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Endometriosis is an inflammatory disease and a long-term condition that can cause significant pain and possible infertility.
Endometriosis is a disease that causes a woman’s endometrium (inner lining of the uterus) to appear elsewhere in the body. Typically, this tissue shows up in other parts of the pelvis, such as the ovaries or the bowel. However, in rare cases, endometrial tissue can be in the brain, lungs, and heart.
This tissue bleeds during the menstrual cycle (along with the usual shedding of the uterine lining), often resulting in considerable abdominal swelling and pain.
Endometriosis is a hormone-dependent condition, meaning nutrition can help treat or manage it. Food significantly influences hormone production and maintenance, immune and inflammatory responses, and smooth muscle contraction.
Additionally, we know that the Western diet has changed hugely over the last few decades with increased consumption of processed foods and refined sugar and decreased consumption of whole foods, fruit, and vegetables. So, food and nutrient intake can significantly impact a hormone-related condition like endometriosis.
Although the exact impact of diet on endometriosis needs further research, evidence suggests that avoiding certain foods can make your condition more manageable.
Trans fats or trans-unsaturated fatty acids are found mainly in fried and processed foods, including most fast foods. A 2010 study that considered data from the Nurses Health Study II found that participants with the highest consumption of trans-unsaturated fat were 48% more likely to receive a future endometriosis diagnosis¹.
Omega-6 fatty acid and arachidonic acid are two main polyunsaturated fats, and their impact on endometriosis is well-studied. The two acids eventually metabolize into prostaglandins² that cause pain and inflammation. High levels result in inflammation and muscle spasms (cramping).
On the other hand, in one particular study, women with the highest levels of omega-3 fatty acid had a 22% reduction in endometriosis³.
Research also indicates that omega-3 fatty acids are anti-inflammatory³ and helpful in managing inflammatory and autoimmune diseases. Adding more omega-3 acid-rich foods to your diet is a worthwhile consideration. Some sources include cold-water fish (salmon, tuna, mackerel, herring, trout, anchovies, among others), nuts, seeds, plant oils, and dietary supplements.
An extensive 2018 study found a link between increased consumption of red meat and endometriosis⁴. Women who ate two or more servings of red meat per day were 56% more likely to receive an endometriosis diagnosis (by laparoscopy) than those who consumed less than one serving per week.
One hypothesis for this finding is that red meat contains heme iron, which is associated with inflammation and oxidative stress mechanisms. So, reducing your intake of red meat may also reduce your endometriosis symptoms by lowering inflammation.
It’s also worth noting women with endometriosis are frequently iron deficient, so it’s worth discussing the role of red meat in your diet and your exact dietary needs with your health practitioner.
In one study, women with endometriosis were asked to cut out gluten for 12 months, and the results were encouraging. 75% of participants reported reduced pain when going gluten-free⁵, and none reported any negative effects on their endometriosis.
Women with endometriosis are more likely to have irritable bowel syndrome (IBS), even when there is no endometriosis on the bowel. The two conditions can have overlapping symptoms.
A low FODMAP diet reduces the symptoms of IBS and may also do the same for endometriosis. Gluten is often found in the same foods high in FODMAPs, so by avoiding gluten, you can avoid some high FODMAP foods, too, and reduce endometriosis symptoms.
However, if a gluten-free diet isn’t significantly helping your symptoms, it may be worth shifting to a low FODMAP diet to find relief like 72% of people did in this 2016 study⁶.
Low FODMAP can be quite a restrictive diet, so it is important to review this option with your doctor and be monitored by a dietitian.
Soy and soy-based products
Soybeans and soy products are high in estrogen and endometriosis is estrogen-dependent. However, researchers are still investigating the complete impact of eating soy on endometriosis. In one study, women given soy formula as infants had more than double the risk of endometriosis⁷ compared with those who had never had soy formula at all.
Caffeine and alcohol
Health professionals recommend limiting your alcohol and coffee intake to lower inflammation and improve endometriosis. Coffee can also alter hormone levels, which may increase estrogen and worsen endometriosis. More clinical research is needed.
As mentioned above, omega-3 fatty acids seem to improve endometriosis pain because of their anti-inflammatory properties. These fatty acids are in fish like sardines, mackerel, herring, and pollock.
If animal-derived sources of fatty acids are not an option, you could increase your consumption of plant sources such as chia seeds, flaxseeds, and walnuts.
Some sources suggest people with endometriosis should minimize their fruit consumption, as it can worsen symptoms, possibly due to high levels of FODMAPs in some fruits. However, fruit is generally part of a good diet if you have endometriosis since it is rich in vitamins, minerals, and fiber.
Vegetables should be part of your diet if you have endometriosis, especially leafy greens, yellow vegetables, and green vegetables. However, one study⁸ found Brussels sprouts, red cabbage, and cauliflower aggravate symptoms despite being extremely nutritious. Still, cruciferous vegetables such as cabbage, broccoli, cauliflower, Brussels sprouts, and kohlrabi are also high in indole-3-carbinol, which can lower estrogen production.
Magnesium has an important role in muscle function. It relaxes the smooth muscle fibers addressing things like chronic constipation, asthma, and hypertension, all of which involve smooth muscle contractions. For this same reason, magnesium is shown to be effective in treating menstrual cramps.
Magnesium supplements can interact with other medications like antibiotics, so it is best to speak with your doctor before adding them to your routine. Leafy greens are also rich in magnesium.
A study found that a high antioxidant diet of Vitamins A, C, and E was associated with higher antioxidant enzyme activity and lower oxidative stress, commonly seen in endometriosis⁹.
Endometriosis is a complex condition to manage, and there is much research still to be done on the disease. However, modifying your diet by avoiding certain foods and adding others can help manage symptoms and improve your quality of life. If possible, it is worth having an in-depth conversation about endometriosis and nutrition with a healthcare professional, such as a registered dietitian.
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