A Guide to the Endometriosis Diet
As we well know, endometriosis is a condition that cannot (yet!) be cured. When I see patients in my private practice, diet plays a huge role in terms of treatment plan, as it can often be easier to maintain than simply taking supplements. In this article, I’ve outlined what the latest research (2010 – present) has to say about food and its relationship to endometriosis.
FODMAPs and Endometriosis
A 2017 study looked at the association between the FODMAP diet and endometriosis, because many people with endometriosis experience symptoms similar to those of IBS. They found that women who follow the FODMAP diet, experience an alleviation in their gut symptoms and endometriosis-related pain. Check out this post to learn more about the FODMAP diet (and get a free meal plan!).
Fruit and Endometriosis
A 2018 prospective study looked at the association of fruit intake and endometriosis. Researchers observed a non-linear inverse association between higher fruit consumption and risk of laparoscopically-confirmed endometriosis. In particular, they discovered that citrus fruits conferred a 22% lower risk of endometriosis, when women consumed over 1 serving of citrus fruits per week.
When purchasing fruit, it’s best to choose organic if the particular fruit you’re interested in is on the Dirty Dozen list. For example, if purchasing strawberries – be sure to purchase the organic version as strawberries are highly sprayed with pesticides. Some pesticides can act as endocrine disruptors, and affect estrogen levels within the body. As of 2018, no citrus fruits appear on the Dirty Dozen list, so purchasing the non-organic version is fine.
Vegetables and Endometriosis
The same 2018 study assessed the relationship between vegetables and endometriosis. Surprisingly, no association was observed between total vegetable intake and endometriosis risk. However, researchers did notice that women consuming over 1 serving of cruciferous vegetables (broccoli, kale, Brussels sprouts, cabbage, etc.) per day, had a 13% increased endometriosis risk.
But before you swear off these veggies for good, this might have been related to the FODMAPs symptoms as mentioned above. If you don’t experience any negative gut symptoms when eating cruciferous veggies – keep eating them! They contain a wide array of important nutrients including DIM, which helps to metabolize estrogen. Obviously this is important as estrogen is one of the theorized causes of endometriosis.
Fish and Endometriosis
The Nurses Study examined the association between fish intake and endometriosis. They observed that consumption of poultry, fish, shellfish, and eggs were unrelated to endometriosis risk.
The Nurses Health Study II also looked at fish consumption (polyunsaturated fatty acids, PUFA) and observed women in the highest fifth of long-chain omega-3 PUFA consumption were 22% less likely to be diagnosed with endometriosis. Another study did not observe this association.
Omega-3 PUFA help in the regulation of prostaglandin and cytokine physiology, especially when it involves inflammation.
Eggs and Endometriosis
The Nurses Study examined the association between egg intake and endometriosis. They observed that consumption of eggs were unrelated to endometriosis risk. Choose organic and cage-free (chickens that are able to roam around in their environment) if possible.
Chicken and Endometriosis
The Nurses Study examined the association between poultry intake and endometriosis. They observed that consumption of poultry was unrelated to endometriosis risk. Nevertheless, choosing antibiotic-free chicken products may be the best choice to keep ‘extras’ out of the diet.
Red Meat and Endometriosis
The same Nurses Study assessed the relationship between meat and endometriosis. They observed that women consuming more than 2 servings/day of red meat/day had a 56% higher risk in endometriosis, compared to women eating 1 serving or less. This was highly noted in non-processed red meats (ie. beef, lamb, pork, hamburger) especially in women who had not reported fertility troubles. Women in the highest category of processed red meat intake (ie. bacon, hot dogs) also had a higher risk of endometriosis. The study did not mention if the women consumed grass-fed, antibiotic and hormone-free meat.
A 2013 review assessed the results from three studies assessing endometriosis risk and meat intake. Unfortunately no definitive conclusion was made.
Meat eaters may want to choose grass-fed, antibiotic and hormone-free meat may be the preferred choice. While it’s true that cows inherently have hormones (just like humans), you may want to avoid any ‘extras.’
Soy and Endometriosis
Soy is a highly contentious food as some of its compounds act as phytoestrogens. Phytoestrogens are all structurally similar and have estrogenic activity and include both isoflavones (found in soy and soy products) and lignan metabolites (found in flax seeds, nuts, grains, and cruciferous vegetables). They can bind to estrogen receptors, and may elicit both estrogenic and anti-estrogenic effects.
A 2017 study assessed the relationship of phytoestrogens and endometriosis, and found no evidence that urinary phytoestrogen concentrations were associated with a higher risk of an endometriosis diagnosis in both a general population and operative sample (women scheduled for a laparoscopy). That said, the women studied were not told to consume more soy products for the purpose of this study. Their regular diet was simply followed.
A 2015 study looked at endometriosis risk and early life factors such as prenatal exposure to diethylstilbestrol (DES), cigarette smoking, and soy-formula ingestion. They observed an association between exposure to regular soy formula feeding during infancy and increased risk of endometriosis (especially in women born after 1965). In animal models, the early exposure to genistein and daidzien many change the uterus and hypothalamic-pituitary-ovarian axis (which continue to develop rapidly after birth, and may be susceptible to hormonal disruption). This study did not have detailed infant feeding data including information on the timing of initiation, duration, and exclusiveness of soy formula feeding as well as information on other sources of infant nutrition such as non-soy formulas and breastfeeding.
Soy does not have to be the enemy, and in fact can be rather helpful – especially when it comes to estrogen metabolism. Be sure to choose products that are organic and non-GMO.
Coffee and Endometriosis
The 2013 looked at four studies involving coffee and endometriosis risk. Two studies showed an increase risk of endometriosis in women who reported coffee consumption. It’s thought that concentrations of early follicular phase estrogens and concentrations of estrone were found to be higher in women with high caffeine intake. Nevertheless more data is needed.
An interesting note about coffee is that it can act as a laxative. It helps to stimulate the movement of the colonic muscles, and promote a bowel movement. This is great because estrogen is able to leave the body, and does not recirculate leading to a relative excess.
Gluten Free Diet and Endometriosis
A small 2015 study demonstrated the relationship between gluten and endometriosis. Results showed that a gluten-free diet could improve pelvic pain, and may in fact improve the management of deep-infiltrating endometriosis.
It’s certainly difficult to avoid some of the above foods
Have any of the foods in this article surprised you? Let me know in the comments below.
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Missmer S, Chavarro J, Malspeis S et al. A prospective study of dietary fat consumption and endometriosis risk. Human Reproduction. 2010;25(6):1528-1535. doi:10.1093/humrep/deq044.
Marziali M, Capozzolo T. Role of Gluten-Free Diet in the Management of Chronic Pelvic Pain of Deep Infiltranting Endometriosis. J Minim Invasive Gynecol. 2015;22(6):S51-S52. doi:10.1016/j.jmig.2015.08.142.