- Endometriosis Diet for Weight Loss : Slay the Side Effects of Endo
- Why Endometriosis Makes Weight Loss Harder
- Leave a Comment Below & Start the discussion
- Diet and Endometriosis
- Replace Trans Fats with Omega-3 Fatty Acids
- Identify Food Intolerance and Eliminate Trigger Foods
- Eat More Vegetables and Fiber
- Endometriosis and Soy
- Don’t Drink Too Much Alcohol
- Vitamins and Minerals for Endometriosis
- Complementary and Alternative Treatments for Endometriosis
- The Punch Line
- What to Eat When You Have Endometriosis
- What Not to Eat With Endometriosis
- What to Eat for Endometriosis
- Focus on Key Nutrients
- Could Going Gluten-Free Help?
- Shopping list for the endometriosis diet
- You might like these
- The Best Foods to Eat and Avoid When You Have Endometriosis
- Dark, Leafy Greens
- Green Tea
- Dark Berries
- 10 Foods To Avoid On An Endometriosis Diet
- Refined Grains
- Red Meat
- The Power of Leftovers
- What To Add To Your Diet: The Basics
- Day 1
- Day 2
- Day 3
- Day 4
- Day 5
- Day 6
- Day 7
- It’s more than just food!
- What Foods to Eat—and to Avoid—If You Suffer from Endometriosis
- What is endometriosis?
- Endometriosis symptoms
- Endometriosis diet
- How a professional can help
- Treatment options
- Further help
- What is Endometriosis?
- Your 14-Step Guide to Addressing Endometriosis with Lifestyle & Diet
- BALANCE by FLO Living Hormone Supplement Kit
- A healthy diet
- Foods to avoid
- Food as a cause of endometriosis
Endometriosis Diet for Weight Loss : Slay the Side Effects of Endo
No matter what the barriers are to weight loss, the best strategy is to recognize them all and develop micro-strategies to address each. Some of these micro-strategies may overlap, but that’s a good thing, for simplicity’s sake.
Why Endometriosis Makes Weight Loss Harder
What helps me develop a strategy in any situation is to take a look at all the moving parts and address each. As it relates to Endometriosis, here are the main barriers to weight loss. We’re going to go one by one, addressing each barrier with a micro-strategy and by the end of this post you will have one large game plan to move forward with in weight loss success.
Endometriosis is an estrogen dependent condition. High levels of estrogen and low levels of progesterone are an indication that a woman has Endometriosis. Generally, if a woman is producing too much estrogen she’ll experience excessive fat gain, particularly in the hips and stomach and bloating. What’s worse is that processed foods on the market only exacerbate the issue. Therefore, even though you may eat a seemingly healthy diet, often times the WAY that the food is prepared for mass production is more harmful to you. For example, animals given antibiotic injections or raised on soy and grain store excess estrogen in their bodies. That estrogen gets passed on to you when you consume them, thus worsening your estrogen dominance.
Here are the estrogen dominance side effects that can make losing weight with Endometriosis more difficult:
Excess Fat Storage
How To Address Estrogen Dominance:
No. 1: Take natural supplements to help you balance your hormones. For example, supplementing your diet with DIM can provide additional weight loss support. I take it myself and notice a HUGE difference in fat loss in my hips and stomach when combined with the diet and strategy. It’s pretty inexpensive and you can grab a bottle off of amazon.
No. 2: Choose organic and responsibly sourced foods over processed irresponsibly sourced foods as processed foods like meats and poultry are injected with antibiotics that promote estrogen production in your body. If you love a good read, please check out “Omnivore’s Dilemma” by Michael Pollan. I’m reading it myself. It’s HIGHLY acclaimed, well written, and really opens your eyes to how the food industry operates. Many of the ways the food industry irresponsibly sources and produces food exacerbate symptoms of hormone imbalances.
Taking birth control is an effective means of managing ovulation but the side effects can be devastating if you already struggle with weight gain. Clinical studies have found that there is no consistent connection between birth control and weight gain. However, women all over the world, including myself, have experienced it and felt able to pinpoint their weight management issues to their birth control. As a side-note, I talked about my experience with my Mirena IUD and what eventually led to my removing the device. If you have the chance, give it a read and let me know in the comments what your thoughts are.
Here are the birth control side effects that can make losing weight with Endometriosis more difficult:
Water Weight Retention
How to Address Potential Weight Side Effects from birth control:
No. 1: Practice mindful eating which will help you understand your cravings and manage your appetite naturally
No. 2: Drink at least 80oz of water each day
No. 3: SWEAT. Exercise daily, whether it be vigorous or moderate. It can be a full strength training routine or speed walking for thirty minutes. I use Sweet Sweat during walks and workouts and it helps me shed excess water weight. Regardless, you want to shed excess water weight by sweating.
No. 4: Hit the sauna. After a good workout, nothing feels better than sitting in the sauna and letting your pores open up. It also encourages your body to sweat more.
No. 5: Don’t drink carbonated beverages like pops, they make gas bloat worse and contain sugars that promote weight gain.
Chronic Pain & Discomfort
Whenever my readers and clients experience physical pain or illness, my first suggestion is for them to skip the gym until they subside. But, what if the pain and illness is chronic? With Endometriosis there are a multitude of ways that you may not be feeling “up” for working out, or just flat out physically incapable of it. For example, some women who choose regular surgeries to treat their Endometriosis which naturally requires downtime for recovery. These surgeries can occur many times throughout the year. It’s not hard to understand how the below list of reoccurring bouts of discomfort and pain could hamper your motivation.
A tool that can potentially help with menstrual pain and cramping is the Livia electronic abdominal treatment for menstrual cramps. It’s intriguing because it’s a drug-free solution (let’s face it sometimes pain-killers don’t cut it), and it’s low profile so it can conspicuously tuck underneath your shirt and in your pants.
Lower Back & Leg Pain
You may find that you struggle with one or any combination of the three issues discussed here today. The thing to remember is that each can be addressed and you have the power to change your life.
How to lose weight despite chronic pain & discomfort:
No.1: Make your diet your main method for weight loss. The good news is that weight loss is 90 percent diet and 10 percent exercise. The difficult news is that because you experience chronic pain, you’re not always going to be able to rely on that 10 percent of exercise that can help you lose weight. What that means is you need to be even more invested in consuming a diet that promotes weight loss.
The main diet tip you need to concentrate on is that you should be eating .8g-1g of protein for every pound you weigh, which generally comes to about 40%-45% of your daily caloric intake. For example, if your daily calorie goal is 1,500 calories, then 40%-50% of those calories should come from protein. This number amounts to between 150g- 187.5g or protein each day.
How to find your calorie & macro goals for your diet (the easy way):
Step 1. Use the Macronutrient Calculator on the I AM & CO Website.
Step 2. Enter your age, height, and current weight.
Step 3. Select the option that best represents how active you are
Step 4. Make a note of your TDEE & BMR numbers as an FYI
Step 5. Select the goal “Fat Loss.”
Step 6. Select between .8-1g of Protein per lb of body-weight
Step 7. Select .3g -.35g of Fat per lb of body-weight
Step 8. Hit “Calculate Results.”
You now know exactly how much calories, protein, carbs, and fat you need to eat to lose body fat. Now to hold yourself accountable, you need to enter those numbers into a calorie tracking app like MyFitnessPal, MyMacros+Diet, or LifeSum. I will show you below how to enter the diet goals you got from my macronutrient calculator into MyFitnessPal.
Entering Calorie & Macronutrient Goals Into MyFitnessPal:
Step 1. Open the App and select the “more” tab in the lower right-hand corner
Step 2. Select “Goals”
Step 3. Scroll to “Nutrition Goals” then select “Calorie & Macronutrient Goals”
Step 4. Adjust your Carbohydrate, Protein, and Fat goals until they’re close to or exactly match the numbers you got from the I AM & CO Macronutrient Calculator.
You’re now ready to begin tracking your meals according to your customized fat burning diet goal.
No. 2: Invest in a 24 hr gym membership without a contract or exercise equipment at home. The point is to be able to “strike” the minute you feel well enough to workout. I stress that you should avoid a gym contract because if you end up having health issues for several months in a row, you need to be able to get rid of that expense if you’re not able to benefit from it.
Leave a Comment Below & Start the discussion
(Remember to always be friendly and supportive!)
Do you or someone you know have Endometriosis? What has been your main struggle with weight loss and what questions do you have?
Nearly all women experience some degree of retrograde menstruation, but it’s been suggested that a higher volume of blood enters the abdomen in women with endometriosis (12).
Two other common theories include:
- Coelomic metaplasia, which occurs cells in the abdominal lining mutate into endometrial implants through a series of reactions in the body. Similarly, it’s been proposed that stem cells and bone marrow cells might change into endometrial implants (6, 13).
- Lymphovascular trafficking, which is the spread of endometrial implants through the lymphatic system.
However, these are just theories for now, and it seems other factors likely play a role as well.
Oxidative stress appears to be a key one. It’s a term that describes cellular damage from molecules called free radicals.
Oxidative stress can be caused by exposure to chemicals and pollutants, stress, and other stimuli including the process of ageing itself (14).
Is Endometriosis an Autoimmune Disease?
Recent research also suggests the immune system could greatly influence disease onset and severity.
Autoimmune disease develops when the body’s immune system mistakenly attacks healthy tissues.
Image source: womensinternational.com
Endometriosis shares several key features with autoimmune disease, including systemic inflammation and the presence of autoantibodies. There’s also a strong overlap between endometriosis and other autoimmune conditions, like celiac disease and Graves’ disease (15, 16, 17, 18).
These similarities have many experts asking whether endometriosis should be classified as an autoimmune disease instead. It’s an emerging area of research that will likely be explored in greater depth in coming years.
Summary: Endometriosis is likely caused by a combination of genetic, immunological, physiological, and environmental risk factors. It’s similar in many ways to autoimmune disease, although it’s not considered to be one at this time.
Diet and Endometriosis
There’s no known cure for endometriosis.
The condition is commonly treated with surgery, hormone therapy, and medications.
No diet has been proven to treat endometriosis either. However, small studies and patient reports suggest that certain diet strategies can help reduce disease risk and lessen symptoms.
This could be because certain foods can help control inflammation and influence levels of certain hormones (estrogen and prostaglandins).
These include omega-3 fats, vegetables, and other foods, which will be discussed below.
Replace Trans Fats with Omega-3 Fatty Acids
Significant research has looked at whether fat consumption affects endometriosis risk and symptoms.
Unfortunately, some studies have found high-fat diets to be more beneficial, while others have found low-fat diets to be better (19, 20).
It’s a tricky area for researchers because fat quality is likely just as important as quantity, perhaps even more so (21).
Omega-3 fatty acids appear to be especially beneficial, while trans fats are thought to increase risk. In one study of nearly 71,000 women (21):
- Women who ate the most trans fats were 48% more likely to have endometriosis than women who ate the least.
- Women who ate the most fats from animal products—and especially palmitic acid—had a 20% higher prevalence of endometriosis than those who ate the least.
- Women who ate the most omega-3 fatty acids were 22% less likely to have endometriosis than those who ate the least.
Even modest increases in omega-3 fat intake appear to be beneficial. One study found that replacing 1% of calories from trans fats with omega-3 fats decreases risk by 50% (21).
Changes in endometriosis risk seen when 1% of calories from monounsaturated, omega-6, trans, and saturated fats are replaced with omega-3 fats (top bars). Bars that extend further to the left represent larger reductions in disease risk. Image Source
The exact mechanism for this is unknown, but omega-3 fats have been shown to reduce inflammatory chemicals in the body, including cytokines and certain types of prostaglandins (22, 23, 24, 25).
For the record, trans fats are bad for you in many ways so replacing them with omega-3s makes sense regardless of whether you have endometriosis.
Aim to eat at least 7 ounces (about 200 grams) of fatty fish per week, and limit baked goods, fried foods, and packaged items.
Summary: Studies suggest that a diet higher in omega-3 fats and lower in trans fats may reduce endometriosis risk and severity. The recommendation for healthy adults of at least 7 ounces (about 200 grams) of fatty fish per week would also be beneficial for women with endometriosis.
Identify Food Intolerance and Eliminate Trigger Foods
Food intolerance can cause unpleasant reactions to specific foods.
Common symptoms include digestive distress and skin rashes.
Small studies have found higher rates of food intolerance in women with endometriosis compared to healthy controls (26).
Troublesome foods vary widely from person to person, but these are the most common:
Gluten and Celiac Disease
Patient testimonials (reports) suggest that a gluten-free diet is effective in treating endometriosis.
This may be true, as some studies have shown an overlap between celiac disease and endometriosis.
This relationship isn’t fully understood, but it’s been proposed that chronic inflammation from celiac disease may trigger the onset of endometriosis (15, 27)
A gluten-free diet may even provide symptom relief for those who don’t have celiac disease.
In one study of 207 endometriosis patients, 75% of participants reported significant reductions in symptom severity after 12 months on a gluten-free diet. They also reported improved mental health, social function, vitality, physical function, and perceived healthiness after following the diet (28).
More studies are needed to understand the relationship between gluten and endometriosis. At the very least, those with celiac disease or a known sensitivity to gluten should strictly avoid it.
FODMAPs are short-chain carbohydrates that are poorly digested in the small intestine.
They reach the colon largely intact and ferment in the gut, causing bloating, gas, abdominal pain, and other digestive symptoms for those who are intolerant of them.
Studies have established strong links between irritable bowel syndrome (IBS) and endometriosis (29).
A low FODMAP diet has been proven for treating IBS, and recent research suggests that it may be useful for easing endometriosis-related bowel symptoms as well. This is due in part to a high overlap rate between IBS and endometriosis.
In one study that included 58 women with both conditions, 72% of patients saw a great improvement in bowel symptoms after 4 weeks on a low FODMAP diet. The success rate for the low FODMAP diet was also significantly higher for women with endometriosis compared to women with just IBS (30).
Click here for more information on how to start a low FODMAP diet trial.
Research has shown strong links between endometriosis and autoimmune disease.
The Autoimmune Protocol (AIP) is a strict elimination diet designed for those with autoimmune disease. It’s meant to correct imbalances in gut bacteria and reduce inflammation.
Unfortunately, there have been no scientific studies on it to date. But patients with various autoimmune diseases have reported symptom relief using the AIP in online forums.
Importantly, note that this diet is very restrictive. It’s meant to be a short-term fix to help identify food intolerances for those with diagnosed autoimmune diseases.
If you have severe endometriosis and another autoimmune condition, a trial of the AIP may help after discussion with your doctor.
A gentler, easier alternative would be to keep a food and symptom journal for several weeks to identify foods that trigger symptoms.
Summary: There’s a strong overlap between endometriosis and food intolerance. Gluten free or low FODMAP diets may be helpful in improving symptoms for some women. The autoimmune protocol may be helpful short-term for those who also have autoimmune disease.
Eat More Vegetables and Fiber
Everyone can benefit from eating more vegetables.
Among many other advantages, higher vegetable consumption is linked to lower risk of endometriosis.
One large study of 504 women found risk to be significantly lower in women who eat a lot of green leafy vegetables (31).
The mechanism for this isn’t fully understood, but many vegetables are high in antioxidants, which help combat oxidative stress.
Vegetables are also high in fiber, which has been said to help rid the body of excessive estrogen.
In one study of 242 women, those who had the highest dietary fiber intake had significantly lower levels of estrone and estradiol (both forms of estrogen) than women who had the lowest fiber intake. The exceptions in this study were grapefruit and avocados, which were linked to higher estrogen levels (32).
Surprisingly, evidence is more mixed when it comes to endometriosis and fruit consumption. One study found higher fruit intake to increase risk, while other studies have found women who eat more fruit to have lower risk (19, 31).
Aim for at least 5 servings of vegetables and 2 servings of fruit per day, endometriosis or not.
Summary: Vegetables contain antioxidants, which may help reverse oxidative stress that comes with endometriosis. Aim for at least 5 servings per day, including leafy greens. Evidence is less clear on fruit intake, but most women would likely benefit from a couple of servings per day.
Endometriosis and Soy
Phytoestrogens are estrogen-like chemicals found in plants.
Soybeans and soy products are the greatest dietary source, but phytoestrogens are also found in flax seeds, oats, fruits, herbs, and other foods.
A certain kind of phytoestrogen (called genistein) that’s found in soy products has been said to help convert testosterone into estrogen. Since endometriosis is estrogen-dependent, some have questioned whether soy should be avoided (34).
Few studies have directly examined the relationship between soy and endometriosis, but limited data indicate it’s neutral, and potentially even helpful.
In one study, women with higher concentrations of soy isoflavones in the urine were less likely to develop advanced endometriosis. This suggests that soy may help protect against the disease (35).
A 2017 study of 495 premenopausal women also found no link between a high soy intake or high urinary phytoestrogens and increased risk of endometriosis (33).
Based on the weight of evidence, soy products do not increase your risk.
Summary: Evidence is not conclusive, but it seems that a high soy intake has no impact on the risk of developing endometriosis. Likewise, it probably does not make endometriosis any worse.
Don’t Drink Too Much Alcohol
Moderate alcohol intake of up to 1 drink per day is generally considered safe for most women.
Beer, bourbon, and red wine contain phytoestrogens, which may convert to estrogen in the body. Just like soy, some have questioned whether they increase endometriosis risk (7, 36).
Three large studies have found risk to be higher among women who drink the most alcohol, while 3 other studies found no link between alcohol and endometriosis (31, 37, 38, 39, 40, 41).
Notably, an often-cited study found that a compound found in red wine called resveratrol may limit the growth of endometrial tissue. But the study was conducted on mice, who were given very high doses of the compound. It wouldn’t be possible to safely drink the amount of wine needed to see any benefit (42).
High alcohol intake causes many health problems, so it’s best to limit yourself to 1 drink per day at most.
Summary: Several studies have found endometriosis risk to be higher among women who drink excessive alcohol, but other studies haven’t shown a link. High alcohol intake, and especially binge drinking, has many negative health consequences. One drink or less per day is best.
Vitamins and Minerals for Endometriosis
Several vitamins and minerals have been reported to relieve symptoms common in endometriosis.
In many cases, studies on vitamins and minerals have used supplements rather than whole foods. As such, it’s difficult to know the amounts of food that would yield similar benefits.
Antioxidants are compounds that protect against oxidative stress and cell damage.
Studies suggest that oxidative stress contributes to endometriosis onset and severity. Research also shows that the antioxidant vitamins C and E may provide symptom relief (4, 9, 43)
In one study of 59 women with pelvic pain and either endometriosis or infertility:
- One group of 46 women received 1200 milligrams (mg) of vitamin E plus 1000 mg of vitamin C daily.
- A second group of 13 women received placebo (fake) pills daily.
After 8 weeks, the vitamin group had significantly lower levels of known inflammatory markers compared to placebo.
A comparison of inflammatory chemicals for the treatment and placebo groups. The black bars represent the treatment group, with a lower level being ideal. Image Source
Women in the vitamin group also showed significant reductions in self-reported everyday pain, compared to placebo (4).
Vitamin C is found in many fruits and vegetables and is particularly high in oranges. Vitamin E is found in foods like almonds and spinach.
Studies have also suggested that vitamin D may protect against endometriosis onset, although other studies have found it to have no significant effect on pain and other symptoms (44, 45).
Vitamin D is found in fortified foods, fatty fish, and egg yolks.
More human studies are needed to know the safest and most effective vitamin doses for endometriosis. Speak with your doctor before beginning any new vitamin or supplement.
Women with endometriosis may be at higher risk for iron-deficiency anemia due to heavy menstrual periods (46, 47).
Symptoms include fatigue, dizziness, headache, shortness of breath, pale skin, weakness, irregular heart beat, and cold hands and feet.
A simple blood test can help determine if you’re iron deficient. Your doctor may recommend supplements to help boost your iron levels.
Diet changes can also help to improve iron status for those who are anemic. Red meat is rich in iron, although it’s best not to consume fatty meats or large quantities of red meat (47).
Other diet sources of iron include seafood, nuts, green leafy vegetables, and fortified grain products.
For the record, the body absorbs iron from meat more effectively than from plant sources.
Vitamin B1 (thiamine) has been reported to ease menstrual pain.
One study of 556 young women with dysmenorrhea found that 100 mg of thiamine per day for 90 days completely relieved menstrual pain in 87% of volunteers and drastically reduced pain in 8% of volunteers (48).
Notably, this study didn’t include women with endometriosis, and thiamine was in capsule form. But it’s possible that it would help those with painful periods.
Know that thiamine deficiency isn’t common among healthy women in industrialized nations. More research is needed to know if higher dose supplements would affect endometriosis (49).
The Recommended Dietary Allowance (RDA) is 1.1 mg per day for women (who aren’t pregnant or lactating) and can be met by eating 3-5 servings of whole grains per day.
Magnesium is an element with many important functions in the body, including nerve and muscle regulation.
It’s available in many plant foods, including leafy greens, almonds, and beans. It’s also available in capsule, powder, and lotion form.
Three small studies have found magnesium to be more effective in reducing menstrual pain than placebo (50, 51, 52, 53).
Few adverse effects were reported in these studies, but supplemental magnesium may cause diarrhea, drowsiness, or other symptoms in some.
Magnesium deficiency is quite common, with nearly half of Americans consuming less than the RDA. Magnesium supplements can help ensure that daily needs are met (54).
Summary: Thiamine, magnesium, and vitamins C, D, and E have been reported to ease pain in endometriosis. Iron may be necessary for women with heavy periods. Ask your doctor if you might benefit from supplements.
Complementary and Alternative Treatments for Endometriosis
Several alternative therapies have shown some promising results for treating endometriosis.
Just note that much of the evidence so far is from preliminary and animal studies.
Probiotics are beneficial bacteria that are found in certain foods and supplements.
Recent research suggests that imbalances in gut bacteria may trigger or worsen endometriosis by altering estrogen and stem cell activity.
The bacteria Lactobacilli seems to play a key role in restoring a healthy balance. Studies of rhesus monkeys with endometriosis showed lower levels of these bacteria compared to healthy monkeys (55, 56).
One small study found the probiotic strain Lactobacillus gasseri to significantly reduce the total weight and surface area of endometrial implants in female mice.
The effects of L. gasseri oral supplements on endometrial implant weight and surface area in female mice, compared to controls. A lower value is better. Click to enlarge. Image Source
The exact reason for this is unknown. Researchers believe that L. gasseri may increase levels of a cytokine called interleukin-12, which has been shown to reduce growth of endometrial tissue (56).
Human studies are needed to know the best probiotic strains and doses for endometriosis.
Melatonin is a hormone that’s commonly used as a sleep aid.
One small study has suggested that it may also help reduce the size of endometrial implants, at least in rodents.
One group of rats with induced endometriosis received injections of melatonin at a dose of 10 milligrams per kilogram of body weight every day for 4 weeks. The rats were then euthanized, and endometrial implants were measured.
Compared to controls (who were euthanized before melatonin treatment) rats who received the injections had significantly smaller and fewer implants (57).
Small human studies have also found melatonin to improve endometriosis symptoms, and particularly pain and use of pain medications. The effective dose in this study was 10 mg per day for 8 weeks (58).
Larger human studies are needed to know if melatonin is safe and effective for endometriosis patients.
Traditional Chinese Medicine
Traditional Chinese medicine (TCM) is used in many parts of the world as a complement to standard medical care.
It incorporates acupuncture, herbal treatments, massage, and other therapies.
Patient testimonials indicate that TCM may provide symptom relief in endometriosis. But scientific evidence is somewhat limited.
One review of 3 studies found that acupuncture improved pain and quality of life for volunteers. Women in this review received up to 16 treatments either once or twice a week for 15-25 minutes per session (59).
And another study of 67 women with endometriosis found acupuncture to greatly improve menstrual pain (60).
Acupuncture is generally well-tolerated with few side effects and may be worth a try for those dealing with pain.
Herbal preparations have been used for centuries in Chinese medicine to treat various conditions.
One review of 2 small studies found traditional herbal preparations to reduce menstrual pain more effectively than hormonal drugs commonly used in endometriosis. No improvements were seen in rectal, back, or vaginal pain (61).
Herbal therapy isn’t for everyone. Medicinal herbs interact with many medications and are not appropriate for those with certain health conditions.
Summary: The probiotic Lactobacillus and supplemental melatonin are thought to limit endometrial tissue growth. Limited evidence suggests that acupuncture and Chinese herbal preparations may reduce pain. These treatments may be worth trying with a doctor’s approval.
The Punch Line
Endometriosis is largely influenced by hormonal and environmental factors that influence oxidative stress.
Since diet can protect cells against damage, alter hormone levels, and reduce inflammation, a change in eating habits may help lessen symptoms.
Several diet strategies are recommended:
- Eat fewer trans fats and more omega-3 fats. Limit baked goods, processed foods, and fried foods, and aim for 7 ounces (about 200 grams) of fatty fish per week.
- Avoid gluten if you have celiac disease or are sensitive to it.
- A trial of a low FODMAP diet is recommended if you suffer from bowel symptoms.
- Eat at least five servings of vegetables per day, including some leafy green veggies.
- Limit alcohol intake to 1 drink or less per day.
- Ask your doctor if you might benefit from supplemental thiamine, iron, magnesium, or vitamins C, D, E. Probiotics and melatonin have also been reported to reduce endometriosis severity and are recommended with a doctor’s approval only.
- Acupuncture is generally well-tolerated and has been said to reduce pain. It may be worth a try for those with pain during and in between menstrual periods.
Endometriosis is a serious and painful condition, but lifestyle changes and the proper diet can greatly improve health and quality of life.
What to Eat When You Have Endometriosis
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There’s little agreement among doctors about whether food choices can help control the symptoms of endometriosis, a condition in which tissue similar to, but not the same as, uterine lining grows outside the uterus.
A major review of 11 studies published in April 2013 in the journal Reproductive Biomedicine Online found the link between diet and endometriosis to be unclear. More research about this connection is needed, the authors say.
A study published in 2017 in the journal Ginekologia Polska points to no clear association, either, although the researchers do find evidence that endometriosis is less likely to develop in the first place in women who eat a lot of fruits and vegetables, fish oils, dairy products, and omega-3 fatty acids. Meanwhile, women who eat foods high in fat, trans-unsaturated fatty acids, alcohol, and beef (along with other red meats) seem to be at increased risk for getting endometriosis.
Supporters of a special endometriosis diet can be found, too. Among the most vocal is British nutritionist and author Dian Shepperson Mills, MA, director of the Endometriosis and Fertility Clinic in the United Kingdom and chair of the Endometriosis SHE Trust. Mills has spoken and written about food choices and endometriosis for years, and details her special endometriosis diet in her 2002 book co-authored with Michael Vernon, PhD, and called Endometriosis: A Key to Healing and Fertility through Nutrition.
Thousands of women have tried the diet, she says, which is designed to reduce inflammation and quiet down the immune system’s angry reaction to endometrial tissue that’s not in its normal place inside the uterus. She says the diet also improves the response to pain, and helps in removing extra estrogen (the female sex hormone) responsible for worsening symptoms. Not only pain but fertility improves, she says.
What Not to Eat With Endometriosis
The nonprofit information hub Healthy Women also supports the thinking that diet and endometriosis symptoms are linked. The site cautions women with endometriosis to stay away from high-fat foods, since they may increase the level of circulating estrogen in the body. The more fat in your diet, the more estrogen your body produces. This also happens if you’re overweight, they say.
“Women with endometriosis should avoid fatty foods, such as red meat and dairy foods that may be high in PCBs and dioxins, to reduce their exposure to these estrogenic pesticides,” adds Shepperson Mills. Use organic food whenever you can, or peel fruits and vegetables, she recommends. Some research suggests a link between dioxins in the environment and increased levels of estrogen.
A review published in 2017 in the journal Oxidative Medicine and Cellular Longevity is one of several sources that describes a link between oxidative stress — which includes the formation of cell-damaging substances called free radicals — and endometriosis. Additional research found that a lack of antioxidants may contribute to endometriosis, while absorbing key antioxidant nutrients like selenium and vitamins A, C, and E may help keep it under control.
You may also want to avoid citrus fruits, like grapefruit and oranges, as they can irritate your stomach and upset the way in which estrogen is excreted by the body. When excluding foods from your diet, just make sure to eat alternatives so you avoid any nutrient deficiencies.
What to Eat for Endometriosis
The core of Shepperson Mills’ diet for endometriosis includes these hallmarks of healthy nutrition:
- Freshness. Buy the freshest food you can find and eat it while it’s fresh. Avoid highly processed foods which are full of additives. Cook with fresh foods, but also eat some raw vegetables and fruit every day. To minimize exposure to pesticides, eat organically grown produce whenever possible.
- Variety. Eat a wide range of foods every day. “Make it fun to try new dishes on weekends and expand your horizons,” says Shepperson Mills.
Your daily diet should provide 75 grams of good quality protein from sources like fish, eggs, and low-fat dairy products. Also include a handful of nuts, seeds, and legumes (such as beans), two portions of red or orange vegetables, two green leafy vegetables, and two fruits, including berries, which are high in antioxidants.
Focus on Key Nutrients
Certain foods rich in key nutrients are important components in a diet for endometriosis:
- Vegetables with B vitamins. “A healthy liver with a plentiful supply of B vitamins can degrade estradiol to estriol,” Shepperson Mills says. “Estriol is the form in which estrogen can be bound to fiber and excreted. The diet needs to have sufficient fiber and B vitamins from green vegetables to help the body deal with the constant breakdown of circulating estrogens. Green, leafy vegetables can also help the nervous and immune systems, and magnesium relaxes smooth muscles found in the intestines and uterus.” The best vegetables: those in the cruciferous family, such as cabbage, sprouts, broccoli, cauliflower, kale, turnips, radishes, horseradish, and watercress.
- Iron-rich foods. “With endometriosis you may experience heavy bleeding, so replacing lost iron is important,” she says. Two types of iron are available in the foods we eat, heme iron from protein sources and non-heme iron from plant sources. Non-heme iron is available in green, leafy vegetables, beetroot, dried apricots, and plain chocolate. Heme iron comes from red meat, eggs, and fish.
- Omega fatty acids. Include 1 tablespoon of cold-pressed vegetable oil in your meals daily. Avoid trans fats, and keep saturated fats low. Sources of omega fatty acids include oily fish such as wild Alaskan salmon and Pacific halibut, and tree nuts, seeds, and extra virgin cold-pressed olive oil.
- Fiber. Shepperson Mills suggests getting 30 grams of fiber each day from fruits, vegetables, nuts, seeds, legumes, and whole grains including rye, oats, rice, corn, millet, and buckwheat to keep your intestinal tract healthy and promote the excretion of excess estrogens.
- Water. Drink four to six 8-ounce glasses of water a day. Avoid caffeine, refined sugars, sweeteners, soda (including diet), and alcohol when struggling with endometriosis or trying to get pregnant.
Could Going Gluten-Free Help?
“Eating a wheat-free diet seems to help many women with endometriosis symptoms,” says Shepperson Mills. “Whether this is a result of gluten or another component of wheat is unclear, but it may be worth excluding wheat for one month to see if it makes a difference to your abdominal pains at periods and ovulation. You could also try to exclude dairy foods if you have excess mucus problems.”
Support for going gluten-free with endometriosis can also be found in a study published in 2012 in the journal Minerva Chirurgica. The findings were promising in this research, which looked back at the experience of 207 women with severe, chronic endometriosis symptoms who removed gluten from their diet for 12 months. Painful endometriosis symptoms lessened for a significant number of the women, and while some reported no change in how they felt, at a minimum none indicated their pain got any worse. “If a particular food is upsetting digestion and causing an immune system response, then that food should be avoided,” says Shepperson Mills.
Some doctors aren’t sure that the diet is beneficial in terms of endometriosis relief per se. “Endometriosis is a funny entity in the sense of immunology,” says John C. Petrozza, MD, an obstetrician-gynecologist and chief of reproductive medicine and IVF at Massachusetts General Hospital Fertility Center in Boston. Patients with endometriosis tend to have “problems with asthma and allergies — it’s not uncommon to have irritable bowel syndrome, lactose intolerance, or gluten intolerance,” he says. “So is the diet really helping the endometriosis or the symptoms of irritable bowel syndrome?”
The bottom line: If you have endometriosis, talk to your doctor or a registered dietitian to see if changes to your diet might be worth trying.
Additional reporting by Andrea Peirce
When I was first diagnosed with endometriosis, there was an air of casualness about the whole thing. I was told it probably wouldn’t come back and, naturally, I thought the same.
While waiting for my second laparoscopy, I started to grasp the impact of endometriosis on my body and began experimenting with diet. The endometriosis diet is essentially anti-inflammatory, given that endometriosis is an inflammatory disease and chronic inflammation causes heightened pain levels. The endometriosis diet, therefore, requires eliminating or reducing foods that are known to increase inflammation, including:
- Red meat
In addition, research has shown that women with endometriosis often have higher levels of estrogen, and that estrogen can encourage tissue growth. This type of diet can help support the liver, which eliminates excess estrogen from the body, and it can also help stabilize hormones thanks to certain nutrients in the food. Nutritionists such as Henrietta Norton suggest that the hormones used in meat production have an additional negative effect on our own hormones, by making their way into our body when consumed.
Norton’s book, “Take Control of Your Endometriosis,” includes compelling statistics from research showing that “women who ate green vegetables 13 times or more per week (roughly twice a day) were 70 per cent less likely to have endometriosis than those who ate green vegetables less than six times per week.”
Though the diet may sound scary at first, it doesn’t have to be about forceful restriction. In the beginning, you could just try cutting down a little on whatever you feel you might be eating slightly too much of, or whatever triggers your pain the most.
A common question I’m asked is, “So what do you eat?” But the truth is, I eat a lot. Cooking for the endometriosis diet doesn’t have to be a problem once you’ve got to grips with what ingredients to buy.
In the U.K., and from my understanding, all over, vegan and gluten-free food options are growing. I know personally it’s become much easier for me to shop at my local supermarket, but my favorite option (and one I really don’t do enough) is online. With online shopping, you rarely have the issue of an item being out of stock or not being sold at a local supermarket, and you get a larger choice. Generally, my shopping list usually includes:
- Fruit and vegetables
- Rice pasta and noodles (or alternatives like lentil pasta, buckwheat noodles, etc.)
- Beans and pulses
- Gluten-free bread such as wraps, pita bread, and loaves
- Gluten-free oats
- Treats like raw dark chocolate and vegan ice cream, often made from coconut milk or cashew nuts
- Nuts, seeds, and dried fruit like coconut chips
- Herbs and spices
- Health foods such as cacao powder
Quite honestly, without the internet, I wouldn’t have had any idea of where to start with gluten-free vegan cooking, but there are so many amazing blogs out there now that the problem has become a lack of time to try them all! Some of the most influential bloggers I follow — who have made the endometriosis diet creative, enjoyable, and accessible — are Jessica Murnane, Ella Mills, Heather Crosby and Dana Shultz. These women have everything from quick, 30-minute meals to birthday cakes and decadent brunches.
Eating out can obviously pose its difficulties. I’ve flirted with the endometriosis diet for many years before fully committing, mainly because I told myself it was too hard to eat out with friends and not be fussy. I’m not saying it’s easy, but since committing to being gluten-free and dairy-free all the time, it’s actually become much easier to make choices, and I’ve become much more confident in speaking to waiters about my requirements. I still go to the places where I know I can eat everything and anything, and those are, of course, my favorite places to go. But now, if a friend wants to go for a pub lunch, I know how to handle it. My answer? Order the sides. I’ve had some pretty good meals made up of all of the bits I can eat and throwing them together.
Each one of us is affected differently by endometriosis and there is no one-size-fits-all when it comes to treatment, conventional or alternative. The endometriosis diet may not have the same effects on you as it has on me; it’s not for everyone and that’s OK. But leading a healthier lifestyle where possible is always a positive choice. So, even if it’s just about getting a better night’s sleep or topping up on your vegetable portions, the endometriosis lifestyle and diet could help support body and mind.
Note: Endometriosis News is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. The opinions expressed in this column are not those of Endometriosis News or its parent company, BioNews Services, and are intended to spark discussion about issues pertaining to endometriosis.
Jessica is the creator of This EndoLife.com, a website dedicated to supporting women with endometriosis, women’s health conditions and the associated mental health issues that accompany them. She is also host of This EndoLife Podcast, where she interviews guests managing chronic illnesses and mental health problems in their own unique ways and are helping others to do the same. Jessica has a background in the arts and charity, having spent the past six years working with organizations supporting women with endometriosis, vulnerable young people and survivors of domestic violence and trafficking. ×Jessica is the creator of This EndoLife.com, a website dedicated to supporting women with endometriosis, women’s health conditions and the associated mental health issues that accompany them. She is also host of This EndoLife Podcast, where she interviews guests managing chronic illnesses and mental health problems in their own unique ways and are helping others to do the same. Jessica has a background in the arts and charity, having spent the past six years working with organizations supporting women with endometriosis, vulnerable young people and survivors of domestic violence and trafficking.
Shopping list for the endometriosis diet
This is the ‘hard-core’ list for those who want to go full-on endo-friendly, gluten free, lactose free.
You can adapt this list if you do not want to go gluten free, or have no problems with lactose. However it is recommended to omit gluten and dairy as many are seeing benefits with reduced symptoms of endometriosis pain. This is because dairy and gluten can cause inflammation which will worsen your symptoms of pain.
This suggested endometriosis food list comprises the essentials to have as basic supplies in your cupboard. You will then obviously be adding additional foods with your weekly shop of fresh produce like fruit, vegetables, meat, fish and other perishables.
You probably have some of these in your food cupboards already. The following is a list of the main cooking ingredients to have in stock for the endo diet. You will no doubt add to these as you go along, as you find recipes that require specific ingredients.
Note – The endometriosis diet is not a vegetarian diet – meat is allowed but you really need to stick with white meat like turkey and chicken as red meat will increase the negative prostaglandins that cause pain and inflammation and make your symptoms worse. If you can afford it, try to eat organic meat as it will be free of the unwanted hormones and chemicals that are often used in modern intensive farming.
Endometriosis diet grocery list
Basic ingredients for your food cupboard
- Sweeteners – stevia, maple syrup, rice syrup, date sugar, honey (if you can get guaranteed organic honey)
- Selection of herb teas – chamomile, fennel and peppermint are all great for the digestive system
- Green Tea – caffeine free – lots of health benefits and can actually protect the body from dioxins
- Gluten free muesli or breakfast cereals
- Gluten free oats – can be used for porridge and used in various puddings. Oats appear to have a soothing effect on the inflammation of endometriosis
- Cacao powder – see the endo-friendly chocolate recipe HERE – and used in many sweet dishes
- Rice noodles – used for Thai dishes and stir fry’s
- Wheat/Gluten free pasta selection
- Rice – brown and basmati
- Various Gluten free flours – depending on what you want to cook – see more on different flours/grains HERE
- All-round Gluten free flour which gives you easy flexibility
- Gluten free rice cakes or crackers – ideal for snacks with things like hummus, nut pate
- Corn flour – to thicken sauces
- Almond flour – which is basically ground almonds and has lots of uses for both sweet and savoury dishes
- Baking powder – To make your own baking powder, mix together 2 parts cream of tartar, 1 part baking soda, and 2 parts arrowroot powder. Store in an airtight container, and substitute any recipe calling for baking. Commercial baking powder usually has unwanted ingredients to stop it caking.
- Almonds and other nuts of your choice – useful for grazing when you have the nibbles
- Dried organic fruit selection – raisins, sultanas, dates etc.
- Dried pulses and lentils of your choice – there are loads of them and they have great flexibility for use
- Tins of: coconut milk, tinned plumb tomatoes – they sell organic varieties in health-stores – a good staple to add to casseroles, tinned chickpeas/garbanzo’s, kidney beans – again available in health stores, ideally with no added salt or sugar.
- Seeds – sesame, sunflower, pumpkin – great for snacking on
- Chia seeds – packed full of nutrition and many flexible uses – add to soups or your breakfast cereal. Ideal to consume in the evening as they are high in the amino acid of tryptophan which is one of the calming amino acids to help you sleep.
- Lots of different herbs and spices
- Olive oil – a good quality, extra virgin, cold pressed
- Flax seed oil – high in omega 3 and can be used for cooking at higher temperatures than olive oil
- Nut oils, sesame oil, walnut oil
- Nut butter (try the ones available in the health store)
- Lemon juice – a good standby to have for many recipes
- Coconut milk – available in tins and a thinner version in cartons
- Coconut oil – full of health benefits and can easily be added to lots of dishes
- Rice wine vinegar – good for dressings
- Apple cider vinegar – has plenty of health benefits
- Tamari – the alternative to soy sauce
- Tahini – similar to peanut butter but made from ground sesame seeds and is used in lots of recipes in the book HERE
- Tubes/little tins of tomato puree
- Nut or rice milks – as an alternative to dairy milk
Health food stores
Have a good look round your local health food store. Many of these stores are now selling items like – gluten/wheat free breakfast cereals, Almond milks, Rice milk, Coconut milk, breakfast/mid-morning snacks. Some stores also sell ready meals, alternative spreads for toast like mushroom paste. Just ensure to check ingredients for soy proteins, wheat powder/flour and gluten.
The other items you need will be purchased as and when you need them, like fresh produce, fruit, and vegetables. Frozen veg is fine as these maintain a reasonable level of nutritional value, but aim to purchase from the freezer in your health store as these should be organic and not covered in sprays and pesticides etc.
Other items you might need
Get a supply of those little freezer trays/containers with lids for freezing separate portions to use later when you have done any bulk cooking. It is a good idea to produce some meals in bulk so you can freeze portions which you can use when you are having a bad day with your endometriosis.
A food processor is a good idea – it takes the hard work out of the preparation for some recipes. If you can afford it, a juice extractor is great – then you can have freshly made juice that does not waste any of the fruit, and obtains as many nutrients and enzymes as possible.
You can download the endometriosis diet shopping list as a simple PDF HERE
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About the Author
Hi, my name is Carolyn Levett, the Founder of endo-resolved – I am a qualified Nutritional Therapist, have also studied a Foundation Diploma in Naturopathy and Practical Aromatherapy as well as being a published author. I used to suffer from severe endometriosis and was able to regained my health and heal from the disease with the support of diet, homeopathy and various life-style changes.
The advice here is to provide support and hope to others that they too can start to improve their health and reduce the impact this disease has on their life – with healing thoughts, Carolyn.
- Diet advice
- Endo diet shopping list
As featured in
The Best Foods to Eat and Avoid When You Have Endometriosis
Small fish such as mackerel have just as many Omega 3 benefits as larger fish, Dr. Shah says. In fact, a 3-ounce serving of cooked mackerel has 1,705 milligrams of omega 3 fatty acids (EPA, DHA, and DPA), according to the USDA National Nutrient Database.
If you choose non-animal sources of protein, almonds can be an excellent option. Plus, they pack antioxidants too, another goal for endometriosis patients. “Almonds contain the antioxidant Vitamin E as well as polyphenols,” Jones says.
Dark, Leafy Greens
The darker the veggies, the more anti-inflammatory power they pack, Jones says—kale, spinach, and chard are the winners in that category, so ditch the romaine or iceberg lettuce when you make your salads.
Broccoli is another great staple to have in the diet because it contains the inflammation and cancer-fighting antioxidants lutein and sulforaphane. (Though in some cases, women who suffer from endometriosis-related digestive issues could have sensitivities to cruciferous veggies like broccoli, so it’s important to experiment with different whole foods to see what works best with your digestive system).
One beneficial drink for endometriosis patients is green tea, according to Dr. Shah. “The compound EGCG, found in green tea, has been studied for cancer treatment, but also applies to endometriosis because it can limit endometrial cell growth,” Dr. Shah says.
Turmeric is known for its immune and heart health benefits. “It’s also been studied for its anti-inflammatory effects,” says Dr. Shah. The key to absorbing it into the body is mixing it with a fat, like hemp seed oil, she explains. She suggests drinking a mixture of turmeric, hemp seed oil, and almond milk as a hearty vegan golden milk.
Just like vegetables, the darker the berries, the richer the antioxidant content, and blueberries, especially wild ones, happen to beat strawberries and raspberries in that respect. Make sure they’re an ingredient in your daily smoothie.
RELATED: We found the best smoothie recipes for weight loss.
Because estrogen helps Endometrial tissue to grow, it’s smarter to stick to foods that can potentially lower estrogen levels in some way. “It’s important to eat things that support the liver in detoxing excess estrogen, including artichokes, parsley, and even lemons, all of which can stimulate liver function,” Dr. Shah says.
10 Foods To Avoid On An Endometriosis Diet
Too much sugar isn’t healthy in any diet, but it can be especially damaging to those who suffer with endometriosis. “White and brown sugar have been hugely inflammatory for me,” Murnane says. In her recipes, she incorporates natural sweeteners: honey, dates, and maple syrup. “When I eat foods with a lot of those sugars I will notice the effects, but not to the extent of processed sugars,” she adds.
You don’t have to completely restrict your diet if you have endometriosis, Jones says, but, she points out, “Excessive consumption of certain foods has been linked to an increased risk of chronic disease. These foods include refined carbohydrates (such as white bread and pastries), soda, and other processed foods.”
Many endometriosis patients choose to go vegetarian or vegan, though white, lean meats such as turkey or chicken are totally fine to keep in the diet, Dr. Shah says. One inflammatory red flag though, according to all the experts we spoke to, is red meat and any other kind of processed meat—a Journal of the American College of Nutrition study found them to cause inflammation, bloating, and weight gain.
Dairy is a major culprit of inflammation many women with endometriosis, including herself, Murnane says. There might be interesting reasoning behind this, Dr. Shah explains. “Dairy can be inflammatory for everyone, but especially negative for women with endometriosis because products like cow’s milk contain a fair amount of estrogen.” It’s best to substitute dairy products to eat less dairy with nut and other plant-based milks, cheeses, and dairy-free yogurts, and to avoid foods that are injecting excess estrogen into the body, Dr. Shah says.
“Eggs have caused many of the women I know with endometriosis a lot of additional discomfort,” Murnane says. This, a Frontiers in Neuroendocrinology study shows, could also be explained by the high estrogen content in eggs, so focusing on more plants and plant-based sources of protein might be beneficial to some women.
Unlike the healthy omega-3 fats found in tuna and salmon, margarine contains fats that are on the other side of the spectrum. Margarine is worth avoiding, says Jones, because it often contains trans fats, which have been known to increase inflammation throughout the body, as well as raise bad cholesterol.
No one wants to be told to skip out on their cup of coffee, but slashing your caffeine intake, even by a little, may help endometriosis symptoms. “Caffeine will trigger more inflammation in the body,” Dr. Shah says, and Dr. Arrington advises the same.
Another habit that many people don’t want to break is drinking, but it could also make a difference in endometriosis symptoms. Murnane says she cut out alcohol after realizing it made her feel unwell, and only has a basic, low-sugar cocktail on a rare occasion. Dr. Arrington supports scientific claims that it can make inflammation, and therefore endometriosis, worse.
Italian researchers have found that eliminating gluten could potentially help lessen the pain of endometriosis—it depends on the patient, though. “Following a gluten-free eating plan may be helpful for many people with endometriosis, but not all. It’s important to start with a careful elimination diet and see if symptoms improve. If there is no improvement in symptoms, gluten is likely not a culprit,” Jones says. Dr. Shah’s rarely instructs patients to eliminate gluten and opt for gluten-free foods if they don’t already have a digestive intolerance or Celiac Disease; instead, she advises them to focus their diet in on whole grains as opposed to refined grains.
Monash University researchers found that lowering or eliminating FODMAPs from the diet can be beneficial to women who suffer from IBS in addition to endometriosis, which isn’t all that uncommon if endometrial tissue affects the bowels. “FODMAPs are short-chain carbohydrates found in several fruits, vegetables, and grains,” Dr. Arrington says. They can also be found in common food seasoners, such as onions and garlic. However, for patients without digestive issues, this elimination may not be necessary. If you’d like to learn more, see whether a low-FODMAP diet can help you find digestive relief.
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The hardest part of the endometriosis diet (in my opinion)?
Having a structure and a “checklist.”
You know what to do. But it’s just hard to actually do it and make it easy…
By having a meal plan, you don’t have to think about what to do.
Your week is already planned out for you.
And, we’ve even put together the grocery list for all these recipes.
Grocery shopping is easy since you have all the recipes in advance. The cooking is planned. And after following the meal plan, there’s a good chance you’ll feel better.
The Power of Leftovers
Here’s the deal:
If you’re planning on cooking every meal, then you’re in for a RUDE awakening…
This is a strategy that I used that has made life much, much easier for me:
I eat a lot of leftovers. I cook a MAX of 2 times per day. Often just one time per day.
And, because I can spend a bit more time making delicious meals, I have no problem eating leftovers!
Therefore, this 1-week meal plan is centered on the power of leftovers.
What To Add To Your Diet: The Basics
Your endometriosis diet recipes will consist of these ingredients:
- Anti-inflammatory foods like green leafy vegetables and olive oil
- Foods with essential fatty acids like wild-caught salmon
- Gluten-free, whole grains and starches like rice & sweet potatoes
Coconut Milk Strawberry Banana Smoothie:
This coconut milk strawberry smoothie makes breakfast easy.
Feel free to add plant-based protein powder or a tablespoon of coconut oil for extra oomph.
Chicken lettuce wraps:
Make sure to avoid the soy sauce in this recipe (even though they recommend the gluten-free tamari).
Coconut aminos are a much better option!
Oh, also, make enough for leftovers 🙂
Roasted broccoli with salmon:
This one-sheet recipe makes dinner easy. Minimal preparation and SUPER easy clean-up.
Not to mention the essential fatty acids that salmon has.
Prepare enough for leftovers!
A handful of walnuts is the perfect snack for fiber and omega 3s.
Coconut Milk Strawberry Banana Smoothie round 2!
Yes, this is the second day in a row you’re having this breakfast.
But it’s just so yummy!
And don’t worry, tomorrow you’ll have a different recipe.
The leftover Chicken lettuce wraps that you made for lunch yesterday!
Simply warm them up and you’ve got another amazing lunch (that you don’t have to cook).
For some extra goodness, add fermented kimchi for a little spice and healthy probiotics.
Sweet Potato Taco Bowls:
A lot of women with endometriosis don’t do so well with corn.
So, we recommend getting rid of the corn in this recipe.
Sweet potatoes are an incredible source of Vitamin A and dietary fiber while also having anti-inflammatory properties.
Prepare enough for 2 meals worth of leftovers!
Our founder, Kaylyn Easton, uses sweet potatoes as a dietary staple for most of her recipes!
Have a handful (or two or three) of this anti-inflammatory granola.
We like this granola brand because we trust the ingredients.
Anti-Inflammatory Blueberry Smoothie:
This recipe calls for almond milk. But, to make shopping easier, we recommend using coconut milk and ditching the almond butter (to make the shopping easier and cheaper).
I personally love smoothies for breakfast.
They’re quick, filling, and I feel so good getting my day started this way.
Leftover Sweet Potato Taco Bowls:
I really like throwing these ingredients back into a pan (not the microwave) if you can.
Oftentimes, the leftovers are better than the original when you use this method!
Leftover Roasted broccoli with salmon that you made for dinner on night 1.
You get a night off from cooking! Whoop whoop!
To make it taste as fresh as it did on night one, squeeze some lemon on both the broccoli and salmon.
Something a little sweeter!
A couple of squares of organic dark chocolate (that’s over 70% cacao). I go with +80% because I like it a little more bitter.
Round 2 of the Anti-Inflammatory Blueberry Smoothie:
You’ll start to notice a pattern here since this is the second day in a row for this smoothie recipe.
I’m a creature of habit so I like consistency. I usually do the same smoothie for breakfast 2-3 days in a row. After 2-3 days I’m ready to mix it up.
Leftover Sweet Potato Taco Bowls:
Throw some fresh salsa on the bowl to make it just as good the second time around.
Spicy Southwest Stuffed Peppers:
Gluten-free, soy-free, dairy-free…
But you would NOT know it.
Make enough for leftovers!
A handful of walnuts.
Sweet Potato Breakfast Bowl:
If you have protein powder, then great!
If not, don’t stress about having it in this recipe.
This recipe is especially good with a topping of walnuts, coconut cream (for some healthy fats), or even a drizzle of local honey for some sweetness.
Make enough sweet potato so that you can warm it up for breakfast the next day.
Leftover Spicy Southwest Stuffed Peppers:
Since these stuffed peppers are easy to store, they make for an easy lunch to bring to work with you.
Strawberry Avocado Salad:
I’m a big fan of adding fresh fruit to a salad.
I’m also a big fan not having to do a lot of cooking for dinner.
This recipe should take less than 15 minutes to prepare (which I love about it!).
You deserve a couple of squares of organic dark chocolate today!
Sweet Potato Breakfast Bowl for the second day:
Sweet potatoes are a great day to start the day because of the low glycemic starch. Basically, a way to boost energy without the negative effects of your body converting them to sugar immediately.
Leftover Strawberry Avocado Salad:
Don’t add the salad dressing to your Tupperware, otherwise your salad will get soggy!
The easiest way to transport salad dressing is to add it to a separate, smaller Tupperware container.
One pan chicken and veggies recipe:
My favorite types of recipes are the one-pan or one-pot recipes.
They’re usually really easy to cook. And (my favorite part) they’re also really easy to clean.
This recipe is full of healthy veggies.
Have a handful (or two or three) of this anti-inflammatory granola.
Go back to the Coconut Milk Strawberry Banana Smoothie:
You might be thinking:
“This is getting repetitive.”
If you want to go for something different, then do it!
Most people succeed with a diet when there is consistency and familiarity. That’s why there’s a lot of repetition in this one-week meal plan.
Leftover One pan chicken and veggies recipe:
If you’re into hot sauce, this is a great recipe to sprinkle some hot sauce on!
Go out to dinner tonight!
Indulge a little bit and don’t worry about cooking (don’t go OFF your diet, but maybe push the limit a little and see how your body feels…).
A great out-to-dinner place that I love is Chipotle. They do a pretty good job of having locally sourced ingredients and you can easily create your bowl that’s friendly to the endometriosis diet.
When I go out to dinner at places that I’ve never been too, it can end up being more stressful than fun. Opt for a restaurant you’re familiar with.
Go for some walnuts again today.
It’s more than just food!
Women with endometriosis need more than just food to heal.
Their vaginal skin needs nutrients to heal, reduce inflammation, and also reduce pain.
Having a healthy, vegan, non-chemical personal moisturizer that you put on daily (that can also be used for less-painful sex) is really important.
What Foods to Eat—and to Avoid—If You Suffer from Endometriosis
And it’s not just for long-time endo sufferers-some studies suggest if you’re at high risk for the condition (such as if an immediate family member has it) or you got an early diagnosis, changing your diet can also lower your risk.
Ahead, the full scoop on the endometriosis diet, including the foods that can help-and those you should skip or limit if you suffer from the condition.
Why Following an “Endometriosis Diet” Matters
Endometriosis is marked by pain-debilitating cramps but also pain during sex, painful bloating, painful bowel movements, and even back and leg pain.
What contributes to that pain: inflammation and hormone disruption, both of which are heavily influenced by diet, says Columbus-based nutritionist Torey Armul, R.D., spokesperson for the Academy of Nutrition and Dietetics.
Additionally, what you eat plays a huge role in combating oxidative stress, Armul says, since this damage is caused by an imbalance of antioxidants and reactive oxygen species (ROS). And a 2017 meta-analysis in Oxidative Medicine and Cellular Longevity reports oxidative stress may contribute to endometriosis.
In short, a beneficial endometriosis diet should focus on reducing inflammation, reducing oxidative stress, and balancing hormones. (Related: How to Balance Your Hormones Naturally for Lasting Energy)
Foods and Nutrients You Should Eat to Help Endometriosis Symptoms
One of the best ways to combat pain is to eat more of anti-inflammatory omega-3 fatty acids, says Godfrey. Countless studies show omega-3s-specifically EPA and DHA-help prevent and resolve inflammation in the body. Wild salmon, trout, sardines, walnuts, ground flaxseed, chia seeds, olive oil, and leafy greens are all great options, both nutritionists agree. (Related: 15 Anti-Inflammatory Foods You Should Be Eating Regularly)
“Vitamin D has anti-inflammatory effects, and research has found a connection between larger cyst size in women with endometriosis and low vitamin D levels,” says Armul. The vitamin is scarce in most foods, but dairy products like milk and yogurt are often fortified and readily available, she adds. FWIW, there is some conflicting research around the role dairy plays in inflammation, but Armul points out this is a huge food group encompassing everything from Greek yogurt to ice cream and milkshakes. Milk and low-fat dairy products are your best bet for reducing inflammation. (FYI, here’s everything you need to know about dietary supplements.)
If you’re lactose intolerant, vegan, or don’t get daily sun exposure, Armul suggests taking a vitamin D supplement daily instead. “Many people are vitamin D deficient especially during and after the winter months,” she adds. Aim for 600 IU of vitamin D, the recommended daily allowance.
In a 2017 study from Poland, researchers report that more fruits and vegetables, fish oils, dairy products rich in calcium and vitamin D, and omega-3 fatty acids lower your risk for endometriosis. The benefits of colorful produce come from reducing oxidative stress-loading up on antioxidants combats the damage and reduces endo symptoms, says Godfrey. The best foods for that: bright fruits like berries and citrus, vegetables such as dark leafy greens, onions, garlic, and spices like cinnamon.
Foods and Ingredients You Should Consider Limiting If You Have Endometriosis
You want to avoid trans fats entirely, which are known to trigger inflammation in the body, Armul says. That’s fried food, fast food, and other highly processed foods.
Godfrey agrees, adding processed foods and high amounts of sugar often prompt pain in endo sufferers. “A diet high in fat, sugar, and alcohol has been linked with the production of free radicals-the molecules responsible for creating the imbalance that leads to oxidative stress,” she explains. (Related: 6 “Ultra-Processed” Foods You Probably Have In Your House Right Now)
Multiple studies suggest eating red meat often increases your risk for endometriosis. “Red meat has been linked to higher estrogen levels in the blood, and since estrogen plays a key role in endometriosis, it is beneficial to cut down,” Godfrey says. Instead, reach for omega-3-rich fish or eggs for your protein, Armul suggests.
Although gluten doesn’t bother everyone, Godfrey says some endo sufferers will experience less pain if they cut the protein molecule from their diet. In fact, research out of Italy found going gluten free for a year improved pain for 75 percent of endometriosis sufferers involved in the study.
It’s quite common for women to have both endometriosis and irritable bowel syndrome. Among those who do, 72 percent significantly improved their gastro symptoms after four weeks of a low-FODMAP diet in one 2017 Australian study. FYI, FODMAP stands for Fermentable Ogligo-, Di-, Mono-saccharides And Polyols, a long phrase for carbs that are poorly absorbed in the small intestine for some people. Going low-FODMAP includes cutting wheat and gluten, along with lactose, sugar alcohols (xylitol, sorbitol), and certain fruits and vegetables. (For the full rundown, see how one writer fared trying the low-FODMAP diet for herself.)
This can get tricky-you don’t want to skimp on the antioxidants abundant in produce or the vitamin D that often comes from dairy. Your best bet: Focus on cutting the foods experts know increase endo issues and bump up your intake of the foods pros say can help. If you still have pain or other gastro symptoms after that, look into reducing gluten and other FODMAPs while still increasing non-offending produce rich in antioxidants.
- By Rachael Schultz @_RSchultz
Endometriosis is a medical condition where body tissues outside of the womb (mainly in the pelvic area) behave like the lining of the womb. These tissues thicken and break down, leading to pain and potential fertility problems.
According to Endometriosis UK, the condition affects one in 10 women in the UK. While typically a life-long condition, symptoms of endometriosis can be managed. As well as medical treatments, like surgery and hormone treatment, certain lifestyle and diet changes can be beneficial.
On this page, we’ll explore endometriosis in more depth, including the symptoms of the condition, the support available and how lifestyle changes and dietary support can help with symptom management.
What is endometriosis?
Endometriosis causes tissue outside of the womb to behave in the same way as the lining of the womb. Typically this affects areas surrounding the womb but, in rare cases, it can occur in other areas of the body like the spine.
The causes of endometriosis are not fully understood and there are several theories as to why it occurs. The most widely accepted theory is that the tissue of the womb lining is not able to leave the body as it should during a period. This causes it to embed on other organs of the pelvis. This does not, however, explain why some experience the condition after a hysterectomy.
Hormones certainly play a part – endometriosis is rare in women who have been through the menopause and so have less oestrogen in their bodies. Oestrogen is a hormone that, when an egg is not fertilised after ovulation, normally causes the womb lining to thicken and then break down. It’s thought that, in endometriosis, oestrogen has the same effect on these womb lining-like tissues that are outside of the womb, leading to symptoms.
Symptoms can vary significantly from person to person and for some women, the symptoms can even go unnoticed.
The most common endometriosis symptoms include:
- painful and/or heavy periods
- pain during/after sex
- pain in the pelvis, lower back and/or lower abdomen
- bleeding between periods
- conception difficulties
While symptoms can vary, many of the above are also often noted alongside fatigue and general lack of energy. Understandably, these symptoms can impact on our general health and well-being, leading to stress and depression for some.
If you suspect you have endometriosis, it’s important to get a formal diagnosis from your doctor. Once your doctor has confirmed the condition, you will be able to explore treatments.
If you have endometriosis, it’s important to consider your diet and lifestyle when tackling the condition. While there is limited research into the impact nutrition has on the condition, we know that what we eat has a big impact on how we feel. Not only that, but addressing your diet can boost your immune system and provide a preventative measure for overall health, too.
That being said, experts believe that following certain dietary principles can help to relieve symptoms related to the condition. It’s believed that eating a balanced, nutritious diet consisting of anti-inflammatory foods is beneficial. Some foods can also help to naturally control hormones, which play a key role in endometriosis symptoms.
Of course, it can work in the opposite way, too – it is thought that certain foods may also have a negative effect, triggering symptoms.
How a professional can help
Changing your diet can be a difficult process, but working with a qualified nutrition professional to support and guide you can help make the transition easier. They will look into your medical history and individual circumstances, to help them create your own tailor-made endometriosis diet plan.
The aim of this plan will be to include elements recommended for an endometriosis diet while promoting long-term changes that can be made gradually. Alongside your new diet, you may also be recommended certain lifestyle alterations. This could include quitting smoking, drinking more water and upping your physical activity. Changes like this are thought to help reduce endometriosis symptoms.
It is recommended that you consult a suitably qualified professional for nutritional advice. They will be able to put together a tailored diet to support your needs, including advice on choosing anti-inflammatory foods rich in vitamins and minerals. Taking your personal health history into consideration, your plan will complement any medical treatments you are already receiving.
You can use our advanced search tool to find a nutrition professional who has experience in treating endometriosis.
For a general overview of what foods to include and limit in an endometriosis diet, please see below.
What to limit:
As already mentioned, when altering your diet following a formal endometriosis diagnosis, it is as much about avoiding certain ‘trigger’ foods as it is about trying to include beneficial food groups.
Limiting the following foods is recommended for those following an endometriosis diet:
Some processed foods can contain certain additives and preservatives that may contribute to inflammation in some people. They may also be high in saturated or processed fats that can promote the production of inflammatory prostaglandins, while potentially offering little in terms of nutritional value.
Read labels, taking note of the guideline daily amount or traffic light labelling guidance, as well as reading the list of ingredients, to see if perhaps there are healthier products you could choose.
Try to cut down the following:
- fried foods
- smoked and processed meats
- white flour and refined grains
- sugary foods
Interestingly, many people with the condition report that symptoms ease after limiting gluten. The link between the two is unknown, but it’s thought that a gluten sensitivity may trigger bowel symptoms which may then increase pain levels.
If you suspect a negative response to gluten-containing foods, try limiting your intake and eating naturally gluten-free options such as wild rice, quinoa and sweet potato, to see if you notice an improvement.
Found in margarine, butter and lard, these fats trigger the production of negative inflammatory prostaglandins. This can cause endometrial cramps and the spread of endometriosis.
Alternatively, foods rich in omega-3 and -6 fatty acids are thought to be crucial for healthy hormone functioning. But before upping your intake of these, be sure to consult a qualified nutritional professional; the wrong combination of omega-6 and omega-3 fatty acids can cause further inflammation.
Full-fat dairy products are relatively high in saturated fats and may, therefore, contribute to inflammation. Try choosing low-fat options for products, like yoghurts and milk, so that you can still benefit from these foods as a source of calcium if you wish. You may also want to limit your cheese intake.
Alternately, if you find you do better with less dairy in your diet, you can opt for calcium-fortified alternatives such as almond, coconut and rice milk.
A healthy liver is important for good hormone balance, as the liver detoxifies chemicals and waste products including excess hormones. Alcohol can be extremely inflammatory and affect vitamin D levels in the liver. So, try to limit alcohol consumption where possible to support the liver in functioning well.
Caffeine can increase menstrual pain and oestrogen levels, as well as aggravating the digestive symptoms many women experience. If you find that caffeine impacts your symptoms, try reducing your intake and trying some healthy and natural alternatives.
Check out Happiful’s guide to caffeine-free energy drinks.
Foods high in phytoestrogens
Phytoestrogens are a natural type of plant oestrogen that can contain toxins that can trigger endometriosis symptoms. One example is unfermented soy products, such as edamame beans, soy milk and soy cheese.
However, when soybeans are fermented – in products such as tofu, natto, miso, tempeh and soy sauce – the beneficial phytochemicals can be more easily absorbed into the body. These products are a good source of omega-3 and protein for the endometriosis diet.
Foods high in synthetic oestrogen
These have a much stronger, stimulating effect and are not cleared very quickly from the body. For example, red meat, which can contain man-made oestrogens that have been mixed into the feed that livestock eat. Like dairy, red meat can be inflammatory and also difficult to digest.
Where possible, it can be best practice to buy herbicide-free, organic produce as synthetic estrogens may also be present in commercially-grown produce. Grain-fed meats are also preferable, in order to avoid hormone fed livestock. Where available, look for grass-fed beef, organic free-range poultry or organically fed pork.
Before making any changes to your diet, please consult your doctor and a qualified nutrition professional.
What to include
Now we know what foods are best to avoid in order to limit food-related symptoms, what foods are important to include in your diet?
Fibre is important as it helps to expel unwanted substances from the body – particularly excess hormones (oestrogen) – in the case of endometriosis. Fibre can also help to stabilise your blood sugar levels and can help to reduce inflammation.
The aim is to include the recommended 30g of fibre a day in your diet. This could be in the form of whole grains, beans and lentils, vegetables and fruits. Soluble fibre is particularly useful as this is the form that binds to substances and reduces their absorption. Examples of soluble fibre include legumes and foods such as chia seeds.
Not sure if you’re eating enough fibre? Here’s an example of how to get more fibre into your diet, from a qualified nutrition professional.
Ensuring to include some iron-rich foods in your diet can replace iron that may be lost through heavy periods – a common symptom of endometriosis. Iron-rich foods include dark green leafy vegetables such as cabbage, kale, spinach and broccoli, red meat or beetroot.
Essential fatty acids (EFAs)
A good balance of healthy fats is essential for most people, but particularly for endometriosis sufferers, as EFAs can aid hormone balance and reduce inflammation, which help to relieve endometriosis symptoms. Look to include foods rich in essential fatty acids such as oily fish (salmon, sardines, mackerel, anchovies), as well as nuts and seeds.
If you don’t think you are getting enough EFAs in your diet, speak to a nutritionist. They may be able to recommend supplements or oils (such as walnut and evening primrose).
While there is no known cure for endometriosis, there are treatments to help manage symptoms. When deciding which treatment to try, you are advised to speak to your doctor who will take your individual circumstances into consideration.
Depending on the severity of your condition, the following treatment options may be offered:
To treat pain and inflammation, non-steroidal anti-inflammatories (NSAIDs) like ibuprofen are often recommended. These can help tackle the inflammation and swelling, as well as alleviating the associated pain. Paracetamol can also be used, however this may not be as effective as it doesn’t reduce inflammation.
Stronger painkillers like codeine can be used if other painkillers are not suitable; however, as a common side-effect is constipation, it can aggravate endometriosis symptoms.
Hormone treatments aim to limit the body’s production of oestrogen. This hormone is responsible for the growth and shedding of endometrial tissue. With less of this hormone, the degree of problem tissues can be reduced.
Hormone treatment cannot treat adhesions (the ‘sticky’ areas of tissue that can fuse organs together) or improve fertility. The most commonly used hormone treatments are the combined oral contraceptive pill or patch, as these can be used over long periods of time.
In more severe cases, surgery can be used to remove tissue. This can help endometriosis symptoms and improve fertility. Depending on the location of the tissue, you may be offered the following surgeries:
- Laparoscopic surgery – The least invasive form of surgery, this is done through keyhole surgery.
- Laparotomy – For severe cases, a wide cut is made to the abdominal area so the affected tissue can be accessed and removed.
- Hysterectomy – Radical surgery is considered if a woman has not responded to other treatments. Hysterectomy is the removal of the womb and can be done with or without the removal of ovaries, though this does not guarantee reduced endometriosis symptoms. Hysterectomy is not a decision to make lightly, so please consider all options and consult your GP before any treatment.
- Endometriosis UK
Content has been reviewed by a dietitian. All content displayed on Nutritionist Resource is provided for general information purposes only, and should not be treated as a substitute for advice given by your GP or any other healthcare professional.
If you or a loved one suffers from endometriosis, you don’t need me to tell you how painful and debilitating the condition can be.
You also probably don’t need me to tell you that conventional medical interventions for endometriosis are limited—and far from ideal. There are some things science knows for sure about endometriosis—for example, that the condition involves inflammation, estrogen excess, and an abnormal immune response—but one of the things science doesn’t know about endometriosis is the best way to treat it. To date, Western medicine’s best tools for dealing with endometriosis are non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or surgery. Both strategies are for pain control; neither one addresses root causes of the condition.
But no woman with endometriosis needs to live without hope. Lifestyle strategies for reducing inflammation, strengthening the immune system, supporting the liver, and balancing hormones can make a huge difference in reducing symptoms and improving quality of life.
What is Endometriosis?
It is a painful, sometimes debilitating, condition that affects as many as one in 15 percent of women ages 15 to 44 in the United States. Endometriosis happens when endometrial tissue, which is normally found in the uterus, grows in places outside the uterus—places where it shouldn’t be.
Most of the time this misplaced endometrial tissue lands on the ovaries or fallopian tubes or, painfully, on the abdomen. Because endometrial tissue responds to the same hormonal shifts that trigger the menstrual cycle, the pain associated with endometriosis will follow the same 28-day cycle as your period.
Astonishingly, and sadly, many women with endometriosis aren’t diagnosed right away. The average delay in diagnosis is almost seven years. Seven years! This means many women suffer with terrible, sometimes crippling, endometriosis-related pain for the better part of a decade, thinking that it is just severe period problems.
Endometriosis can happen to any menstruating women. But why the condition strikes some women and not others is not entirely clear. Some women may be genetically predisposed. Two other factors are: (1) a faulty immune system response—in women with endometriosis, the immune system fails to destroy the endometrial tissue that lands outside the uterus—and (2) excess estrogen in the body. Unfortunately, and simply by virtue of the world we live in today, excess estrogen in women (and many men) is more the norm than the exception.
Inflammation also plays a role. And inflammation, like estrogen excess, is driven by lifestyle. What we eat and the toxins we are exposed to (and how well our bodies can detox them) drive inflammation and hormone imbalances.
Your 14-Step Guide to Addressing Endometriosis with Lifestyle & Diet
You can work to reduce inflammation, balance hormones, and support your immune system with food and lifestyle. Here’s what I recommend for helping ease endometriosis symptoms.
- Start by limiting—and eventually eliminating—exposure to toxic forms of estrogen found in household cleaners, cosmetics, and bathroom products. Go through your house with a fine tooth comb and:
- Replace cosmetic and body care products with natural alternatives, this includes, soap, shampoo, hair styling products, deodorant, lotions, cosmetics, and perfumes
- Replace standard laundry soap with green alternatives. You can now find many clean alternatives on the shelves of big box stores, sitting side by side with the old (toxic) standbys. Clean alternatives are comparable in price and work just as well. You can opt for unscented products or products that have been scented with natural fragrance.
- Replace household cleaning products with clean alternatives. You can buy effective products at almost all big box stores or you can make your own, which is cheaper and healthier. The main ingredients in most DIY cleaning products are vinegar and baking soda.
- Take off your shoes at the door (and ask your guests to do the same). A lot of pesticides and other hormone-disrupting chemicals are tracked in on the bottom of shoes. Stopping those chemicals in their tracks is a great way to protect yourself!
- Just say no to pesticides and other chemicals in your food. Shop organic exclusively if you can. If you are on a budget, avoid the dirty dozen (or buy them organic) and feel okay about buying the clean 15 even when not organic.
- Emphasize dark leafy greens, cruciferous vegetables, low-glycemic fruits like berries and other high-fiber foods to support gut health and help your liver carry out important detox functions. The liver is responsible for breaking down and eliminating excess estrogen, and cruciferous vegetables directly support that detox process.
- Eat more healthy fats like those found in olive oil, coconut oil, and avocados. Healthy fats help support healthy hormone ratios in the body.
- Emphasize lean animal protein over other kinds of meat. They are less inflammatory.
- Limit red meat. Studies have linked red meat consumption with increased risk for endometriosis.
- Help kick your immune system into high gear with immune-supportive foods like carrots, kale, cabbage, broccoli, beets, artichokes, lemons, onions, garlic, and leeks.
- Limit sugar. Sugar fuels inflammation.
- Use targeted herbal support to further support liver detox and speed up estrogen metabolism. Think milk thistle, flax seeds, and dandelion root.
- Take evening primrose oil to decrease inflammation.
- Reduce or eliminate dairy, wheat, alcohol, and caffeine to improve your immune response.
- Take a probiotic to rebalance gut flora and support estrogen metabolism.
- Use Vitex and a B6 supplement daily to balance out excess estrogen.
- If you consult a doctor for your endometriosis, ask some key questions.
If you’re reading this article because your friend, sister, or family member is struggling with this condition, share this article with her!
Too many women believe the myth that endometriosis has to ruin your life every month.
And always remember, that once you have the right information about how your body really works, you can start making health choices that finally start to work for you! You can do this – the science of your body is on your side!
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Endometriosis is an estrogen-dependent chronic gynecologic disorder that significantly reduces the quality of life of affected women. Characterized by adhesions of endometrial fragments in extra-uterine sites (predominantly in the peritoneal cavity and ovary but occasionally on the diaphragm, liver, and abdominal wall), the condition occurs in ~10% of the general population and is associated with infertility, pelvic pain, and increased risks for ovarian and other cancers (1,2). Our understanding of its etiology and complex, multi-factorial origins remains inadequate (3-5). Moreover, its asymptomatic nature at the early stages can significantly delay clinical diagnosis. Treatment options are currently limited to hormonal therapy or surgical management; however, these methods are non-curative, may not align with women’s reproductive goals, and frequently lead to recurrence after cessation of treatment (6). Delineating the factors that contribute to lesion development and progression is key to providing opportunities for prevention and more efficacious therapeutic interventions.
Diet is a leading risk factor for many chronic diseases (7,8). The linkage between diet and endometriosis, summarized in a recent review (9), underscores the ability of anti-inflammatory components present in foods to mitigate endometriosis. Nevertheless, there are certain caveats to consider. Notably, most reported studies which support the linkage were conducted using animal models of endometriosis and findings were simply extrapolated to humans. Moreover, in the few studies with affected women, the investigations were predominantly retrospective or case-control, which are prone to selection and/or recall bias and were typically too limited in duration to sufficiently illuminate effects of dietary interventions on lesion development and progression. In the recent paper by Yamamoto et al. (10), the authors report on a prospective cohort study that evaluated the association between intake of red meat, poultry, fish and seafood on the risk of laparoscopically-confirmed endometriosis. In this work, the authors provide important insights on a role for diet in the development and progression of human endometriosis, and highlight important areas for future research. This manuscript is notable for several strengths in study design. First, a large number of pre-menopausal women (total of 81,908 from The Nurses’ Health Study II) with intact uteri and with no prior diagnosis of endometriosis or cancer (except for skin melanoma in a few cases) were followed for a duration of over 20 years (1991 to 2013). Second, diet was assessed using an extensively validated semi-quantitative food frequency questionnaire that incorporated portion size and frequency of intake. Third, endometriosis was laparoscopically-confirmed, obviating uncertainties in diagnosis. The 3,800 cases (women), representing 1,019,294 person-years of follow-up, provided a strong platform to advocate significant dietary influences on endometriosis risk.
From this important data set, we learn that intake of red meat, either as processed or unprocessed, is a major culprit in promoting endometriosis risk (hence, seeing red). Replacement of red meat with fish, shellfish or eggs was associated with lower risk of endometriosis. A quite unexpected result was the rise in endometriosis risk with increasing intake of poultry, albeit this was not as robust as seen for red meat. Yet another surprising finding is that the effect of red meat is independent of animal fat or its most common saturated fatty acid, palmitic acid. The take-home message of the study is consistent with that of a recent report that fish intake relative to red meat, lowers the risk of type 2 diabetes, yet another chronic disease (11). Interestingly, with type 2 diabetes, poultry consumption showed protective effects not noted with endometriosis.
This research sheds light on potential nutrients that may promote red meat’s observed effects on endometriosis risk. The intriguing possibility that heme iron constitutes a major component responsible for the negative effects of red meat consumption is consistent with a previous report suggesting a potential association between heme, which is abundant in red meat, and colon cancer risk (12). In that study, colonic epithelia of rats fed heme-supplemented diet showed higher proliferation rates when compared to those of control counterparts, irrespective of dietary fat content. In a population case-control study of adenocarcinoma of the esophagus and stomach, Ward et al. (13) reported that higher intake of heme iron and total iron from meat sources constitutes a risk for these cancer types. Iron can cause oxidative stress and DNA damage and heme iron catalyzes the endogenous formation of N-nitroso compounds, which are potent carcinogens (13). However, the heme iron hypothesis in colorectal cancer posits local mutagenic effects, which may not be easily extrapolated to ectopic lesion development.
A number of important points are worth considering from Yamamoto et al.’s study. First, the significant increase in endometriosis risk associated with red meat was found from comparing women consuming ≥2 servings per day (equivalent to 14 servings or more per week) with women consuming ≤1 serving per week; the latter effectively being non-red meat eaters. Interestingly, even 2–4 servings per week elicited a modest increase in endometriosis risk, suggesting that limiting red meat consumption to less than once weekly is best. Second, the study indicated that women with the highest red meat consumption (and hence, greater risk for endometriosis) were more likely to be overweight or obese and had greater caloric intake. These observations beg the question of whether the frequency of eating red meat contributes to higher body mass index (BMI) and are seemingly inconsistent with previous studies indicating lower BMI as a risk factor for endometriosis and a predictive factor for severe endometriosis (14,15). In a recent report (16), mice experimentally-induced with endometriosis exhibited lower body weights than sham controls (non-endometriotic mice) with ad libitum feeding. The study’s authors posited that endometriosis may be causal to rather than a consequence of, loss of body weight and body fat due to the accompanying disruption of hepatic metabolic gene expression (16). In a related study using another mouse model of endometriosis (17), high fat-diet promotion of endometriosis occurred in the absence of weight gain, ovarian dysfunction and insulin resistance, but was associated with increased systemic inflammation and oxidative stress. Since metabolic dysfunction rather than BMI is more highly correlated with many chronic diseases (18), the latter commonly characterized by persistent low levels of inflammation, the analyses of pro-inflammatory cytokines and metabolites from Yamamoto et al.’s patient cohort may help address the lingering question on the association between diet, endometriosis and metabolic status. Third, given the estrogen-dependent nature of endometriosis, the authors raise the likelihood that red meat may increase endogenous levels of estrogen in substantial red meat consumers. This is an arguable point since serum levels of estradiol in women with and without endometriosis are comparable (19), although the possibility that local (endometrial tissue) estrogen synthesis is elevated with increased red meat intake cannot be excluded. Harmon et al. (20) compared the levels of estrogens (estrone and estradiol) in sera of premenopausal women with low (considered semi-vegetarians) and high meat (red meat, poultry) intake, and found that serum estrogens were lower in semi-vegetarians than non-vegetarians. However, that study was limited by small sample size, and further data are required to clarify this association. Finally, with the mounting evidence that a woman’s exposure to environmental disrupting chemicals can modulate her reproductive system beginning at early life (21), it is possible that organic pollutants present in farmed animal products may contribute to increased risk of endometriosis. While fish and shellfish are similarly subject to environmental insults, the specific contaminants and the degree of contamination may be different between the animal groups.
Distinct dietary protein sources (e.g., red meat, poultry, fish, eggs), which are known to differ by amino acid composition and fatty acid content were compared in Yamamoto et al.’s report. In recent years, the potential link between dietary protein source and the composition of the gut microbiota has gained considerable ground (22,23). The participation of the gut microbiota in the pathogenesis of endometriosis has been posited as well, based on the role of the gut in regulating signaling molecules that orchestrate inflammatory, immune and proliferative pathways (24). Coming from another viewpoint, Yuan et al. (25) demonstrated significant changes in gut microbiota composition during the development of endometriosis in a mouse model. While the validity of a potential bidirectional relationship between endometriosis and the microbiota has yet to be confirmed in humans, the notion that dietary-induced changes in the intestinal milieu can influence endometriosis and vice-versa, may lead to a more personalized approach and novel biomarkers to reduce the risk for this condition.
The study by Yamamoto et al. lays the foundation to better understand how the multi-faceted nature of endometriosis may be managed by simple dietary changes and provides a compelling case for women of reproductive-age to reevaluate their dietary habits for the prevention of chronic disease.
Endometriosis is a disease marked by tissue that should only lines the uterus growing elsewhere in the pelvic cavity, usually around the reproductive organs, and the bowels and bladder. These growths are referred to as lesions or implants.
The uterine tissue reacts to the hormonal changes that occur during the menstrual cycle, and thickens in preparation for pregnancy. If no pregnancy occurs, the tissue breaks down naturally and is expelled as part of the menstrual cycle.
Endometrial lesions undergo the same monthly cycles in response to hormones such as estrogen, but once broken down cannot leave the body. This can lead to pain and inflammation, and can result in organs becoming stuck together.
Endometriosis currently has no cure, although several treatments can help to manage the condition. Lifestyle changes, like adjustments to diet, may also ease pain and improve overall health.
A healthy diet
A healthy diet for endometriosis may consist of foods that are anti-inflammatory and do not alter a person’s hormone levels, such as organic foods.
A diet high in fruit and vegetables accompanied by lean meat, poultry, eggs, or seafood may help reduce the symptoms of endometriosis. Low-dairy or dairy-free alternatives can provide vitamin D, and work to reduce inflammation without causing digestive problems.
Choosing organic foods can also help to manage endometriosis, as these tend to be lower in certain chemicals that can increase estrogen levels in the body. Keepng estrogen levels low helps to reduce the likelihood of a symptoms flare.
Foods to avoid
Eliminating or reducing the intake of some foods may reduce the symptoms of pain, nausea, and cramping women with endometriosis experience. These symptoms can be exacerbated by foods that can stimulate inflammation. Examples include dairy, gluten, high-fat foods, caffeine, and processed foods with added sugar.
Soy products can increase estrogen levels, which may worsen the symptoms of endometriosis as well as triggering the growth of new lesions if consumed in large quantities. Red meat, such as beef, is also associated with increased estrogen levels and the worsening of endometriosis symptoms. It should be consumed sparingly.
As every patient is different, it is possible that some foods may trigger a worsening of symptoms in some people while having no effects in others. Recognizing which foods may aggravate disease symptoms and eliminating them from your diet can help to improve quality of life.
Food as a cause of endometriosis
While the exact cause of endometriosis is not well understood, it is possible that an unhealthy diet can increase the risk of developing it. Studies examining certain dietary factors and endometriosis risk have been mixed in their results. For example, while not proven, the chemical polychlorinated biphenyl is thought to be associated with an increased risk of endometriosis, as it may alter the immune response and mimic the action of estrogen. This chemical can be found in some fatty foods, and in caffeinated drinks such as cola.
Endometriosis News is strictly a news and information website about the disease. It does not provide medical advice, diagnosis or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.