Episode 104 – Nutrition For Endometriosis

  • Endometriosis is a condition where tissue that is similar to the tissue that normally lines the inside of your uterus (which is called the endometrium) grows outside of the uterus.  
  • The condition affects roughly 1 in 10 women of childbearing age. 
  • It is often painful and comes with a host of symptoms that can greatly impact someone’s quality of life.  
  • There is no cure for endometriosis – although it is often medically managed with hormonal birth control and/or surgery  
  • So nutrition definitely should not be viewed as a solution for endometriosis, but rather one way that may help to ease symptoms and manage the condition  

How Does Diet Help? 

  • Diet can clearly help manage IBS symptoms. While it won’t solve symptoms in every situation – it is clear that it can play a role there. 
  • The more debateable aspects are the other stuff 
  • Diet can potentially help through other mechanisms like: 
  1. Reducing inflammation 
  2. Managing oestrogen levels 
  3. Reducing the production of harmful tissue 
  • This is a tricky area to navigate. We are trying to walk the line between identifying areas where nutrition can help, without overhyping things e.g. suggesting that if you make changes to reduce inflammation, it will solve all problems 

IBS Specific Stuff 

  • Starting here because it is the clearest link between nutrition and endo management. 
  • Many people with endo, experience IBS type symptoms due to their condition  
  • One study highlighted that 72% of women with both IBS and endometriosis who undertook the low FODMAP diet for 4 weeks showed a >50% improvement in symptoms.  
  • Most other concepts of IBS management also apply – we have plenty of content on the ideal nutrition blog about managing IBS symptoms including bloating, constipation and diarrhoea  

Anti-inflammatory Style Diet 

  • This is super broad. But general principles of a healthy diet apply. 
  • Dietary approaches such as the Mediterranean diet fit into this category, and there is some early promising evidence of benefit there 
  • Another specific area of research within this category is omega 3 intake. 
  • Animal research has indicated that omega 3’s can help reduce the formation of cystic lesions 
  • We also have research indicating that people with higher than average omega 3 intake are 22% less likely to develop endo.  
  • Meanwhile research on those with high trans-fat intakes have found a 48% increased risk of endo. 
  • One study found that omega 3 supplements reduced pain in those with endo – but I would still caution against fully buying into that without more research. If relevant, it will likely be even more relevant for those coming from a lower baseline intake. 
  • It also makes sense to increase the intake of antioxidant rich foods in general. Some research looking at antioxidant supplementation in the form of vitamin C and E has found significant reductions in pelvic pain, and mild improvements in period pain and cramps. 

Red Meat 

  • Research on red meat is always difficult to interpret. 
  • Higher red meat intake is linked with endo. And there are proposed mechanisms around this involving haem iron. 
  • How much of this is due to the combination of saturated fat + low fibre + higher calorie intake + lower antioxidant intake etc etc. It’s hard to say.  
  • Regardless, at a minimum I would be a bit cautious and avoid particularly high intakes of red meat. 
  • The world health organisation recommends for everyone that red meat should be limited to <500g raw weight red meat weekly, which is what I would typically suggest to all clients including those with endo 
  • But realistically, what likely matters more is the dietary context of that red meat intake  

Gluten 

  • This is another nuanced area that I don’t like talking about in shorter form content such as Instagram 
  • Technically, the research is surprisingly positive here. 
  • One study with 207 participants showed that 75% of them had a decrease in pain after going gluten-free for 12 months. 
  • I think it is always worthwhile being sceptical. But this study has also been repeated under similar circumstances with similarly impressive results. In the repeated study participants experienced an average drop in pain of 50% over a 3-month period. 
  • I am personally not at a point where I am recommending a gluten-free diet to those with endometriosis. I think it would take a fair bit more before I jump to that conclusion. But it is worth being aware that this research exists. 
  • It is also worth being aware that fructans, which are found in wheat, are a FODMAP. This can contribute to IBS symptoms in some individuals. Reducing/eliminating gluten also reduces the intake of fructans. This could lead to improvements by itself for some people, even if gluten was not the original issue. 
  • Going gluten free also influences a bunch of other dietary factors too 
  • Another perspective is that it is possible to have an incredibly healthy diet without gluten still, so it’s just another thing to consider, even if it’s not necessarily a recommendation. 

Dairy 

  • Dairy is not inflammatory and neither is gluten in the absence of coeliac disease 
  • Some research has actually linked dairy consumption with a lower risk of developing endo. 
  • Since IBS and Endo have overlap though, it is also worthwhile considering the possibility of lactose intolerance if you are experiencing symptoms after consuming dairy products  

Oestrogen 

  • Elevated levels of oestrogen are often seen with endometriosis. And this can effect symptoms such as fatigue, heavy periods and aggravated PMS. It also potentially contributes to growth of tissue outside of the uterus. 
  • This is a less clear area for how diet can play a role – but there are examples such as higher fibre diets reducing excess oestrogen resorption in the large intestines. 
  • We do not really have clear research on strategies looking at this specifically in endo. But we do also see medical options around this approach.  

Summary 

  • Follow an anti-inflammatory style diet rich in plant foods, fibre, antioxidants & omega 3 
    • Limit red meat intake  
    • Manage IBS symptoms appropriately based on symptoms, which may include going through a FODMAP elimination diet process directed by a Dietitian

Relevant Links/Resources

Blog Posts

Studies Mentioned