Endo and the Hidden Cost of Pharmaceuticals
Pharmaceuticals are under the "toxin" section because, not only do they have such a profound impact on our cellular biology, but they’re prescribed by the gallon to people with chronic pain. This means its easier than one could imagine to get in the habit of using a chemical-cocktail everyday to simply survive. From birth control pills, NSAIDS, Vicodin, Tramadol, Tums, Prilosec and more, the average woman with endo could be taking a handful of pills everyday to balance and counterbalance and counterbalance again the negative affects.
I wasn’t raised “au-natural”... not at all. I was raised lovingly, of course, but pharmaceuticals, antibiotics, and standard doctor recommendations were the common course for sickness. That’s why I never really questioned my obgyn when he recommended daily NSAIDS for pain, birth control for hormone suppression, and Prilosec for the indigestion cause by the NSAIDS. To me at the time, it seemed like the course I had to take to control my endo symptoms.
I only began to wonder of the effects of the drugs I was taking on my body’s ability to heal after my first surgery. I was prescribed Oxycodone to deal with the pain, a drug I had never taken before but one that definitely numbed the pain. As I started taking them I immediately acquired recurrent sinus infections, terrible ones! For the 6 whole weeks after my surgery not only was my pelvis slow to mend, but my head was so infected with puss I couldn’t breathe. Never had I been so sick or trying to heal, for so long, . It got me thinking … what am I taking?
The research I found in answer to that question forced my mindset into a 180 turn around. Before, I thought I absolutely needed these drugs to combat the chronic disease I assumed I would fight the rest of my life. In fact, I began to realize that the daily use of these drugs were inhibiting my ability to heal in so many ways, and my reliance was creating a more debilitated state than I knew. It’s a big part of why I went so downhill after my symptoms sprung up… why my fatigue grew and grew, why my belly became increasingly bloated, and why my digestion turned sluggish.
Sometimes pharmaceuticals are necessary, indeed a much needed relief, and this is not about shaming anyone for taking what they need, when they need it. Rather, it's about education on the hidden costs of using these crutches long term so you, as an endo-patient, can manage your disease most effectively.
Birth Control and Malnutrition
The option of not taking birth control can be slightly contentious in general for sexually active women, not just the endo community. I was so indoctrinated from childhood that women need to take birth control it almost seemed like a right of passage. Plus doctors prescribe it for any hormonal abnormality so not only does it stop babies, but it can give you a period, stop a period, control acne, or act as a line of defense from endometriosis. All these, of course, are bandaids - birth control will never fix any of these problems, it can just help shelve them for a while.
Whether you take contraceptives or not, here’s a well-known fact that's not contentious: it causes nutritional deficiencies. It has been shown that the key nutrient depletions concern folic acid, vitamins B2, B6, B12, vitamin C and E and the minerals magnesium, selenium and zinc. All of these vitamins and minerals are absolutely necessary for proper body function, and remember “malnutrition is the primary cause of immunodeficiency worldwide”
Another study not only shows birth control depletes the same nutrients listed above, but it also decreases glucose tolerance - meaning your ability to tolerate carbohydrates more or less. It also shows that you’re even more likely to develop nutritional deficits on birth control if you “just had a baby, are planning to have a baby later, already show nutritional deficiencies, have had recent illness or surgery, have poor dietary habits, are still growing or have a family history of diabetes or heart disease.” That means most women who develop endometriosis, who I would assume already have a low nutrient level, are even more likely to become depleted.
NSAIDS, Miscarriage, Ulcers, and Leaky Gut
The NSAID family - non steroidal anti-inflammatory drugs -- is among the most common pain relief medicines in the world, and includes the names of Ibuprofen, Aleve, Aspirin, Naproxen, and more. The only pain killer I was prescribed long term was Naproxen, I was told I could take it every day, but I should have my liver levels checked periodically to make sure I was okay. This should probably have worried me, but I was 24, confused, and ready to be “back to normal”. The thing was, after taking NSAIDS just about every day I grew further and further away from normal, until my new normal felt really really shitty.
The first thing I learned was that NSAIDS really mess up your stomach. I developed such severe bloating and stomach discomfort I thought I had a parasite until my Doc told me it was a bad case of acid reflux and prescribed me Prilosec. It helped, so now I was taking NSAIDS and Antacids everyday to feel normal. Looking back, it was the start of my most severe “endo belly” yet.
The truth is, it's well known that NSAIDS cause stomach bleeding and ulcers. They cause damage to the stomach mucosa which, you guessed it, will create issues of intestinal permeability and malabsorption. In a 1998 study, scientists observed the affects of NSAIDS on permeability (leaky gut) and found “intestinal permeability changes were significantly more pronounced and frequent” on NSAIDS, no matter which variety was taken. A 2011 study done to examine if NSAID intestinal damage could be avoided found that “There is still no proven method of preventing or curing small intestine damage due to NSAIDs. The simplest method is to stop taking the drugs.”
Additionally, for those women trying to battle endo and achieve pregnancy, it turns out there are links to NSAIDS and increased miscarriage rates. This study show women who took NSAIDS in early pregnancy are 2.4 times as likely to have a miscarriage as those who did not. It’s worth noting this specific issue linking NSAIDS and miscarriage needs further review, the entire medical community isn’t sold on it yet, but it’s good to note if you are trying to get pregnant that this could be a possibility.
Antacids and malabsorption
With all the other pharmaceuticals causing issues with nutrient absorption, it’s not surprising antacids too affect your digestive efficiency. Antacids do exactly that, they lower acid in your stomach, which has the direct function of breaking down and assimilating nutrients. So it shouldn’t be a shock that in one study, Omeprazole (Prilosec) significantly impacted the rates of absorption of vitamin b12 — 8.4 times less to be specific. More studies have linked antacids with reduced absorption to calcium, vitamin B12, iron and magnesium, with long term use potentially leading to bone loss and fractures.
Opiates and Immunosuppression
Opiate drugs include the well-known likes of Oxycodone, Vicodin, Tramadol, and Morphine. Whether you have endometriosis or not, you’ve probably been prescribed some at one time or another, which is why they’re also becoming the most widely used recreational drug in the nation. In the case of suppressing pain, they definitely work, but did you know what they’re even better at suppressing? Your immune system.
In one study, opiates were found to decrease immune response by 20-30%! Another widely peer reviewed study showed “opiates can immediately disrupt the body's first line of defense against harmful external bacteria … opiate abuse impairs innate immunity and is responsible for increased susceptibility to bacterial infection”. The link is so clear that opiates cause a poor immune response, patients with AIDS have been directed not to take them. But what about those of us with auto-immune, or who deal with chronic infections and sickness all the time? I was never told anything about this.
After my second surgery I did a self test. I only took Oxycodone for 2 days for the severe pain, but then I opted out completely. No no no, i’m not a sucker for pain, the truth is often times pain can be bearable if we let it be, if we accept we are going to be in slight pain and chose to be okay with it ... plus I really wanted to give my body the chance it needed to heal. Not like I was doing anything but watching movies anyways :) That time around it only took about 2 weeks for me to be back on my feet and getting stronger, without a single bout of sickness. Could have been coincidence but, well, the studies show it. Opiates suppress the immune system, meaning you won't heal quickly, nor stay healthy.
Pharmaceuticals: is it worth it?
All of this is laid out to help you reach a better understanding of just how pharmaceuticals will affect you long term. If you pop an Advil for a headache every once in a while you’re probably not going to get an ulcer, but if you have a chronic debilitation disease and pop pain pills, hormone pills, or any other pill everyday, you will develop nutritional deficiencies, ulcers, leaky gut, infections, and more. That’s why the idea of “feeling better” is so alluring, but the costs on your body can be horrendous.
This picture on the right is one of me the year before I finally woke up to what was happening to my life and my body. Even though I'm smiling was a sad time in my life. I had seriously lost all my muscle - I used to be so strong and my body had simply eaten it - and if you look at the back of my head you can see a large chunk of curls where my hair had literally just broken off. Like, a 10 inches of my hair just snapped off, it was awful. I was basically, skinny, pale, and weak with a completely beyond functioning level of fatigue. Even though I ate plenty, I was extensively malnourished, my stomach chronically bloated and in pain, and something that had gotten so much worse since the beginning of my endo ... when I started taking meds.
When are pills okay?
Truly this is a question only you can answer yourself. For me, I understood I had to break my birth control-NSAID-Antacid cycle in order to fully begin my recovery process. Thank goodness I never took opiates consistently, but the costs of everything else on my gut health was still more than enough to make me see how far I had fallen since I got my diagnosis 4 years prior. I had lost so much weight, was so deeply fatigued, utterly miserable, and I didn’t know what was contributing to the misery more: the endo or the pills I took for the endo.
That’s why you’re going to have to check in with yourself and ask honest questions, seeking honest answers. If you're in so much pain that even considering less pills is out of the question, that's okay! That's why these drugs were invented, to help people with acute pain or other issue. Knowledge is simply understanding you might need pharmaceutical help now, but as you heal and the pain lessens you might be more open to the possibility of taking a pain-pill or hormonal-pill break.
For women who aren't at level 10 pain, now that you know the nutritional deficiencies these pills can cause, ask if it makes sense for you to limit them. Maybe ask yourself if the pills helped at first, but now you don’t feel much better? Have you created a new normal of not feeling well nearly all the time? I know is that in my own journey, these drugs were interfering with me being better, and there was a intuition deep inside that kind of already knew it.
It may not be in everyone’s journey but if this resonates with you, I urge you to try living without them for a time. Indeed if you follow the Heal Endo path, you might find yourself ditching the pills and not needing any more anytime soon.