Uterine fibroids (UFs), also known as leiomyomas, are the most common benign tumors in women of reproductive age, disproportionately affecting women of color. Traditionally, medical intervention is often delayed until the advanced stages, frequently necessitating invasive surgeries like hysterectomy or myomectomy. These procedures can lead to high recurrence rates and increased healthcare costs. Emerging research highlights the complex interplay of genetic, environmental, and lifestyle factors in the development of UFs, paving the way for innovative prevention methods. This article explores the potential of the Mediterranean diet and other lifestyle interventions in the prevention and management of UFs, focusing on the LIFE UP awareness strategy (Lifestyle Interventions, Food Modifications, and Environmental Practices for UF Prevention). This strategy emphasizes cost-effective, safe, and accessible measures that can prevent UFs, improve overall reproductive health, reduce the need for invasive procedures, and generate substantial cost savings for individuals and healthcare systems.
Understanding Uterine Fibroids
Uterine fibroids (UFs) are a prevalent global health concern impacting many women during their reproductive years. Historically, UFs were often monitored until symptoms like heavy menstrual bleeding (HMB), anemia, painful periods, and pelvic pain necessitated surgical intervention. Diagnosis and treatment of UFs employ a range of techniques, from pelvic examinations and imaging techniques like ultrasonography, MRI, and CT scans. Treatment options range from non-hormonal and hormonal medical interventions to surgical procedures, depending on the patient’s symptoms and goals.
Known risk factors for UFs include age, race, BMI, pregnancy history, hypertension, vitamin D levels, hormonal imbalances, and exposure to endocrine-disrupting chemicals (EDCs). Genetic factors and lifestyle choices, such as diet and stress levels, also play a role. Currently, there is no validated method for preemptively screening asymptomatic women for UF risk. Shear wave elastography (SWE) has been proposed as a potential screening tool capable of detecting subtle changes in myometrial tissue elasticity that may indicate a higher risk of UFs. Additionally, researchers are exploring urinary inflammatory biomarkers, alone or in combination with SWE, to identify presymptomatic women at risk.
The LIFE UP Awareness Strategy
This article delves into prevention methods, spotlighting the LIFE UP awareness (Lifestyle Interventions, Food Modifications, and Environmental Practices for UF Prevention). The goal is to empower women and healthcare professionals with practical insights to improve the quality of life (QOL) for those dealing with UFs.
The Challenge of Recurrence and the ESCAPE Approach
Addressing the recurrence of UFs after myomectomy is a substantial concern in the realm of secondary prevention. Myomectomy, while selectively removing clinically significant UFs and preserving the uterus, presents a risk of symptom resurgence and the potential need for additional procedures. Despite the high recurrence rates, established guidelines for preventing symptom recurrence or inhibiting new UFs growth post myomectomy are currently lacking. One promising approach is the ESCAPE (Evidence-Based Approach for Secondary Prevention) of UF management. Utilizing options such as vitamin D (4000 IU/day), EGCG (800 mg/day), and EDC-free products is deemed safe, efficacious, and economically viable for extended use by women who have undergone myomectomy, aiming to prevent UF recurrence. This approach is being actively pursued in a clinical trial named ERADICATE-UF.
Read also: A Review of the Mediterranean Diet in Kidney Disease
The Role of Diet and Nutrition in Fibroid Management
Diet and nutrition are fundamental in maintaining the general health of populations, including women’s health. Health status can be affected by nutrient deficiency and vice versa. Gene-nutrient interactions are important contributors to health management and disease prevention. Nutrition can alter gene expression, as well as the susceptibility to diseases, including cancer, through several mechanisms. Gynecological diseases in general are diseases involving the female reproductive system and include benign and malignant tumors, infections, and endocrine diseases. Benign diseases such as uterine fibroids and endometriosis are common, with a negative impact on women’s quality of life, while malignant tumors are among the most common cause of death in the recent years.
The Mediterranean Diet: A Potential Protective Factor
Research suggests that dietary factors play a role in the risk and growth of UFs, highlighting the importance of maintaining a healthy and balanced diet to reduce the likelihood of developing this condition. A Mediterranean diet, rich in vegetables, fruits, whole grains, legumes, nuts, and olive oil, and low in red meat, is one such dietary approach. Studies indicate that this diet can reduce inflammation in the body.
Following a Mediterranean diet means adding plenty of fresh and cooked green vegetables, fresh fruit, legumes, and fish to your plate. A Mediterranean diet is one way to do this. Research shows that eating these foods regularly may help lower your risk for fibroids. On the other hand, eating beef, ham, lamb, and other red meat may raise your risk.
The Mediterranean diet has proven to be beneficial in several aspects of human health in general and has also been studied in relation to fertility. Previously, Vujkovic et al. studied the association between a preconception diet and in vitro fertilization (IVF) in a cohort of subfertile couples in the Netherlands and showed that adherence to the Mediterranean diet is associated with a higher chance of pregnancy. A similar effect was later confirmed in a Dutch cohort of couples undergoing first-time in vitro fertilization (IVF), and the authors explained that the high fat content of vegetable oil as part of this diet could be the driving force behind this association. Subsequently, a prospective cohort study of 244 non-obese women who underwent their first IVF in Athens showed that adherence to the Mediterranean diet is associated with an increased chance of clinical pregnancy and live birth. Results from the Nurses’ Health Study cohort, which included 438 reported infertilities related to ovulation disorders, showed a significant association between female fertility and consumption of low-glycemic carbohydrates, monounsaturated fatty acids, proteins of plant origin, and supplements with iron, folate, and vitamins. The authors concluded that adherence to such components, which are essentially present in the Mediterranean diet, is associated with a lower risk of ovulatory infertility.
Specific Dietary Recommendations
An essential aspect of a diet aimed at preventing UFs is the inclusion of vegetables, particularly those that are rich in fiber. Vegetables provide valuable nutrients and contribute to the regulation of hormone levels, which is beneficial for UF prevention. Incorporating plant-based protein sources such as beans, lentils, whole grains, nuts, seeds, and lean meats can further support hormonal balance and facilitate regular bowel movements. Leafy greens, including kale, spinach, and collard greens, are particularly beneficial.
Read also: Delicious Mediterranean Recipes
A poor diet can contribute to the development and progression of UFs. Several components of a poor diet have been associated with an increased risk of UFs. These include a high intake of processed and refined foods, sugary beverages, unhealthy fats, and a low consumption of fruits, vegetables, and fiber-rich foods. Such dietary patterns may contribute to hormonal imbalances, inflammation, and oxidative stress, all of which can promote the growth of UFs. A diet high in processed and refined foods, including refined carbohydrates and added sugars, has been linked to an increased risk of UFs. These foods have a high glycemic index, leading to rapid spikes in blood sugar levels and potentially influencing hormone levels in the body. Furthermore, consuming an excess of unhealthy fats, particularly saturated and trans fats, can contribute to inflammation and disrupt hormonal regulation. This may create an environment conducive to the development and growth of UFs. An insufficient intake of fruits, vegetables, and fiber-rich foods has also been associated with an elevated risk of UFs. These foods are rich in antioxidants, vitamins, and minerals that help combat oxidative stress and inflammation. Dietary fiber has been shown to have protective effects against UFs by aiding in hormonal balance and promoting regular bowel movements.
To reduce the risk of UFs, adopting a healthy and balanced diet is crucial. This includes consuming a variety of whole foods, such as fruits, vegetables, whole grains, lean proteins, and healthy fats. Limiting the intake of processed and refined foods, sugary beverages, and unhealthy fats is also recommended.
Foods to Limit or Avoid
Sugary foods and simple carbohydrates may trigger or worsen fibroids. These foods spike blood sugar levels. This causes your body to make too much insulin. Excess insulin can cause weight gain and affect fibroid growth. It's best to avoid refined carbs and added sugars such as table sugar, glucose, dextrose, maltose, corn syrup, high fructose corn syrup, white bread, rice, pasta, and flours, soda and sugary drinks, fruit juice, potato chips, crackers, and packaged energy bars.
Some foods contain natural ingredients that mimic the estrogen in the body, called phytoestrogens. Other foods have added hormones or trigger your body to make more estrogen. Some of these foods may have protective effects when consumed in small to moderate amounts, but have negative effects when consumed in high amounts. You may need to limit or avoid foods such as red meat from sources that include added hormones, soy beans, soy milk, tofu, and flax seed.
The Importance of Fiber
Fiber-rich foods aid weight loss and balance hormones. They also help to keep blood sugar levels steady. For these reasons, fiber may help prevent and slow the growth of fibroids. Add these whole foods to your diet: cooked and raw vegetables, cooked, raw, and dried fruit, whole grain bread and pasta, cruciferous vegetables, oats, lentils, and beans. Consistent bowel movements coupled with a healthy gut flow and optimal enzyme function play a vital role in breaking down toxins, including phthalates, and facilitating their elimination from the body.
Read also: Mediterranean Diet, Instant Pot Style
The Role of Potassium
Potassium helps to counter the effects of salt to balance blood pressure. Add these potassium-rich foods to your daily diet: avocado, bananas, citrus, cantaloupe, collard greens, dates, lentils, oat bran, potatoes, and tomatoes.
The Benefits of Dairy
Add dairy products such as yogurt and full-fat cheese to your diet. Dairy is rich in calcium, phosphorus, and magnesium. These minerals may help prevent fibroids and slow their growth. Fortified milk also contains vitamin D.
Green Tea and Antioxidants
Green tea contains several antioxidants. A study found that one of these, epigallocatechin gallate, may help slow the growth of fibroids by bringing down inflammation and high estrogen levels. Green tea may also improve symptoms of heavy bleeding due to fibroids, such as low iron.
Addressing the Impact of Alcohol
Limiting alcohol consumption is recommended for women in order to reduce the risk of UFs. Studies have consistently shown an association between alcohol intake and an increased risk of developing UFs. It is advisable for women to restrict their alcohol consumption to no more than one drink per day. Drinking any type of alcohol may increase your risk for fibroids. This can happen because alcohol raises the level of hormones needed for fibroids to grow. Alcohol may also trigger inflammation. One study found that women who drank one or more beers a day increased their risk by more than 50 percent. Avoid or limit alcohol to help reduce your risk.
Several studies have provided evidence of a positive association between alcohol consumption and the risk of UFs. The exact mechanism behind this relationship is not fully understood, but it is believed that alcohol may influence hormone levels and disrupt hormonal balance, which can contribute to the development of UFs.
The Significance of Vitamin D
Vitamin D may help reduce your risk of fibroids by almost 32 percent. Your body makes this “sunshine vitamin” naturally when your skin’s exposed to sunlight. If you have darker skin or live in cooler climates, you’re more likely to be deficient. Supplements can help raise your levels, along with foods such as egg yolks, fortified milk, cheese, and dairy products, fortified cereals, fortified orange juice, fatty fish such as salmon, tuna, and mackerel, and cod liver oil. Long-chain omega-3 fatty acids seem to improve female infertility, although it is unclear whether environmental toxins in such food sources, such as fish, can reduce this benefit.
Vitamin D plays a crucial role in the management of fibroids, with research indicating its potential to reduce the size of these growths. Vitamin D's importance extends to its ability to inhibit the production of pro-inflammatory substances that contribute to fibroid growth. Additionally, it promotes apoptosis, a process where cells naturally die, including those constituting uterine fibroids. Foods that are rich in vitamin D can help manage levels of this nutrient.
Other Nutrients and Supplements
Milk thistle (Silybum marianum) is a well-known herb acknowledged for its hepatoprotective properties. It contains a compound called silymarin, known to possess antioxidant and anti-inflammatory effects. These properties can aid in shielding liver cells from harm and promoting their regeneration. Milk thistle, along with green tea and dandelion root (Taraxacum officinale), has been utilized to support liver health and exhibit diuretic properties. It is believed to enhance bile flow, facilitating the digestion and elimination of toxins from the liver. Other herbs like Uva ursi, celery root, and parsley primarily assist kidney function and promote detoxification.
The Impact of Lifestyle Factors
Beyond diet, other lifestyle factors play a significant role in fibroid development and management.
Managing Stress
The concept of “stress” permeates our daily lives, which presents both advantages and challenges for stress researchers. Numerous observational studies have demonstrated the detrimental impact of stress on health. A meta-analysis conducted by Qin H et al. revealed that chronic psychological stress may elevate the risk of UFs by 24% (OR, 1.24, 95% CI [1.15, 1.34]). Interestingly, they found a statistically significant association between chronic psychological stress and the risk of UFs, particularly among non-Hispanic Blacks. The influence of chronic psychological stress extends to the activities of the Hypothalamic-Pituitary-Adrenal (HPA) and Hypothalamic-Pituitary-Gonadal (HPG) axes, both of which can contribute to the development or progression of UFs by affecting estrogen or progesterone levels and inducing reproductive dysfunction. Furthermore, norepinephrine has the potential to promote the synthesis of pro-inflammatory cytokines by upregulating the activity of Nuclear Factor Kappa B (NF-κB) through key inflammation- or proliferation-related pathways such as those of JNKs and p38-MAPKs. This cascade of events ultimately leads to the onset of UFs. Moreover, chronic psychological stress has been associated with increased levels in multiple circulating inflammatory markers, including IL-6, IL-1β, and IL-10. Therefore, the reported link between chronic psychological stress and the risk of UFs appears to have a strong racial/ethnic component, which may help explain the observed disparities in UFs among different racial and ethnic groups.
Maintaining a Healthy Weight
The hypothesis that a high BMI contributes to an increased risk of UFs was supported by our study, specifically indicating a higher risk in premenopausal women. Baird et al. found that women who engaged in at least four hours of vigorous physical activity per week were more likely to experience a decreased risk of UFs. The relatively low levels of recreational exercise among women in China, compared to other countries, may explain why a similar protective effect was not observed between non-occupational activity and UFs. BMI was considered a risk factor for UFs solely in premenopausal women. Prospective studies have consistently shown a significant association between an increased BMI and the risk of UFs. Obesity is believed to contribute to UF development primarily by elevating endogenous hormone levels, reducing serum hormone-binding globulin, altering estrogen metabolism during premenopausal conditions, and affecting the signaling controls of myometrial cells, such as insulin receptors, insulin-like growth factors, and peroxisome proliferator-activated receptors. A prospective study has also reported that the positive effect of BMI on UFs seems to be limited to premenopausal and perimenopausal women, rather than postmenopausal women. It is plausible that an increased BMI in postmenopausal women may be associated with a decrease not only in estrogen levels, but also in UF growth factors such as IGF-1. Obesity is associated with an increased risk of UFs. Maintaining a healthy body weight through regular physical activity and a balanced diet can help reduce this risk.
Balancing Estrogen Levels
Estrogen is a hormone important for healthy fertility in both women and men. However, too much estrogen can increase your risk for fibroids or make them worse. Many treatments for fibroids work by lowering estrogen levels. Other ways to balance estrogen levels include: losing weight, avoiding hormone-disrupting chemicals. Natural and synthetic chemicals can throw off your endocrine balance, raising estrogen levels. These chemicals can leach into your body through skin and food. Avoid or limit coming into contact with chemicals found in fertilizers, pesticides, plastics such as BPA, nonstick coatings on cookware, fire retardants, dyes, paints, and some personal care products.
Monitoring and Managing Blood Pressure
Research shows that a high number of women with severe fibroids also have high blood pressure. More research is needed to find out if there’s a link. Balancing blood pressure is vital for your overall health. Try these tips: avoid added salt, limit high-sodium processed and packaged foods, check your blood pressure daily with a home monitor, exercise regularly, lose weight, especially around the waist, avoid or limit alcohol, increase potassium by eating a majority of plants at each meal, quit smoking and avoid secondhand smoke. If you have high blood pressure, take medication as prescribed and see your doctor for regular checkups.
The Use of Hormonal Contraceptives
The use of hormonal contraceptives such as birth control pills or intrauterine devices (IUDs) has been shown to reduce the risk of UFs. Women should consult with their healthcare providers to determine which contraceptive method is best for them.
Addressing Chronic Lifestyle Diseases
Chronic lifestyle diseases (CLDs) exhibit common modifiable risk factors that contribute to their long-term development. Recognizing the socio-behavioral predictors can greatly assist in the establishment of impactful community-based programs focused on prevention, intervention, and treatment. CLDs, such as cardiovascular diseases, diabetes, and certain types of cancer, often share similar underlying causes. Factors like an unhealthy diet, physical inactivity, tobacco use, excessive alcohol consumption, and stress contribute to the development and progression of these diseases over time. By targeting these modifiable risk factors, it is possible to reduce the burden of CLDs in communities. Understanding the socio-behavioral predictors associated with CLDs is crucial for designing effective prevention, intervention, and treatment programs. Socioeconomic factors, cultural influences, access to healthcare, education levels, and individual behaviors all play significant roles in the development and management of CLDs. By taking these factors into account, community-based programs can be tailored to address the specific needs and challenges of the population. Prevention efforts should focus on promoting healthy behaviors and lifestyle choices. This includes initiatives to improve access to nutritious foods, promote physical activity, reduce tobacco and alcohol use, and enhance stress management skills.
Nutrition and Gynecological Health: A Broader Perspective
Gynecological diseases are diseases of the female reproductive organs; these diseases are considered a public health and social problem. These diseases include benign and malignant tumors, infections, and endocrine disorders. All these diseases significantly impact women’s quality of life, and many of them, unfortunately, are still lacking efficient treatment plans. Promoting both primary and secondary prevention is essential for the sake of these afflicted women and their reproductive health. Sometimes, applying such preventive approaches is as or even more important than curative procedures. Gene-nutrient interactions are central contributors to health management and disease prevention. Nutrigenomics and nutrigenetics are defined as sciences that investigate the relationship between genetic variations and nutrient requirements. Interestingly, it was recently reported that nutrients can drive epigenetic changes that can influence such requirements. Nutrition can alter gene expression, as well as the susceptibility to several diseases, including cancer, through genetic and epigenetic changes. During the past decade, it has become clearer that nutrition can exert imprinting effects on the human genome, with many studies indicating that early life nutrition could influence the risk of developing chronic diseases in adulthood. For example, with regard to the role of nutrition in cancer development, existing evidence suggests that dietary components can impact disease pathogenesis via the activation of tumor suppressor genes, cellular apoptosis, protein translation, and noncoding microRNAs (miRNAs) with roles in messenger RNA (mRNA) stability and translation.
The Role of Nutrition in Infertility
Infertility is estimated to affect 8-16% of reproductive-age couples worldwide. Lifestyle and nutritional factors have been shown to be important elements of normal reproductive function. The literature exploring the relationship between diet and infertility has expanded over the past decade. Studies agree that the intake of folic acid is recommended for the prevention of neural tube defects and has been shown to be related to a lower frequency of infertility and a lower risk of pregnancy loss.
Nutrition and Polycystic Ovary Syndrome (PCOS)
Polycystic ovary syndrome (PCOS) is a complex and common hormonal condition in women of reproductive age, characterized by ovulatory dysfunction, chronic anovulation, altered menstruation, and ovarian small cysts on one or both ovaries, which may affect fertility [31]. It is found in approximately 5% to 10% of women aged between 18 and 44 years, making it among the most widespread diseases of reproductive-age women. Based on the previous literature, PCOS is associated with other common disorders, such as insulin resistance, obesity, type 2 diabetes, hypertension, endometrial cancer, and hyperandrogenemia. Although the actual cause of PCOS remains unclear, evidence points to the role of environmental factors, including lifestyle and dietary habits, in the prevention and treatment of PCOS. Therefore, considering these factors may propose new therapeutic strategies for PCOS patients. One of the most prominent approaches in treating PCOS is diet therapy for the sake of reducing insulin resistance and reproductive dysfunction. Considering the association of PCOS with obesity and insulin resistance, it should be noted that approximately a 5% to 10% decrease in weight may increase reproductive activity. This might be achieved by weight loss, a decrease in the intake of foods with a high glycemic index and foods rich in fatty acids, and intake of sufficient omega-3, vitamin D, and chromium.
tags: #mediterranean #diet #fibroids #research