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The endo diet: fact or fad

Updated: Jul 5, 2023

Is there such thing as a diet for endometriosis?

While there’s no such thing as a silver bullet for managing the root cause of endometriosis through diet, there are things within your control that are worth trying.

If you’ve been struggling with endo for a while, you’ve probably learned that it’s a complex condition that often requires a multi-disciplinary approach.

Diet could be one of them.

It’s worth noting that there are any number of diet and nutrition companies trying to sell you the “cure” for endo.

And, a search on endo forums will give you the illusion that others have completely solved their symptoms through diet.

But what works for one person may not work for you.

We’ll go into the existing evidence behind different dietary habits so you are informed of the options.

From there, it might be worth trying to incorporate one of them at a time and tracking your pain or symptoms to see if they improve.

A quick recap on endometriosis

Endometriosis is a hormone-dependent, inflammatory, gynecological condition affecting an estimated 176 million individuals worldwide.

Symptoms can range from mild pelvic pain to debilitating painful periods and infertility, although these, and additional symptoms are different for every woman.

In addition, the severity of the pain does not always reflect the severity of the disease.

What research around diet and endometriosis can show us more clearly is how symptoms may improve or reduce by the addition or removal of some key elements within a diet.

Diet can contribute to hormonal imbalance and inflammation

Hormonal imbalances and inflammation may play a role in the development of endometriosis.

The hormone estrogen plays a key role in the growth and shedding of the endometrium, and high levels of estrogen in the body may increase the risk of endometriosis.

Factors that can affect estrogen levels include obesity, high levels of stress, and exposure to certain environmental toxins.

In particular, there is growing evidence that suggests that diet and blood sugar regulation may play a role in the development and progression of endometriosis.

High blood sugar levels have been linked to inflammation in the body, and chronic inflammation has been associated with an increased risk of endometriosis.

Inflammation is the body's natural response to tissue damage or infection.

It is characterized by swelling, redness, heat, and pain. In endometriosis, inflammation occurs in the endometrial tissue that has grown outside of the uterus.

This tissue can become inflamed and cause pain, especially during menstruation.

Studies have shown that women with endometriosis are more likely to have high levels of inflammation markers in their blood, such as C-reactive protein (CRP) and interleukin-6 (IL-6). High levels of CRP and IL-6 have been linked to an increased risk of developing type 2 diabetes and other metabolic disorders.

In addition, maintaining a healthy weight is also important in the management of endometriosis.

Obesity has been linked to an increased risk of endometriosis, and losing weight through a healthy diet and exercise may help to reduce the risk or improve symptoms of the condition.

Some key diets that have started to be explored with endometriosis include:

So, is there a tried and tested diet that will work for everyone with endometriosis?

Not yet. But, there is a growing body of evidence that there are some important dietary adjustments that are worth trying for a period of time to see if your symptoms get better, stay the same, or potentially get worse.

We’ll review what the evidence says about different food groups and how they connect to endometriosis symptoms.

Try eat fish, and omega 3’s to help manage inflammation

Omega three oils found in fish, seafood and some seeds seem to decrease inflammatory, hormone-like substances (prostaglandins).

Some prostaglandins can be elevated in the abdominal fluid of those suffering from endometriosis and contribute to the mechanism of pain.

Few studies have looked at the direct effect of fish alone on endometriosis symptoms, however, some researchers suggest that women with endometriosis consume lower levels of Omega 3’s and vegetables, those with higher levels of Omega 3 in their blood have decreased risk of endometriosis.

Other studies suggest what is more important is the ratio of Omega 3 to Omega 6’s oils to reduce inflammation.

While the omega-3 content of each fish varies widely, based on what the fish has eaten, consuming a standard piece of salmon 2-3 times per week is enough to meet the recommended intake. However you need to consider alongside this, how much omega-6 foods such as cereals, eggs, poultry, whole grains and nuts, are also being eaten.

Try to reduce or eliminate red meat, which is potentially inflammatory

Maintaining a diet low in red meat has been recommended for many chronic conditions such as cardiovascular disease and colon cancer.

Research in respect of endometriosis is currently in its infancy although some reviews are now showing reducing the consumption of red and processed meats <2 servings per week can be beneficial not only in the pain of endometriosis, through reduction of inflammation but also in reducing risk.

This needs to be balanced with the knowledge that many with endometriosis may have a heavier period, so the requirements for iron may be higher.

To add more discussion around this area some researchers have suggested that the form of iron found in red meat (heme) can cause issues via a chemical reaction of oxidation of the heme and its effect on endometrial tissue .

To work around this, a selection of foods that contain non-heme iron such as dark green leafy greens, fruits, nuts, and seeds may prove useful.

Try reducing gluten to manage inflammation

Gluten is a protein found primarily in the grains wheat, barley, rye and oats although it is commonly found in other common foods such as beer, bottled condiments, and sausages and is present as a thickening in many shop-bought sauces.

A number of studies have found that individuals with endometriosis may be more likely to have celiac disease or non-celiac gluten sensitivity, and that following a gluten-free diet may improve symptoms of endometriosis in these individuals.

Most people do not have celiac disease, but some report having some type of non-coeliac gluten sensitivity (NCGS) with symptoms such as flatulence, bloating, and disturbed bowel function, similar to some of the endometriosis bowel symptoms.

Some studies have been carried out looking at the benefits of a gluten-free diet on endometriosis symptoms. This was done over a period of 12 months primarily looking at its effect on painful intercourse, painful periods, and generalized pelvic pain, together with the quality of life.

The results were positive, recording that 75% of people had improved pain perception in all areas and improved quality of life, with no worsening of pain in the remaining 25%, however, the study was retrospective meaning it relied on study participants to remember events from the past and that makes is more difficult to be certain of the results.

Generally, if you remove gluten from our diet and you feel better for it, then that is a good outcome. This is not an essential nutrient, so if this reduces symptoms then continue.

The jury is still out on whether dairy worsens endometriosis symptoms

Studies on dairy and endometriosis are inconclusive. From a health perspective, dairy contains high amounts (62%) of saturated fats (25) the milk sugars lactose (26) (a type of FODMAP) galactose and the protein casein.

It also contains several beneficial nutrients such as calcium, phosphorus, vitamin A, vitamin D, riboflavin, vitamin B12, potassium, zinc, choline, magnesium, selenium, conjugated linoleic acid and various hormones such as prolactin, estrogen, progesterone, corticoids, androgens, prostaglandins and IGF-1.

There have been some concerns due to the high saturated fat, hormones and milk’s effect on increasing serum IGF 1, - a protein that may contribute to promoting endometrial lesion growth.

Studies so far do not offer conclusive evidence either way with various dairy products such as cheese and yogurt acting differently than milk in increasing IGF1.

Complicating this is that a study done over a long period of time called the Nurses Health study showed that individuals who consumed more than 3 servings a day of dairy were 18% less likely to be diagnosed with endometriosis than women eating only 2 servings per day.

A special note for people with Irritable Bowel Syndrome (IBS) and endometriosis

FODMAPs (Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols) are fermentable carbohydrates molecules in certain foods such as dairy, wheat, rye, and certain fruit and vegetables such as apples, pears, peaches, watermelon, onion, garlic, mushrooms, etc.

When these molecules are removed or reduced in the diet, it offers some improvements for those who have concurrent Irritable Bowel Syndrome (IBS) with endometriosis.

Restriction of such a high number of healthy foods however long term is problematic and those with endometriosis are usually instructed to keep a diet diary and continue removing only the foods that cause an issue while reintroducing all other non-reactive foods long-term.

So will a change in my diet improve my endometriosis?

In conclusion, endometriosis is a chronic condition that is characterized by inflammation and is linked to insulin resistance and abnormal blood sugar levels.

While the exact connection between these factors is not fully understood, diet may play a role in the development and management of endometriosis.

Some studies suggest that a healthy diet may help reduce inflammation and improve symptoms of endometriosis.

Note: The content on this page is for informational purposes only and is not intended to be professional medical advice. Do not attempt to self-diagnose or prescribe treatment based on the information provided. Always consult a physician before making any decision on the treatment of a medical condition.


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