The Endo Diet Meal Plan: Managing Endometriosis Through Nutrition

Endometriosis, a condition where tissue similar to the uterine lining grows outside the uterus, affects a significant number of women. While there is no cure, research suggests that diet can play a crucial role in managing symptoms and potentially influencing the development of the condition. This article explores the concept of an "endo diet" meal plan, focusing on nutritional strategies to alleviate inflammation, balance hormones, and support overall well-being.

Understanding Endometriosis and Its Symptoms

Endometriosis is a chronic condition characterized by the presence of endometrial-like tissue outside the uterus. This can trigger an inflammatory response as the body's immune system tries to deal with tissue which shouldn’t be there. The immune system releases chemicals, such as cytokines and prostaglandins, which cause pain and further damage.

Symptoms can vary but often include:

• Pelvic and lower back pain, especially during periods
• Pain during or after sex
• Painful bowel movements
• Pain urinating
• Fatigue
• Digestive problems including diarrhea, constipation, and bloating
• Fertility problems

The exact cause of endometriosis remains unknown, but some experts speculate that our western diet and lifestyle could be a factor.

The Role of Diet in Managing Endometriosis

Inflammation is key in the development of endometriosis and is linked with many of the symptoms. Current advice is to avoid or limit foods which are known to trigger inflammation - and eat more foods which may be anti-inflammatory. This can help manage some of the symptoms associated with endometriosis. It's important to note that everyone is different and what may trigger pain for you may not for another.

Read also: The Hoxsey Diet

Foods to Incorporate into Your Endo Diet

A balanced diet rich in specific nutrients can help reduce inflammation and support overall health for individuals with endometriosis.

• Omega-3 Fatty Acids: These are known to help reduce inflammation, improve HDL cholesterol and protect heart health. Some research also shows that omega 3’s may help in reducing endometrial tissue and endometrial inflammation in the body, especially in those diagnosed with stages 3 or 4. Healthy sources include salmon, tuna, pacific oysters, trout, sardines, herring, swordfish, anchovies, mussels, mackerel, nori (seaweed), walnuts, flax seeds, chia seeds, hemp seeds, pumpkin seeds, canola oil, soybeans, and some fortified foods (eggs and vegan products). Aim to eat at two portions of oily fish a week. If you don’t eat fish, consider taking a supplement.
• Increased Protein Variety: Getting a variety of protein sources (both animal and plant based) and a variety of fats can help ensure balance and potentially decrease endometriosis progression. Opt for these protein sources: Chicken, Turkey, Fish, Shellfish, Beef, Pork, Beans, Peas, Nuts and seeds, Dairy and eggs, Soy products (tofu, tempeh, TVP), Seitan, Protein powders, Other vitalized wheat gluten products.
• Vitamin D: Research has shown those with autoimmune diseases tend to be deficient in vitamin D. This in itself can lower immunity in the human body. Research specifically in endometriosis has seen that vitamin D supplementation may also reduce inflammation and endometrial lesions. Food sources of Vitamin D include: Salmon, tuna, mackerel, Irradiated (UV treated) mushrooms, Fortified dairy and non-dairy milks (check the food label), Fortified OJ, yogurts and cereals (check the food label), Sunlight, Egg yolks, Cheese.
• N-acetylcysteine (NAC): NAC comes from the amino acid L-cysteine and is an approved drug by the FDA often used for acetaminophen overdose. It is also seen as an important compound that helps produce the antioxidant glutathione, which may be helpful for DNA health and cancer prevention. In endometriosis research, human trials have seen a reduction in endometrial cysts when taking NAC. NAC is not approved for supplemental use since it is an approved drug, but it is found in many supplements. Consuming foods high in cysteine can give a similar effect to taking NAC. Food sources of cysteine: Beans, Peas, Peanuts, Chicken, Turkey, Eggs, Yogurt, Sunflower seeds, Cheese.
• Flavonoids: Flavonoids-which are a type of antioxidant-like quercetin, resveratrol and sulforaphane have been found to positively impact endometriosis. Resveratrol: blueberries, cranberries, peanuts, red wine, grapes, grape juice, cocoa and bilberries. Sulforaphane: kale, broccoli, brussels sprouts, cabbage, broccoli and cauliflower. Quercetin: cherries, berries, apples, citrus, kale, broccoli, scallions, onions, olive oil, olives, tea, grapes, red wine, parsley, sage and garlic.
• Vitamins C and E: Some endometrial research has supported vitamins C and E reducing inflammation, dysmenorrhea and pelvic pain. These studies used supplemental versions of the vitamins, but both of these micronutrients are abundant in food. Food sources of vitamins C and E: Vitamin C: oranges, grapefruit, clementines, red and green bell peppers, kiwi, tomatoes, broccoli, potatoes, strawberries, cantaloupe, passion fruit, guava, goji berries, durian and mango. Vitamin E: olives, olive oil, avocados, avocado oil, peanuts, seeds, nuts, spinach, broccoli, sunflower oil and safflower oil.
• Green Tea and Curcumin: EGCG (a catechin found in green tea) and curcumin (found in the spice turmeric) have both been shown to reduce inflammation in the body.
• Fiber: High estrogen levels can make endometriosis symptoms worse. Fiber can help your body eliminate excess estrogen. How? Fiber helps you poop. And when you poop, it gives your body a chance to get rid of extra estrogen. Aim for about 35 grams of fiber each day. Some people can benefit from fiber supplements. But you can also up your intake by eating fiber-filled foods, like: Fruits and vegetables, focusing on the whole foods, not juice, which strips out the fiber, Ground flaxseed, which is great to add to smoothies or home-baked foods, Legumes, like beans, lentils and chickpeas, Whole grains, including whole-wheat pasta and brown rice. Increase fibre intake. High-fibre diets are associated with a reduced risk of endometriosis and modifying fibre can be helpful in managing symptoms associated with endometriosis. There are many different types of fibre - prebiotic fibre (found in onions, leeks, mushrooms, asparagus, cabbage, flax seeds and oats) can worsen symptoms. For women with digestive problems, soluble fibre tends to be better tolerated than insoluble fibre, and for anyone with constipation, eating soaked chia seeds or kiwi can be very helpful.
• Magnesium: Magnesium can help ease muscle cramps, including menstrual cramps that can come with having endometriosis. Magnesium-rich foods include: Fruits, particularly bananas, papaya, avocados and blackberries, Leafy greens, like arugula, dark lettuce, kale and spinach, Legumes, like black beans and edamame, Nuts and seeds, especially almonds and pumpkin seeds.
• Zinc: Zinc helps regulate your menstrual cycles, which is important for hormonal balance. It can help your body ovulate (release an egg). That includes foods like: Poultry, like chicken or turkey, Red meat, but limit this to two low-fat servings per week, Shellfish, including oysters, crab and lobster, Eggs, but limit yourself to one a day.

Foods to Limit or Avoid

Certain foods can exacerbate inflammation, disrupt hormone balance, and worsen endometriosis symptoms.

• Red Meat: A high intake of red meat is thought to increase risk of inflammation and is associated with a higher risk of developing endometriosis. Limit red meat to no more than twice a week and avoid processed meats such as sausages, ham, bacon and salami as much as possible. According to a 2018 study, red meat consumption - both processed and unprocessed - increases the development and the progression of endometriosis.
• Dairy and Gluten: Some women find that cutting out gluten and dairy can help alleviate symptoms, particularly bloating and wind. It doesn’t work for everyone, so if after three to four weeks you see no improvement, slowly introduce them back into your diet. When cutting out any foods it’s important to change one thing at a time, otherwise it’s difficult to pinpoint the food causing the problem. If you cut out dairy for more than a few weeks, make sure you get enough calcium from other foods in your diet. Going on a gluten-free diet may reduce pelvic pain in individuals with endometriosis.
• Alcohol: This can contribute to inflammation, increase oestrogen levels, and have an adverse effect on the gut bacteria which could make symptoms worse or trigger a flare up. This doesn’t mean you need stop drinking alcohol completely, but stick within the safe guidelines and monitor your reaction of alcohol using a food diary.
• Ultra-Processed Foods (UPFs): A diet high in UPFs has been shown to increase the risk of inflammation so choose unprocessed or minimally processed foods as much as possible.
• Refined and Free Sugars: A diet high in free sugars can increase risk of inflammation and have an adverse effect on gut bacteria. Free sugars are sugars that are added to food or drinks, and sugars found naturally in honey, syrups (like date syrup), unsweetened fruit juices, smoothies and purées.
• Fermentable Carbohydrates: A low FODMAP diet can help alleviate symptoms like bloating, flatulence, constipation and diarrhoea. It is a complicated and restrictive diet, so if you're going to try this approach it's best to seek the advice of a dietitian.
• Histamine Foods: Some women find that avoiding histamine-containing foods be can helpful. Histamine occurs naturally in foods including tomatoes, aubergine, avocados, seafood, smoked meats, red wine, aged cheese and fermented foods such as sauerkraut and kimchi.
• Caffeine: Caffeine in tea, coffee and some soft drinks can make symptoms worse for some people, so keep an eye on how much you consume and make a note of it in your food diary. Caffeine has been shown to increase the availability of oestrogen in the follicular phase of the menstrual cycle. This supports the suggestion that caffeine is best avoided in those with Endometriosis.
• Highly Processed Foods: Processed and packaged foods aren’t healthy for anyone. And if you have endometriosis, cutting back on your intake can help. Processed foods are the ones that come in a box or bag and have long lists of ingredients. They don’t have the vitamin and mineral content you’ll find in fresh foods. Instead, they tend to be chock-full of things that may worsen inflammation and stir up endometriosis symptoms. That includes ingredients like: Simple carbs, Sugar, Salt, Saturated fats, Preservatives, Food dyes.

The Importance of Food Journaling

Sophie Medin, RD, director at CityDietitians, recommends keeping a food diary - a record of what you eat, how you feel and what else is going on in your life - which can help you identify foods or other triggers that make symptoms better or worse. Between 3.8% and 37% of individuals with endometriosis are affected by bowel endometriosis or intestinal endometriosis. According to the Endometriosis Foundation of America, the best way to figure out what diet works for you is by listening to your body and recording the foods you eat in a food journal for 14 to 30 days. Be sure to jot down how each food makes you feel. It's important to note that everyone is different and what may trigger pain for you may not for another.

The Endo Diet as Part of a Holistic Management Plan

It’s also important to talk with your provider about other ways to manage your symptoms, care for your mental health and address all the ways in which endometriosis is affecting your well-being.

• Maintain a healthy weight. Excess body fat can produce extra oestrogen, which can increase inflammation which may worsen endometriosis symptoms. Research suggests that being within a healthy weight range can be beneficial when you have Endometriosis, but we know that not everyone is at their healthiest emotionally and physically when trying to fit into what is considered to be a healthy weight.
• Exercise regularly. Regular exercise is really important for our general health and for balancing hormones, improving mental health and reducing stress hormones. This doesn’t mean that you need to be up at 5am doing a HiTT class everyday. Exercise and movement should include things that make you feel good and that you enjoy. In fact, HiTT exercise can increase our stress hormones which are associated with increased inflammation.
• Manage stress. Worry and stress can influence not only your mind, but it can have a negative impact on your body. When you are feeling stressed, your body releases adrenaline along with a hormone called cortisol. This hormone creates a fighting response in the body which can often result in the feeling of having an upset stomach and can also increase inflammation. Some people can experience diarrhoea and stomach cramps, feeling nauseas and a loss or increase of appetite when stressed. In the case of chronic stress, our appetite can be increased, leading to comfort eating.

Supplements to Consider

Supplements are never a substitute for a healthy balanced diet but research shows that some supplements may be beneficial for women with endometriosis.

Read also: Walnut Keto Guide

• Vitamin D: A 2022 study found low levels of vitamin D to be associated with increased risk of endometriosis. Other studies show taking vitamin D supplements could help reduce pelvic pain.
• Omega-3: The evidence that omega-3 can be helpful for women with endometriosis is very convincing, so if you don’t eat fish, it's a good idea to take a supplement.
• Antioxidants: Research suggests that vitamins C and E may help reduce inflammation and pelvic pain associated with endometriosis.
• Probiotics: Emerging studies suggest that the gut microbiome may play an important role in the development and management of endometriosis. Although clinical studies in humans are currently limited, trying a supplement may be worth considering.
• Magnesium: Magnesium can have an anti-spasmodic effect by helping with muscle relaxation. Research has shown that magnesium may support pain management in Endometriosis.

Intuitive Eating: A Balanced Approach

Intuitive eating is about reconnecting with your body's natural hunger and fullness cues. Its philosophy goes beyond just food choices and fosters a more mindful and positive relationship with your body and health.

Here are the core principles of intuitive eating:

• Reject the Diet Mentality: Ditch the "good" vs. "bad" food labels and focus on nourishment.
• Honor Your Hunger: Eat when your body is hungry and stop when comfortably full.
• Make Peace with Food: Allow yourself to enjoy all foods without guilt.
• Body Positivity: Respect your body and its needs.
• Discover the Joy of Movement: Focus on activities you enjoy, not just burning calories.

By prioritizing intuitive eating within your endometriosis nutrition plan, you can experience a multitude of benefits:

• Reduce Stress.
• Support Hormone Balance.
• Improve Overall Health.

Sample Endometriosis Diet Meal Plan

Here is an example of a meal plan that includes foods that may help with endometriosis symptoms:

• Breakfast: Oatmeal with berries and nuts, flax seeds.
• Lunch: Salad with grilled chicken or fish, avocado, and olive oil dressing.
• Dinner: Baked salmon with roasted vegetables (broccoli, cauliflower, kale).
• Snacks: Fruits, nuts, seeds, yogurt.

Important Considerations

• Supplements are not regulated by the FDA and may interact with medications. Make sure to talk with your doctor before taking supplement forms of any of these nutrients. Unless supplementation is recommended by your doctor, all of these nutrients listed above are available in foods and easy to include in your daily diet.
• If you have cut out food groups, particularly meat and/or dairy, it is easy to become iron deficient and deficient in things like B12, zinc and calcium and vitamin D. Any nutritional deficiencies can exacerbate inflammation in the body as you have to work hard to compensate for the lack of those nutrients.
• If financial constraints or food access is a concern for you, here are a few tips: Canned or frozen produce and proteins are always great options. If you live in a food desert, buying canned foods online may be something to consider. Certain online retailers accept SNAP benefits. Consider applying for food stamps (SNAP). Seek help from food pantries and other food assistance programs like Brighter Bites. Look for options in restaurants and convenience stores with fruits, veggies, whole grains, legumes, chicken, turkey, fish or plant-based proteins.
• Chew your food well and try to sit down to eat.

Read also: Weight Loss with Low-FODMAP

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