How Eating For Stable Blood Sugar Helped My Endometriosis Symptoms

When I was 21 and wrapping up my undergraduate degree in journalism, I had just landed my first big reporting assignment for a television station. But while on assignment, I had to keep running to the bathroom to take deep breaths, loosen my waistband, and brace myself against a stall door to work through debilitating menstrual cramps. At least that's what I thought I was experiencing.

At the urging of my mother, I later went to my OB/GYN. He performed exploratory laparoscopic surgery1 to determine I had endometriosis.

The pain I was enduring resulted from internal bleeding and tissue cramping. The diagnosis explained why my periods (and many other days throughout my cycle) often left me in tears.

Even though my doctor at the time performed ablation surgery2 on my endometrial lesions, my pain did not resolve. So I went back to the doctor. He told me I should just get pregnant.

Fast-forward a good 20 years, and we still don't have a cure for endo, and we don't have what I, or the World Health Organization4 for that matter, would consider effective treatments for the condition.

But I'm not surprised. In 2022, the National Institutes of Health dedicated less than 0.1% of their research funding to the study of this chronic condition that affects 1 in 105 people assigned female at birth of reproductive age, significantly reduces quality of life6, and costs the United States an estimated $22 billion a year in lost productivity. (FYI, in rare cases, people assigned male at birth can have endo too.)

Like many people with endo who've been left in the lurch regarding treatment and care, I had to do my own research. I discovered that dietary changes, although not a cure, may help alleviate endometriosis symptoms. Back in the early aughts, the prevailing wisdom regarding diet and endo was to go vegan.

The simplified theory was that eating some animal products7, like red meat, could drive prostaglandin production. Prostaglandins, although crucial for the body, when overproduced can cause the uterus (and that endometrial-like tissue) to contract, leading to pain and cramping. Plus, prostaglandins are implicated8 in the pathophysiology of endo.

As a medical journalist, I do a lot of writing and related research regarding metabolic health. And I've learned quite a bit about glucose (blood sugar) and insulin levels and how they affect or drive many medical conditions. Could endo be one of them?

First, it helps to understand some of what endometriosis growths do. They secrete pro-inflammatory cytokines10.

Cytokines are proteins that cells release; they can either be pro-inflammation or help reduce inflammation. Specifically, endometrial growths secrete interleukin-1β and tumor necrosis factor-α—though there are more. IL-1β and TNF-α11, as they are known for short, also impact nociceptor sensory neurons12 that detect potential threats and lead to the sensation of pain. Endometrial growths also increase Cyclooxygenase-210. COX-213 is an enzyme also implicated in pain.

When you pop that ibuprofen capsule or tablet to ease a headache, the inhibition of COX-2 is how those nonsteroidal anti-inflammatory medications work. COX-2 overexpression in the body is a risk factor for the recurrence of endometriosis14 after surgical removal. Endometriosis has links to a host of autoimmune diseases15, and some researchers theorize that endo is itself an autoimmune condition16. However, it is currently not designated as one.

Insulin is a hormone released by pancreatic cells in response to glucose entering the bloodstream. It signals cells to uptake glucose for energy. When the bloodstream is continually flooded with glucose—which can occur from consuming too many high-carb or processed-carb foods—the pancreas produces even more insulin to convince cells to absorb glucose. Over time, cells get overwhelmed and cannot take in any more glucose, so they stop responding to insulin's action. Hence insulin resistance.

Hyperinsulinemia, or a high insulin level, which is associated with insulin resistance, can also lead to low levels20 of sex-hormone-binding globulin. SHBG binds sex hormones20, controlling the amount of free or available sex hormones in the body. So a low SHBG level can lead to an increase in available estrogen.

Endometriosis also interferes with the adipokines adiponectin and leptin21. Adipokines are cytokines produced in fat tissue. Endometriosis is linked to high leptin levels and low adiponectin levels.

More than two decades have passed since I was diagnosed with endometriosis. I've since had four additional laparoscopic surgeries to excise endometriosis lesions. None minimized my pain and bleeding. In 2017, I had a hysterectomy, keeping just one ovary. Although not an endometriosis cure, the hysterectomy dramatically helped me.

In 2021, I wore a continuous glucose monitor for one month. Doing so gave me valuable insights into how the foods I ate affected my glucose levels and helped me eat to stabilize my blood sugar. I believe that these dietary changes have also helped keep symptoms at bay.

The painful symptoms of endometriosis might be eased by focusing on keeping blood sugar levels more stable via a diet that's low-carb, high in omega-3 fatty acids, and prioritizes fiber. That's because endometriosis is an inflammatory condition that high blood sugar, or even just blood sugar swings, may worsen.