EP.283/ Why your endo may be worse in january
Today’s episode is continuing with the theme of why some of your conditions may be worse in January, and today, we’re focusing on endometriosis.
Before we get into it, this is a short episode where I am giving you an overview of some of the ways these things can affect people with endo, but it’s not an exhaustive list. In fact, each of these topic areas could have their own episode with a deep dive into how the science works in regards to hormones, inflammation, liver function and so on, but rather than overwhelm you with a bunch of science, I am keeping in what you need to know and have linked to some further resources if you want to learn more.
Additionally, the strategies I’m suggesting are very much top line suggestions, but if you go to last week’s episode and listen from 14 minutes in, I give a much more detailed breakdown of how to make these changes there.
Finally, you’re going to hear today mainly about dietary and lifestyle choices that can influence our endo and that we may have been more prone to in December. However, I want to be really clear here – endometriosis is not your fault. I wish you could enjoy more sugar, alcohol, whatever you love, over December, without it flaring up your conditions. It’s my belief that the ones off are really not as important as your daily, consistent choices and so if you choose to indulge a bit at Christmas or at a hen do or whatever, I want you to enjoy that, because my focus is actually on the day in, day out habits of your lifestyle and nutrition and those are much more important than a single month of the year.
But, having said all that, the reality is, that certain foods and lifestyle choices can and do raise inflammation, affect hormones and so on. And this can mean an increase in endo symptoms come January.
That doesn’t mean you should listen to this episode and scold yourself. Absolutely not. The point of this episode is to help you understand why you may be feeling worse, so that instead of panicking that your endo has suddenly grown overnight or that something is drastically wrong, you can maybe have a bit more of a sense of control, because why it’s happening is now clearer to you. You can then make informed choices to improve your symptoms, because you know what to change.
This also doesn’t mean that next December you can’t have a bit of sugar or sip of alcohol, but if you want to learn ways to counteract the effects of some of these festive foods next year, I have several episodes from December about how to enjoy the season and look after your endo and the links to those episodes are in the show notes.
Alright, so now we’ve addressed those issues, let’s look at why your endo symptoms may be worse in January.
Lack of sleep raises inflammation levels and pain signals
So many of us come out of December sleep deprived, and even though that’s common and may seem normal, given the heightened activity and social demands of the season, it’s not great for our health.
We all know the importance of good sleep – but for many of us with endometriosis and chronic conditions, the impact of sleep deprivation can be felt more acutely.
It’s widely understood that inflammation is one of the key drivers of growth and pain with endometriosis. What you might not know is that lack of sleep actually causes a rise in inflammation, which could result in more pain and endo related symptoms.
To compound the problem, research shows that sleep deprivation decreases the brain’s natural pain relievers, like dopamine, and makes us more sensitive to pain.
So already, we can see why endo may be worse come January. But have you noticed yourself feeling worse about it too? Lack of sleep has been shown to worsen feelings of anxiety and depression, which can cause us to further panic about our symptoms if they’re worsening this month. The problem is however, that psychological stress, like depression and anxiety, make the brain feel unsafe, which causes it to turn up the volume on pain, because it’s looking for any threat possible which may be the cause of the unsafety. If you want to understand how this works, I’ve attached a link to another episode with Christie Uipi, who shares exactly how pain is produced.
Sugar raises inflammation levels
Moving onto sugar, which is the favourite indulgence of the holiday season for many of us!
As you’ve probably learnt by now, sugar and the resulting blood sugar spikes, raise levels of inflammation in the body, which in turn, especially when repeated, can heighten pain levels. It’s one of the reasons why I don’t recommend tucking into sugar laden comfort foods if you have pain on your period (which I assume you most likely do, if you’re listening to this), as it can make that pain worse – a lesson that took me a long time to learn prior to training in endometriosis!
The other problem that can arise from excessive sugar consumption, is hormonal imbalances. Repeated blood sugar spikes can cause hormonal shifts in the body which results in oestrogen dominance and even decreased progesterone levels, and whilst oestrogen dominance can come with its own set of symptoms like tender breasts, PMS, bloating, etc. it can also come with symptoms that look a whole lot like endo, such as premenstrual cramping, painful periods, clots and heavier bleeding. Additionally, if you have elevated oestrogen levels, especially if those oestrogen levels are left unchecked because progesterone isn’t high enough to keep oestrogen under control, then we may find ourselves with more active endo, as endo is an oestrogen dependent disease for most of us (there is some research to suggest this varies from person to person and progesterone may have some influence in some cases).
Finally, just a little side note – lack of sleep also increases blood sugar instability and the likeliness of blood sugar spikes, which can of course worsen the effects of the extra sugar we may have consumed over the holiday season.
Alcohol increases oestrogen dominance
Next up is alcohol, which I think many people typically increase in December.
Alcohol can contribute to blood sugar instability, so everything I just said in regards to sugar, also applies to alcohol.
However, alcohol, especially when consumed regularly, can raise full body inflammation and cause inflammation in the gut. We know, in terms of endo, that gut inflammation and gut problems like leaky gut (which alcohol can contribute to), can worsen pain and inflammation in the pelvic area and may even be linked to the growth of endo, due to certain types of toxins, known as lipopolysaccharides, which escape through a leaky gut wall and enter the pelvic cavity. Again, this is a short episode so we won’t be deep diving into that here, but if you want to learn more about the gut-endo connection, I’ve linked to a few resources in the show notes.
Additionally, alcohol may cause oestrogen dominance or excess and lowered levels of progesterone, in fact, research has linked alcohol to both of these scenarios, even with just moderate consumption.
Your liver is responsible, in partnership with the gut, for removing waste and excess oestrogen from the body. However, your liver will always prioritise toxins first, and that unfortunately, includes alcohol. What happens in this case is that oestrogen gets pushed to the back of the queue, and continues to build up, and some will eventually be reabsorbed by the blood stream, resulting in excess oestrogen levels.
Another way alcohol may raise oestrogen is by increasing the conversion of testosterone into oestrogen, whilst research shows it can suppress the production of progesterone.
So, if you were drinking regularly or heavily during December, it’s likely that your oestrogen levels are a bit off, which can result in the scenario I listed earlier, of heavier bleeding, more cramps, more endo activity, etc.
Physical exertion may increase adhesion pain
This one may sound unusual, but if you’re getting more pain and you were particularly active in December, with lots of dancing, running around and physical exertion, there’s a chance that you might be experiencing adhesion pain.
Adhesions are web-like collagen structures that form after surgery or from endometriosis (and other things), and unfortunately, if you’ve had a surgery for endo, it’s very likely, based on the data, that you have some adhesions. Adhesions form from scar tissue, and they can attach ovaries to your bladder, your bladder to your uterus, and so on, and the pressure and pain they cause can be extremely debilitating. The problem is that once adhesions are there, they can tug your body in certain ways and cause organs to be pulled in various directions, which can mean that if you then become particularly active, you may upset things.
Does this mean you shouldn’t have danced the night away on New Year’s Eve? Absolutely not, but you may need to get these adhesions addressed so that you can dance and be social without pain in the future!
Caffeine may increase oestrogen levels
Okay, lastly, if you were drinking extra cups of cosy coffee, black tea, matcha, or hot chocolate across the cold month of December, then you likely increased your caffeine intake.
This may or may not be a problem for you – it depends on how your body responds to it. Research shows that for some, caffeine is anti-inflammatory, whilst for others, it’s inflammatory. Now, you may be thinking ”but isn’t coffee, green tea, dark chocolate, etc. supposed to be really good for the gut and overall health?”. Yes, that’s true! But you can still have these things without the caffeine by buying decaffeinated versions (just look for coffee made with the Swiss Water process, which uses water, rather than chemicals to decaffeinate the beans).
This inflammation is especially true if you have IBS-D, which is IBS diarrhoea type, as caffeine can trigger diarrhoea and repeated diarrhoea can inflamed the intestines and cause further aggravation like cramps, etc.
Additionally, caffeine may increase your oestrogen levels. Remember what I was saying about alcohol being prioritised by the liver? Well, it’s a bit similar. Yes, caffeine will be prioritised by the liver, putting oestrogen on the back burner, but there’s more to it as well. Oestrogen and caffeine are metabolised (in simple terms, detoxed from the body) using the same enzyme, called CYP1A2. Some people have genetic differences which means this enzyme that it doesn’t work as well, so if you’re taking in a lot more caffeine and this enzyme is already having a hard time doing its job, you can see where a problem may arise!
The other issue with caffeine is that it triggers the flight or fight response, by stimulating the production of cortisol and adrenaline. If you’re being triggered into this state repeatedly, on a daily basis or several times a day, this will eventually have an effect on your sex hormone levels. When the body or brain is stressed, your body believes you’re not in a safe environment to conceive and will start suppressing ovulation, progesterone production, etc. Again, we could deep dive into the various ways this works, but to keep this episode digestible, I’ll leave it there and direct you to some further resources.
Okay, so now you have more of an understanding as to why you may have more endo symptoms this month, I hope that it’s maybe reducing your panic around whether your endo has suddenly got worse out of the blue. The chances are, it will calm down again next month, and the month after that, and so on.
But we can certainly do some things to support that to happen…
Prioritise sleep – if you’re chugging on the caffeine, reducing that might need to come first! But if not, try building up to giving yourself a nine-hour sleep window. If you’ve been used to late nights or sporadic wake up times, you’ll likely need to make gradual progress towards your ideal sleep and wake time as your circadian rhythm (otherwise known as your sleep-wake cycle, will take some time to adjust and get into the routine).
Dim the lights and get off screens at least an hour before bed. If you can’t do that, get some blue light blocking glasses, set your phone to night mode (so it turns red), and turn down the brightness on all devices.
If you have trouble where you wake during the night, have a listen to the episode I’ve linked in the show notes.
Be mindful of sugar consumption – replace sugary treats with dark chocolate, fruits, yoghurt, etc. and healthy snacks, and try to keep sugar like maple syrup, honey and table sugar to special occasions or a weekend treat. This may take a while to get to, because sugar is a very addictive substance, so you may need to do this gradually to prevent difficult withdrawals.
Additionally, focusing on stabilising your blood sugar, again, over time (you don’t need to rush this process) will help you to crave sugar less and I’ve linked to some resources for learning about blood sugar in the show notes.
Reduce your caffeine intake if possible and if you feel it’s affecting you – I The best way to determine if you can tolerate caffeine, would be to remove it for one month, see how you feel, and then reintroduce it and look for symptoms. Be mindful of noticing your tolerance levels too – start slow with one cup a day and see how you feel, and then notice how you feel on two cups a day, etc. However, you really shouldn’t jump in to going decaf straight away as you can stress your body and get some pretty nasty withdrawals. Do this gradually and have a listen of last week’s episode for some tips and examples.
If you’re pretty sure you can metabolise caffeine well and it doesn’t cause any inflammatory reactions, I do still encourage you to consume caffeine with a meal which will help lessen the effects on your stress hormones, and therefore your sex hormones.
Reduce alcohol - If you’ve increased your alcohol intake and you’re looking to cut down, I’ve got some very detailed ideas on how to do this in last week’s episode, and I’ve linked to that in the show notes, and I also have some suggestions on how to lessen the burden of alcohol in episode 277.
Address adhesions - Finally, adhesion pain may take some time to calm down, but what we want to do is bring circulation and the immune system to the area to help clear scar tissue, so this is where self-massage and things like castor oil packs can help! Additionally, certain stretches and professional massages are really required to actually create some mobility and break the adhesions down, and I’ve linked to an episode all about adhesion management strategies in the show notes.
Show Notes
Sleep
https://endometriosisnews.com/2020/09/17/5-ways-sleep-deprivaton-affects-endometriosis/
https://www.theendobellycoach.com/podcast/how-the-brain-increases-endo-pain-and-how-pelvic-pain-becomes-chronic-with-christie-uipi-of-curable
https://www.theendobellycoach.com/podcast/night-waking-endo?rq=waking
Blood sugar resources
https://endometriosis.net/living/diet-sugar
https://endometriosis.net/living/how-to-balance-your-blood-sugar-levels-to-reduce-endo-symptoms
Alcohol
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8926958/
https://www.theendobellycoach.com/podcast/what-is-the-endo-belly-endometriosis-ibs?rq=endo%20belly
https://www.theendobellycoach.com/podcast/endo-belly-treatment-endometriosis-ibs?rq=endo%20belly
https://www.theendobellycoach.com/podcast/endo-belly-endometriosis-sibo-ibs?rq=endo%20belly
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4519769/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5902457/
https://www.ncbi.nlm.nih.gov/pubmed/28988571
https://academic.oup.com/alcalc/article/35/5/417/206575
Adhesions
https://www.theendobellycoach.com/podcast/strategies-loosen-adhesions-frozen-pelvis?rq=adhesions
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Produced by Chris Robson