Endometriosis & Nutrition is a loaded topic, but I can safely say that what’s at the end of your fork influences your health, fertility, and endometriosis. I wish I could say that nutrition would cure endo, but honestly… It won’t. With that said, nutrition should be part of a holistic plan to navigate endometriosis.
I’m arming you with what’s currently known about endometriosis & nutrition.
Foods to Include
Omega-3s
Women with the lowest intake of Omega-3s are at higher risk of developing endometriosis. (Khanaki 2012, Missmer 2010, Parazzini 2004)
Fish, especially salmon, sardines, and anchovies, contain high Omega-3s, an anti-inflammatory fatty acid.
These healthy fats are also found in olive oil, eggs from pastured chickens, nuts and seeds, especially flax, chia, walnuts, and almonds.
Of course, you can take fish oil but I’ve covered that in a different post. You can check out the Top 6 Supplement for Endometriosis HERE!
Vegetables & Fruit
The risk of endometriosis decreases as you eat more vegetables and fruit. These delicious rainbow-colored foods also reduce symptoms. (Afrin 2021, Parazzini 2004)
However, if vegetables, especially cruciferous vegetables, bring on gas and bloating, you’re not alone. These symptoms are often associated with IBS (irritable bowel syndrome), an often shared health concern with endometriosis, and they worsen pelvic pain. (Harris 2018)
It can be hard to distinguish between IBS and endo, so make a plan to track your symptoms. Tracking helps identify food-related triggers. Consider working with a holistic provider to support gut health so that if you do have IBS + endo, you can work on reducing the IBS symptoms that are compounding your pelvic pain.
Low FODMAP Diet
Have you heard of the Low FODMAP diet? It improves abdominal pain, gas, bloating, constipation, and diarrhea by 50% in those with endo + IBS who follow it for four weeks. (Moore 2017)
If you haven’t heard of FODMAPs, they are sugars in food that aren’t absorbed properly in the gut and trigger the symptoms mentioned above.
FODMAP stands for:
Fermentable: This is the process through which gut bacteria ferment undigested carbohydrates to produce gases. Think bloated, painful belly!
Oligosaccharides: Fructans & Galactooligosaccharides (GOS) are found in foods such as wheat, rye, onions, garlic, and legumes.
Disaccharides: Lactose is in dairy products like milk, soft cheeses, and yogurt.
Monosaccharides: Fructose is in honey, apples, high fructose corn syrup, etc.
And
Polyols: Sorbitol and mannitol are in some fruits and vegetables and used as artificial sweeteners.
The best online resource for information on FODMAPs and the Low FODMAP Diet is Monash University. https://www.monashfodmap.com/about-fodmap-and-ibs/
Considerations:
- Choose organic – the pesticides on fruits and veggies worsen endometriosis
- If you tend toward IBS symptoms, work with a holistic provider to improve your gut health and consider a Low FODMAP Diet.
- Get at least 6-8 cups of veggies per day. There are tons of options! Eat them raw, steamed, roasted. However you like them, just get them in your body!
Foods to Exclude
Red Meat
The amount of red meat you consume is correlated with your estrogen level. Estrogen contributes to a worsening of endo. (Afrin 2021) If you’re getting two or more servings per day, your chance of endometriosis is 56% higher than if you had it once a week.
Just take it out! It’s not worth the added estrogen exposure and known risk of endo.
Gluten
A gluten-free diet was shown to reduce endometriosis-associated pain in a 12-month study. (Marziali 2012) This is a heated topic. I do recommend having a blood test to assess for celiac-related antibodies prior to starting a gluten-free diet. But if that’s not in the cards and you want to try it, there’s no harm in doing so. If it helps, that’s wonderful!
Alcohol
The more alcohol you drink, the more likely you are to have endo and worsen your symptoms. (Parazzini 2013)
Cut it out! It’s not worth it. It’s also not helping your fertility if TTC is on your to-do list at the moment.
Foods We’re Unsure About
Dairy
There have been a handful of studies that support the consumption of dairy with endo. In fact, some of the studies concluded that as dairy consumption increases, the risk of endometriosis decreases. The exception was butter. Yes, you read that right.
I have a few concerns with this…
- Dairy has the potential of containing several endocrine disrupting chemicals, including dioxins, which are found primarily in the fat.
- It will also contain hormones which could contribute to your overall estrogen load.
- Dairy is a common immune mediated food trigger and could potentiate immune dysregulation, inflammation, and gut pain.
So, my verdict is, if you want to consume dairy make sure you’re able to check all of these boxes:
- You do not have a food allergy or sensitivity to dairy or it’s protein components
- Always choose organic
- Low fat (this is not an ideal form but will reduce your exposure to dioxins)
- No butter
Foods & Environmental Toxins: A note on endocrine disrupting chemicals in & on food
pesticides
I already mentioned a few times that choosing organic is gonna help an Endo Sister out. The lingering pesticide residues in and on food is an endocrine disruptor, meaning it can wreak havoc on your hormonal balance and add to your estrogen exposure.
plastic
Here’s the deal, your plastic water bottles, food containers, and wrapping are an issue, especially if heated. They are adding to your hormonal burden. Ditch the plastic in your kitchen. Grab a stainless steel or glass water bottle and switch to glass food containers. These are easy replacements that make a huge difference.
The Take Home Message
Mediterranean Diet
I cannot find any data on the Mediterranean diet and endometriosis specifically; however, when I assimilate all of this information, it is clear that a Mediterranean-style diet is the best overall option.
This style of eating is based on the traditional foods that people consume in countries bordering the Mediterranean Sea, including France, Spain, Greece, and Italy. It is primarily plant-based, including plentiful amounts of non-starchy vegetables, fruit, whole grains, fiber, nuts, seeds, dairy, olive oil, and fish, with smaller amounts of other animal-based proteins. It typically excludes processed foods, added sugar, and refined grains.
There are fantastic online resources and entire cookbooks dedicated to this type of diet. Two of my favorites include:
Endometriosis is complex! If you’re new here, check out my other Endometriosis-Related Blogs for all the details on this condition!
You Don’t Have To Do This Alone!
If you have endometriosis, you’re thinking about getting pregnant or struggling with fertility, pregnancy loss, unsuccessful IUI, or IVF consider working with a holistically-minded provider who can offer a thorough assessment of your whole health and provide personalized therapeutic options. Or let me know if you need some 1:1: support! 🙂
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Tamara 🙋🏻♀️
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References
Afrin S, AlAshqar A, El Sabeh M, Miyashita-Ishiwata M, Reschke L, Brennan JT, Fader A, Borahay MA. Diet and Nutrition in Gynecological Disorders: A Focus on Clinical Studies. Nutrients. 2021 May 21;13(6):1747. doi: 10.3390/nu13061747. PMID: 34063835; PMCID: PMC8224039.
Barrett JS. Extending our knowledge of fermentable, short-chain carbohydrates for managing gastrointestinal symptoms. Nutr Clin Pract. 2013 Jun;28(3):300-6. doi: 10.1177/0884533613485790. Epub 2013 Apr 24. PMID: 23614962.
Beauchamp GK, Keast RS, Morel D, Lin J, Pika J, Han Q, Lee CH, Smith AB, Breslin PA. Phytochemistry: ibuprofen-like activity in extra-virgin olive oil. Nature. 2005 Sep 1;437(7055):45-6. doi: 10.1038/437045a. PMID: 16136122.
Chiaffarino F, Cipriani S, Ricci E, Mauri PA, Esposito G, Barretta M, Vercellini P, Parazzini F. Endometriosis and irritable bowel syndrome: a systematic review and meta-analysis. Arch Gynecol Obstet. 2021 Jan;303(1):17-25. doi: 10.1007/s00404-020-05797-8. Epub 2020 Sep 19. PMID: 32949284.
Harris HR, Eke AC, Chavarro JE, Missmer SA. Fruit and vegetable consumption and risk of endometriosis. Hum Reprod. 2018 Apr 1;33(4):715-727. doi: 10.1093/humrep/dey014. PMID: 29401293; PMCID: PMC6018917.
Issa B, Onon TS, Agrawal A, Shekhar C, Morris J, Hamdy S, Whorwell PJ. Visceral hypersensitivity in endometriosis: a new target for treatment? Gut. 2012 Mar;61(3):367-72. doi: 10.1136/gutjnl-2011-300306. Epub 2011 Aug 25. PMID: 21868492.
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Marziali M, Venza M, Lazzaro S, Lazzaro A, Micossi C, Stolfi VM. Gluten-free diet: a new strategy for management of painful endometriosis related symptoms? Minerva Chir. 2012 Dec;67(6):499-504. PMID: 23334113.
Missmer SA, Chavarro JE, Malspeis S, Bertone-Johnson ER, Hornstein MD, Spiegelman D, Barbieri RL, Willett WC, Hankinson SE. A prospective study of dietary fat consumption and endometriosis risk. Hum Reprod. 2010 Jun;25(6):1528-35. doi: 10.1093/humrep/deq044. Epub 2010 Mar 23. PMID: 20332166; PMCID: PMC2873173.
Moore JS, Gibson PR, Perry RE, Burgell RE. Endometriosis in patients with irritable bowel syndrome: Specific symptomatic and demographic profile, and response to the low FODMAP diet. Aust N Z J Obstet Gynaecol. 2017 Apr;57(2):201-205. doi: 10.1111/ajo.12594. Epub 2017 Mar 17. PMID: 28303579.
Nirgianakis K, Egger K, Kalaitzopoulos DR, Lanz S, Bally L, Mueller MD. Effectiveness of Dietary Interventions in the Treatment of Endometriosis: a Systematic Review. Reprod Sci. 2022 Jan;29(1):26-42. doi: 10.1007/s43032-020-00418-w. Epub 2021 Mar 24. PMID: 33761124; PMCID: PMC8677647.
Parazzini F, Chiaffarino F, Surace M, Chatenoud L, Cipriani S, Chiantera V, Benzi G, Fedele L. Selected food intake and risk of endometriosis. Hum Reprod. 2004 Aug;19(8):1755-9. doi: 10.1093/humrep/deh395. Epub 2004 Jul 14. PMID: 15254009.
Parazzini F, Viganò P, Candiani M, Fedele L. Diet and endometriosis risk: a literature review. Reprod Biomed Online. 2013 Apr;26(4):323-36. doi: 10.1016/j.rbmo.2012.12.011. Epub 2013 Jan 21. PMID: 23419794.
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Disclaimer: This website and post include general information about nutrition, health, and fertility. This content is not medical advice. It is not a replacement for medical advice, diagnosis, or treatment of any health condition or illness. With that said, if the reader or any other person has a medical condition, concern, or illness, they should consult with their personal doctor or another appropriately licensed healthcare provider. The reader should also never disregard professional medical advice or delay in seeking advice because of something discussed in this information. It is imperative to consult your doctor or another appropriately licensed healthcare provider before implementing any changes to your diet, fitness routine, lifestyle, medications, or nutritional supplements.
Information provided in this document and the use of any products or services related to this document by you does not create a doctor-patient relationship between you and Tamara Darragh, ND, DC. Statements regarding dietary supplements have not been evaluated by the Food and Drug Administration and are not intended to diagnose, treat, cure, or prevent any disease.
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