as part of preventive strategies for endometriosis.
I Am the 1 in 10—What Should I Eat? A Research Review of Nutrition in Endometriosis
December 11, 2022
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Endometriosis •
Endometriosis
Did you know?
Gut microbiota predict endometriosis better than vaginal microbiota.
This review explores how dietary modifications impact endometriosis progression. Antioxidants, omega-3s, and anti-inflammatory diets show promise in symptom relief and hormonal regulation. Personalized nutrition emerges as a pivotal tool for improving patient outcomes.
What Was Reviewed?
The paper titled "I Am the 1 in 10—What Should I Eat? A Research Review of Nutrition in Endometriosis" provides an extensive review of the role of nutrition in the management and progression of endometriosis. The authors systematically explore various dietary factors and interventions, including antioxidants, polyphenols, omega-3 fatty acids, a low-nickel diet, and the Mediterranean diet, among others, in relation to their effects on inflammation, hormonal modulation, and oxidative stress in endometriosis patients.
Who Was Reviewed?
The review primarily evaluated research studies involving women diagnosed with endometriosis. It integrated findings from human clinical trials, observational studies, and in vitro research to synthesize current evidence on nutritional influences on endometriosis-related symptoms and disease progression.
What Were the Most Important Findings?
The review highlighted that endometriosis is a chronic inflammatory and estrogen-dependent condition where dietary modifications can play a pivotal role. It emphasized the following:
Antioxidants and Polyphenols: Foods rich in antioxidants, such as fruits, vegetables, and specific compounds like resveratrol, demonstrated anti-inflammatory and pro-apoptotic effects in reducing endometriosis severity. Polyphenols, especially phytoestrogens, can modulate estrogen activity, impacting endometriotic lesion growth.
Dietary Fats: Omega-3 fatty acids were shown to reduce inflammation and dysmenorrhea, while high consumption of omega-6 and trans fats increased risks.
Specific Diets: The Mediterranean diet, with its anti-inflammatory properties, low-FODMAP and low-nickel diets showed potential benefits in reducing gastrointestinal and systemic symptoms. Gluten-free diets also alleviated pain in a subset of patients.
Dairy and Vitamin D: Dairy consumption, particularly calcium- and vitamin D-rich products, was associated with reduced endometriosis risk. Vitamin D showed immunomodulatory effects, improving inflammatory responses.
Red Meat and Iron Overload: Excessive red meat consumption elevated estrogen and prostaglandin levels, exacerbating endometriosis. The condition was also linked to iron overload in peritoneal fluid, contributing to oxidative stress and infertility.
What Are the Greatest Implications of This Review?
The findings underscore the potential for personalized dietary interventions in endometriosis management, emphasizing the integration of anti-inflammatory, low-toxin, and nutrient-rich foods. Clinicians can leverage these insights to recommend diets tailored to reduce inflammation, regulate estrogen metabolism, and mitigate oxidative stress, thereby improving quality of life and fertility outcomes for patients. Furthermore, the review reinforces the importance of microbiome-targeted dietary strategies in addressing endometriosis-related dysbiosis.
The impact of endometriosis on dietary choices and activities of everyday life: a cross-sectional study
September 22, 2023
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Endometriosis •
Endometriosis
Did you know?
Gut microbiota predict endometriosis better than vaginal microbiota.
This review highlights how gluten-free, Mediterranean, and anti-inflammatory diets improve pain perception in endometriosis by reducing inflammation and modulating the gut microbiome. Probiotics and bioactive nutrients such as curcumin enhance therapeutic outcomes.
What was reviewed?
This systematic review evaluated the impact of dietary interventions on pain perception in women diagnosed with endometriosis. It explored the connections between dietary changes and the alleviation of symptoms, particularly chronic pain, and assessed the potential of specific dietary patterns and nutrients to influence disease progression and symptom severity. The review included evidence from various studies highlighting the role of diets such as gluten-free, Mediterranean, and anti-inflammatory diets, along with the incorporation of specific nutrients and probiotics.
Who was reviewed?
The review included studies examining women diagnosed with endometriosis, focusing on their dietary habits, pain management strategies, and overall quality of life. The population spanned diverse stages of endometriosis and varying symptom severities, with dietary interventions as a common self-management approach.
What were the most important findings?
The review identified several key dietary patterns and nutrients that positively influenced pain perception and symptom management in women with endometriosis. A gluten-free diet was associated with symptom relief in patients experiencing gastrointestinal-related pain, while the Mediterranean diet showed benefits in reducing inflammation and pain severity due to its high content of antioxidants, omega-3 fatty acids, and polyphenols. Anti-inflammatory diets also gained traction, particularly in severe cases of endometriosis, where eliminating saturated fats and processed meats improved symptom management.
Major microbial associations (MMAs) of endometriosis were also highlighted, particularly the role of probiotics like Lactobacillus in alleviating pain and potentially modulating the gut microbiome to reduce systemic inflammation. The findings emphasize the therapeutic potential of dietary supplements such as curcumin, resveratrol, and quercetin, which possess anti-inflammatory and antioxidant properties.
What are the greatest implications of this review?
The findings suggest that dietary interventions and supplements can serve as non-invasive and complementary strategies for managing endometriosis-related symptoms, particularly chronic pain. By modulating systemic inflammation and influencing the gut microbiome, specific dietary patterns and nutrients may provide a tailored approach to alleviating symptoms. The review underscores the importance of integrating nutritional guidance into endometriosis management protocols.
Trace Elements and Endometriosis: Insights into Oxidative Stress and Novel Therapies
October 14, 2021
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Metals •
Metals
Lorem ipsum dolor sit amet, consectetur adipiscing elit. Proin ut laoreet tortor. Donec euismod fermentum pharetra. Nullam at tristique enim. In sit amet molestie
Endometriosis •
Endometriosis
Did you know?
Gut microbiota predict endometriosis better than vaginal microbiota.
This review explores the role of trace elements and oxidative stress in endometriosis, highlighting their potential as therapeutic targets. It underscores the need for further research into the trace elements’ roles in endometriotic lesions.
What was reviewed?
The article reviews the role of trace elements in the pathogenesis and management of endometriosis, a chronic, estrogen-dependent inflammatory disease. It synthesizes existing research on the impact of oxidative stress and environmental exposure to trace elements like zinc, nickel, cadmium, and copper, linking these factors to the formation and proliferation of endometrial-like lesions outside the uterus.
Who was reviewed?
The review focuses on studies involving women with confirmed endometriosis, highlighting environmental and biological factors such as trace element concentrations in blood, urine, and peritoneal fluid. Additionally, it incorporates experimental findings, including animal models, to explore the mechanistic roles of trace elements.
What were the most important findings?
The review emphasizes the link between oxidative stress and endometriosis, with trace elements acting as potential modulators of this process. Zinc, for instance, is identified for its antioxidant and anti-inflammatory roles, with lower levels in endometriosis patients potentially contributing to lesion formation. Nickel, on the other hand, has been implicated in the condition as a metalloestrogen, as further evidenced by improved symptoms following a low-nickel diet. Cadmium and lead, known for inducing oxidative stress, show conflicting associations with endometriosis, though some evidence suggests their presence synergistically exacerbates disease severity. Copper's involvement in angiogenesis and its elevated levels in endometriosis patients suggest a role in lesion proliferation. The review also highlights discrepancies in study findings, emphasizing the need for further research on trace elements within endometriotic implants rather than just systemic fluids.
What are the greatest implications of this review?
The review underscores the potential of targeting trace elements and oxidative stress as therapeutic strategies for endometriosis. It calls for more comprehensive research into the specific roles of trace elements within endometriotic tissue, as these could pave the way for novel diagnostic markers and treatments. Additionally, the environmental and dietary implications of trace element exposure warrant further exploration, particularly in the context of prevention and symptom management.
Nickel Sensitivity and Symptom Management in Endometriosis: The Role of a Low-Nickel Diet
January 28, 2020
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Metals •
Metals
Lorem ipsum dolor sit amet, consectetur adipiscing elit. Proin ut laoreet tortor. Donec euismod fermentum pharetra. Nullam at tristique enim. In sit amet molestie
Endometriosis •
Endometriosis
Did you know?
Gut microbiota predict endometriosis better than vaginal microbiota.
Nickel •
This study offers new insights into the potential link between nickel sensitivity and symptom severity in endometriosis, suggesting that a low-nickel diet may be a promising intervention for alleviating associated gastrointestinal and gynecological symptoms.
What Was Studied?
This pilot study investigated the prevalence of nickel (Ni) allergic contact mucositis (ACM) in women with endometriosis who experience gastrointestinal symptoms and evaluated the effects of a low-nickel diet on these symptoms. The study focused on assessing the gastrointestinal, extra-intestinal, and gynecological symptom reductions associated with Ni ACM and dietary interventions.
Who Was Studied?
The study enrolled 84 women of reproductive age diagnosed with endometriosis who reported significant gastrointestinal symptoms. Thirty-one participants completed the study, undergoing a diagnostic nickel oral mucosa patch test (omPT) and a subsequent three-month low-nickel diet intervention. Participants were evaluated using symptom questionnaires both at baseline and after dietary changes.
What Were the Most Important Findings?
The study found that 90.3% of participants tested positive for Ni ACM, suggesting a high prevalence of nickel sensitivity among women with endometriosis.Following three months of adhering to a low-nickel diet, significant reductions in all evaluated symptoms were reported. Gastrointestinal symptoms such as abdominal pain, bloating, and diarrhea showed marked improvement. Extra-intestinal symptoms, including fatigue and headaches, and gynecological symptoms such as pelvic pain and dysmenorrhea, also exhibited statistically significant decreases. These findings indicate that nickel sensitivity may contribute to the symptomatic burden of endometriosis, and dietary interventions targeting nickel can alleviate these issues.
The study suggests a potential mechanistic link between nickel exposure, immune responses, and the exacerbation of endometriosis symptoms. Major microbial associations (MMAs) relevant to this context include those influenced by dietary changes, although specific microbiome alterations were not detailed.
What Are the Greatest Implications of This Study?
This research highlights nickel sensitivity as a significant yet previously under-recognized contributor to gastrointestinal and systemic symptoms in endometriosis patients. The findings suggest that incorporating nickel sensitivity screening and low-nickel dietary recommendations could represent a transformative approach to symptom management in endometriosis. Although the sample size was small, the results offer strong preliminary evidence for revising dietary protocols in clinical practice to include low-nickel guidelines, potentially improving the quality of life for patients.
Exploring the link between dietary zinc intake and endometriosis risk: insights from a cross-sectional analysis of American women
October 23, 2024
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Endometriosis •
Endometriosis
Did you know?
Gut microbiota predict endometriosis better than vaginal microbiota.
STOPs •
STOPs
Did you know?
The radical mastectomy for breast cancer was standard practice for nearly 60 years before less invasive options were proven effective.
This study links higher dietary zinc intake with increased endometriosis risk among American women, highlighting zinc’s complex role in immune modulation and estrogen-related pathways. Findings emphasize the importance of balanced intake for managing endometriosis risk.
What was studied?
This study investigated the association between dietary zinc intake and the risk of endometriosis among American women. Using cross-sectional data from the National Health and Nutrition Examination Survey (NHANES) collected between 1999 and 2006, the researchers aimed to evaluate whether zinc intake, as a key nutritional factor, was linked to the prevalence of endometriosis. Zinc is known for its essential roles in immune modulation, antioxidative defense, and regulation of matrix metalloproteinases (MMPs), all of which are implicated in endometriosis progression.
Who was studied?
The study included 4,315 American women aged 20–54 years, of whom 331 were diagnosed with endometriosis based on self-reported doctor diagnoses. Participants’ dietary zinc intake was assessed using 24-hour dietary recall interviews, with additional data on demographics, lifestyle, and health covariates collected. Women with extreme caloric intakes or incomplete data were excluded to ensure robustness of results.
What were the most important findings?
The study revealed a positive correlation between higher dietary zinc intake and the risk of endometriosis. Women consuming over 14 mg/day of zinc had a significantly higher adjusted odds ratio (1.60, 95% CI: 1.12–2.27, p = 0.009) compared to those with intake ≤8 mg/day. Zinc’s dual role in immune modulation and antioxidative defense was emphasized, particularly its regulation of matrix metalloproteinases (MMPs) like MMP-2 and MMP-9, which are key enzymes in tissue remodeling and endometriotic lesion invasion. Interestingly, despite zinc’s known antioxidative and anti-inflammatory roles, excessive intake appeared to have a counterproductive effect. These nuanced findings highlight zinc’s complex role in endometriosis pathophysiology.
What are the greatest implications of this study?
This research underscores the potential for dietary zinc as both a marker and modifiable factor in endometriosis risk. It raises questions about zinc’s dualistic effects, where optimal levels may support immune health, but excess intake could exacerbate estrogen-related pathways in endometriosis. Clinicians should be cautious when recommending zinc supplementation for reproductive health, particularly in populations at risk for endometriosis. Furthermore, this study strengthens the biological plausibility of microbiome involvement in endometriosis, as zinc is a crucial cofactor for microbial activity, and its imbalance may alter the gut and pelvic microbiota implicated in the disease.
Fruit and vegetable consumption and risk of endometriosis
January 12, 2018
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Endometriosis •
Endometriosis
Did you know?
Gut microbiota predict endometriosis better than vaginal microbiota.
STOPs •
STOPs
Did you know?
The radical mastectomy for breast cancer was standard practice for nearly 60 years before less invasive options were proven effective.
Higher fruit intake, especially citrus fruits, was inversely associated with laparoscopically confirmed endometriosis, suggesting a protective effect potentially linked to beta-cryptoxanthin. In contrast, cruciferous vegetables were linked to increased risk, highlighting the complex interplay between diet and endometriosis risk factors.
What Was Studied
This study explored the potential link between the consumption of fruits and vegetables and the risk of laparoscopically confirmed endometriosis. Using data collected from the Nurses' Health Study II, the researchers analyzed dietary habits over a 22-year period, investigating whether certain food groups and nutrients influenced the likelihood of developing endometriosis.
Who Was Studied
Participants included premenopausal women aged 25–42 years who were enrolled in the Nurses' Health Study II cohort. These women completed biennial surveys assessing health status, lifestyle factors, and dietary intake. Those with a history of endometriosis, cancer, infertility, or hysterectomy were excluded from the analysis, ensuring a focused evaluation of diet and disease development.
Most Important Findings
The study found an inverse relationship between fruit consumption, particularly citrus fruits, and the risk of endometriosis. Women who consumed citrus fruits frequently were less likely to develop endometriosis. Conversely, no significant association was found between total vegetable intake and the disease. Cruciferous vegetables, however, were unexpectedly linked to an increased risk. Beta-cryptoxanthin, a nutrient found in citrus fruits, appeared to play a protective role, and the beneficial effects of fruit consumption were especially notable among participants who had a history of smoking. These findings suggest a potential role for specific dietary components in either mitigating or exacerbating the risk of endometriosis.
Implications
The findings highlight the importance of dietary considerations in understanding endometriosis risk. The protective association of citrus fruits underscores the potential of targeted nutritional interventions to reduce risk. The increased risk observed with cruciferous vegetables raises questions about the role of gastrointestinal symptoms, as these vegetables are high in fermentable oligosaccharides, which could exacerbate symptoms and lead to increased diagnosis rates. Future studies exploring these dietary patterns in greater depth are warranted to clarify the underlying mechanisms and to guide dietary recommendations for those at risk.
Endometriosis
Endometriosis involves ectopic endometrial tissue causing pain and infertility. Validated and Promising Interventions include Hyperbaric Oxygen Therapy (HBOT), Low Nickel Diet, and Metronidazole therapy.
Chronic Pelvic Pain (CPP)
Chronic Pelvic Pain (CPP) is persistent pain in the pelvic region lasting six months or longer, often multifactorial, impacting physical and emotional well-being, and associated with various medical conditions.
Infertility
Infertility is the inability to conceive after 12 months of regular, unprotected sex. It affects both men and women and can be due to various physical, hormonal, or genetic factors. Treatments include medication, surgery, assisted reproductive technologies, and lifestyle changes.
Irritable Bowel Syndrome (IBS)
Irritable Bowel Syndrome (IBS) is a common gastrointestinal disorder characterized by symptoms such as abdominal pain, bloating, and altered bowel habits. Recent research has focused on the gut microbiota's role in IBS, aiming to identify specific microbial signatures associated with the condition.
Metalloestrogens
Metalloestrogens are metals that activate the estrogen receptor in the absence of estradiol.
Metalloestrogens
Metalloestrogens are metals that activate the estrogen receptor in the absence of estradiol.
Nickel
Bacteria regulate transition metal levels through complex mechanisms to ensure survival and adaptability, influencing both their physiology and the development of antimicrobial strategies.
Zinc
Zinc is an essential trace element vital for cellular functions and microbiome health. It influences immune regulation, pathogen virulence, and disease progression in conditions like IBS and breast cancer. Pathogens exploit zinc for survival, while therapeutic zinc chelation can suppress virulence, rebalance the microbiome, and offer potential treatments for inflammatory and degenerative diseases.
References
- Bacterial infection linked to endometriosis.. Venkatesan P.. (The Lancet. (July 18, 2023))
- The Main Theories on the Pathogenesis of Endometriosis.. Lamceva J, Uljanovs R, Strumfa I.. ( Int J Mol Sci. (Feb 21, 2023))
- Harris, H. R., Eke, A. C., Chavarro, J. E., & Missmer, S. A. (2018). Fruit and vegetable consumption and risk of endometriosis. Human Reproduction, 33(4), 715–727. doi:10.1093/humrep/dey014 . Harris, H. R., Eke, A. C., Chavarro, J. E., & Missmer, S. A.. (Journal of Human Reproduction. 2018.)
- Irritable Bowel Syndrome-Like Disorders in Endometriosis: Prevalence of Nickel Sensitivity and Effects of a Low-Nickel Diet. An Open-Label Pilot Study. . Borghini R, Porpora MG, Casale R, et al.. (Nutrients. (Jan 28, 2020))
- Nickel Allergy Is a Risk Factor for Endometriosis: An 11-Year Population-Based Nested Case-Control Study.. Yuk JS, Shin JS, Shin JY, Oh E, Kim H, Park WI.. (PLoS One. October 6, 2015.)
- Adverse events due to suspected nickel hypersensitivity in patients with essure micro-inserts.. Zurawin RK, Zurawin JL.. Zurawin RK, Zurawin JL. (Minim Invasive Gynecol. 2011)
- Harris, H. R., Eke, A. C., Chavarro, J. E., & Missmer, S. A. (2018). Fruit and vegetable consumption and risk of endometriosis. Human Reproduction, 33(4), 715–727. doi:10.1093/humrep/dey014 . Harris, H. R., Eke, A. C., Chavarro, J. E., & Missmer, S. A.. (Journal of Human Reproduction. 2018.)
- The role of iron in the pathogenesis of endometriosis: a systematic review. . Wyatt J, Fernando SM, Powell SG, et al.. (Hum Reprod Open. (Jul 27, 2023 ))
- Bacterial iron detoxification at the molecular level.. Bradley, Justin M et al.. (Journal of Biological Chemistry. (December, 2020))
- Irritable Bowel Syndrome-Like Disorders in Endometriosis: Prevalence of Nickel Sensitivity and Effects of a Low-Nickel Diet. An Open-Label Pilot Study. . Borghini R, Porpora MG, Casale R, et al.. (Nutrients. (Jan 28, 2020))
- Nickel Allergy Is a Risk Factor for Endometriosis: An 11-Year Population-Based Nested Case-Control Study.. Yuk JS, Shin JS, Shin JY, Oh E, Kim H, Park WI.. (PLoS One. October 6, 2015.)
- Presence of metalloestrogens in ectopic endometrial tissue.. Silva, N. & Senanayake, Hemantha & Peiris-John, Roshini & Wickremasinghe, Rajitha & Sathiakumar, Nalini & Waduge, Vajira.. (J Pharm Biomed Sci. 2012)
- Presence of metalloestrogens in ectopic endometrial tissue.. Silva, N. & Senanayake, Hemantha & Peiris-John, Roshini & Wickremasinghe, Rajitha & Sathiakumar, Nalini & Waduge, Vajira.. (J Pharm Biomed Sci. 2012)
- Does Exposure of Lead and Cadmium Affect the Endometriosis? . Kim M-G, Min Y-S, Ahn Y-S.. (International Journal of Environmental Research and Public Health. 2021)
- Brief Review of Endometriosis and the Role of Trace Elements.. Osuchowska-Grochowska, Ida & Blicharska, Eliza & Gogacz, Marek & Nogalska, Agata & Winkler, Izabela & Szopa, Agnieszka & Ekiert, Halina & Tymczyna-Borowicz, Barbara & Rahnama-Hezavah, Mansur & Grochowski, Cezary.. (International Journal of Molecular Sciences.)
- Presence of metalloestrogens in ectopic endometrial tissue.. Silva, N. & Senanayake, Hemantha & Peiris-John, Roshini & Wickremasinghe, Rajitha & Sathiakumar, Nalini & Waduge, Vajira.. (J Pharm Biomed Sci. 2012)
- Does Exposure of Lead and Cadmium Affect the Endometriosis? . Kim M-G, Min Y-S, Ahn Y-S.. (International Journal of Environmental Research and Public Health. 2021)
- Brief Review of Endometriosis and the Role of Trace Elements.. Osuchowska-Grochowska, Ida & Blicharska, Eliza & Gogacz, Marek & Nogalska, Agata & Winkler, Izabela & Szopa, Agnieszka & Ekiert, Halina & Tymczyna-Borowicz, Barbara & Rahnama-Hezavah, Mansur & Grochowski, Cezary.. (International Journal of Molecular Sciences.)
- Exploring the link between dietary zinc intake and endometriosis risk: insights from a cross-sectional analysis of American women. Huang, Y., Wei, Y., Liang, F. et al.. (BMC Public Health (2024))
Lamceva J, Uljanovs R, Strumfa I.
The Main Theories on the Pathogenesis of Endometriosis.Int J Mol Sci. (Feb 21, 2023)
Read ReviewHarris, H. R., Eke, A. C., Chavarro, J. E., & Missmer, S. A.
Harris, H. R., Eke, A. C., Chavarro, J. E., & Missmer, S. A. (2018). Fruit and vegetable consumption and risk of endometriosis. Human Reproduction, 33(4), 715–727. doi:10.1093/humrep/dey014Journal of Human Reproduction. 2018.
Read ReviewBorghini R, Porpora MG, Casale R, et al.
Irritable Bowel Syndrome-Like Disorders in Endometriosis: Prevalence of Nickel Sensitivity and Effects of a Low-Nickel Diet. An Open-Label Pilot Study.Nutrients. (Jan 28, 2020)
Read ReviewYuk JS, Shin JS, Shin JY, Oh E, Kim H, Park WI.
Nickel Allergy Is a Risk Factor for Endometriosis: An 11-Year Population-Based Nested Case-Control Study.PLoS One. October 6, 2015.
Read ReviewZurawin RK, Zurawin JL.
Zurawin RK, Zurawin JL.
Adverse events due to suspected nickel hypersensitivity in patients with essure micro-inserts.Minim Invasive Gynecol. 2011
Read ReviewHarris, H. R., Eke, A. C., Chavarro, J. E., & Missmer, S. A.
Harris, H. R., Eke, A. C., Chavarro, J. E., & Missmer, S. A. (2018). Fruit and vegetable consumption and risk of endometriosis. Human Reproduction, 33(4), 715–727. doi:10.1093/humrep/dey014Journal of Human Reproduction. 2018.
Read ReviewWyatt J, Fernando SM, Powell SG, et al.
The role of iron in the pathogenesis of endometriosis: a systematic review.Hum Reprod Open. (Jul 27, 2023 )
Read ReviewBradley, Justin M et al.
Bacterial iron detoxification at the molecular level.Journal of Biological Chemistry. (December, 2020)
Read ReviewBorghini R, Porpora MG, Casale R, et al.
Irritable Bowel Syndrome-Like Disorders in Endometriosis: Prevalence of Nickel Sensitivity and Effects of a Low-Nickel Diet. An Open-Label Pilot Study.Nutrients. (Jan 28, 2020)
Read ReviewYuk JS, Shin JS, Shin JY, Oh E, Kim H, Park WI.
Nickel Allergy Is a Risk Factor for Endometriosis: An 11-Year Population-Based Nested Case-Control Study.PLoS One. October 6, 2015.
Read ReviewSilva, N. & Senanayake, Hemantha & Peiris-John, Roshini & Wickremasinghe, Rajitha & Sathiakumar, Nalini & Waduge, Vajira.
Presence of metalloestrogens in ectopic endometrial tissue.J Pharm Biomed Sci. 2012
Read ReviewSilva, N. & Senanayake, Hemantha & Peiris-John, Roshini & Wickremasinghe, Rajitha & Sathiakumar, Nalini & Waduge, Vajira.
Presence of metalloestrogens in ectopic endometrial tissue.J Pharm Biomed Sci. 2012
Read ReviewKim M-G, Min Y-S, Ahn Y-S.
Does Exposure of Lead and Cadmium Affect the Endometriosis?International Journal of Environmental Research and Public Health. 2021
Read ReviewOsuchowska-Grochowska, Ida & Blicharska, Eliza & Gogacz, Marek & Nogalska, Agata & Winkler, Izabela & Szopa, Agnieszka & Ekiert, Halina & Tymczyna-Borowicz, Barbara & Rahnama-Hezavah, Mansur & Grochowski, Cezary.
Brief Review of Endometriosis and the Role of Trace Elements.International Journal of Molecular Sciences.
Read ReviewSilva, N. & Senanayake, Hemantha & Peiris-John, Roshini & Wickremasinghe, Rajitha & Sathiakumar, Nalini & Waduge, Vajira.
Presence of metalloestrogens in ectopic endometrial tissue.J Pharm Biomed Sci. 2012
Read ReviewKim M-G, Min Y-S, Ahn Y-S.
Does Exposure of Lead and Cadmium Affect the Endometriosis?International Journal of Environmental Research and Public Health. 2021
Read ReviewOsuchowska-Grochowska, Ida & Blicharska, Eliza & Gogacz, Marek & Nogalska, Agata & Winkler, Izabela & Szopa, Agnieszka & Ekiert, Halina & Tymczyna-Borowicz, Barbara & Rahnama-Hezavah, Mansur & Grochowski, Cezary.
Brief Review of Endometriosis and the Role of Trace Elements.International Journal of Molecular Sciences.
Read ReviewHuang, Y., Wei, Y., Liang, F. et al.
Exploring the link between dietary zinc intake and endometriosis risk: insights from a cross-sectional analysis of American womenBMC Public Health (2024)
Read Review