Endometriosis is condition that affects 1 in 10 New Zealand women. It occurs when the tissue from the uterus (the endometrial cells) travels outside of the uterus. These cells continue to be stimulated by female hormones and shed blood during menstruation each month. For many endo sufferers, the condition is painful, debilitating, and life-changing.
When we see clients in clinic suffering from endometriosis, we often find they are so exhausted and desperate to find the right diet to best manage their condition. They are often confused about what to eat and are desperate to achieve food freedom. Studies show that with correct nutrition, symptoms such as abdominal pain, gut disturbances, heavy periods and fertility can significantly improve.
There are a few key nutrients to consider when it comes to eating the best diet for your endo. Firstly, focus on a high-fibre diet. Fibre works by binging to estrogen, promoting estrogen excretion and reducing levels in the body. In fact, one study showed that vegetarians excrete 2-3 times more estrogen in their stools compared to meat eaters (1, 2). To ensure you are getting enough fibre in your diet, aim for ½ a plate of fruits or vegetables at every meal, snack on nuts and seeds, include legumes in your meals and swap your white bread and rice for wholegrain or brown varieties.
To help manage inflammation and reduce oxidative stress related to endo, a high antioxidant diet is recommended. Think lots of colourful fruits ang vegetables like berries, leafy greens, citrus fruits and tomatoes; nuts and seeds and olive oil for vitamin E; wholegrains, seafood and Brazil nuts for selenium. There is evidence to suggest that supplementation with fish oils for women with endometriosis can reduce pain and the need for pain medication. Omega-3 fatty acids are a potent antioxidant with anti-inflammatory properties and are thought to reduce prostaglandins in endo. Include at least two serves of oily fish per week and lots of health fats such as olive oil, avocados, walnuts and flax seeds alongside a daily fish oil supplement of 600-1000mg per day.
There is no endometriosis diet. However, there are some existing evidence-based diets that may support endometriosis management. All of this is consistent with a Mediterranean diet and studies show a Mediterranean diet is effective in reducing symptoms related to endometriosis (3,4). In a nutshell, the Mediterranean diet consists of a high intake of plant-based foods such as colourful fruits and vegetables, legumes, wholegrains, nuts and seeds, and plant oils such as olive oil. There is a big focus on omega-3s from oily fish such as salmon and tuna, whilst red meat should be limited to twice per week. Foods that are high in saturated fat, refined sugar and salt such as processed meats, takeaways or bakery items should be limited.
For women with endometriosis who are also suffering from IBS type symptoms such as bloating, abdominal pain and constipation or diarrhoea, the low FODMAP is often an effective way of managing symptoms and providing food freedom. The low FODMAP diet consists of three phases (elimination, reintroduction and personalisation) and should only be undertaken with the support and guidance from a dietitian.
Food freedom is not usually associated with 'diets'. Quite the opposite. Food freedom is often anti-diet. Despite this you'll notice we've mentioned a few diets in this blog post. The ones we've mentioned here aren't your typical fad diets that involve wide-spread restriction. They are evidence-based and are some of the very few diets that our Dietitians talk about with clients. By working with a Dietitian you can learn what foods can trigger your endometriosis flares or make them worse. You can minimise your exposure to a small range of foods for longer-term food freedom and have a varied diet. After all, your diet should always be getting more varied as you heal.
(1) Goldin BR, Adlercreutz H, Dwyer JT, Swenson L, Warram JH, Gorbach SL. Effect of diet on excretion of estrogens in pre- and postmenopausal women. Cancer Res. 1981 Sep;41(9 Pt 2):3771-3. PMID: 7260944.
(2) Nap A, de Roos N. Endometriosis and the effects of dietary interventions: what are we looking for? Reprod Fertil. 2022 May 30;3(2):C14-C22. doi: 10.1530/RAF-21-0110. PMID: 35814941; PMCID: PMC9259892.
(3) Nirgianakis K, Egger K, Kalaitzopoulos DR, Lanz S, Bally L, Mueller MD. Effectiveness of Dietary Interventions in the Treatment of Endometriosis: a Systematic Review. Reprod Sci. 2022 Jan;29(1):26-42. doi: 10.1007/s43032-020-00418-w. Epub 2021 Mar 24. PMID: 33761124; PMCID: PMC8677647.
(4) Ott J, Nouri K, Hrebacka D, Gutschelhofer S, et al. Endometriosis and nutrition-recommending a Mediterranean diet decreases endometriosis-associated pain: an experimental observational study. J Aging Res Clin Practice. 2012;1:162–166.
Exciting plant foods, 5 recipes for FODMAP/IBS, menstruation, fertility or menopause
Recipe To Eat If You Have Endometriosis