Endometriosis, a condition affecting approximately 10% of women, involves the growth of tissue similar to the uterine lining outside the uterus. This can trigger inflammation and a range of symptoms, including pelvic pain, fatigue, and digestive issues. While there is no cure, dietary modifications can play a significant role in managing symptoms and improving overall well-being. This article explores the principles of an "endo diet," providing guidance on food choices and lifestyle tips to help reduce inflammation and support hormonal balance.
Understanding Endometriosis and the Role of Diet
Endometriosis is characterized by inflammation as the body's immune system reacts to the misplaced tissue. The immune system releases chemicals that cause pain and further damage. As the number of women suffering from endometriosis has increased over the last few decades, and while this is partly due to improved awareness and better diagnosis, some experts speculate that our western diet and lifestyle could be a factor.
Diet can affect endometriosis because inflammation is key in the development of endometriosis and is linked with many of the symptoms. The primary goal of an endometriosis diet is to reduce inflammation, decrease estrogen levels, and support immune function. 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.
Key Principles of the Endometriosis Diet
There is no one-size-fits-all diet when it comes to endometriosis, and what works for one person will not necessarily help another, so unfortunately, it’s a question of trial and error. It's essential to identify individual food triggers and adopt a personalized approach. 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.
Foods to Limit or Avoid
- Red Meat: 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.
- 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.
- 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.
Foods to Emphasize
- Fiber: High estrogen levels can make endometriosis symptoms worse. Fiber can help your body eliminate excess estrogen. Fiber helps you poop, giving your body a chance to get rid of extra estrogen. Aim for about 35 grams of fiber each day. Fiber-filled foods include fruits and vegetables (focusing on whole foods, not juice), ground flaxseed, legumes (beans, lentils, and chickpeas), and whole grains (whole-wheat pasta and brown rice). Increase your fiber intake gradually to minimize digestive discomfort.
- Healthy Fats: Omega-3 fatty acids can calm inflammation from endometriosis. Good food sources of omega-3s include fatty fish (salmon, sardines, and tuna), nuts and seeds (especially walnuts, chia seeds, and flaxseed), and plant oils (flaxseed oil and canola oil). Monounsaturated fats, found in avocados, nuts and seeds, olive oil, peanut butter, and safflower oil, also have anti-inflammatory properties.
- Magnesium: Magnesium can help ease muscle cramps, including menstrual cramps that can come with having endometriosis. Magnesium-rich foods include fruits (bananas, papaya, avocados, and blackberries), leafy greens (arugula, dark lettuce, kale, and spinach), legumes (black beans and edamame), and nuts and seeds (almonds and pumpkin seeds).
- Zinc: Zinc helps regulate your menstrual cycles, which is important for hormonal balance, and can help your body ovulate. Zinc-rich foods include poultry (chicken or turkey), red meat (limit to two low-fat servings per week), shellfish (oysters, crab, and lobster), and eggs (limit to one a day).
The Anti-Inflammatory, Mediterranean-Style Diet
Following an anti-inflammatory, Mediterranean-style diet can be beneficial. Focus on fruits, vegetables, whole grains, lean proteins, healthy, unsaturated fats and foods rich in polyphenols like berries and green tea.
Read also: Nutrition for Endometriosis
Lifestyle Tips for Reducing Inflammation
In addition to dietary changes, certain lifestyle adjustments can further support symptom management:
- Maintain a Healthy Weight: Excess body fat can produce extra oestrogen, which can increase inflammation which may worsen endometriosis symptoms.
- Increase Omega-3 Fatty Acids: Omega-3 fats found in oily fish like salmon, mackerel, and fresh tuna have anti-inflammatory properties. Research found that women who had a high intake of omega-3 were less likely to develop endometriosis. Aim to eat at two portions of oily fish a week. If you don’t eat fish, consider taking a supplement.
- 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. Sophie says, 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.
The Importance of Meal Planning and Preparation
Adhering to an endometriosis diet requires planning and preparation. Batch cooking and food prepping can save time and ensure healthy options are readily available. Focus on preparing meals with plenty of protein and vegetables.
Breakfast is a crucial meal to focus on, as it sets the tone for the day's blood sugar balance. Prioritize protein in the morning and consider batch cooking or prepping ingredients in advance to make breakfast quick and easy.
Dinner is another opportunity to prioritize cooking and create leftovers for lunch. Prepare enough food to feed everyone and have extra for the next day.
The Role of Supplements
Supplements can complement a healthy diet but should not replace it.
Read also: Endometriosis Diet and Lifestyle
- 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.
Seeking Professional Guidance
Navigating the complexities of an endometriosis diet can be challenging. Consulting a registered dietitian or healthcare professional can provide personalized guidance and support. They can help identify individual food triggers, develop a tailored meal plan, and address any nutritional deficiencies.
Embracing a Sustainable Lifestyle
The endometriosis diet is not a short-term fix but a long-term lifestyle change. It's important to approach dietary modifications with patience and self-compassion. Focus on making gradual, sustainable changes that can be maintained over time. Remember to enjoy the process of cooking and experimenting with new recipes.
Read also: The Hoxsey Diet