Endometriosis is a chronic condition characterized by inflammation and hormonal imbalances, where tissue similar to the uterine lining grows outside the uterus. This can lead to pelvic pain and fertility issues. While there's no one-size-fits-all "endometriosis diet," research suggests that certain foods can significantly impact symptoms by influencing inflammation and hormone levels. This article explores how diet may affect endometriosis, which foods to include and limit, and provides sample meal ideas to help manage symptoms.
Does Diet Impact Endometriosis?
Endometriosis is marked by chronic inflammation and unbalanced hormones. Tissues grow outside the uterus, contributing to pelvic pain and potentially hindering pregnancy. The food and beverages consumed can significantly impact symptoms by influencing inflammation and hormone levels.
Foods with anti-inflammatory properties, such as fruits, vegetables, whole grains, and fatty fish, may help reduce inflammation and alleviate pain. Incorporating foods that help balance estrogen levels, like high-fiber options, may help reduce endometriosis growth. Some foods also contain vitamins and minerals like vitamin C, zinc, and magnesium, which may promote overall health and ease endometriosis symptoms.
Conversely, foods that increase inflammation, such as processed foods, trans fats, and red meat, may worsen inflammation and increase hormone imbalance, potentially exacerbating symptoms.
Foods to Include in an Endometriosis Diet
While no specific "endometriosis diet" exists, certain foods may help reduce inflammation and circulating estrogen while boosting essential vitamins and minerals.
Read also: Nutrition for Endometriosis
Fruits and Vegetables
Fruits and vegetables offer several healthy benefits for endometriosis. They are full of fiber, which may help reduce estrogen levels. A 2020 systematic review found that fiber has several effects on the gut microbiome (beneficial bacteria and viruses in your gut) and circulating hormones that can help reduce estrogen levels. Eating fiber also promotes regular bowel movements and a healthy microbiome. Constipation and a poor microbiome are common among people with endometriosis.
Consuming a diet full of fruits and vegetables also has the potential to reduce overall inflammation and boost vitamin C levels. There's no limit on what fruits and vegetables can be eaten for endometriosis, but some options include:
- Apples
- Avocados
- Bananas
- Berries
- Citrus fruits
- Dates
- Grapes
- Melons
- Asparagus
- Beets
- Bell peppers
- Cabbage
- Carrots
- Celery
- Cucumbers
- Leafy greens
- Green beans
- Peas
- Radishes
- Squash
- Tomatoes
Whole Grains
Whole grains have multiple ways they may help reduce endometriosis symptoms. They’re an important part of a balanced diet, and similar to fruits and vegetables, whole grains are also packed with fiber that may help reduce overall inflammation, prevent constipation, and balance estrogen levels. Whole grains are also a good source of B vitamins, which studies show may help reduce incidences of endometriosis. Another benefit of whole grains is their high levels of magnesium. Studies suggest that people with endometriosis have low levels of magnesium. Magnesium is an important mineral for helping smooth muscles relax, such as the smooth muscles of the uterus that cause cramping. Eating a magnesium-rich diet may reduce discomfort associated with endometriosis uterine cramping. Whole grains include:
- Whole wheat bread
- Quinoa
- Oatmeal
- Brown rice
- Whole cornmeal
- Barley
- Whole wheat pasta
It’s important to note that some people with endometriosis may have a sensitivity to gluten and feel better when they avoid grains containing gluten.
Proteins
Protein is an essential part of a balanced diet and can be a good source of vitamin D, zinc, and omega-3 fatty acids, each of which may help reduce inflammation and endometriosis discomfort. Good sources of protein include:
Read also: The Keto-Endometriosis Link
- Fish such as salmon, tuna, mackerel, and cod
- Shellfish such as shrimp, lobster, crab, and oysters
- Liver
- Egg yolk
- Cheese
- Poultry
- Beans
- Nuts, such as walnuts
- Dairy products
- Chia seeds
- Flax seeds
Healthy Fats
Healthy fats, such as monounsaturated fats and omega-3 polyunsaturated fatty acids, are an important part of reducing inflammation associated with endometriosis. A review of research demonstrates the potential benefits of omega-3 fatty acids in:
- Reducing signs of inflammation
- Reducing the growth of extra blood cells in endometriosis tissues
- Inhibiting endometrial cell growth
A 2020 clinical trial revealed that individuals who took 1000 milligrams of fish oil supplements daily experienced a notable decrease in endometriosis pain. Foods that contain healthy fats include:
- Fatty fish (salmon, herring, mackerel, sardines, trout, sea bass)
- Chia seeds and flaxseeds (including flaxseed oil)
- Olive, canola, avocado, and soybean oil
- English or black walnuts
- Kidney beans
- Avocados
Foods to Avoid or Limit for Endometriosis
Certain foods may cause increased inflammation or estrogen levels. These can include:
- Red meat: Red meats may increase inflammation and worsen symptoms. Consider limiting it to a couple of servings a week.
- Soy: Studies suggest people with endometriosis may have fewer symptoms when they avoid soy products (edamame, soy milk, tofu, miso, soy sauce, and some meat alternatives).
- Dairy: Dairy products such as milk, yogurt, cheese, ice cream, and butter may worsen endometriosis symptoms. However, research is mixed on this, and some people benefit from dairy.
- Gluten: In one study, people with endometriosis who avoided gluten had fewer symptoms. Gluten is found in many grain products such as bread, pasta, pastries, cakes, crackers, and other foods.
- Processed foods: Processed foods are packed with sugar, trans and saturated fats, and additives that may contribute to inflammation.
- Sugar: It’s best to avoid or limit added sugar as it can lead to changes in the body that increase inflammation.
- Coffee: Coffee may cause irritation for some people with endometriosis. However, the research is mixed.
- Alcohol: Alcohol may play a role in increasing symptoms of endometriosis and inflammation. It’s best to limit alcohol intake to one or two drinks a week.
Sample Meal Plan for an Endometriosis Diet
Below are several meal ideas that may help with symptoms of endometriosis.
Breakfast
- Overnight oats with almond butter and banana: Combine oats, almond milk, almond butter, and sliced bananas in a jar. Refrigerate overnight.
- Smoothie bowl with mixed berries and chia seeds: Blend frozen berries, greek yogurt, spinach, and almond milk until smooth. Pour into a bowl and top with granola, chia seeds, slivered almonds, and fresh berries.
- Egg and veggie breakfast muffins: Whisk eggs with diced vegetables (onions, bell peppers, spinach) and pour into muffin tins. Bake until set.
Lunch
- Turkey and avocado wrap with hummus: Fill a whole wheat wrap with sliced turkey breast, mixed greens, mashed avocado, and some hummus.
- Lentil soup with spinach and tomatoes: Simmer lentils with diced tomatoes, vegetable broth, garlic, and spices. Add fresh spinach leaves towards the end of cooking for a hearty and nutritious soup.
- Quinoa and chickpea salad with lemon-tahini dressing: Toss cooked quinoa, chickpeas, cucumber, cherry tomatoes, and mixed greens with some fresh lemon juice and tahini.
Snack
- Apple slices with almond butter
- Veggie sticks with hummus or guacamole
- Greek yogurt parfait with granola, honey, and berries
Dinner
- Baked salmon with roasted vegetables: Marinate salmon filets in a mixture of olive oil, lemon juice, garlic, and herbs. Bake until flaky and serve with a side of roasted vegetables like brussels sprouts, sweet potatoes, and asparagus tossed in olive oil, salt, and pepper.
- Vegetable stir-fry with chicken: Sauté chicken with garlic, ginger, and soy sauce until cooked through. Add in a colorful array of stir-fry vegetables like bell peppers, broccoli, snap peas, and carrots. Serve over brown rice or quinoa.
- Stuffed bell peppers with quinoa and black beans: Halve bell peppers and remove seeds. Fill with a mixture of cooked quinoa, black beans, corn, diced tomatoes, onions, and spices. Bake until peppers are tender and serve with a side of avocado slices and a dollop of Greek yogurt or salsa.
Other Tips for Improving Endometriosis with Diet
In addition to eating well-balanced meals that reduce inflammation and estrogen, here are some additional tips for improving your endometriosis:
Read also: Endometriosis & Weight Management
- Get professional guidance: Consult with a registered dietitian who specializes in endometriosis to develop an individualized diet plan.
- Experiment with elimination diets: Consider trying an elimination diet to identify foods triggering or exacerbating your endometriosis symptoms. Some common trigger foods include gluten, dairy, and soy, although sensitivities vary.
- Stay hydrated: Drink plenty of water throughout the day to support your overall health and hydration, as this helps your body function at its best.
- Try supplements: If you are still experiencing frequent or severe endometriosis symptoms, consider taking a supplement such as quercetin, N-acetylcysteine (NAC), probiotics, resveratrol, and alpha-lipoic acid after consulting with your healthcare provider.
The Role of Specific Nutrients and Foods
Polyphenols
Numerous studies provide solid evidence of positive health effects of eating a diet rich in vegetables and fruits, because of the existence of the bioactive plants’ composites, especially polyphenols. Polyphenols have proven anti-cancer, anti-inflammatory, anti-atherosclerotic, antioxidative and anti-hypertensive properties. The anti-inflammatory potential of natural dietary polyphenols might be used in the management of endometriosis as an inexpensive, non-toxic and readily available agent. Several studies indicate an inverse correlation between polyphenol application, such as phytoestrogens and female cancer risk.
Phytoestrogens (PE)
Phytoestrogens are naturally occurring plant compounds which are structural and functional homologies with estrogen. There are three classes of PE: lignans, stilbenes, and flavonoids. Phytoestrogens are found in vegetables, fruits, tea, grains, beans, sprouts, soybean, oilseeds and cabbage. PE are very similar in structure to estrogen, and, owing to that similarity, they can function as weak estrogenic factors interfering with molecular and hormonal signaling, which prevents the advancement of non-insulin-dependent diabetes, cancer, obesity, cardiovascular diseases and negative menopausal symptoms. Phytoestrogens could link to estrogen receptor (ER) and affect ER-mediated responses. A lot of case-control studies investigated connection in the midst of PE ingestion and endometriosis risk.
Resveratrol (RSV)
Among the most known and tested polyphenols, whose beneficial influence on health was proven in in vitro and in vivo models and in clinical tests, is resveratrol (RSV). More than 70 types of plants and plant-based products, principally black and red grapes, red wine, berries and nuts, comprise RSV, which is a phytoalexin and a phytoestrogen. A number of in vitro tests have investigated the impact of RSV on endometrial and endometriotic cells and have demonstrated a pro-apoptotic function and inhibitory effect on cell proliferation and invasive growth.
Vitamin C
Vitamin C, among the most important antioxidatives, strongly reduces free radicals. Humans are incapable of synthesizing vitamin C, so it should be provided with food or in the form of supplements/medications. Peppers, citrus, kiwi, broccoli, tomatoes, potatoes and strawberries are some of the products renowned for their high content of vitamin C
Spices and Herbs
Herbs and spices, such as oregano, rosemary, thyme and parsley, contain high levels of polyphenols, especially phenolic acids and flavonoids. There are many herbs with known or potential significant anti-inflammatory activity. The spices with the most known anti-inflammatory effect are: thyme, oregano, basil, rosemary, mint, sage, curcuma, dill, cinnamon, parsley, clove, lemon grass, nutmeg, ginger, fenugreek, pepper and chili pepper . Consuming turmeric in conjunction with black pepper (containing piperine) increases the bioavailability of curcumin by up to 2000%.
Tea
White and green tea contain more catechins (substances classified as polyphenols) with strong antioxidant properties compared to black tea. White tea comprises minerals, proteins, amino acids, caffeine, gallic acid and catechins . Caffeic acid, a polyphenol present, e.g., in coffee, some vegetables and legumes, reduces oxidative stress, which can alleviate complications from endometriosis.
Dairy
There are some hypotheses regarding potential biochemical and physiological effects of dairy on the risk of developing EMS. Among them is that a high consumption of calcium-rich dairy products may reduce inflammatory and oxidative stress by decreasing inflammatory factors: tumor necrosis factor-a (TNF-a), reactive oxygen species and IL-6 .
Fish Oil and Polyunsaturated Fatty Acids (PUFAs)
Fish oil has been shown to decrease circulating levels of series 2 prostaglandins and decrease dysmenorrhea and inflammatory symptoms. Polyunsaturated fatty acids (PUFAs) are fatty acids containing a minimum of two double bonds. Omega 3 (n-3) and omega 6 (n-6) PUFAs are found in fatty fish and seed/vegetable oils.
Fatty fish and cod liver oil contain vitamin D3 (cholecalciferol) and its metabolite, 25(OH)D3, a fat-soluble secosteroid hormone that plays a significant role as a immunomodulatory and anti-proliferative mediator.
Additional Lifestyle Considerations
Maintaining a Healthy Weight
Research suggests that being within a healthy weight range can be beneficial when you have Endometriosis.
Hydration
You should aim to consume a minimum of 2 liters of water per day to ensure your body is doing its job to excrete any build up of harmful particles.
Exercise
Regular exercise is really important for our general health and for balancing hormones, improving mental health and reducing stress hormones.
Rest and Sleep
Lack of sleep causes inflammation in the body so do your best to optimize your sleep hygiene where you can.
Stress Management
Worry and stress can influence not only your mind, but it can have a negative impact on your body. Have a look online for stress management strategies such as guided meditation and breathing exercises. Talking honestly about your worries and concerns is important for everyone and can help significantly with stress and anxiety.
Takeaway
Endometriosis is a condition associated with heightened levels of inflammation and estrogen. Planning meals and snacks around consuming fruits, vegetables, whole grains, proteins, and healthy fats may help reduce some endometriosis symptoms and reduce inflammation. Also, learning to avoid or limit foods that trigger symptoms or enhance inflammation, such as processed foods, meat, soy, and sugar, may help you feel more comfortable and healthy overall.
How a Dietitian Can Help
A dietitian can play a significant role in helping you discover which foods may be impacting your inflammation and hormone balance and give personalized guidance on how to adjust your diet. They can also offer practical strategies and support to help address emotional and behavioral aspects of eating, such as mindful eating practices and stress management. As you progress, a dietitian can monitor your response to the dietary changes and make necessary adjustments to your meal plan to optimize your outcomes.
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