Environmental exposures to endocrine disrupting chemicals (EDCs) and their role in endometriosis
Endometriosis is a subject close to my heart. Despite years of infertility, it was only after I had my children, after 12 rounds of IVF, that endometriosis scarring was picked up on my ovaries.
When I recall the debilitating menstrual periods I suffered in my 20s, I wish I had known that this was not what normal looked like. I ran a shop at the time and, on several occasions, recall locking the door and crawling to the stock room to curl up in a ball, waiting for the pain to pass. I have passed out cold on the bathroom floor in pain. This is not normal.
The medical term for painful periods is dysmenorrhea and is one of a triad of symptoms, along with painful sex, dyspareunia, and infertility that may be used for a diagnostic interpretation for endometriosis.
Biologically, endometriosis is an oestrogen-dependent, chronic, and inflammatory gynaecological condition that is characterised by the proliferation of a functional endometrial tissue that develops outside the uterus wall.
Endometriosis effects between 10-15% of menstruating women between the ages of 24 and 40, that is more than 1 in 10 of us. There is a strong hereditary risk factor, so understanding if your mother or sister struggled with painful periods, or were diagnosed with endometriosis, could be a warning sign. If you suffer from endometriosis, talk with your daughter to stress that painful periods should not be ignored.
Emerging evidence is exploring the link between endometriosis and environmental toxins; EDCs, which stands for Endocrine (hormone) Disrupting Chemicals, this is a combined toxic soup of new chemicals, released into the environment year on year which have a hormone-disrupting effect on our bodies.
Let’s explore some of these chemicals, where they are found and what we can do to reduce our risk for exposure.
Synthetically produced environmental chemicals (EDCs) mimic hormones like oestrogen and alter their signalling pathways in the body.
A systematic review of the scientific literature in 2020 examined 29 research papers dedicated to exploring the link between EDCs and endometriosis; their findings were as follows:
• Phthalates were positively associated with the prevalence of endometriosis.
o Phthalates are found in soft flexible plastics used in toys, PVC and vinyl as well as in cosmetics and fragrances from eyeshadows, to foundation, nail polish and perfume.
• The majority (71%) of studies revealed a significant association between bisphenol A and environmental pollutants (dioxins, dioxin-like compounds, pesticides, polychlorinated biphenyls) and the prevalence of endometriosis.
o BPA is found in the lining of tin cans, and until recently baby’s bottles. Pesticides are commonly found on sprayed fruits and vegetables. To avoid the main culprits, you can check the EWG Dirty Dozen list, published each year and may be surprised to learn that annually strawberries top the list. Dioxins are released into the atmosphere as a result of human activities such as fuel combustion. They deposit on land, seas and plants where they are consumed bu animals. Over 90% of the human intake comes food, mainly from animal origin.
• A positive association between copper, chromium and prevalence of endometriosis was demonstrated in one study only.
• Cadmium, lead and mercury were not associated with the prevalence of endometriosis.
Without listing and referencing every one of the thousands of man-made toxins in circulation today, consider that it is not simply the action of one plastic bottle or cling-film wrapped sandwich, rather it is the accumulative effect of all of these actions over days, months and years, which could start to be minimised with a few simple swaps.
It is no surprise to learn that the human body is little more than a great big sponge. We are constantly mopping up and squeezing out everything around us, the food we eat, the air we breathe, the lotions we apply, the objects we touch.
Even before breakfast you will have washed and lathered, rinsed and applied, spritzed and sprayed a multitude of products. They make us feel and smell good; we rarely stop to consider that they are often made from a combination of chemicals prepared in a factory.
Once we get down to the kitchen things don’t get much better, from the sprays we use to wipe down the kitchen surfaces, the Teflon coating on our glossy non-stick pans, the rust proof coating inside that can of tomatoes you have just opened; chemicals pervade every corner of our lives. We step out of the house, the fumes on the road, more fire-retardant coating in the fabric of the car seat, the waterproof gym jacket we are wearing, the plastic water bottle lying half-finished on the seat beside us. It’s a man-made world, it’s a concrete jungle, it’s a chemical soup. We might choose not to think about it too much, but we know it’s out there.
Around 80’000 chemicals exist in food and consumer products today & 1’500 new synthetics are introduced every year.
Until a substance is proven toxic/poisonous or the lethal dose level is established, that substance remains in use.
Essentially, all chemicals are presumed safe until proven otherwise.
Toxicologists face not only the challenge of testing the different means of exposure; inhalation, ingestion or absorption, but also the dose and the frequency/longevity of exposure. Such testing is expensive and prone to inaccuracies in human beings when conducted over long periods of time. Since the ‘Toxic Substances Control Act – 1976’ was passed over 40 years ago, only 5 chemicals have ben regulated.
Asbestos, Lead, Mercury, PCBs and Formaldehyde, with a possible micro bead ban being introduced this year.
Innocent until proven guilty may be an attitude we live to regret.
Whilst we cannot avoid all environmental toxins, education and voluntary self-restraint are useful tools for reducing the overall body burden of toxins.
What can we do to help ourselves minimise exposure?
BPA is said to mimic the function of oestrogen, disrupting hormone levels. All industry-funded studies found no correlation between BPAs and ill health compared with 92% of government- funded studies reporting adverse effects!1
Avoid reusable plastic shatterproof water bottles unless they clearly state BPA free.
Minimise your use of canned foods unless they clearly state BPA free (Companies such as Biona and Heinz are introducing BPA-Free linings in their cans1. Be sure to store leftovers in the fridge in a china or Pyrex dish and put a plate on top to act as a lid. Decant any leftover foods from open cans.
It is virtually impossible to avoid PBDEs but to minimise exposure you can add an HEPA filter to the hoover to cut down on dust particles. These are available cheaply online. Dust with a damp cloth, rather than a dry duster to avoid the spread of dust. Avoid reupholstering old foam furniture or lifting old carpets too rigorously as this will release particles into the environment.
Don’t hang on to those old plastic toys as Phthalates were only banned from them in 2008. Check for codes on plastic bottles, Δ3 and 7 contain phthalates. Fragrances are often phthalate-based, so look out for those labelled “synthetic fragrance free” or “Phthalate free”.
Read more at www.mypure.co.uk or Burts Bees to familiarise yourself with alternative products that are available.
Don’t heat up microwave food in the plastic tray it comes in.
No single theory explains the development of endometriosis, it is more than likely that it stems from a combination of various mechanisms. We can however look to lessen the load of EDCs. Recall, it is not simply the action of one plastic bottle or cling-film wrapped sandwich, rather it is the accumulative effect of all of these actions over days, months and years, which could be minimised with a few simple swaps.
Several dietary principles are key in a natural approach to endometriosis.
• Reduce inflammatory foods and increase anti-inflammatory foods
• Support your natural detoxification pathways
• Increase dietary fibre to speed up transit time and promote a healthy microbiome.
• Increase anti-inflammatory omega-3 foods and reduce trans fats
The NHANES Study II (Nurses Heathy Study) found a 22% decrease in endometriosis in the women with the highest intake of Omega-3 fatty acids. Increasing your intake of wild caught oily fish such as salmon and trout, flaxseeds and chia seeds.
Antioxidant supplementation of Vitamin C, E and A increases cellular immunity. Antioxidants may contribute by inhibiting proliferation of free radicals.
Dark green leafy vegetables are a rich source of both B Vitamins and sulphoraphanes, helping the natural role of liver detoxification of inactive oestrogens, preventing their reuptake in the body.
Progesterone has been shown to modify the action of oestradiol. Women without enough progesterone cannot adequately oppose oestrogen, leading to problems of oestrogen excess/dominance. The DUTCH test can be particularly useful at measuring and identifying the relative abundance of oestrogen to progesterone during the luteal phase of the menstrual cycle.
In summary, for all women, and especially those with endometriosis the primary dietary recommendation is to increase the consumption of high fibre, organic, fruits and vegetables, increase the consumption of fatty fish (wild caught) and pay specific attention to the liver supporting nutrients found in broccoli, brussels sprouts, cabbage and cauliflower.
A closer attention to the overall toxic load of EDCs will also help play a supportive role. From cosmetics to clothing, food containers and non-organic foods, it is the cumulative of positive changes across all areas of nutrition and lifestyle that will help target the mechanisms for endometriosis.
1. Hartle, J.C., Navas-Acien, A. and Lawrence, R.S. (2016) The consumption of canned foods and beverages and urinary Bisphenol A concentrations in NHANES 2003-2008. Environmental Research. 150(10), p.375-382.
2. Harley, K.G., Kogut, K., Madrigal, D.S., Cardenas, M., Vera, A., Mesa- Alfaro G., She, J., Gavin, Q., Sahedi, R., Bradman, A., Eskenasi, B. and Parra, K.L. (2016) Reducing Phthalate, Paraben, and Phenol Exposure from Personal Care Products in Adolescent Girls: Findings from the HERMOSA Intervention Study. Environmental Health Perspective. 124(10), p.1600-1607.
*“Slow Death by Rubber Duck” How the Toxic Chemistry of everyday life affects our Health by Smith, R. and Lourie, B. (2011) Counterpoint LLC.
If you want to find out more about the toxic chemicals in our environment and how they may affect our health, this is a humorous and thought-provoking book.