Natural Dietary Treatments for Fibroids

The same diet that helps regulate hormones in women may also reduce exposure to endocrine-disrupting pollutants.

Fibroids are the most common benign tumors in women. They can grow to a foot in diameter and affect the majority of women before they hit menopause. Although fibroids tend to be asymptomatic, when symptoms do occur, they tend to manifest as heavy menstrual bleeding—so much so that women may get anemic and experience a lot of pain. So, what can women do? I discuss this in my video The Best Diet for Fibroids.

Up to half go into surgery and get their entire uterus removed. “Although hysterectomy is generally considered a safe operation, complications occur in a significant proportion of patients” and, obviously, you can’t have kids any more. The alternative is a variety of hormone-modulating drugs, which can shrink the fibroids and provide relief, but many of these drugs have significant side effects, like bone loss, so you really don’t want to be taking them for more than a few months. What’s the bottom line? “There is currently no evidence to support the routine use of medical treatment in women with uterine fibroids.” No wonder many women turn to “complementary and alternative treatments…including exercise, diet, herbs, and acupuncture.”

Women who exercise seven or more hours a week do seem to have lower risk of having fibroids than women who exercise less than around 20 minutes a day, but exercise has never been put to the test for treating fibroids. Likewise, to date, there isn’t a single randomized controlled trial of acupuncture for the treatment of fibroids to help guide us. 

In terms of herbs, there are two Asian herbal preparations that show promise—a five-herb combo called Guizhi Fuling and a Malaysian ten-herb formula that contains “secret ingredients” that must not be that secret since they’re just listed in the study, as you can see at 1:50 in my video—and they seemed to work as well as a leading drug. The problem is that traditional Asian herbal remedies may contain a few extra ingredients, like arsenic, mercury, and lead, which have been detected in most of the samples tested from Asian market and health food store shelves, and not just a little. Some, apparently, had really toxic amounts. So, these two Asian herbal preparations “may reduce fibroid size, but there is insufficient evidence to support the efficacy or safety of these treatments.” And, certainly, don’t try to apply caustic herbs internally, as this can lead to scarring, stenosis, and ulceration.

Well, what about diet? In one of the largest studies of diet and fibroids, fibroid tumors were “associated with beef and ham consumption, whereas high intake of green vegetables seems to have a protective effect.” The researchers figured that the “association between levels of estrogen, diet, and breast and endometrial [uterine lining] cancers also may help us understand” why. Indeed, “[f]or breast and endometrial cancers, a direct association with the frequency of consumption of meat and ham was observed…whereas protection was conferred by high intake of vegetables and fruits.” Thus, there may be these shared risk factors between estrogen-responsive malignant tumors, like breast cancer, and estrogen-responsive benign tumors, like fibroids.

We know the presence of fibroids seems to correlate with an increase in the amount of estrogens flowing through your body, for example, and that women eating vegetarian diets have significantly lower levels of excess estrogen. Researchers are using this knowledge to try to explain why there are lower rates of endometrial cancer—that is, lining-of-the-uterus cancer—and possibly breast cancer among vegetarian women, but it could also help explain the fibroid findings. “The incidence of breast cancer among vegetarian American women (Seventh Day Adventists) is 60 to 80 per cent of the incidence among American women in general, and the incidence among women in Africa and Asia is even lower.” Why might vegetarian women have lower estrogen levels? A famous study in the New England Journal of Medicine concluded that it was their “increased fecal output, which leads to increased fecal excretion of estrogen,” resulting in lower blood levels. Double the fecal output, in fact, as you can see at 4:07 in my video.

And, you can put it to the test. Maybe the same reason African-American women have more fibroids is the same reason they have worse breast cancer survival: too much estrogen in their bloodstream due to a less than optimal diet. So, researchers designed a study to see what would happen if they were switched to a more plant-based, higher fiber diet. Compared with the Caucasian women, the African-American women started out with much higher estrogen levels, again helping to explain their increased mortality from breast cancer. But, after they were put on a healthier diet, all of their levels came down, “suggest[ing] that a substantial reduction in breast cancer risk can be achieved” by adopting a diet centered around more whole plant foods. The same also appears to be true for fibroids, especially eating lots of cruciferous vegetables—broccoli, cabbage, and Chinese cabbage—as well as tomatoes and apples.

Women who underwent premature puberty, starting their periods before age 11, may also be at increased risk of fibroids later in life, and we know that higher childhood red meat intake is associated with earlier age of starting one’s period, though total protein and animal protein in general may contribute. For example, girls who eat meat tend to start their periods about six months earlier than vegetarian girls. Those who eat meat analogues like veggie burgers and veggie dogs start their periods nine months later on average, and a similar puberty normalizing influence was found with consumption of whole plants foods, such as beans. 

It could also be the endocrine-disrupting pollutants that build up the food chain. Researchers took samples of internal abdominal fat from women and found there appeared to be a correlation between the presence of fibroids with the levels of a number of PCBs in their fat. So, does that mean fish-eaters have higher risk of fibroids? Researchers did find a small increase in risk associated with the intake of long-chain omega-3 fats, mostly from “dark-meat fish consumption,” by which they meant fish like sardines and salmon. This could be because of “the endocrine-disrupting chemicals commonly shown in fish,” or it could just be a statistical fluke. It would be consistent with the increased risk seen among “sport-fish consumers.” 

Recognizing that diet and endocrine-disrupting persistent organic pollutants have been associated with a variety of gynecologic conditions, including fibroids, researchers looked at consumers of fish fished out of the Great Lakes and found a 20 percent increased risk for every ten years they had been eating the fish. In the most comprehensive study to date, researchers compared pollutant levels in fat samples from women with fibroids to fat liposuctioned out of women without fibroids. They didn’t just find higher levels of PCBs in fibroid sufferers, but also long-banned pesticides, like DDT and hexachlorocyclohexane, PAHs, which are polycyclic aromatic hydrocarbons formed when coal is burned, tobacco is smoked, and meat is grilled, as well as heavy metals, arsenic, cadmium, lead, and mercury. These levels correlated not only to fibroids, but also to seafood consumption or excess body fat. So, the researchers determined that “shedding excess weight and limiting seafood consumption would confer a protective effect” on fibroid tumor development by minimizing exposure to environmental pollutants as much as possible.

Okay, so a plant-based diet may be best, but is there a plant in particular that has been shown to be particularly powerful?

Plant-based compounds with disease-preventive properties, dietary phytochemicals are found in whole grains, fruits, vegetables, beans, split peas, chickpeas, and lentils, herbs, spices, nuts, and certain beverages. As I discuss in my video The Best Food for Fibroids, we know they can help regulate the initiation, promotion, and spread of cancerous tumors, so what about benign tumors like fibroids? Most anti-cancer drugs on the market now were originally derived from plants or plant products, so why not try to use plants to target the inflammation or blood supply of fibroids? Might fibroids be a consequence of chronic inflammation within the body? We know that women with fibroids are more likely to eat more beef and ham, and fewer fruits and green vegetables, but whole plant foods don’t just have anti-inflammatory effects but antioxidant effects as well. “If the generation of free radicals exceeds the protective effects of antioxidants, oxidative damage will occur,” which has been implicated in a variety of disease states, including gynecological conditions such as fibroids. 

If you collect fresh fibroids, as well as normal uterine tissue from hysterectomy surgeries, the fibroid cells have significantly fewer antioxidant enzymes, as you can see at 1:20 in my video, so might antioxidant-rich foods help? Well, if you drip some strawberries onto cells in a petri dish, you can apparently kill of some fibroid tumor cells, while leaving normal uterus cells alone. But, what good does that do us? That’s only relevant if we can show those strawberry compounds get absorbed through our gut and achieve high enough concentrations in uterine tissue. The same with curcumin, the component of the spice turmeric. One of its so-called “miraculous” properties is suppressing the growth of uterine fibroid cells, but, again, that was just in vitro. Yes, an inhibitory effect was found and at concentrations that don’t compromise the growth of normal, regular uterine tissue, but my patients are people, not petri dishes. 

It’s pretty neat to find out what happens to human fibroid cells as you drip higher and higher concentrations of green tea compounds on them in a test tube, as you can see for yourself at 2:19 in my video, but I care less about what happens in vitro or in mice, whether or not they have any clothes on—one study looked at “a nude mice model”—but there were no randomized, controlled clinical studies until 2013. 

Subjects were randomized to green tea extract or placebo for four months. In the placebo group, fibroid volume increased by 24 percent. That’s what fibroids do; they continue to grow. However, those randomized to the green tea group showed a reduction in total fibroid volume—and not just by a little. There was a dramatic decrease, shrinking by almost a third, which is a highly significant difference, as you can see at 3:02 in my video. Okay, but did the women feel any better? Yes, they experienced a dramatic decrease in symptom severity, as well. Month after month, nothing much happened in the placebo group, but those taking the pills that looked the same but happened to contain green tea compounds had consistent improvement and felt lessening symptoms, each month better than the last, as well as an improved health-related quality of life, month after month, that was significantly better than control. What’s more, their blood counts got better too. With all that continued excess blood loss every month, the blood levels kept decreasing in the placebo group, but they reversed in the green tea group. So, anemia also significantly improved, because average blood flow significantly diminished. And, all this—the fibroid shrinkage, less pain, better periods—was achieved with “no adverse effects.” 

So, not only were the results comparable to those for the drugs that are commonly used—again, without the side effects—but the results were also comparable to uterine artery embolization, where they try to cut the blood supply to the fibroid, which is great—unless they accidentally cut the blood supply to the rest of the uterus and cause uterine necrosis, one of many reported major complications. Others include death, not only of the fibroid, but also of the patient, along with other potential complications that may arise from accidentally clogging off non-target arteries. In my book, a side-effect-free solution as good as a more invasive procedure is potentially better than. The researchers conclude that green tea compounds show “promise as a safe and effective therapeutic agent for women with symptomatic UFs [uterine fibroids]. Such a simple, inexpensive, and orally administered therapy can improve women’s health globally.” 

Relatively safe doesn’t mean risk-free, however. Although there were no liver function abnormalities detected, this was a small study. If you give green tea extract pills to a thousand women for a year, like they did in the Minnesota Green Tea Trial for breast cancer, the livers in about 1 in 17 women started to get inflamed and a few became serious. Now, the dose they used in this study was twice that of the fibroid study and it’s not completely clear if the pills were the only cause, but, in general, we should try to avoid extracts and instead get nutrition from foods as grown—or at least from foods as grown that are then dunked in hot water, like green tea. 

The researchers had to use pills in this study, because they wanted it to be a double-blind study and it’s hard to create a placebo tea that looks, smells, and tastes like the real thing. I don’t think we should take green tea extract pills, though. We should drink green tea. The problem is that the dose the researchers used was about 11 cups a day, which would be a lot of caffeine. You could choose decaf, though, and it’s not outside the realm of possibility to drink a couple quarts of tea a day, especially if doing so may shrink your fibroids so much you can keep your uterus. But, for all we know, five cups of tea a day would work or maybe even three cups or one cup. No other dose has been tested, so we just don’t know. But, you can test it in your own life. If you have fibroids, it couldn’t hurt to add a few cups of green tea to your daily diet and see if you start feeling better.

And, for even more on fibroids, see Should Women with Fibroids Avoid Soy? and Talcum Powder and Fibroids.

For more on contaminated herbal products, see Get the Lead Out and Some Ayurvedic Medicine Worse Than Lead Paint Exposure.


I’ve got dozens and dozens of videos on the effects of diet on estrogens, such as:

In health, 

Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live presentations:

How to Reduce Your TMAO Levels

Should we be concerned about high-choline plant foods such as broccoli producing the same toxic TMAO that results from eating high-choline animal foods such as eggs?

Choline- and carnitine-rich foods—meat, eggs, and dairy—can be converted by our gut flora into trimethylamine, which in our livers is then turned into TMAO, a toxic compound that may increase our risk of heart failure, kidney failure, and atherosclerosis, or heart attacks and strokes. The good news, though, is that this “opens up exciting new nutritional and interventional prospects” for prevention, as I discuss this in my video How to Reduce Your TMAO Levels.

Okay, so how do we do it? Well, if our gut bacteria can take meat, dairy, and eggs and turn them into TMAO, all we have to do is…destroy our gut flora! We could give people antibiotics to eliminate the production of TMAO. However, that could also kill our good bacteria and “facilitate the emergence of antibiotic-resistant bacterial strains.”

What about probiotic supplements? Maybe if we add good bacteria, they will crowd out the ones that take the meat, egg, and dairy compounds and turn them into the TMA that our liver turns into TMAO. But, that doesn’t work. Adding good bacteria doesn’t seem to get rid of the bad. What if we added new bacteria that could somehow siphon off the TMA made by the bad bacteria? Well, there’s a bacterium inside the guts of cows and sheep that turns trimethylamine into methane. Could we use that bacterium to get rid of some of the trimethylamine from our gut, like a cow fecal transplant? There’s a problem with that. If it didn’t take, you’d have to keep giving it to people: “Continuous administrations may be necessary if subjects do not become colonized.” So, might the fact that Consumer Reports found fecal contamination in every sample of beef it tested be a good thing? No. Methane-producing bacteria may be able to eat up our TMAO, but, unfortunately, these bacteria may be associated with a variety of diseases, from gum disease down to colorectal cancer, as you can see at 2:15 in my video.

If antibiotics and probiotics aren’t going to work to prevent gut bacteria from taking meat, dairy, and eggs and turning them into the trimethylamine, which our liver makes TMAO out of, I guess we have no choice but to cut down on…our liver function!

That was the billion-dollar answer to cholesterol. The same foods—meat, dairy, and eggs—raise our cholesterol, but dietary change isn’t very profitable. So, the drug industry developed statin drugs that cripple the liver’s enzyme that makes cholesterol. Could “pharmacologic inhibition” of the enzymes in our liver that make TMAO “potentially serve as a therapy for CVD [cardiovascular disease] risk reduction”? Trimethylaminuria is a genetic condition in which this enzyme is naturally impaired, in which there is a build-up of trimethylamine in the bloodstream. The problem is that trimethylamine is so stinky it makes you smell like “dead fish.” So, “given the known adverse effects…from sufferers of fish odor syndrome, the untoward odorous side effects of inhibiting this enzyme make it a less attractive [drug] target.”

Do we have to choose between smelling like dead fish or suffering from heart and kidney disease? If only there were some other way we could stop this process from happening. Well, what do those with trimethylaminuria often do to cut down trimethylamine levels? They stop eating animal products.

About a third of those who complain of bad body odor despite good personal hygiene test positive for the condition, but reducing or eliminating meat, egg, and dairy intake can be a real lifesaver. But, given what we now know about how toxic the end product TMAO can be for normal people, cutting down on animal products may not just save the social lives of people with a rare genetic disorder, but help save everyone else’s actual lives.

The “simplest point of intervention” is to simply limit the consumption of foods rich in choline and L-carnitine, which “can be an effective strategy to limit circulating TMAO.” But, wait! We could always try to genetically engineer a bacterium that eats up trimethylamine, but “the simplest and safest recommendation” may just be to eat more healthfully. You can completely eliminate carnitine from the diet, since our body makes all we need, but choline is an essential nutrient so we do need some. Thankfully, we can get all we need in fruits, vegetables, beans, and nuts. “However excess choline, such as that found in eggs, may be worth avoiding.”

Need we worry about high-choline plant foods, like broccoli? Consumption of cruciferous vegetables is associated with a significantly longer life and less cardiovascular disease mortality, as you can see at 5:34 in my video. To see what was going on, researchers took the vegetable highest in choline, brussels sprouts, and had people eat two cups a day for three weeks. What happened? Their TMAO levels actually went down. It turns out that brussels sprouts appear to naturally downregulate that TMAO liver enzyme—not enough to make you stinky, but just enough to drop TMAO.

And, people who eat completely plant-based may not make any TMAO at all—even if you try. You can give a vegan a steak, which contains both choline and carnitine, and there will not even be a bump in TMAO because vegetarians and vegans have different gut microbial communities. If we don’t eat steak, then we don’t foster the growth of steak-eating bacteria in our gut. So forget the cow—how about getting a fecal transplant from a vegan? From a TMAO standpoint, we may not have to eat like a vegan as long as we poop like one.


Can you sense my frustration as I read paper after paper proposing those ridiculous (but profitable!) answers when the safe, simple, side-effect-free solution was staring them in the face the whole time? It makes me think of so many parallels, not the least of which are:

For more on TMAO, the “smoking gun” of diet-microbiome-disease interactions, see:

In health,

Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live presentations:

Is Nutritional Yeast Healthy for Everyone?

Those with certain autoimmune diseases such as Crohn’s disease should probably not eat nutritional yeast.

Thousands of years ago, some yeast floated down into our flour and drinks, pleasing our palates, and we’ve been regularly exposed to it ever since. Yeast isn’t a problem for most people, but even non-disease-causing microbes could potentially trigger autoimmune diseases like Crohn’s disease in those who are susceptible because their finely tuned immune balance is somehow off. Maybe that’s why bakers have the highest Crohn’s disease mortality and, from a different data set, also have among the highest rates of Crohn’s disease, as you can see at 0:30 in my video Is Nutritional Yeast Healthy for Everyone? Perhaps a “hypersensitivity to baker’s yeast…may play a role in Crohn’s disease.”

If you take people with Crohn’s and remove from their diets the three foods to which they appear to have the most antibodies, in order to try to calm their disease, and then add those foods back, you can provoke the symptoms once again and re-stimulate the inflammation. So, for example, an anal fistula gets nice and dry off those foods, starts oozing again once the foods are back in the diet, and then the spigot’s turned back off when the foods are removed once more, as you can see (ew!) at 0:57 in my video.

However, without a control group, you can’t exclude the possibility of a powerful placebo effect. There hadn’t been any such randomized controlled trials until researchers came up with a brilliant design. They tested people with Crohn’s for antibodies to 16 different foods and then randomized the subjects into two groups. Both groups were told to avoid four foods, but one group was told to avoid the four foods they reacted most to, while the other group was told to avoid the foods they reacted least to. The group assignments were given in sealed envelopes, so no one knew who was in which group until the end. So, did it matter? Yes, more than twice the probability of major clinical improvement was seen in the group told to stay away from the four foods their blood reacted most to—but that wasn’t just yeast. In fact, the “exclusion of milk, pork, beef, and egg was most strongly associated with improvement,” leading the researchers to suggest that perhaps instead of doing fancy blood tests, we should just tell our patients to cut out meat and eggs and see how they do. This would be consistent with population studies that associate “diets high in animal fat” with an increased risk of inflammatory bowel diseases, as well as interventional studies showing that a plant-based diet, in which meat is cut down to about one serving every two weeks, can drop relapse rates as low as an extraordinary 8 percent over two years.

But, what about the whole yeast question? Can’t you just put some yeast up someone’s butt and see what happens? Why, yes! Yes, you can, and researchers have. Indeed, researchers tested rectal exposure to six different foods, including yeast, in Crohn’s disease patients. This was kind of like a skin prick test, but instead of pricking the skin, they pricked the inside of people’s rectums with various foods. You can see at 3:00 in my video the various prick sites for the different foods, and it’s clear that yeast gave the most significant reaction in Crohn’s patients.

It appears that baker’s yeast, which is the same yeast as brewer’s yeast and nutritional yeast, may indeed have disease-causing importance in Crohn’s disease, but the good news would then be that it “may be of therapeutic relevance.” If Crohn’s patients went on a yeast-free diet, would they feel better? You don’t know until you put it to the test.

In fact, that’s exactly what the original study linking yeast and Crohn’s disease suggested back in 1988. “A controlled trial of a yeast free diet for patients with Crohn’s disease may therefore be worth while.” Why did it take years before such a study was done? Well, who’s going to fund it? Big Soda Bread? Thankfully, there are charities like the National Association for Colitis and Crohn’s disease, willing to put up the (yeast-free) dough.

Nineteen patients with Crohn’s disease ate their regular diet for a month and were then switched to a yeast-exclusion diet. There was a significantly higher CDAI, Crohn’s Disease Activity Index, which assesses symptoms like abdominal pain and diarrhea, during the period when they were eating yeast, compared to the yeast-free period. So, there was worse disease activity with yeast than without. Okay, but what was this yeast-free diet? They didn’t just cut out bread and beer. The researchers switched people from dairy milk to soy milk and from white flour to whole wheat, for example. Just cutting out milk can sometimes help with inflammatory bowel disease, as you can see at 4:43 in my video.

So, with so many dietary changes, how do we know what role the yeast played? This is how we know what role the yeast played: After placing the subjects on the new yeast-free diet, they then challenged the Crohn’s sufferers with either a capsule of yeast or a placebo. A tiny amount of yeast, like giving them a quarter teaspoon of nutritional yeast a day, made them worse, suggesting “yeast may be important in the pathogenesis [disease process] of Crohn’s disease.”

Now, for the vast majority of people, yeast is not a problem, but in susceptible individuals, it may trigger an abnormal immune response in the gut. But, wait. I thought the paratuberculosis bug was considered a trigger for Crohn’s disease. Well, maybe infection with paraTB is what “induces a hypersensitivity response to dietary yeast.” Who knows? The bottom line is that people with Crohn’s disease should not go out of their way to add baker’s, brewer’s, or nutritional yeast to their diets.

I introduced this topic in Does Nutritional Yeast Trigger Crohn’s Disease?, then took a bit of a tangent with Is Candida Syndrome Real?. Next, I finish up this video series by talking about another autoimmune disease that appears to be affected: Dietary Cure for Hidradenitis Suppurativa.


For more on Crohn’s, see Preventing Crohn’s Disease with Diet and Dietary Treatment of Crohn’s Disease

And paratubercuwhat? See Does Paratuberculosis in Milk Trigger Type 1 Diabetes? and Does Paratuberculosis in Meat Trigger Type 1 Diabetes?

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In health,

Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live presentations: