EP.369/ Study Spotlight: Can Reducing Alcohol Really Improve Your Endometriosis Pain, and Why?

Podcast

31 Oct

In this episode, I am continuing our Study Spotlight Series on the study: Dietary Modification and Supplement Use For Endometriosis Pain.

Today we’re looking at the dietary changes findings, and we’re starting with alcohol. The study found that out of those who tried reducing or eliminating alcohol, 53% experienced a reduction in pain.

Now again, like we discussed when we looked at the study overall, we don’t have information on how long people reduced alcohol for or by how much, so there are variables here - some people may have reduced alcohol for only a week, and saw no improvements, so went back to their usual amount, others may have reduced it for a month before they saw improvements, and so on. And as I said before, other factors could have remained that may have trumped the removal of alcohol, such as a diet rich in sugar, which unfortunately we know has an impact on oxidative stress and inflammation, which both contribute to pain. There’s also of course so many variables regarding what’s happening in each participant’s lives that could be influencing pain levels, what state their endo may be in, how tight their pelvic floor is, do they have adhesions from surgery or endo itself, and if they have any other contributing factors of pelvic pain associated with endo, like pelvic congestion syndrome, SIBO/IBS or interstitial cystitis.

But now we’ve looked at the possible variables of the study, is there any other evidenced out there to suggest that reducing alcohol intake could help?

There have been a number of studies looking at endometriosis risk and alcohol consumption. Results have been consistently mixed, but the latest meta-analysis of all the research concluded there was only a borderline statistical difference between no alcohol intake and any amount of alcohol intake and endometriosis risk, yet there was a significant association between moderate alcohol consumption and endometriosis risk when compared to no alcohol intake at all.

However, the researchers did conclude that the studies had limitations and that more research was needed. The researchers also suggested that the possible association could potentially be due to endometriosis patients treating pain with alcohol consumption, so that it looks like there’s an association between the two, but in fact people just drink more with endo in order to try and numb the pain.

So what about evidence showing pain increases with alcohol? One study looked at 484 participants and their management strategies for endometriosis, and 52.8% of those who used alcohol to essentially numb pain in the moment, reported an increase in pain (as well as fatigue and hangovers) the following day. Interestingly, alcohol was a self-management strategy with the highest report of adverse effects following use.

Previous research has also found an association between menstrual pain severity and alcohol intake, though some of the research findings have been conflicting.

Now, we can see that more research needs to be done, but the general research trends lean towards alcohol making endometriosis or menstrual pain worse. So, why does that happen?

There are a number of reasons.

Alcohol consumption promotes oxidative stress. Oxidative stress is a damaging process in the body which is also heavily linked to endometriosis growth and development and inflammation.

Oxidative stress triggers the release of inflammatory mediators, including interlukein-6, cytokines and prostaglandins, which are all involved in endometriosis inflammation and development. Alcohol increases prostaglandin production by stimulating inflammatory cytokines, which trigger the release of inflammatory prostaglandins. Prostaglandins are a key driver behind endometriosis and menstrual pain. Research has shown that people with endo and dysmenorrhea (meaning period pain) have higher levels of inflammatory prostaglandins. We also know that inflammatory prostaglandins are central to endometriosis development and progression.

Alcohol is also known to increase intestinal permeability (a.k.a leaky gut), resulting in the release of lipopolysaccharides (toxins from certain type of bacteria), into the blood stream and surrounding area. LPS bind to cytokines and trigger an inflammatory response including the release of prostaglandins, and are yet another key factor in endometriosis development. LPS have been found in higher levels in the peritoneal fluid (the fluid found on the pelvic and abdominal region) in people with endometriosis.

We also know that alcohol can negatively impact blood sugar, which can result in more oxidative stress and can also influence hormonal changes.

Which leads me on to our last point, and that’s how alcohol can affect hormones.

Numerous studies have shown alcohol increases oestrogen production and can decrease progesterone. We know that oestrogen plays a lead role in stimulating endometriosis growth, and that progesterone can help dampen the effects of oestrogen. If we have excess oestrogen production, compounded by a reduction in progesterone, we can see how this can exacerbate endometriosis symptoms and possible activity. This can also pave the way for oestrogen dominance and excess proliferation of the uterine lining, meaning that periods could be heavier, more painful and more clotty.

Okay, the data is pretty clear on alcohol consumption and increased inflammation, oxidative stress, unhealthy blood sugar changes, intestinal permeability and increased LPS in the blood stream and hormonal disruption, all of which can contribute to endometriosis symptoms and activity.

So, given this, I do think that what participants are reporting in terms of seeing an improvement in pain when alcohol is reduced, is valid. And in fact, I see this consistently with my clients.

But does this mean you can never drink again? Of course not, but it might mean, if you’re really struggling with your endo symptoms and you’re open to some lifestyle changes, that you might want to moderate your alcohol consumption.

Now, one of the most helpful things we can do is eliminate alcohol for one month entirely. This gives the gut lining a chance to heal and for the intestine wall to repair, so that it’s not so leaky and less LPS can pass through, and for hormones to stabilise and inflammation to lower. This gives you a really clear picture as to whether removing alcohol can help, though I will say that three months is normally a really good time frame to allow the body to recover and for hormones to stabilise, and to see positive effects of any strategy, but standardly, if we’re eliminating a food group, we’re doing it for a month.

Then, following that month, you may want to reintroduce it occasionally, at times that you feel are best suited for you. For example, perhaps you really like a glass of wine with dinner each night, but maybe you now move to having it with dinner on Fridays or just once or twice a week with dinner, or perhaps you might prefer to keep it to social outings only, and if you’re a social butterfly, perhaps for special occasions like weddings and birthdays, otherwise you might end up drinking pretty regularly if you’re very sociable! I would experiment with different approaches to see which benefit your pain the most, and which suit your lifestyle the most. For example, you might feel the best benefits from pretty much being alcohol free and keeping alcohol to special occasions, whereas others may find that going from 4 drinks a week to 1 or 2 is enough to see improvements.

If you can’t do a month alcohol free to calm any intestinal inflammation, consider doing 3 weeks or 2, or even just a week, and then working out what you could reduce it down to overall.

And if you’re not ready to reduce your alcohol intake yet, that’s absolutely your choice, we all have different ways of managing endo, and you may find other ways that work better for you, or suit your lifestyle more. You have to find a way that works best for you and enhances your quality of life, not takes it away.

Okay, that’s it for this week! See you next week.

Show Notes:

This episode is sponsored by Mira, your at-home hormone testing device. Use this link and code 2DJESS20 to get 20% off the device and any future wand orders.

Study Spotlight

https://www.theendobellycoach.com/podcast/new-endo-survey-study-review

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2831953

Alcohol and endo risk

https://www.mdpi.com/2306-5710/10/2/33#B97-beverages-10-00033

https://pmc.ncbi.nlm.nih.gov/articles/PMC9645754/

Alcohol and endo pain

https://link.springer.com/article/10.1186/s12906-019-2431-x

Alcohol and period pain

https://www.jpagonline.org/article/S1083-3188(19)30270-0/abstract

https://www.mdpi.com/2227-9032/11/9/1289#B36-healthcare-11-01289

https://bmjopen.bmj.com/content/15/2/e088537