Why is anti-inflammatory supplementation important in endometriosis?
Currently we know that endometriosis It involves complex interactions between hormones, the immune system, and inflammation, as well as the process of new blood vessel formation (angiogenesis). Despite this, endometriosis remains a mysterious disease whose exact mechanism of development remains unclear, and the search for optimal treatment methods continues. Knowing the mechanism of the disease is important because knowing it allows us to apply effective therapies, both pharmacological and non-pharmacological. The basis, of course, are the therapies recommended by the treating physician—medications and surgery. Furthermore, proper nutrition, exercise, and physiotherapy, ensuring adequate rest and sleep will be fundamental to improving quality of life and managing endometriosis symptoms. Properly selected supplementation based on current scientific and clinical research also plays a significant role in this process.
What is inflammation and what does it have to do with endometriosis?
Inflammation is a consequence of immune system activation and, in most cases, is a physiological and necessary process whose purpose is simply to remove a factor that poses a threat to the body (e.g., a microorganism), and then coordinate and repair the resulting damage. In such a situation, we speak of acute inflammation. Unfortunately, in many diseases, including endometriosis, a situation can arise where the threat cannot be effectively eliminated or the inflammatory response cannot be properly suppressed. This leads to continuous stimulation of the immune system and the emergence of chronic inflammation.
This leads to a situation where chronic inflammation becomes systemic and can affect virtually every cell in our body, causing a range of symptoms, from localized pain to systemic symptoms like chronic fatigue and nutritional deficiencies. Inflammation also increases the risk of tissue damage (through the formation of free radicals) and has a profound impact on our hormonal balance.
Chronic inflammation can be compared to a smoldering fire whose flame is almost imperceptible, but can burn indefinitely when supplied with "fuel" in the form of pro-inflammatory factors, e.g. cyclical damage caused by improperly implanted endometrium in the peritoneum. Therefore, lifestyle, anti-inflammatory diet and supplementation are so important in endometriosis and help to “quench” chronic inflammation.
Why is anti-inflammatory supplementation important in endometriosis?
As mentioned at the beginning, the foundation is, of course, the therapies recommended by your doctor, as well as proper nutrition, exercise, rest, and sleep, which will provide the foundation for improving well-being and controlling inflammation. Properly selected supplementation can result in a synergistic effect through anti-inflammatory, antioxidant, and immunomodulatory effects, inhibiting the formation of new blood vessels and cell division within the endometrium. This action has a potential impact on symptoms diseases that negatively affect the quality of life, work and study performance and personal relationships, which in turn causes high levels of stress.
It's worth noting that some symptoms associated with endometriosis, such as heavy periods, may increase the risk of iron deficiency. It has also been shown that women with endometriosis have lower vitamin D levels than women without endometriosis. In such cases, supplementation may be necessary.
How to start supplementation for endometriosis?
The absolute minimum for every woman with endometriosis is supplementation with vitamin D and omega 3 fatty acids. Diagnostics show that vitamin D may play a role in both the prevention and treatment of endometriosis. A 2020 meta-analysis of available studies on this topic found that low vitamin D levels were associated with an increased risk of endometriosis diagnosis and increased severity of disease symptoms. Vitamin D is responsible, among other things, for controlling the body's production of molecules that "quench" inflammation, so its deficiency may exacerbate chronic inflammation.
Omega-3 fatty acids, on the other hand, have well-demonstrated anti-inflammatory properties not only in the context of endometriosis but also other chronic inflammatory diseases.
Antioxidants – a protective shield in endometriosis
The presence of inflammation stimulates cell production of free radicals and increases oxidative stress. Free radicals are highly reactive molecules that damage cellular structures in their path. The only solution in such a situation is antioxidants, which neutralize free radicals and stop the destructive chain reaction they initiate. Furthermore, antioxidants "quench" chronic inflammation. Therefore, another group of compounds that are particularly important for women with endometriosis are antioxidants.
Research indicates that women with endometriosis have lower blood levels of certain antioxidants, such as vitamin E, compared to healthy women. This is particularly noticeable in women struggling with infertility. One randomized trial demonstrated that supplementing with vitamins C and E significantly reduced endometriosis symptoms compared to a placebo (control) group.
Polyphenols – natural support in the fight against the symptoms of endometriosis
Polyphenols are compounds found naturally in plants—vegetables, fruits, spices, and nuts. Numerous studies have demonstrated their anti-inflammatory and antioxidant potential. Interestingly, the molecular mechanism by which polyphenols act on the body is similar to that observed in some painkillers and anti-inflammatory medications (e.g., ibuprofen).
Polyphenols that have the potential to support endometriosis include curcumin and resveratrol. A 2019 meta-analysis found that taking curcumin supplements may exert anti-inflammatory effects by reducing levels of inflammatory markers (IL-6, hs-CRP), which may be elevated in endometriosis patients.
In turn, studies involving women with endometriosis have shown that the anti-inflammatory effect of resveratrol helps reduce menstrual pain and pelvic pain.
N-acetylcysteine – an anti-inflammatory amino acid
N-acetylcysteine (NAC) is a form of the amino acid cysteine that has undergone a chemical modification, i.e., acetylation. This amino acid is naturally present in certain vegetables, such as onions and garlic.
NAC has very interesting properties, as it prevents excessive cell division, including that occurring within the endometrium. Furthermore, NAC has been shown to reduce the activity of inflammatory proteins.
One study found that oral NAC supplementation reduced endometriosis-related pain and the extent of lesions. Furthermore, supplementation was observed to reduce the CA125 marker in the blood (which may be elevated in women with endometriosis).
Literature
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- Bahat YP et al. Dietary supplements for treatment of endometriosis: A review. Acta Biomed. 2022; 93(1): e2022159.
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- Tabrizi R. et al. The effects of curcumin-containing supplements on biomarkers of inflammation and oxidative stress: A systematic review and meta-analysis of randomized controlled trials. Phytother Res. 2019 Feb;33(2):253-262.
- Dull AM et al. Therapeutic Approaches of Resveratrol on Endometriosis via Anti-Inflammatory and Anti-Angiogenic Pathways. Molecules. 2019 Feb 13;24(4):667.
- Santanam N. et al. Antioxidant supplementation reduces endometriosis-related pelvic pain in humans. Transl Res. (2013) 161:189–95.
- Donabela FC et al. Serum markers of oxidative stress in infertile women with endometriosis and controls. Fertility and Sterility. 2010;94(4):S40.
- Anastasi E. et al. Efficacy of N-Acetylcysteine on Endometriosis-Related Pain, Size Reduction of Ovarian Endometriomas, and Fertility Outcomes. Int J Environ Res Public Health. 2023 Mar 7;20(6):4686.
- Faghfouri AH et al. The effects of N-acetylcysteine on inflammatory and oxidative stress biomarkers: A systematic review and meta-analysis of controlled clinical trials. Eur J Pharmacol. 2020 Oct 5;884:173368.
Monika Królak-Wasilewska
Monika Królak-Wasilewska is a clinical dietitian. She graduated with distinction from the Faculty of Human Nutrition and Consumer Sciences at the Warsaw University of Life Sciences (SGGW), specializing in dietetics. She is a member of the Polish Association of Dietitians (PSD) and the Polish Association of People with Celiac Disease and on a Gluten-Free Diet. She is a member of the Program Council of the Endopolka Foundation. She is a valued expert invited to television programs on nutrition.