By: Alicia Jerome MS, RDN
Endometriosis is a complex and painful condition that affects millions of women worldwide. It occurs when the tissue that normally lines the inside of the uterus (the endometrium) begins to grow outside of it. This can lead to a range of distressing symptoms, including severe pelvic pain, heavy menstrual bleeding, and infertility. While endometriosis has no known cure, there are various treatment options available, including surgery and medications. However, nutrition can play a vital role in managing the symptoms and improving the overall health and well-being of those with endometriosis.
Understanding Endometriosis and Its Connection to Nutrition
Endometriosis is an estrogen-dependent condition, meaning that its growth and symptoms are closely tied to estrogen levels in the body. Hormonal imbalances can exacerbate the symptoms of endometriosis, making it crucial to understand how nutrition affects hormone regulation.
- Estrogen Dominance: Endometriosis is often associated with estrogen dominance, a condition where there is an excess of estrogen relative to progesterone. This hormonal imbalance can lead to increased pain and inflammation. Certain foods and dietary patterns can contribute to or alleviate estrogen dominance. For example, cruciferous vegetable (broccoli, cauliflower, kale, cabbage, etc.) contain indole-3-carbinol and sulforaphane which help the liver breakdown and eliminate excess estrogen. More examples are given below in the dietary recommendations.
- Inflammation: Inflammation is a key driver of endometriosis symptoms. A pro-inflammatory diet can worsen pain and discomfort. Conversely, an anti-inflammatory diet can help reduce inflammation and alleviate symptoms. (Read our recent blog on Inflammation)
Dietary Recommendations for Endometriosis
“The Endometriosis Health and Diet Program” by Dr. Andrew S. Cook offers practical dietary recommendations to help individuals manage their symptoms and improve their overall health. Below are some key guidelines from the book:
- Emphasize Whole Foods: Focus on a diet rich in whole foods, including fruits, vegetables, whole grains, lean proteins, and healthy fats. These foods provide essential nutrients and help reduce inflammation. A study by Harris (2018) revealed a 22% lower risk of developing endometriosis when women consumed >1 servings of citrus fruits per day. Additionally, there was a 70% lower risk when women had 13 or more servings of green leafy vegetables per week.
- Limit Processed Foods: Reduce or eliminate highly processed foods, which often contain high levels of sugar, unhealthy fats, and additives that can exacerbate inflammation.
- Manage Sugar Intake: High sugar consumption can lead to blood sugar spikes and crashes, affecting hormone balance. Reducing sugar intake can help stabilize blood sugar levels.
- Choose Anti-Inflammatory Foods: Incorporate foods that have anti-inflammatory properties, such as fatty fish (rich in omega-3 fatty acids), turmeric, ginger, and green tea. Antioxidants in green tea, called catechins, can help modulate estrogen levels.
- Fiber for Digestive Health: A diet high in fiber can support healthy digestion and help eliminate excess estrogen from the body by preventing reabsorption in the large intestine. Whole grains, legumes, and vegetables are excellent sources of fiber.
- Protein Sources: Opt for lean protein sources like poultry, fish, and plant-based options such as beans and tofu. These provide essential amino acids without the saturated fats found in red meat. A balanced protein intake can allow the body to regulate estrogen production.
- Healthy Fats: Include sources of healthy fats, like avocados, nuts, and olive oil, in your diet. These fats can help reduce inflammation and support hormonal balance. A special note should be made for flaxseed, both a healthy fat and source of fiber, for its role in acting as both an estrogen receptor agonist or antagonist, depending on the body’s needs.
- Dairy and Gluten Sensitivity: Some individuals with endometriosis may experience relief from their symptoms by reducing or eliminating dairy and gluten from their diet.
- Alcohol and Caffeine: Limit or avoid alcohol and caffeine, as they can disrupt hormone balance and exacerbate symptoms in some individuals.
- Portion Control: Pay attention to portion sizes to maintain a healthy weight, as excess body fat can contribute to estrogen production.
A whole-foods, plant-based diet is naturally anti-inflammatory, high in fiber, and low in sugar and processed foods. While plant-based health professionals would whole-heartedly agree with most of the food recommendations listed above, one caveat would be the source of protein. There is growing evidence that meat, and specifically red meat, consumption may exacerbate endometriosis because of its contribution of cholesterol and saturated fat and increase in whole body inflammation.
According to Kassam, Kassam, and Simon (2022), “Endometrial tissue can convert cholesterol to estradiol, raising concerns about dietary cholesterol and saturated fat, which are almost exclusively found in animal derived products.” The significance of this is estradiol is primarily responsible for stimulating the growth and proliferation of endometrial tissue. Specifically, another study by Yamamoto et al (2018) showed that women who ate >2 servings of red meat per day had a 56% higher risk of endometriosis than women who ate <1 serving per week.
In addition to dietary changes, nutritional supplements may be beneficial for managing endometriosis symptoms. Dr. Cook's book discusses several supplements that can support hormonal balance and reduce inflammation. These may include:
- Omega-3 Fatty Acids: Fish oil supplements can help reduce inflammation and improve hormonal balance.
- Magnesium: Magnesium supplements can alleviate muscle cramps and pain associated with endometriosis.
- Vitamin D: Adequate vitamin D levels are essential for overall health, and they may play a role in managing endometriosis symptoms.
- Probiotics: Probiotics can support gut health and reduce inflammation by promoting a balanced gut microbiome.
- Herbal Supplements: Some herbal supplements, such as chasteberry and turmeric, have shown promise in managing endometriosis symptoms.
It's important to note that the impact of diet and supplements on endometriosis can vary from person to person. What works for one individual may not work for another. A personalized approach, in consultation with you, the registered dietitian, is essential. Additionally, it's crucial to maintain a balanced and varied diet to ensure that all nutritional needs are met.
Endometriosis is a challenging condition that affects many aspects of a person's life, from their physical well-being to their emotional health. While there is no cure for endometriosis, focusing on nutrition, as outlined in "The Endometriosis Health and Diet Program" by Dr. Andrew S. Cook, can provide valuable tools for managing symptoms and improving overall quality of life. By making informed dietary choices, reducing inflammation, and addressing hormonal imbalances, individuals with endometriosis can take a proactive step towards better health and well-being.
The registered dietitian is positioned to create a personalized nutrition plan tailored to meet the specific needs and circumstances of individuals with endometriosis.
- Cook, A. S., & Cook, D. (2017). The Endometriosis Health & Diet Program: Get your life back. Robert Rose Inc.
- Harris, H.R., Eke, A.C., Chavarro, J.E., Missmer, S.A. Fruit and vegetable consumption and risk of endometriosis. Hum Reprod 2018; 33(4): 715-727. Doi: 10.1093/humrep/dey014
- Kassam, S., Kassam, Z., & Simon, L. (2022). Plant-based nutrition in clinical practice. Hammersmith Health Books.
- Yamamoto, A., Harris, H.R., Vitonis, A.F. Chavarro, J.E., Missmer, S.A. A prospective cohort study of meat and fish consumption and endometriosis risk. Am J Obstet Gynecol 2018; 219 (2); 178.el-178.e10. doi: 10.1016/j.ajog.2018.05.034.