We take a look at the evidence around eating for Endometriosis, the potential role of the gut in the disorder and pay tribute to the Naturopathic principle ‘Treat the Individual’ when it comes to adopting a sustainable healthy eating plan for managing symptoms.
Endometriosis is a chronic reproductive disorder with the disease affecting 5-15% of women of child-bearing age,(1) of which 30-50% suffer from Infertility.(1) There is evidence surrounding nutritional aspects related to the pathogenesis and progression of endometriosis(2) with existing studies suggesting that diet is a potentially modifiable risk factor for the disorder.(1) When a diet is deficient in nutrients this can result in oxidative stress, promote epigenetic abnormalities(2) and can affect several processes that are involved in endometriosis, including inflammation, prostaglandin metabolism and oestrogen activity.(3)
Foods to include when Eating for Endometriosis
Several findings point to increased consumption of certain foods exerting a protective effect, reducing the risk of development and possible regression of disease. Foods to incorporate are:(1,2,4,5)
- Fresh Fruit
- Vegetables, especially green varieties and preferably organic
- Whole grains
- Omega-3 fatty acids and Fish oils for their anti-inflammatory effects
- Dairy products rich in calcium and vitamin D
In summary: predominantly plant-based diets and diets high in fibre increase oestrogen excretion and decrease concentrations of bioavailable oestrogen and thus may lower endometriosis risk.(6)
Foods to avoid when Eating for Endometriosis
Dietary risk factors that increase the likelihood of endometriosis include consumption of:(1,3,4,5,7)
- Food rich in trans-unsaturated fatty acids and hydrogenated vegetable fat (margarine, some breads and cookies, snack foods, fried foods, processed products)
- Consumption of fats and generally high-fat diets
- High intake of beef
- Other kinds of red meat
- Ham, cold cuts and sausages
In summary: high-fat diets have been associated with increased serum oestrone, oestrone sulphate and oestradiol levels in premenopausal women(6) and a high oestrogen state is a contributing factor to endometriosis. One study found that persons with endometriosis who ate a gluten-free diet experienced improvement in painful symptoms, physical function, overall health experience, vitality, social function and mental health.(3)
General guidelines when Eating for Endometriosis (2,8,9)
– Eat organic wherever possible as studies have shown that certain classes of pesticides may produce oestrogenic effects like organochlorines which interfere with hormonal pathways by acting on oestrogen and androgen receptors
– Drink plenty of filtered water or mineral water
– Increase omega 3 fatty acids
– Minimise meat, dairy products, wheat and sugar
– Avoid refined foods and additives
– Minimise caffeine and alcohol since among infertile women, several studies have reported increased risk of infertility with intake
Gut health is just as important as diet choices
The gut microbiome may play a part in the pathogenesis of Endometriosis based on the role of the gut in regulating signalling molecules that orchestrate inflammatory, immune and proliferative pathways.(10) Preliminary findings indicate that dietary-induced changes in the gut may influence Endometriosis and vice-versa.(10) About 3.8–37% of women with Endometriosis(11) have endometriotic implants in extra-pelvic locations, including the gastrointestinal tract and abdomen(12) which may contribute to gut symptoms. An Australian study showed that a low-FODMAP diet could reduce bowel symptoms in women with endometriosis.(3) A Naturopathic approach includes addressing gut health and helping to manage digestive health complaints associated with the disorder.
Treat the Individual
It’s important to make dietary changes that are sustainable and enjoyable. Talking to a professional can help in the initial phase of change by assisting with decisions about what to include and exclude and assessing macronutrient and micronutrient intake. It’s an intuitive process and self observation is key. Studies have shown promising results with self-reporting surveys being a way for women to actively participate in diet change.
A survey in 2017 of Australian women between the ages of 18-45 with diagnosed endometriosis showed dietary changes were one of the most highly rated in terms of self-reported effectiveness in pain reduction.(7) Similarly in Sweden, women self reported on diet changes with most excluding or decreasing gluten, dairy products and carbohydrates and avoiding junk food. They also increased intake of fruit, vegetables and fish and cooked meals from scratch. The participants noticed that if they did not pay attention to the dietary change, ‘the endometriosis symptoms came back’. The participants emphasised that reactions to dietary changes were individual and the authors of the study emphasised that increased well-being occurred after adopting an individually-adapted diet.(3) These findings show how empowering diet change can be when paying attention to detail concerning diet choices, especially to help identify the culprits that contribute to pain and other symptoms. They also show how personalised nutritional medicine is key.
Good Food is Good Medicine
Endometriosis has a significant negative impact on the lives of women and current medical treatments often do not give sufficient pain relief or have intolerable side effects for many.(7) Naturopathy and Nutrition has much to offer for Endometriosis. While there are also several therapeutic strategies that can be implemented alongside diet change, Food is Medicine! Dietary changes may be beneficial to improve period pain, premenstrual symptoms and infertility associated with the disorder. If you are suffering from Endometriosis, or even suspect that you may have the condition and are feeling inspired to make some positive changes for your Reproductive health, we are here to help you create a strategy that works for you.