Last month I was asked by the Endometriosis Foundation of America to give a presentation on nutrition and endo. With the ability to talk about anything at all I truly considered it all. What I decided to speak about is one factor I consider to be the “elephant in the endo-room” of nutrition, so-to-speak: Blood Sugar Dysregulation.

Now, if you’ve been around my site you’ve seen the other blogs connecting the dots between many symptoms of endo. Indeed blood sugar dysregulation is associated with bloating (yup), fatigue (yup), poor nutritional status (yup), inflammation (total yup). You’re catching what I’m throwing; it’s associated with lots of symptoms endo is also associated with, which is why we must ask “is blood sugar dysregulation causing these symptoms, or is the endo?” The answer may surprise you. While it’s obviously not a silver bullet for “healing endo”, for many clients I’ve worked with it has been a proverbial life safer. From jettisoning chronic fatigue and bloating, to getting pregnant, balancing blood sugar has helped a ton of clients symptomatically.

In this blog I’m going to talk about something different, though. Here you will learn how blood sugar dysregalation contributes to the establishment, progression, and immune dysfunction associated with endo. This means it’s not just provoking your symptoms, but that a blood sugar rollercoaster can make your disease itself (all those endo lesions in your body) worse. One way (of many) that diet may be able to directly influence your disease.

Blood Sugar Imbalance 101

Carbohydrates are pretty simple macronutrients, consisting of sugars, starches, and fiber. At a cellular level, most sugars and starches transform into glucose (our body’s main form of fuel). This glucose in the blood stream is called “blood sugar”. Your body works hard to always have a small but steady stream of glucose circulating at all times, ready to feed your cells.

Your blood glucose needs to be kept at a very consistent yet minimal level throughout the day, with just enough to feed your cells but not too much to cause problems. To keep it at this very perfect level, we rely on a complex “braking system” to slow the absorption of sugars into the bloodstream. Fiber, fat, and protein make up this braking system. When we eat carbohydrate-rich foods in their natural form (i.e., fruits, veggies, grains, beans, etc.), and pair them in a meal with proteins and fats, the entire package slows the absorption of glucose to a slow drip. 

When glucose does finally drip into circulation, it pairs with a hormone called insulin. Insulin escorts glucose to the cell door, where it politely knocks and hands over the glucose. It does this to every single cell in your body (there are trillions), from your eyeball to your cervix. Think of it like this: moderate levels of insulin + glucose = well fed cell.

Unfortunately, most of us eat a low-fiber diet based around refined flours, sugar, grains, and starches: store-bought bread, pasta, cereals, baked goods like cakes and cookies, frozen meals, pizza, breakfast cereal, boxed meals, soda or other sweet drinks, margarine, chicken nuggets, hot dogs, soy products like vegan meats and cheeses (yes, even organic or marketed as “healthy”). Stripped of fiber and nutrients, lacking quality protein and fat, and infused with sugar and starch, these foods spike our blood glucose levels with every meal, snack, or sugary beverage.

When carbohydrate consumption like this dominates over quality protein, fat, and fiber, your blood sugar will start to rollercoaster—where your glucose, insulin, hunger levels, and energy levels spike and plummet all day long. Blood sugar rollercoasters like this affect the vast majority of Americans, starting with low blood sugar dips (shaking or feeling faint when hungry), becoming hungry so fast you feel “hangry” (hungry + angry), or hypoglycemia.

A blood sugar rollercoaster means two things that are important to endo: 1) sometimes you will have excess glucose and insulin in your system, and 2) other times you’ll have too little glucose. Unfortunately, both  may influence the way our endo behaves.

Too Much Glucose = Endometriosis Establishment, Progression, Pain, & Tissue Damage

Excess glucose floating in the body is dangerous because sugar is highly reactive to proteins (which your body is obviously made up of). This results in 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, it also creates something even more damaging: Advanced Glycation End-Products, known as AGEs. 

AGEs in the body cause damage by connecting to a type of cell receptor aptly called RAGE. When AGE connects to RAGE, it triggers an avalanche of free radicals, with an ensuing tidal wave of inflammation and tissue damage (like my enormous natural disaster analogies? Yah, because this is an endo-disaster). This is how AGEs damage blood vessels, tissues, and organs: by causing so much damage to protein fibers that they become stiff, brittle, and malformed, eventually making it hard for blood and nutrients to get where they need to be (one reason why diabetic patients can have their limbs amputated).

Unfortunately, those of us with endometriosis may have significantly more RAGE receptors within our peritoneal and follicular fluid, as well as localized in certain endo cells. And, in the case of blood sugar dysregulation, high levels of glucose can become the main contributor of AGEs within your body, creating a category 4 hurricane of AGEs with each soda (or cold-pressed carrot juice), ready to carpet bomb your peritoneal cavity with free-radical damage.

Let me put that another way: your body is basically inviting tornadoes of destruction directly to your endo lesion when glucose levels are too high. Because of all this free radical damage there will be an increase in the amount of oxidative stress and tissue damage, which will naturally invite more inflammatory immune factors that promote the growth of new endo “roots” that anchor endo to the tissue. (1-3)

Too Much Insulin = Endo-Related Immune Dysfunction, Establishment, and Progression

Too much circulating insulin is another story, one that may encourage the janitorial aspect of immune dysfunction associated with endo.

Endometriosis cells are shown to have their energy metabolism a bit messed up, because they produce more lactic acid than a normal, healthy cell. Too much lactic acid changes the pH around the endo lesion so that immune surveillance factors can’t function properly (kind of like creating an invisibility cloak around the lesion) thereby reducing endo-cell death. Not only that but lactate is a key driver of cell invasion, “rooting down,” and immune suppression—changes implicated in the establishment and survival of endo lesions.

Unfortunately, high levels of circulating insulin increases the rate at which your endo cells produce lactic acid, meaning blood sugar dysregulation may directly contribute to more immune dysfunction, endo progression, and establishment. If you’ve heard that “sugar feeds cancer”, this is actually the same mechanism at play—and why it also appears that “sugar feeds endo”. (4-6)

Too Low Glucose = Endometriosis Establishment and Progression

But wait, the blood sugar roller coaster isn’t yet over, because after the surge you arrive at the well-known “blood sugar crash,” a very stressful time for your body when you don’t have enough glucose in your system. To keep you alive until you eat, your body releases stress hormones reserved for emergencies—cortisol and adrenaline. Now you’re shaky, hangry, grumpy, nervous, short of breath, and/or faint—stressful signs your body is in desperate need of a glucose fix, even though you just ate two hours earlier.

Unfortunately, both cortisol and adrenaline are associated with endometriosis establishment and progression. This is thanks to the hormone–immune conversation, where a constant surge in adrenaline tells the immune system to produce many of the exact inflammatory immune players endometriosis relies on to thrive. Not to mention that chronic stress promotes “stress-induced immune dysregulation,” which has been associated with a state of chronic low-grade inflammation. This may be why mice subjected to chronic stress tests developed endo lesions twice the size as those without chronic stress. Conversely, blocking adrenaline production has been noticed to stop the rooting down and progression of endo. This is how stress = actual endometriosis lesion provoker, more thann just symptoms.

So if you’re having blood sugar dips numerous times per day (as many of us do), the flooding of stress hormones may start to directly impact your endo. (7-9)

Time to Balance

It should be apparent by now how blood sugar dysregulation is one of the biggest endo-enemies. Too much glucose slams the body with monsoons of free radical damage. Too much insulin provokes a wild-fire of smoke that prevents the immune system from cleaning up shop. Too little glucose floods the system with a tsunami of endo-provoking stress hormones. Sorry to be so dramatic with my word choice, but I want to drive home the fact that, with targeted dietary interventions, we could end this whole endo-disaster. That’s right folks, you now know you have the power in your hands to end this calamity just like Captain Planet himself.

Understanding the links between endo and blood sugar dysregulation helps make sense why some people feel SO MUCH BETTER when they balance blood sugar alone. I’ve even seen some of my endo clientele suffering more from blood sugar issues than from endo. Fatigue, anxiety, unhealthy weight gain they’re unable to lose, tremendous bloating, depression, pain (joints, period, back), and nervousness—all potential symptoms of blood sugar that has coated the delicate internal system. So severely are some reacting to excess sugars and starches that they’re shocked when their pain disappears or they get pregnant from balancing blood sugar alone. This is not at all to say that balancing blood sugar is everyone’s silver bullet, but after watching clients who have witnessed miraculous turnarounds from addressing this issue alone, I now believe it’s a true endo non-negotiable.

Want to start? Check out my super-cheap ebook The Honey Blood Test. And be excited for my new book where I’ll dive even deeper into how blood sugar dysregulation and other dietary factors can literally change the expression of your endo.

1) 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

2) 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

3) Bloemer, J., Bhattacharya, S., Amin, R., & Suppiramaniam, V. (2014). Impaired insulin signaling and mechanisms of memory loss. Progress in molecular biology and translational science, 121, 413–449. https://doi.org/10.1016/B978-0-12-800101-1.00013-2

4) Horne, A.W., Ahmad, F.S., Carter, R., Simitsidellis, I., Greaves, E., Hogg, C., Morton, N.M., & Saunders, P.T.K. (2019). Repurposing dichloroacetate for the treatment of women with endometriosis. Proceedings of the National Academy of Sciences, 116(51), 25389-25391. http:www.doi.org/10.1073/pnas.1916144116

5) Zheng, J., Dai, Y., Lin, X., Huang, Q., Shi, L., Jin, X., Liu, N., Zhou, F., & Zhang, S. (2021). Hypoxia‑induced lactate dehydrogenase A protects cells from apoptosis in endometriosis. Molecular medicine reports, 24(3), 637. https://doi.org/10.3892/mmr.2021.12276; Choi, S. Y., Collins, C. C., Gout, P. W., & Wang, Y. (2013). Cancer-generated lactic acid: a regulatory, immunosuppressive metabolite?. The Journal of pathology, 230(4), 350–355. https://doi.org/10.1002/path.4218

6) Hirschhaeuser, F., Sattler, U. G., & Mueller-Klieser, W. (2011). Lactate: a metabolic key player in cancer. Cancer research, 71(22), 6921–6925. https://doi.org/10.1158/0008-5472.CAN-11-1457

7) Guo, S. W., Zhang, Q., & Liu, X. (2017). Social psychogenic stress promotes the development of endometriosis in mouse. Reproductive biomedicine online, 34(3), 225–239. https://doi.org/10.1016/j.rbmo.2016.11.012

8) Gouin, J.-P. (2011). Chronic stress, immune dysregulation, and health. American Journal of Lifestyle Medicine, 5(6), 476–485. https://doi.org/10.1177/1559827610395467 

9) Long, Q., Liu, X., Qi, Q., & Guo, S. W. (2016). Chronic stress accelerates the development of endometriosis in mouse through adrenergic receptor β2. Human reproduction (Oxford, England), 31(11), 2506–2519. https://doi.org/10.1093/humrep/dew237