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I recently read an article about concerns with the use of flaxseed in women with adenomyosis due to its estrogen activity. This article intrigued me since I have always promoted the use of this nutrient, so I did some research.
The reason that I promoted the use of flaxseed in women with adenomyosis is because I had tremendous symptom relief after adding flaxseed to my diet. At that time, I had been suffering terribly with severe pain, and I was desperate to find anything that would help me. I had been on all kinds of medications, none of which helped, and had several surgeries. I read up on the health benefits of flaxseed, and I was ecstatic when, after I added it to my diet, my pain level dropped dramatically.
I have since published a book, Adenomyosis: A Significantly Neglected and Misunderstood Uterine Disorder, and have included an entire chapter on the benefits of omega-3 fatty acids in the treatment of adenomyosis. Flaxseed contains very high levels of omega-3 fatty acids. Another chapter is dedicated to phytoestrogens, and flaxseed also falls into this category.
The concern with the use of flaxseed is that it contains a substance called lignans. Lignans are a type of phytoestrogen. Phytoestrogens are substances that can act like estrogen in the body. Many people are concerned that lignans may increase their estrogen levels and lead to further problems with adenomyosis since it is an estrogen-dependent disorder. A very reasonable concern, for sure.
The subject of phytoestrogens is a very complicated topic as I found out while doing research for my book. I found out that some phytoestrogens are not advised while others may actually help those with hormone-dependent disorders such as adenomyosis. Let me explain.
Phytoestrogens compete against our own natural (endogenous) estrogen for the estrogen receptor sites in our body. Estradiol is an example of endogenous estrogen. In general phytoestrogens are much weaker than endogenous estrogen. According to Seidl and Stewart, “the relative potency of phytoestrogens is, at most, only 2% that of estradiol.”¹ That is a general statement, however, and is not always the case as you will see below.
Proponents of the use of phytoestrogens argue that since they are so weak and they compete with our own estrogen which is much stronger, our estrogen levels should drop which would be good for hormone-sensitive disorders. However, recent research has shown that these substances act in different ways. In fact, a few phytoestrogens have, in fact, been found to be as strong as estradiol.
Some phytoestrogens are estrogen agonists, meaning that they increase estrogen levels. As stated previously, a few have been reported to be as strong as estradiol. However, some estrogens are antagonists, meaning that they decrease estrogen levels. Black cohosh is an example of an estrogen antagonist. A study by Rebbeck et al. has shown the use of black cohosh in women with breast cancer may have a protective effect since this herb has been shown to have anti-estrogenic effects.²
The most important thing to know is just because a nutrient is known to be a phytoestrogen, that doesn’t necessarily mean that it’s bad for women with hormone-sensitive conditions. It all depends on the specific phytoestrogen and if it works in an agonist or antagonist fashion. Now, let’s look at flaxseed specifically.
The few studies out there regarding flaxseed and estrogen activity have been inconsistent. However, evidence seems to be pointing in the direction that flaxseed may actually be beneficial in hormone-sensitive disorders. However, much more research needs to be done to confirm these findings. Many experts still warn about the use of flaxseed in hormone-sensitive disorders.
- A study was performed where women with recently diagnosed breast cancer ate one muffin per day for 40 days that contained 25 mg flaxseed. The researchers noted a reduction in tumor growth during this time.
- A case-controlled study in the U.S. showed that women with this highest intake of lignans had the lowest risk of endometrial cancer and ovarian cancer.
- Another study showed a reduction of breast tumor growth and metastasis in rats that consumed a diet high in lignans.
- According to WebMD, “some early laboratory and animal research suggests that flaxseed might actually oppose estrogen and might be protective against hormone-dependent cancer.”³
These findings are suggestive of an estrogen-antagonist action in the lignans found in flaxseed. However, if you are still worried about this nutrient, there are other options, such as fish oil which contain high levels of omega-3 fatty acids without the controversial lignans. Omega-3 fatty acids have been found to be very beneficial in the treatment of endometriosis.
- A study done by Covens, Christopher, and Casper in 1988 showed that “dietary supplementation with fish oil, containing the n-3 polyunsaturated fatty acids EPA and DHA can decrease intraperitoneal PGE2 and PGF2-alpha production and retard endometriotic implant growth in this animal model of endometriosis”.4
- Another study done by Missmer, Chavarro, Malspeis, Bertrone-Johnson, and Hornstein in 2010 states “…those women in the highest fifth of long-chain fatty acid consumption were 22% less likely to be diagnosed with endometriosis compared with those with the lowest fifth of intake…”5
Hopefully more studies will be done soon on lignans and their effects on estrogen levels so these preliminary findings can be confirmed or disproven. We need clear answers so we can deal with these hormone-related disorders, especially adenomyosis, effectively.
If you want to try flaxseed to see if it helps you, the following brand is the kind that I purchased years ago when I tried it (click on image to purchase through Amazon):
For more detailed information on phytoestrogens, omega-3 fatty acids, and flaxseed, check out my book, Adenomyosis: A Significantly Neglected and Misunderstood Uterine Disorder. Click on image to purchase through Amazon.
¹Seidl, M.M. & Stewart, D.C. (1998). Alternative treatments for menopausal symptoms: Systematic review of scientific and lay literature. Canadian Family Physician, volume 44. Retrieved from http://www.europepmc.org/backend/ptpmcrender.fcgi?accid=PMC2278270&blobtype=pdf
²Rebbeck, T.R., Troxel, A.B., NOrmal, S., Bunin, G.R., DeMichele, A., Baumgarten, M.,…Strom, B.L. (2007). A retrospective case-control study of the use of hormone-related supplements and association with breast cancer. International Journal of Cancer, 120, 1523-1528. doi: 10.1002/ijc.22485
4Covens, A.L., Christoper, P., & Casper, R.F. (1998). The effect of dietary supplementation with fish oil fatty acids on surgically induced endometriosis in the rabbit. Fertility and Sterility, 49(4), 698-703. Retrieved from http://www.researchgate.net/publication/20324462_The_effect_of_dietary_supplementation_with_fish_oil_fatty_acids_on_surgically_induced_endometriosis_in_the_rabbit
5Missmer, S.A., Chavarro, J.E., Malspeis, S., Bertrone-Johnson, E.R., & Hornstein, M.D. (2010). A prospective study of dietary fat consumption and endometriosis risk. Human Reproduction, 25(6), 1528-35. doi:10.1093/humrep/deq044
Another excellent article from Bloomin’ Uterus. She mentions flaxseed also in this article and how she avoids it. I have always promoted the use of flax with endo and adeno as I had tremendous symptom relief during my struggle. However, as I recently discovered, there are some concerns with its use. After reading all the evidence, I still personally do promote the use of flax, and I will get into this in much more detail in a future blog. In the meantime, read up on parabens – it is really important to avoid the use of this type of xenoestrogen as much as possible! Thanks, Lisa, for another informative article!
What are Parabens? Parabens are chemicals used as preservatives in consumer products. Why are they Bad for Us? If you happen to suffer from Endometriosis, or any other estrogen-driven condition (like breast cancer), please be aware that parabens mimic estrogen. Just like soy. Just like flax. Parabens are an “endocrine disruptor,” which alters our body’s hormone […]
During my struggle with adenomyosis and through my research, I have found that the following foods and supplements may improve symptoms of adenomyosis and estrogen dominance. This information may be particularly useful to those who do not want to undergo a hysterectomy.
Would you like to comment on your own experiences regarding diet and adenomyosis? See “My Blog” and tell your story!
1. Fiber – helps to rid the body of excess estrogen. Good sources include beans, nuts, seeds, oatmeal, and fresh vegetables.
2. Omega-3 fatty acids – an anti-inflammatory nutrient that has also been shown to balance hormone levels. Sources include anchovies, mackerel, wild salmon, herring, sardines, tuna, walnuts, chia seeds, and flaxseed.
3. Organic foods – because of the way they are grown, these foods contain less xenoestrogens.
4. Cruciferous vegetables – contain a substance called diindolylmethane that has been shown to help the body rid itself of excess estrogen. Sources include broccoli and cauliflower.
5. Phytoestrogens – weaker estrogens than that found in the human body and they compete for estrogen receptor sites. Good sources include flaxseed, sesame seeds, pistachios, sunflower seeds, almonds, beans, soy, multi grain bread, rye, and barley. Sunflower seeds also have a high vitamin E content which has aromatase inhibiting action. See “Treatments” for more information on aromatase inhibitors.
6. B vitamins – help to balance hormone levels. Sources include tuna, salmon, turkey, chicken, beans, potatoes, milk, bananas, and eggs.
7. Foods high in magnesium and zinc – these nutrients help to increase progesterone production. Sources include bran, dark chocolate, pumpkin, squash, edamame, molasses, roast beef, oysters,crab, and lamb.
8. Foods high in sulfur – help to detoxify the liver by binding to estrogen and eliminating it through the GI system. Good sources include onions, garlic, lemons, and leafy green vegetables such as kale, spinach, and swiss chard. Kale chips can be made at home by adding some olive oil and salt and baking it in the oven. Alternatively, I found some wonderful kale chips at Trader Joes. They are a nice alternative to regular potato chips.
9. Vitamin E – low levels of this vitamin are associated with high estrogen in the body.
10. White mushrooms – these have been shown to have some natural aromatase inhibiting action. Since aromatase synthesizes estrogen, eating food with aromatase inhibiting action helps to lower estrogen levels and may possibly help to reduce adenomyosis symptoms. See “Hormonal Imbalance?” and “Treatments” for more information.
11. Citrus fruits – contain d-limonene which helps in the detoxification of estrogen in the liver. Examples include oranges, tangerines, lemons and grapefruit.
12. Seaweed – an effective xenoestrogen detoxifier. Examples include dulce, kelp and nori.
13. Brazil nuts – contain high levels of selenium which is known to have aromatase inhibiting action. See “Hormonal Imbalance?” and “Treatments” for more information.
Herbs high in phytoestrogens and other useful supplements
Phytoestrogens are weaker estrogens and therefore may have a beneficial effect for those suffering from estrogen dominance. Please refer to “Different Types of Estrogen” for a full explanation. This subject is often misunderstood by the general public. Although research is pointing to the overall benefits of phytoestrogens in women’s health, there are conflicting studies. It is strongly recommended to talk to your physician before using the following herbs, especially if you have a family history of estrogen sensitive tumors (breast, uterine, ovarian).
This section has been updated as of May 5, 2016. I have done extensive research on phytoestrogens in preparation for writing my second book, and some of the previously advised herbs have been taken off this list. This list may be updated again as I learn more about phytoestrogens. I recently talked to another adeno sister who brought up an excellent point. Phytoestrogens are weaker estrogens, and in theory, if you increase your phytoestrogen intake, they will occupy the estrogen receptor sites in the body and will prevent the dangerous xenoestrogens from doing so. That sounds great, but it is also necessary to have a liver that is functioning optimally so that it can break down these dangerous xenoestrogens and get rid of them. Just as an example, let’s say a woman with adeno increases her phytoestrogen intake but still eats a lot of processed or junk food. Her liver may be sluggish, so the potent xenoestrogens are still in her body – the liver is not able to break them down efficiently, and they are not eliminated from the body. Eventually the phytoestrogens will disconnect from the estrogen receptor sites, and since the xenoestrogens are still in her body, these dangerous chemicals will then attach to the receptor cells. This, in theory, could lead to a very dangerous estrogen dominant condition. Again, this is just a theory. This topic is very complicated, and we are learning new things every day. I urge you to do your own research and talk to an expert before using phytoestrogens. I do believe they COULD help if, and only if, you change your diet and lifestyle as well.
For a more detailed discussion of phytoestrogens and herbs, please read my book, Adenomyosis: A Significantly Neglected and Misunderstood Uterine Disorder.
1. Milk Thistle – This amazing herb has been known for thousands of years to protect and nourish the liver. Silymarin is the active constituent of the plant, and this substance protects the liver from damage by toxins several ways. First of all, it is a strong antioxidant, and it has been shown to be more effective than both vitamin C and vitamin E. It also helps to prevent the depletion of glutathione which is needed for the proper functioning of the liver. Silymarin has been repeatedly shown to be beneficial in treating cirrhosis and hepatitis. Since estrogen is processed in the liver, it is vital to keep the liver healthy, so the addition of this herb to the diet of adenomyosis sufferers is an excellent idea!
2. Damiana – Known for its aphrodisiac properties, this herb may help with anxiety, depression, hot flashes, and night sweats. It may inhibit aromatase which is needed to convert androgens to estrogen. A 1998 study found that this herb had anti-estrogenic activity, and, according to Zava et al. (1998), this herb is one of the six highest progesterone-binding herbs. It has also been noted that this herb may contain compounds similar to progesterone. Damiana may interact with other herbs and supplements that alter progesterone levels.
3. Dandelion – Believe it or not, this little yellow weed is an invaluable herb. Dandelion, also known as “pee in the bed”, is a powerful diuretic which could be invaluable if you suffer from severe bloating due to adenomyosis. An additional benefit is this herb will reduce bloating without causing the body to lose large quantities of potassium, an unwanted side effect of diuretic drugs such as Lasix. According to Zhi et al. (2007), this herb may be useful “for the clinical treatment of reproductive hormone-related disturbances” (Abstract).
4. Royal Jelly – This nutritious supplement is made from bees. The major constituent is water (67%), but it also contains many nutrients such as protein, sugars, fatty acids, minerals, enzymes, vitamin B5, vitamin B6, and a little bit of vitamin C. It has been used for PMS, insomnia, menopause, and liver disease, and it has been reported to decrease inflammation and nourish the endocrine system. According to Hiroyuki et al (2012), this supplement appears to increase testosterone levels in men and also appears to have no effect on the conversion of aromatase in humans. Caffeic acid phenethyl ester (CAPE) is a substance that is found in bee propolis. Jung et al. studied CAPE in 2010 and found that it had binding affinity to ERβ. Also, CAPE did not increase the growth of MCF-7 estrogen receptor-positive breast cancer cells, and it did not increase the uterine weight.
5. Dong Quai – Zava et al. (1998) report that this herb did not inhibit the production of alkaline phosphatase, which means it does not block the activity of progesterone. In addition, this group notes that this herb has very little estrogenic activity. This herb may actually suppress estradiol synthesis since saliva levels in women who take this herb are very low.
6. Grape Seed Extract – Discovered in 1951 by the French scientist Dr. Jacques Masquelier, this amazing supplement has been shown to be a potent aromatase inhibitor. The ability of this supplement to inhibit aromatase may be very beneficial to women who suffer from estrogen dominance. In a study by Kijma, Phung, Hur, Kwok, and Chen (2006), grape seed extract was shown to possibly be a useful treatment in cases of hormone-dependent breast cancer. Grape leaves, especially the leaves of the red grape, have been shown to have astringent qualities, and this might be beneficial in treating heavy menstrual bleeding. In addition, the proanthocyanidins in grape seed extract are powerful antioxidants which can help keep the liver healthy. Although the data is insufficient, grape seed extract may also help in cases of premenstrual syndrome.
7. Melatonin – This hormone is produced in the pineal gland and is important in modulating our circadian rhythms. It is also a free radical scavenger, helps with the proper functioning of the immune system, and plays an important role in the regulation of sex hormones. Recent studies have shown this hormone may reduce binding to estrogen receptors while it increases binding to progesterone receptors. A study by Rato et al. (1999) showed melatonin interfered with the activation of an estrogen receptor by estradiol. Abd-Allah, El-Sayed, Abdel-Wahab, and Hamada (2003) showed a 59 percent reduction of estrogen receptors in rats that were treated with melatonin. In addition, this same group showed an increase in progesterone receptors of 53 percent in these same rats.
8. N-acetyl cysteine (NAC) – NAC is an excellent antioxidant and chelator of heavy metals. It is an excellent supplement as it aids in optimum liver function. It is derived from the amino acid cysteine and contains a good amount of sulfur.
9. Oregano – According to Zava et al. (1998), oregano is one of the six highest progesterone binding herbs. In addition, the volatile oils in oregano help to detoxify the liver.
10. Quercetin – Quercetin is a plant flavonoid and a strong aromatase inhibitor. A study done by van der Woude et al. (2005) showed that quercetin exerts phytoestrogen-like activity. The group states “the results point at the relatively high capacity of quercetin to stimulate supposed ‘beneficial’ [estrogen receptor] beta responses as compared to the stimulation of [estrogen receptor] alpha, the receptor possibly involved in adverse cell proliferative effects” (Abstract). Quercetin is found in red wine, green tea, onions, berries, and apples. It works best when taken with Vitamin C.
11. Rosemary – According to the Cleveland Clinic (2016), rosemary may lower estrogen levels. This herb is also anti-inflammatory, and its volatile oils aid in liver detoxification.
12. SAMe – Also known as s-adenosyl methionine, this substance is made in the body as a result of a reaction between methionine and ATP. Methionine must be supplied through the diet as it cannot be made by the body. SAMe is an excellent source of sulfur and helps to convert estradiol (E2) into the less harmful estriol (E3). SAMe has been used for PMS and premenstrual dysphoric disorder (PMDD), a more severe form of PMS. It has also been used to help with depression and may even be useful in liver disease. SAMe is an anti-inflammatory and used to relieve pain. An interesting study by Frezza, Tritapepe, Pozzato, and Di Padova (1988) looked at the use of SAMe in women who had a past history of liver disease called intrahepatic cholestasis of pregnancy (ICP). These women have an increased sensitivity to estrogen. They concluded “The data support the belief that SAMe acts as a physiological antidote against estrogen hepatobiliary toxicity in susceptible women” (Abstract).
14. Black cohosh – A member of the buttercup family, this wonderful herb has been used extensively by the North American Indians. It has a long history of use for premenstrual syndrome and menstrual cramping, and it may also be helpful with menopause symptoms such as irritability, hot flashes, and vaginal dryness.
15. Chasteberry – also known as Vitex, this herb is frequently advised for women who suffer from PMS. Chasteberry influences the pituitary to produce more lutenizing hormone (LH) which in turn signals the ovaries to produce more progesterone. So, this herb is especially valuable in women who are suffering from estrogen dominance.
9. Resveratrol – this wonderful supplement has numerous health benefits, one being an aromatase inhibitor. Since aromatase synthesizes estrogen, eating food with aromatase inhibiting action helps to lower estrogen levels and may possibly help to reduce adenomyosis symptoms. See “Hormonal Imbalance?” and “Treatments” for more information. Resveratrol can be taken as a supplement (usually extracted from the Japanese knotwood plant) or can be consumed by eating the following foods: red grapes, red wine, peanuts, or cocoa.
10. Good Quality Probiotic – this will support the gastrointestinal tract which will ensure proper elimination of estrogen from the body.
Try to avoid the following foods:
Excess saturated fats
When I was going through my struggle with adenomyosis, I could not get any relief from any medication that the doctors had given me. Believe me, I was put on a bunch of them. At the time, I had been diagnosed with irritable bowel syndrome (which was incorrect as I found out many years later). I finally got to the point of looking into holistic treatments since these medicines weren’t helping me.
About 8 years into my ordeal with adenomyosis, I came across an article about the health benefits of flaxseed, an excellent source of omega-3 fatty acids. I was so impressed that I immediately ordered some and added it to all kinds of foods, from spaghetti to yogurt. To my shock and amazement, my symptoms began to improve!
This led to my thesis work for my Master’s degree in Holistic Nutrition. I ended up publishing my thesis titled “The Health Benefits of Omega-3 Fatty Acids in Irritable Bowel Syndrome and Inflammatory Bowel Disease”. Remember, at the time I thought I was suffering from irritable bowel syndrome.
Although my symptoms had improved, they hadn’t gone away completely. Seventeen years into my struggle, I had a hysterectomy. The pathology report showed that I had deep, diffuse adenomyosis with possible fibroids. My symptoms stopped completely after this surgery. I was shocked to find out that I had actually had adenomyosis and NOT irritable bowel syndrome!
Recent research is now showing that there is a link between endometriosis symptoms and low intake of omega-3 fatty acids. Although as of yet I have not found studies on adenomyosis and diet, endometriosis is a similar disorder, and in fact the two disorders are often times seen together.
In 2010, an article was published by Stacey Missmer from Harvard University entitled “A prospective study of dietary fat consumption and endometriosis risk”. They analyzed 12 years of data from the Nurses’ Health Study II. They found that increased intake of omega-3 fats were associated with an decreased occurrence of endometriosis. In addition, those who had the highest intake of trans-fats were 48% more likely to be diagnosed with endometriosis. Their conclusion states that this “provides another disease association that supports efforts to remove trans fat from hydrogenated oils from the food supply.”¹
There are many other studies that have been done recently that have come up with similar conclusions. Therefore, if you have either of these disorders, it might behoove you to remove trans fats completely from your diet and increase your consumption of omega-3 fatty acids.
¹Source: Pub Med: Missmer, Stacey A. et al. “A prospective study of dietary fat consumption and endometriosis risk.” Channing Laboratory, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, published in Human Reproduction (Impact Factor):4.67), 03/2010; 25(6):1528-35.