8 Endometriosis Diet Tips That May Help You Manage Symptoms, According to Experts
Dietary changes won't cure endometriosis, but they could offer some relief.
Dealing with endometriosis can be a regular lesson in frustration. There are treatments available, but they don't work well for everyone. And, if that describes you, it's understandable that you'd want to do everything you can to try to make yourself feel better. Enter, an endometriosis-focused diet.
As you probably know, endometriosis is a condition where tissue that forms the lining of the uterus grows outside of it. That can lead to symptoms like intense pelvic pain before and during your period, diarrhea, and pain during sex.
It's important to get this out there upfront: Going on a special diet won't cure endometriosis and isn't even a guarantee to help your symptoms. But experts say you might get some form of relief from altering what you eat. "There is some data that diet may play a role in either exacerbating or controlling symptoms," Amanda N. Kallen, MD, an assistant professor of obstetrics and gynecology at the Yale School of Medicine, tells Health. "But dietary changes alone should not be considered a first-line treatment for true endometriosis."
Still, "the role of diet in endometriosis has gained more attention in recent years," says Jessica Shepherd, MD, an ob/gyn in Texas, tells Health. Several processes that are linked to endometriosis, like inflammation and estrogen activity, can be impacted by your diet, Dr. Shepherd says, leading doctors to think there might be something there.
"Eating a healthy diet can make you feel more comfortable and healthy overall, and there are some studies evaluating whether dietary changes can be a complementary therapy as well," Christine Greves, MD, a board-certified ob/gyn at the Winnie Palmer Hospital for Women and Babies, tells Health.
Though there are no clear recommendations at this point for eating a special diet when you have endometriosis, it's generally thought that some changes might help. Interested in giving it a try? Doctors say these dietary moves are worth considering.
Limit trans fats
Trans fats can naturally occur in animal products or be added to processed foods for taste and texture. But trans fats can raise your bad (LDL) cholesterol levels and lower your good (HDL) cholesterol levels, per the American Heart Association. Eating trans fats also raises your risk of developing heart disease, stroke, and type 2 diabetes.
An older but often-cited study published in the journal Human Reproduction analyzed 12 years of data from the Nurses' Health Study II, looking specifically at diets in women. Researchers found that, among 1,199 cases of endometriosis, women who ate a diet high in trans fats were 48% more likely to be diagnosed with endometriosis than others. "A high intake of trans fats and potentially of animal fats is associated with a higher risk of endometriosis," Dr. Shepherd says.
Trans fats tend to show up in fried, process, and fast foods, and can show up on food labels as "partially hydrogenated oils"—doing your best to avoid them may help.
Gluten is a protein found in most grains, and it usually works as a binder in breads and baked goods. There isn't a ton of data on this one, but one older study had 207 endometriosis patients go on a gluten-free diet and found surprising results. After 12 months on the gluten-free diet, 75% of patients had a "statistically significant" change in their pain. As a result, the authors concluded, "painful symptoms of endometriosis decrease after 12 months of gluten free diet."
Research has linked gluten with bodily inflammation—and that may exacerbate endometriosis pain, Dr. Greves says.
Eat a low FODMAP diet
FODMAP stands for fermentable oligosaccharides, disaccharides, monosaccharides and polyols. These are short-chain carbohydrates that your small intestine has trouble absorbing, per Johns Hopkins Medicine. As a result, some people can struggle with digestive symptoms like stomach cramps, diarrhea, and bloating after eating foods high in FODMAPS, like dairy-based milk and yogurt, wheat products, asparagus, onions, apples, and pears.
One smaller study published in The Australian & New Zealand Journal of Obstetrics & Gynaecology, looked at 160 women and found that 72% of those with endometriosis reported a more than 50% improvement in bowel symptoms after four weeks on a low FODMAP diet, compared to 49% of people with irritable bowel syndrome (endometriosis is often misdiagnosed as IBS). "The low FODMAP diet appears effective in women with gut symptoms and endometriosis," the researchers concluded.
FWIW: Low FODMAP foods include things like eggs, meat, some cheeses (brie, cheddar, feta), almond milk, rice, eggplant, cucumbers, grapes, and strawberries.
Keep tabs on how much red meat you eat
A review of studies on diet and endometriosis in a Polish obstetrics and gynecology journal found a link between eating beef, ham, and other types of red meat and a higher risk of endometriosis. The exact reason for the link isn't clear, but research has found red meat may cause inflammation in your body—and bodily inflammation may exacerbate endometriosis, Dr. Greves says.
Stock up on fruits
This one is slightly vague, so hang in there: A study published in 2018 in Human Reproduction that analyzed data from 70,835 women who participated in the Nurses' Health Study II cohort found that those who ate more fruits—especially citrus fruits—had a lower risk of developing endometriosis than those who didn't partake in a high-fruit diet. It wasn't a lot of fruit—just one serving or more a day. "Our findings suggest that a higher intake of fruits, particularly citrus fruits, is associated with a lower risk of endometriosis," the researchers concluded.
It's hard to say whether the data translates to helping once you actually have endometriosis but Dr. Greves points out that eating foods that are good for your overall health may simply make you feel better as a whole—and that may make it easier to handle endometriosis symptoms.
Eat iron-rich food
It's common to struggle with fatigue and weakness when you have endometriosis. Research published in the journal Comparative Medicine has suggested it might be due to lower levels of iron in people who have the disease. Iron is an essential component of hemoglobin, a red blood cell protein that transfers oxygen from your lungs to your tissues, and having low iron levels can cause symptoms like fatigue and trouble concentrating.
The only way to know for sure if you're struggling with low iron is to see your doctor for a blood test. If you do, in fact, have low iron levels (aka anemia), your doctor may recommend that you take a supplement or to try to eat more foods with iron. Those can include lean meats, seafood, and iron-fortified foods, like cereal.
Reach for foods high in omega-3 fatty acids
Omega-3 fatty acids are important components of the membranes that surround each cell in your body, per the National Institutes of Health (NIH). They also help give your body energy and help keep important organs like your heart and lungs working well.
Research has found that people who take omega-3 fatty acids (i.e. fish oil) have less endometriosis pain and inflammation, and even improve the quality of life in people with severe endometriosis. The why is a little unclear, but it's been suggested that omega-3 fatty acids positively impact the productions of prostaglandins, compounds in the body that have hormone-like effects, and reduce pelvic pain.
"The literature suggests that an increased consumption of omega-3 has a positive effect on endometriosis," Dr. Shepherd says.
Have antioxidant-rich foods
Antioxidants are man-made or natural substances that might prevent or delay some types of cell damage.
A study of 398 patients with endometriosis-associated pelvic pain, published in the European Journal of Obstetrics & Gynecology and Reproductive Biology, found that those who took antioxidant supplements had a significant drop in pain after six months. It's not entirely clear why, but Dr. Greves says that it could be linked to bodily inflammation, something antioxidants typically fight. "The hope is that it could act on the inflammatory process and reduce the pain," she says.
If you want to add more antioxidants into your diet, having more fruits and vegetables is a good way to go.
Again, doctors say that a healthy diet isn't considered a first-line treatment for endometriosis—but eating well may help with your symptoms. Kallen says that dietary changes "can be a reasonable part of a multi-pronged treatment approach" for endometriosis.
"Eating a healthy diet doesn't hurt and may actually make a person feel better," Dr. Greves says. "In turn, it may give them more strength when having the discomforts of endometriosis."
If you're in pain, talk to your doctor and keep the dialogue open. Whether dietary changes or hormone therapy will help, you shouldn't have to live that way.
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