Recent study finds Black women who eat high glycemic index foods may have greater risk of uterine fibroids.
By Nana Ataa Ofosu-Benefo, MS, RD, CDN, IBCLC
When I turned 36 a few years ago, I went through what seems to have become a rite of passage in my family: I was diagnosed with uterine fibroids. My mother has fibroids. All of her three sisters also had fibroids until they were systematically removed by total hysterectomies. I can count on both hands how many of my African American girlfriends ranging in age from mid-twenties to early 50s–also have fibroids. So while my diagnosis did not come as a shock to me, I was plagued by thoughts of “I'm a pretty healthy person, what did I do wrong?” “Are fibroids simply my fate?” “What can I do about them now, and still maintain my fertility?”
What Are They?
Uterine fibroids (leiomyomata uteri) are the most common benign growths present in the muscular wall of the uterus of women, usually over 30 years of age. Fibroids are two to three times more likely to occur in African American women than in other American women. They are one of the leading causes for hysterectomy in the United States. Even though they are benign, fibroids may cause reproductive problems such as uterine enlargement, heavy abnormal uterine bleeding, pelvic pressure, severe cramping, pain, infertility, and miscarriage.
What Causes Them? Up and Coming Fibroid Research
Earlier menopause, fewer births after age 24, alcohol intake, and a physically inactive lifestyle were factors associated with fibroid development in African American and white women. Prenatal exposure to DES (diethyl stibesterol) and higher circulating LH (lutenizing hormone, a hormone produced by the pituitary to promote ovulation) levels are also linked to fibroid development.
In spite of high morbidity rates and high medical costs associated with the management and treatment of fibroids, there has been little epidemiological study of this condition. African American women are thought to be at higher risk based on hysterectomy statistics. Health disparity issues for uterine fibroids are reflected in the higher prevalence statistics and in the fact that African American women have larger and more numerous tumors. However, it is not clearly known if this is a true physiological difference or due to differences in access to health care, diagnosis and treatment options.
It is interesting to note that studies have shown that African American women using advanced treatment for infertility, such as in vitro fertilization, do not have the same rates of success as white women. National Institute of Child Health and Human Development (NICHD) investigators examined this issue in a setting where access to care was not an issue, and “observed that the presence of uterine fibroids in African American women was largely, if not entirely, responsible for the reduction in success of advanced fertility treatment”. Depending on where they are located in the uterus (see diagram), fibroids can interfere with the implantation of a fertilized egg.
Based on studies of gene regulation in uterine fibroids, NICHD investigators have noted similarities between fibroids and keloids, a disorder of wound healing that is also increased in African Americans. The NICHD research team has noted that the shared abnormalities in formation of connective tissue between keloids and fibroids raise the possibility of a genetic predisposition that may explain the increased prevalence of the two conditions. The results of these studies build upon the Fibroid Growth Study conducted by the National Institute of Environmental Health Sciences, that revealed fibroid growth greater than 3 inches (5 cm) was largely due to deposition of connective tissue, not in increase in cell number. The connective tissue generated by the cells comprising uterine fibroids is markedly abnormal and this fact may contribute to fibroid growth, as abnormally formed connective tissue cannot be remodeled and absorbed as would normally formed connective tissue.
What Does Food Have to Do With It?
Low glycemic index foods (such as most non-starchy vegetables, fruits, avocado, nuts and legumes, unsweetened soy milk, non-fat dairy products, minimally-processed whole grains) slowly release sugars into the blood. Those with high glycemic index (such as sugary drinks, bottled fruit juices, breads made from refined flours, 'instant' versions of starches like instant or quick oats, quick grits, instant noodles, white rice, white potatoes) release sugar rapidly and cause the body to release hormones, like insulin, to compensate for blood sugar spikes. (Check out http://www.glycemicindex.com/ for more information on the glycemic index and eating lower on the glycemic index scale.) Between 1997 through 2007, out of a total of 21,900 premenopausal Black women, Boston University researchers found 5800 of them with uterine fibroids diagnosed during ultrasound or after hysterectomy. Those with higher rather than lower glycemic index levels (calculated from food intake records) generally had greater fibroid risk, after allowing for several other factors potentially associated with fibroid development. They also found that Black women younger than 35 years old with a higher glycemic load had greater fibroid risk than their counterparts with the lowest glycemic load.
Eating for Improved Reproductive Health
Since scientists are not yet certain why diet might affect the growth of uterine fibroids, they are reluctant to recommend a specific “anti-fibroid diet”. However, there are a few lifestyle modifications that will help improve your overall reproductive health:
- Higher carbohydrate diets (>55% of total daily calories) can lead to higher insulin levels, which in turn are linked to levels of other hormones thought to encourage fibroid growth (estrogen). Prolonged intake of foods with high glycemic index are established risk factors for obesity, type 2 diabetes, and heart disease. These associations alone are good reasons to cut back on foods that tend to cause blood sugar to spike.
- Increasing dietary fiber intake is known to help prevent blood sugar spikes and it enhances estrogen excretion, which can improve hormonal balance. Gradually increase your fiber intake, with a goal of 25 grams of fiber daily. As you increase your fiber intake, it is also necessary to increase your fluid intake (shoot for six to eight 8-ounce cups each day) to keep stools soft and easy to pass.
- Regular exercise lowers circulating levels of blood estrogens, so adding exercise to your daily schedule can be a natural approach for regaining hormonal balance. After the ovaries, fat cells are big producers of estrogen. Regardless of your actual weight, women with greater stores of body fat generally have higher levels of estrogen, so it follows that reducing overall caloric intake, reducing intake of saturated fats, coupled with increased caloric expenditure (via daily exercise) will reduce total body fat composition, and may also reduce high levels of estrogen.
The following list of websites provides a general understanding of uterine fibroids and some treatment possibilities. All questions specific to your case should be addressed during regular consultation with your local OB/GYN physician and your local registered dietitian.
Nana Ataa Ofosu-Benefo is a registered dietitian and lactation consultant who lives and works in South Hill,VA.
References
Hendry, J. Diet may alter fibroid risk in Black women. Reuters Health Information, 3/16/10. http://www.nlm.nih.gov/medlineplus/news/fullstory_96487.html Accessed 5/11/2010.
Office of Research on Women's Health, NIH, DHHS. Status of Research on Uterine Fibroids (leiomyomata uteri) at the National Institutes of Health. March 2006. pp 1- 11.
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