EP.331/ Dairy and endo: What you need to know
At the end of last year I released a series on dairy and its possible effects on endo pain, endo belly and hormones, as well as its benefits - as I know so many of you are confused about the topic.
Today, I want to provide you with a summary of these episodes, so you can get the top lines in one place, and then of course you can deep dive into the individual episodes if you need to.
So, a big, BIG disclaimer here in case you haven’t listened to the previous episodes. If you’re vegan, please feel free to skip this episode. This episode is not about being for or against dairy, it’s about providing you with information so you can make an informed decision about whether dairy is right for you. The research is very varied and our reactions to dairy really depend on our own individual genetics, so the key takeaway here is that it’s worth investigating if dairy agrees with you personally before coming to any conclusions.
Of course this series also does not address ethics or environmental considerations with dairy, I am simply focusing on the health side. It goes without saying that choosing ethical and environmentally friendly brands and farms is always preferable where possible, if it is accessible to you, whilst being mindful of our consumption of products that can affect the environment.
So, let’s get into it.
Pain
If you have issues with lactose, A1 casein or histamine, these components of dairy could worsen pain and inflammation with endo.
A1 casein
A1 casein is type of milk protein found in cow’s dairy that for some people (not all) can lead to intestinal inflammation and leaky gut, which can allow for full body inflammation and the spread of bacterial toxins called LPS, which worsen endo. A sensitivity to A1 casein can also up regulate the release of inflammatory cytokines, prostaglandins and histamines, which all are involved in endo and period pain.
Lactose
If you’re intolerant to lactose, the intestinal inflammation, if consistent, can cause low grade, full body inflammation, which can lead to more pain. Additionally, this constant irritation of the gut can affect the gut lining causing leaky gut, allowing for the release of LPS.
Histamine
In terms of histamine, certain dairy foods are richer in histamines, such as aged cheeses and yoghurts. Additionally, as we just explored, if you’re sensitive to A1 dairy, this can cause a histamine release too. Histamines are involved in uterine contractions and pain with our periods and endo, and so if you have elevated levels of histamines or you struggle to break them down, you may find you’re more sensitive to these kinds of dairy products.
Arachidonic acid
Finally, dairy contains arachidonic acid, a type of omega 6 fat that helps to make our inflammatory prostaglandins. If we’re eating an imbalanced diet with a high intake of omega 6 and a low intake of omega 3, which helps to make our anti-inflammatory prostaglandins, we may find we’re making too many of the inflammatory ones.
Hormones
Insulin
Dairy has been shown to raise insulin levels higher than one would expect for its carbohydrate content, which may lead to insulin resistance over time. Remember that insulin is the hormone that regulates blood sugar and when this is too high, it causes hormonal problems.
However, fermented dairy is associated with a lower risk of type 2 diabetes, reduced insulin and glucose levels.
So it’s not currently clear from the research what the overall impact is on insulin, and it may depend on your own genetics and body, as well as the dairy you’re consuming.
Androgens
Dairy contains naturally occurring growth factors, including insulin-like growth factor 1 (IGF-1). These growth factors, along with possible increases in insulin levels, can raise androgen levels, like testosterone. But in contrast, research on women also showed a reduction in testosterone and an increase in sex hormone binding globulin, which binds to testosterone. So again, it may be individual.
Oestrogen
In some studies, it was shown that dairy could increase oestrogen levels, however, the research looked at men, women and children but they did not measure the hormone levels of the women. Instead, they looked at ovulation times of women, which were not affected by dairy, so if hormones were affected, it doesn’t seem like those effects were significant enough to disrupt the cycle.
In contrast, a study specifically focused on women, found that as dairy intake increased, estrogen decreased.
Progesterone
Research has shown a rise in progesterone with dairy consumption, however, if insulin levels and androgen levels rise high enough to prevent ovulation, this would cause low progesterone levels.
It’s important to note that decreased progesterone levels have not yet been shown in the studies, but anovulation has been observed, which would negatively affect progesterone production by default, as you must ovulate to make progesterone.
Ovulation
Research has shown a greater risk of anovulation (skipped ovulation) with cream and yoghurt (particularly low fat yoghurt) and an increased risk of anovulatory infertility with a greater intake of low fat dairy (meaning one cannot get pregnant because they’re not ovulating). In contrast, an increased intake of full fat diary was associated with a lower risk of anovulatory infertility.
Responses are individual
Researchers don’t exactly know how dairy influences hormones yet, but most research indicates that dairy does seem to have some impact on hormones, so at this stage, it’s about identifying how you personally respond to it.
Endo belly
Lactose
68% of the global population is estimated to be lactose intolerant and lactose intolerance is very common in the SIBO population. Research estimates that up to 80% of people with endo may also have SIBO, so if you have SIBO, it's worth treating that to see if you can resolve your lactose intolerance. Lactose is also high FODMAP, which means it's rapidly fermentable, which can increase gas and bloating in people with IBS, SIBO, etc.
Not all dairy is high in lactose and most people with lactose intolerance can actually tolerate a small amount; 12g at any one time, and about 24g over the day.
A1 casein
A1 casein is type of milk protein which research suggests some people find triggers intestinal inflammation and gut issues. It's worth noting that whilst it's true for a number of people, not everyone will have this reaction. A2 casein has been observed as typically better tolerated and this comes from sheep and goat's dairy, as well as buffalo, Guernsey and Jersey cows.
Histamine
Histamines are inflammatory immune chemicals that are made in the body, but are also found in dairy products, especially fermented/aged. Histamine issues are quite common within the endo population, and we may have a hard time breaking down histamines. This can cause gut problems like diarrhoea, intestinal pain and bloating, as well as allergy symptoms, inflammation and pain. Gut health problems like SIBO can be a root cause of histamine issues, so healing your gut may allow you to digest more high histamine foods with time.
Pros
So if you do tolerate dairy or some types of dairy, what are some of the most relevant pros for this community?
Pain support
Dairy is one of the few sources of food based vitamin D and it contains bioavailable calcium. When I say bioavailable calcium, what I mean is that it is easy for the body to absorb and use. There is plenty of calcium in plant foods, but some of these plant foods have other nutrients in which affect our ability to absorb the calcium. For example, the oxalates in spinach bind to calcium, which affects our ability to absorb it.
Vitamin D and calcium are both essential to managing and lowering period pain. In fact, research has shown less period pain in those who ate more dairy, than less and showed associations with less menstrual pain with diets that contain fruit, veggies, dairy, legumes and whole grains.
Low levels of calcium causes more uterine contractions and so research has shown improvements in pain with a higher intake of dairy.
Fertility
As we just explored briefly earlier, certain types of dairy, such as full fat yoghurt, are associated with a lower risk of anovulatory infertility.
Probiotic foods may help lower system inflammation
The other positive of dairy is that in some research, fermented dairy has been associated with lower inflammatory markers and inflammatory disease risk, and a recent meta-analysis confirmed these benefits, though noted that only specific inflammatory markers reduced.
Research has shown that people with endo have higher levels of inflammatory markers, and we know that inflammation impacts our pain levels and disease progression, so lowering these markers is a step towards managing the disease.
Blood sugar
Unfortunately, the endo community are at higher risk of metabolic syndromes, including type 2 diabetes and clinically, we often see blood sugar imbalances within this community. As we touched upon earlier, fermented dairy has been associated with lower insulin levels and glucose levels, and having these two balanced can help us manage energy levels, hormones and pain. If you’d like to understand more about that, I’ve linked to a recent episode in the show notes.
Fermented dairy intake is also associated with a lowered risk of type 2 diabetes. It is insulin resistance that eventually develops into diabetes, and so it’s likely that the reduced insulin levels and glucose levels is what helps reduce the risk of type 2 diabetes with fermented dairy.
If you tolerate dairy, or some types of dairy, fermented dairy could play a role in helping you to manage your blood sugar and reduce your risk of metabolic syndrome.
Fermented dairy may help improve endo belly gut dysbiosis
People with endo may have less beneficial bacteria and short-chain fatty acids, both of these factors can have an influence on endo pain and progression and if you’d like to learn more about that, I’ve linked to some recent episodes in the show notes. Probiotic foods not only replenish healthy bacteria levels, but also improve short chain fatty acid production, and research has demonstrated that fermented dairy products like kefir and yoghurt improve the gut microbiome, as well as the SCFAs we’re often low in too, like butyrate. I’ve linked to an episode on this topic in the show notes.
Can help heal leaky gut
Finally, fermented dairy may play a role in helping us to heal leaky gut - providing we tolerate it of course, as if we don’t, that can irritate the gut lining and actually cause leaky gut. As we explored earlier, the presence of leaky gut can and does allow for bacteria and lipopolysaccharides to cross the border from our gut to our blood stream, and spread systemically, triggering inflammation, but also into the pelvic cavity, where pathogenic bacteria and LPS have been found in people with endometriosis and are implicated in the development of the disease.
Leaky gut is a major contributor to bacteria and LPS translocation (meaning movement from one place to another) and so healing leaky gut is a key strategy in managing endometriosis.
We know that microbiome dysbiosis, which is common in endo, is a driver of intestinal inflammation and intestinal permeability, so improving the microbiome could have an indirect beneficial effect on the gut lining. Additionally, whilst we don’t have specific studies on dairy for the gut lining (that I can find), research does show that probiotics foods help to support gut barrier integrity.
How to know if dairy is or isn’t for you
If you suspect lactose intolerance, you can actually be tested by your doctor for this, so I have linked to the NHS guidance in the show notes
For dairy in general, the most evidenced-based and accurate way to determine if you have a sensitivity or intolerance to dairy would be to conduct an elimination diet. This would be a 4 week period of time where you completely remove dairy, and then you would reintroduce dairy in a systematic manner. Typically this would be 3 days of reintroducing one animal type of dairy, such as goat’s dairy, followed by 4 days of no dairy, to observe any delayed reactions. If you have no reactions, you could bring that type of dairy back in, and then try the next type. If you do react, you would wait for symptoms to entirely subside and then try the next type of dairy. This method is very helpful for understanding gut intolerances and sensitivities.
Now because dairy may affect your cycle or your period pain, you may actually find it more useful to test a certain type of dairy based on an entire cycle, but this would take a long time. It could also be helpful to base this on the components of dairy that we see problems with i.e. high lactose, A1, high histamine, etc.
So for example, cycle one, you remove all dairy and observe your cycle and period.
The next cycle, you could reintroduce A2 types of dairy only and see how your symptoms are. Of course, if you notice symptoms straight away, such as gut problems, you don’t need to force yourself to continue for an entire cycle. If you find that you felt good when you ate no diary for a month and also felt good when you only had A2 sources, this implies that A1 dairy is not ideal for you.
You could also do cycle experiments with fermented diary only, but no non-fermented dairy such as cream and milk or low lactose dairy only, or low histamine dairy only.
It really depends on what you suspect is the issue for you, but the best place to begin, and the simplest would likely to be to start with a complete eradication for 4 weeks/one cycle, and then try an entire cycle with A2 dairy, as this is often where people see improvements.
If you then feel like you need to get more detailed and nuanced, you could then experiment with these other examples I have given you. This can often be where tailored guidance from an expert like a nutritionist, dietician or health can be helpful.
Generally, I recommend that you work with someone where possible, or at least have the guidance of a course or book written by an expert, for example, Dr Megan Rossi has a great gut health book which walks you through an elimination diet for dairy.
If removing dairy for an entire month feels triggering or too difficult, perhaps try taking it out in the week leading up to and during your period, to see if you observe any improvements. Remember, inflammation takes time to calm down, so it may not be enough for you to see a difference from, but for some, it may work wonders, so could be worth a try!
Now remember, this is general education only and I am speaking to hundreds of you, so I can’t tailor this to your personal issues. Again, as I said, it would be ideal if you could work with a practitioner, if not, at least inform your doctor as elimination diets are medically approved and evidenced-based ways of testing for intolerances and sensitivities, so in theory, they should understand why you want to try it. And of course, if you have a history of disordered eating, it’s best to work with a mental health practitioner and doctor before considering any kind of elimination diet.
Okay so that sums up and finalises our series on dairy and endo.
As you can see, it’s not straight forward, but with some experimentation, you should be able to identify if dairy is right for you, which types, and how much.
Show notes
References for dairy and pain (see show notes)
https://www.theendobellycoach.com/podcast/dairy-endo-pain
References for dairy and hormones (see show notes)
https://www.theendobellycoach.com/podcast/does-dairy-affect-endo
References for dairy and endo belly (see show notes)
https://www.theendobellycoach.com/podcast/endo-belly-dairy
Endo and inflammatory markers
https://journals.mk/aph/article/view/6060
https://pmc.ncbi.nlm.nih.gov/articles/PMC5859972/
https://pmc.ncbi.nlm.nih.gov/articles/PMC7956504/#:~:text=The analysis of the values,with severe endometriosis (median values:
Endo and metabolic risk
https://www.theendobellycoach.com/podcast/glycemic-index-load-endo
Endo and gut bacteria and short chain fatty acids
https://www.theendobellycoach.com/podcast/endometriosis-butyrate
https://www.theendobellycoach.com/podcast/endometriosis-short-chain-fatty-acids
https://www.theendobellycoach.com/podcast/endometriosis-propionate-acetate
https://pmc.ncbi.nlm.nih.gov/articles/PMC10805679
https://www.theendobellycoach.com/podcast/endo-fermented-foods
Lactose testing
https://www.nhs.uk/conditions/lactose-intolerance/
Elimination diet guidance
https://www.nhs.uk/conditions/food-intolerance/
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