Oxidative stress is one component of endometriosis that is pretty radical. It refers to the damage caused by reactive oxygen species (ROS), also known as free radicals. When ROS damages your cells and tissues, it’s referred to as “oxidative stress””, but you could also call it free radical damage if you like.

Free radicals are a crucial component of your immune systems protective mechanism against invaders. If your immune system detects foul play (like a pathogen, virus, any sort of cellular damage, etc) it sends in these bad boys to seriously f*$# things up.  Free radicals are, well, pretty radical in that they can d-e-s-t-r-o-y cellular membranes at an incredible rate - a great weapon to have in your army. Think of them as wild ninjas with swords, slashing everything around them to pieces. You want a free radicals one your army’s front line, that’s for sure

But you definitely don’t want them to linger because these wild ninjas don’t spare a human cell over a pathogenic cell, meaning that free radicals will damage you, your cells and your tissues just as easily as that of a virus or pathogen. To halt them after the attack, free radicals are subdued by being paired with an antioxidant, not usually a problem to find within a healthy body under normal conditions. It’s like the ninja needed some handcuffs, and antioxidants act as such.

However, in the context of significant and chronic inflammation, you are going to generate a lot of free radicals. Like, a lot. To stop them all, you need a lot of antioxidant handcuffs. Just as problematic as it would be to find yourself low on handcuffs with many dangerous ninjas, so too does it become problematic if you’re low on antioxidants, allowing the free radical destruction continue. 

This is when free radicals become radically damaging. When zipping around an area doused with chronic inflammation, they damage everything around (even you) and there’s simply not enough antioxidants to stop them. The tissue damage that ensues is called oxidative stress, and is exactly what happens in endometriosis, as those of us with endo are known to have incredibly high levels of oxidative stress in the peritoneal cavity (1).

Oxidative Stress and Endometriosis

Inflammation-based damage like this is associated with endo on so many levels. For one, it may be an instigator in creating endo, which means its prevention in the first place could prevent endo from developing in some people (again, “some people”, because endo can develop from different circumstances into different types of disease depending on who you are).

Once you have endo, oxidative stress is one reason we can have an astounding amount of pain, scar tissue, and adhesions, because these ninja’s-on-crack took their job too seriously and mutilated our insides (quite literally in some of our cases). It’s why - depending on who you are - stopping the oxidative stress in its tracks can protect your pelvis, reproductive organs, and/or other organs from devastating scarring, reduce pain, help overcome infertility, and help reverse chronic fatigue, headaches, joint pain, and more. So yes, handcuffing ninjas is extremely important. Here are 3 tip to get you on the path today:

Step 1: An antioxidant Rich Endometriosis Diet stops Free Radical ninjas

It’s astounding just how much damage free radicals can do, and conversely just how important it becomes to consume an incredibly high amount of antioxidants every single day. It’s why dietary shifts that promote very high levels of antioxidant consumption and restrict pro-inflammatory/free radical-forming foods and activities can reduce endo symptoms (2). Basically, you need to eat a lot of handcuffs to stop the ninjas… and this will also help remove one of the big triggers of inflammation in your body.

Antioxidants are small molecules that fight free radicals in the body. While your body makes a certain amount of its own antioxidants, you must eat the others in your diet, and they come from both plant and animal based foods. For example, many plants (like veggies, fruits, nuts, and seeds) are loaded with vitamin C, E, phytonutrients, and selenium, while animal based foods are often our best sources of zinc, CLA, vitamin A (retinoids), and omega 3ʻs, and both plant and animal contain the best sources of vitamin E. All very important antioxidants to have, and why I recommend a balanced omnivorous diet for endo-folk.

And you’re probably going to need, well, a lot. Boatloads perhaps. That’s because someone with chronic inflammation may actually have much higher nutrient needs than by simply meeting the RDI (lowest level needed by others) since inflammation itself burns through antioxidants like wildfire. This was observed in one study that demonstrated that while women with endometriosis were consuming the same amount of antioxidants as their non-endo peers, their antioxidant capacity was still lower, suggesting our need is actually much higher than someone without inflammation (3).

So how much do we need? This is a good question, and again, perhaps A LOT. One study that supplementing endo-patients with 1000 mg vitamin C and 1200 iu vitamin E per day (so 16x and 54x the RDI respectively) for two months saw significant decreases in inflammatory markers within the peritoneal fluid (a fancy word for the fluid that lines the pelvic cavity). Moreover, 43% of participants saw reduction in chronic every-day pain, 37% a reduction in menstrual pain, and 24% a reduction painful sex. The authors conclude vitamin E and C “are highly efficient alternative therapy to relieve chronic pelvic pain in women with endometriosis” (4). 

Another 2009 study examined how increased food consumption of antioxidants could counter oxidative stress in women with endometriosis with compelling results. The researchers recruited Mexican women of low socio-economic backgrounds both with and without endo to apply a high-antioxidant diet including 1050iu beta carotene, 500 mg vitamin C, and 20 mg vitamin E per day. This was simply achieved by eating 8 servings a day of assorted fruits and vegetables for the beta-carotene and vitamin C, plus 4 tbsp pumpkin seeds and 3 tbsp peanuts to meet the vitamin E requirement. No supplements were consumed.

After switching to this higher antioxidant diet, the women with endometriosis had some dramatic gains. Researchers found that their serum levels of these antioxidants rose after just the first month, while an interesting side phenomenon occurred that their endogenous antioxidants SOD and glutathione (these are the antioxidants your body makes) levels rose after three months. Hence, oxidative stress markers were reduced. I love this study as it illustrates how simple and affordable changes in diet can decrease the oxidative stress associated with endometriosis, bring blood levels of antioxidants back to sufficiency, and even increase our endogenous antioxidant activities (5).

Here’s an image of how your uterus feels about the term “antioxidant-rich diet” (notice she’s not being attacked by ninjas).

You should feel the same as this uterus! Why I always go back to my recommendation of 6-9 cups of veggies PER DAY as the foundation of your diet, in combination with cold water fatty fish, shellfish, glycine rich cuts of red meat, organ meats, and moderate amounts of nuts and seeds. Altogether this will put you in the endo-protective category of eating.

Step 2: Use Endometriosis Diet and Lifestyle Strategies to Stop Excess Free Radical Creation

Let’s say you have a large bowl of handcuffs in your body, just enough to subdue all of the miniature ninjas at your endo-site. Problem is, you also have more ninjas coursing through your body far away from your endo…and they need to be handcuffed too. That’s why we need to reduce the systemic inflammation in order to better utilize our antoixdants.

It’s easy to use up all the handcuffs prematurely if you’re not sleeping well, stressing a lot, dealing with gut infections, recurrent viruses, chemical laden body or cleaning products, or, well, any other cellular triggers. It’s one reason why someone with a Lyme infection and mold sensitivity, or another person with a high mercury level, will start to feel better in their endo (a seemingly totally separate thing) once they address these underlying triggers sapping their immune focus and antioxidant capability.

Additionally, we need to make sure not to consume free-radical forming foods. One example is vegetable oils, something I consider our endo arch-enemy #1. With seemingly-healthy names like soy, canola, corn, safflower, sunflower, rapeseed, or simply vegetable, these oils are stuffed into just about every processed food product on the shelf, in nearly all restaurant food, vegan butters, and maybe even on your shelf for cooking. The problem is that the processing and refining techniques that turn these seeds into cooking oils render them oxidized even before you open the bottle - yes, even organic oils. This means they can trigger a chain reaction of oxidative damage in the body, promoting system-wide inflammation every time you consume them (6).

Here’s another one that creates a ton of free radicals for us endo-gals: blood sugar dysregulation. If you want a fresher on what this means, click here, but basically it’s when your diet in combination with your body create high levels of circulating glucose and insulin.

Excess glucose in the bloodstream is dangerous because sugar is highly reactive to proteins, resulting in a chemical reaction called glycation  - the process in which sugar reacts to proteins to create chemical bonds of “stickiness” (ever get a lollipop stuck in your hair?). Not only is glycation damaging in its own right, but it also creates a ton of free-radicals (7).

This is why I like to recommend you go to your kitchen and throw any/all veggie oils you have in the trash, and start to swap out any processed foods with whole foods that don’t include veggie oils as a main ingredient. And if you need help balancing blood sugar, I do have a super-cheap ebook on it (serious, it’s $6) you can check out here. And yes, you can still have blood sugar dysregulation even if you eat mainly unprocessed, whole foods - so for all you “organic sugar addicts” out there, you’re not off the hook ;)

While these are just a few small examples, the big message is that we need to be eating well, sleeping well, pooping well, and moving well to create a bodily foundation that doesn’t create even more free-radicals.

Step 3: Remove triggers that instigate ninjas at ground zero

Are you curious why the ninja’s arrived at where your endo is in the first place? Ninjas that are perhaps continuing to instigate more damage currently?

The answer could be different for many of us since we don’t all have the same triggers. However, per my last blog, the same generalities hold true. It could be bacteria, thick/clotty/contaminated menstrual debris from retrograde menses, localized estrogen production that grows the endo while damaging healthy tissue in its wake, or even poor body mechanics/sedentarism. And yes, endo lesions can of course become one too but, again, endo is one of many triggers so we really need to start sleuthing out all of the others before we just assume it’s the endo. 

Use Your Endometriosis Diet to Get Handcuffing!

If you’ve been following my blog, insta, and books for while, you’ll know what I’m about to say: eat a ton of low starch veggies. Make them the foundation of your plate and life. From here add in some fruit, beans, or starchy veggies and you need (athletes and chronic stressors may need more), and balance with quality proteins in the form of cold-water fatty fish, shellfish, organ means, glycine-rich cuts (like meat on the bone, roasts, and other tough cuts), and even red meat (preferably grass-fed or organic if you can afford it). Cook with ancestral oils such as olive, coconut, lard or tallow (pastured varieties only here), butter, ghee, or orangutang-friendly palm oil.

Phytonutrient-rich (a class of antioxidants) options are the ones we often hear about of, and for good reason: green tea or matcha, deep purple berries, (organic) red wine, dark chocolate or cacao, herbs, and spices. The thing these all have in common is that they make food taste phenomenal and meals fun, so it shouldn’t be too hard to infuse more fun/flavor into your meals, right?

If you have an IBS or digestion related gut-issue and want to vomit at this recommendation, don’t fret. Make it your goal to correct/fix the gut first, and then incorporate more foods into your life.

Remember, if you want support I do have a recipe book, The 4-Week Endometriosis Diet Plan, that will help guide you through what eating this many veggies looks like :)

Now quick, go start handcuffing those ninjas!

1)  Scutiero, G., Iannone, P., Bernardi, G., Bonaccorsi, G., Spadaro, S., Volta, C. A., Greco, P., & Nappi, L. (2017). Oxidative Stress and Endometriosis: A Systematic Review of the Literature. Oxidative medicine and cellular longevity, 2017, 7265238. https://doi.org/10.1155/2017/7265238

2) Ngô, C., Chéreau, C., Nicco, C., Weill, B., Chapron, C., & Batteux, F. (2009). Reactive oxygen species controls endometriosis progression. The American journal of pathology, 175(1), 225–234. https://doi.org/10.2353/ajpath.2009.080804

3)  Savaris, A. L., & do Amaral, V. F. (2011). Nutrient intake, anthropometric data and correlations with the systemic antioxidant capacity of women with pelvic endometriosis. European journal of obstetrics, gynecology, and reproductive biology, 158(2), 314–318. https://doi.org/10.1016/j.ejogrb.2011.05.014

4) Santanam, N., Kavtaradze, N., Murphy, A., Dominguez, C., & Parthasarathy, S. (2013). Antioxidant supplementation reduces endometriosis-related pelvic pain in humans. Translational research : the journal of laboratory and clinical medicine, 161(3), 189–195. https://doi.org/10.1016/j.trsl.2012.05.001

5)  Mier-Cabrera, J., Aburto-Soto, T., Burrola-Méndez, S., Jiménez-Zamudio, L., Tolentino, M. C., Casanueva, E., & Hernández-Guerrero, C. (2009). Women with endometriosis improved their peripheral antioxidant markers after the application of a high antioxidant diet. Reproductive biology and endocrinology : RB&E, 7, 54. https://doi.org/10.1186/1477-7827-7-54

6) Deol, P., Fahrmann, J., Yang, J., Evans, J. R., Rizo, A., Grapov, D., Salemi, M., Wanichthanarak, K., Fiehn, O., Phinney, B., Hammock, B. D., & Sladek, F. M. (2017). Omega-6 and omega-3 oxylipins are implicated in soybean oil-induced obesity in mice. Scientific reports, 7(1), 12488. https://doi.org/10.1038/s41598-017-12624-9

7) Ramasamy, R., Vannucci, S. J., Yan, S. S., Herold, K., Yan, S. F., & Schmidt, A. M. (2005). Advanced glycation end products and RAGE: a common thread in aging, diabetes, neurodegeneration, and inflammation. Glycobiology, 15(7), 16R–28R. https://doi.org/10.1093/glycob/cwi053

8) Fujii, E. Y., Nakayama, M., & Nakagawa, A. (2008). Concentrations of receptor for advanced glycation end products, VEGF and CML in plasma, follicular fluid, and peritoneal fluid in women with and without endometriosis. Reproductive sciences (Thousand Oaks, Calif.), 15(10), 1066–1074. https://doi.org/10.1177/1933719108323445