Diet for Endometriosis
by Sue Kira, Naturopath & Clinical Nutritionist
– Symptoms you may experience with endometriosis
– Endometriosis is fed by an excess of oestrogens in the body
– Endometriosis and conception
– How can changing your diet help?
– Painful prostaglandins and diet
– Other foods & substances known to aggravate endometriosis
– What foods support clearing endometriosis and fibroids?
– Foods that are bad for Endometriosis and Fibroids
– Foods that are good for Endometriosis and fibroids
– More about a Diet for Endometriosis and Fibroids
Within the uterus there can be fibroid masses or adenomyosis, but the two conditions are not the same. Fibroids are masses of tissue attached to the uterine wall and adenomyosis is a growth within the uterine wall. Whereas endometriosis is generally when the cells originating from the lining of the uterus, called the endometrium, grow outside of the uterus.
Endometriosis is often found on and around the pelvic and abdominal organs, including the ovaries, but rogue cells can also be found in the eyes, nose, bowel and many other parts of the body.
About 10% of women of between the ages of 15-50 are affected by endometriosis, which is around 180 million women worldwide. 30-40% of women with infertility suffer from endometriosis and up to 90% of women with pelvic pain have endometriosis.
Symptoms you may experience with endometriosis
Pain is a key symptom of this condition and is not related to how severe the disease is, but the location of endometrial tissue. Bleeding at menstruation can be heavy, with or without clots, is often of longer duration, or earlier than the true period starting point. Some women have many symptoms including severe pain, whereas others have no symptoms.
Some women discover they have endometriosis because they have not been able to become pregnant, or because endometriosis is found during an operation for something else. About three out of four women with endometriosis have pelvic pain and/or painful periods. In the early stages of the disease, one or two mild symptoms may be felt for the first day or two of a period. Later, symptoms may get worse for more days of the month, both during and before the period and at ovulation time.
Sometimes there can be bleeding from the bowel or bladder along with changes in bowel habits, such as constipation or diarrhoea, or there may be an increase in bladder frequency or an increase in abdominal bloating at period time.
Endometriosis is fed by an excess of oestrogens in the body
We have good and bad oestrogens produced by the body, plus we can also get externally sourced oestrogens called ‘phytoestrogens’, which come from certain foods.
Then there are the chemical based oestrogens called ‘xenoestrogens’ that are found in toiletries and cosmetics. These are the worst type.
In our environment, we can be affected by what are called ‘endocrine disruptors’ which are substances that can play havoc with our hormones. These are found in substances like plastics (water bottles), flame retardants in clothes or carpets, furniture polish, cleaners, check-out printed dockets and the list goes on.
Endometriosis and conception
Endometriosis can make it difficult to get pregnant because the endometrial cells release chemicals that cause inflammation. This interferes with the ability to conceive and can also affect the development of the embryo.
In moderate to severe cases, scarring caused by endometriosis may interfere with the release of an egg at ovulation because of damage or blockage. This damage may also prevent the journey of an egg along the fallopian tube and/or the sperm from reaching the egg, causing fertility problems.
As mentioned there are around 180 million women around the world suffering from the effects of uterine abnormalities such as fibroids, endometriosis and adenomyosis. Add to this breast lumps, tender breasts, polycystic ovaries, menstrual irregularities, period pain, excessive bleeding, fallopian tube issues, PMS symptoms, cervical abnormalities, uterine, cervical and breast cancer and you have a massive chunk of the population directly affected by hormonal imbalances.
But why is this happening? The medical and scientific world looks at various connections to chemical toxicity, heavy metals, emotional imbalances, stress, hormones of course…and the list goes on. But not many have looked at diet, until somewhat recently. On the other hand, natural health practitioners start by looking at diet, which is where more studies are needed.
Several studies found a strong correlation between endometriosis, fibroids and other related conditions with diets high in red meat, carbohydrates, processed foods, sugar, alcohol, and low in green vegetables and fresh fruit.
If you have endometriosis, fibroids or similar, your diet could be having a major impact on your condition.
How can changing your diet help?
An improved diet for endometriosis and fibroids can help to:
- Reduce symptoms of pain
- Relieve cramps
- Reduce inflammation
- Reduce bloating
- Reduce excess bad oestrogen
- Balance hormones
- Reduce weight: oestrogen is stored in fat and endometriosis is fed by oestrogen
- Reduce toxins: found in additives, preservatives, cosmetics, pesticides, cleaning products
- Increase energy levels
- Boost your immune system
- Improve overall health and vitality
The reason that certain foods make endometriosis symptoms worse is because of chemical reactions in the body that are caused by these foods. Some of these chemical reactions can be both subtle and complex. The health of the gut, immune system and liver also come into play.
A healthy digestive system will have good bacteria, enzymes and the necessary vitamins and minerals to keep hormones and hormone pathways in balance.
The symptoms of endometriosis and fibroids can respond well to diet changes. Your body is sensitive to what you put into it, so if you have any food intolerances or allergies, or too much sugar or caffeine, then these sensitivities can develop into hormonal imbalance symptoms.
Painful prostaglandins and how diet can help
Prostaglandins are very complex natural fatty acids that are derived from food we eat. There are many different forms of prostaglandins, some good for us and others that are inflammatory and pain inducing.
The painful symptoms of endometriosis and menstrual cramps are due to prostaglandins. So as well as dealing with oestrogen, it is important to look at prostaglandin levels in the body.
A change in diet can alter the level and the types of prostaglandins in your body. The aim of an endometriosis support diet is to reduce ‘bad prostaglandins’, because they increase uterine contractions, pain and inflammation, and increase levels of the ‘good prostaglandins’ because of their muscle relaxing and anti-inflammatory effects.
The good omega3 fatty oils lead to good prostaglandin production. Some of the best sources of omega3 oils are found in marine and plant oils from oily fish, walnuts, chia seeds, pumpkin seeds and dark green leafy vegetables.
At the same time, it is important to reduce intake of the fatty acids that stimulate the bad prostaglandins which are found in animal fats like butter and red meat. Also avoid or eliminate other prostaglandin inducing foods such as refined and concentrated carbohydrates like white bread, flour, cakes, pasta etc.
If you can remove all grains from your diet then that will be even better for you. Grains contain phytic acid which can aggravate symptoms of endometriosis. Another aggravating substance for endometriosis is gluten, but if you avoid grains then you will be avoiding most gluten sources. Gluten can be found in other items like soy sauce.
Other foods & substances known to aggravate endometriosis
Foods also known to aggravate endometriosis include:
– Caffeine: a known phytoestrogen
– Dairy: causes inflammatory reactions via prostaglandins
– Chocolate: contains sugar, which is inflammatory + often contains dairy
– Eggs (unless organic): can contain chemical residues which are known endocrine disruptors (such as dioxin).
– Most grains: contain insoluble fibres
– Chemicals: see below
– Alcohol: see below
It is important to avoid anything that will increase the chemical load on the liver, including additives, preservatives, or any chemical for that matter, including those in our cleaning and personal care items.
The liver detoxifies and converts our hormones, so it is important to protect the liver in many ways as possible. This includes avoiding alcohol, which not only disrupts the liver from doing it’s many beneficial jobs, but also uses up valuable B group vitamins needed for good hormone production.
What foods support clearing endometriosis and fibroids?
Soluble sources of fibre, particularly from fruits, vegetables, nuts and seeds help to decrease the circulating oestrogen in your system by supporting good gut function and good levels of friendly bacteria needed for detoxification and nutrient absorption.
Care is needed to limit the use of the more insoluble fibres such as those found in most grains, as these absorb any available water in the gut and slow down your digestive system and reduce the excretion of oestrogens.
There are some special foods that are particularly good at supporting hormone pathways and these include things like mustard greens, other dark green vegetables, and especially the brassica family of vegetables such as broccoli, cabbage, cauliflower and Brussels sprouts.
These contain compounds like sulphur (sulphuraphane) which helps the liver to detoxify the bad type of oestrogens, and compounds that up-regulate (make more efficient) the phase two pathway of the liver called Glucuronidation, which help to clear excess oestrogens and endocrine disruptors.
Foods rich in B12, B6 and zinc are also very important to support hormone pathways.
However, please note that some find that a Low FODMAP diet helps to considerably reduce endometriosis pain with some studies showing the pain level is reduced by 8 fold on a low FODMAP diet.
This then opposes the high Brassica foods mentioned above as they are all high FODMAP foods. In light of this, it is important to speak to your primary health care provider about your symptoms and if FODMAP foods aggravate your system (give you wind, bloating etc) then your practitioner may feel that a Low FODMAP diet may suit you better, at least initially.
Foods that are bad for Endometriosis and Fibroids
- Wheat and other gluten grains
- Caffeine from the many sources
- Dairy products
- Red Meat, including Pork (some say that chicken is not good but organic pasture raised chicken that hasn’t been given hormones is ok in moderation)
- All trans fats, cooked vegetable oil
- Refined carbohydrates, but almost any grain can be detrimental
- Additives, preservatives and chemicals in general
Foods that are good for Endometriosis and Fibroids
- Fruits, especially low GI, low sugar, low fructose types
- Vegetables, especially cruciferous & leafy green vegetables
- Amaranth, buckwheat, chia, quinoa, flax (linseeds)
- Beans such as Navy Beans, which are high in Choline, as are grass fed organic eggs and liver
- Chicken in moderation (must be free range grass fed & preferably organic)
- Fish & Seafood and other foods high in Omegas 3 fats
More about a Diet for Endometriosis and Fibroids
It is important that you work with your health care provider to investigate different aspects, such as measuring your different types of hormones, especially the different oestrogens, and address any imbalances with your gut, liver, adrenal glands and immune system. These all need to be working well to support your body back to good hormone balance.
Even though these issues are extremely common, that doesn’t make them ok or normal, and they should not be taken lightly. Having any of these issues can lead to worse conditions, such as cancer of various reproductive tissues.
A diet for endometriosis and fibroids is a great adjunctive tool to have alongside what your practitioner advises. Diet is something that you can have total control over, but if you are unsure about any of the foods or you have a concern or a symptom that arises from eating these foods, then talk to your practitioner.
Just because a food is deemed healthy doesn’t mean you are not intolerant to it. We are all different and can have variable responses.
While a diet for endometriosis and fibroids is not considered a cure, the idea is to eliminate foods considered detrimental and include foods that support the body, to allow your body to do its natural job of healing.
Important: While on the diet do not stop any medications or supplements previously prescribed unless advised otherwise by your medical or health care professional. Also, during the early stages of a new diet, you may experience symptoms such as fatigue, headaches or body aches, which may occur because your body is detoxifying. If you are unsure about a symptom at any time, check immediately with your medical or health care professional.
Client name and identifying information changed
When April first came to see me she wanted to stop taking the pill to have a baby. April was initially diagnosed with endometriosis when only 14, after previously suffering many months of agonising pain with each period.
Later in life, she went off the pill a few times to fall pregnant, but her endometriosis would come back with a vengeance.
April’s doctor previously advised her to continue to take the contraceptive pill until she wanted to fall pregnant. However, after much research, April discovered that if she worked with a naturopath she might be able to fall pregnant naturally and clear her endometriosis at the same time. So this time she wanted to approach things differently.
April seemed otherwise healthy, not overweight, her skin was clear and eyes bright, but this was while her hormones were under the control of the pill. April explained that her skin would normally be a mess when she was off the pill.
Going over her health history, diet and lifestyle choices, I could see that she had been prescribed lots of antibiotics as a child for recurrent tonsillitis, until her tonsils were removed when she was eight. During her school years, her diet was poor, including sugary cereals topped with chocolate milk for breakfast, bread with vegemite or jam for lunch, and dinners of processed chicken nuggets, cheese and fruits, pasta dishes and she didn’t like vegetables.
As a young adult she drank lots of alcohol and took a few ‘recreational’ drugs. When she met the man of her dreams, a personal trainer and health fanatic, her diet became healthier, but still included lots of starchy carbs and alcohol most weekends. I also discovered that she loved perfumes, hair care products and make-up, all quite heavily laden with chemicals.
It was clear to me that the loads of antibiotics taken early in her life would have upset her inner eco-system friendly bacteria levels, which was made worse by her previous atrocious diet. April said she had been on her ‘better diet’ for 18 months and had tried coming off the pill – with disastrous results.
But April wasn’t aware that other current factors in her life were still damaging her body.
These included the carbs, trans fats, lack of good fats, too much sugar (still), alcohol affecting her liver, oh and loads of coffee, plus all the chemicals she used in her personal care regime. There was also the possibility that her gut flora might not be right as the ‘pill’ also destroys good bacteria, along with vital nutrients such as B vitamins.
First, we needed to see what was going on with her gut, which revealed she had an overgrowth of candida species of organisms and very low levels of all good bacteria. We also tested her hormone pathways which showed that her liver wasn’t converting her hormones through the right pathways, giving her increased risk of the endometriosis returning, and possibly more nasty things over time if not corrected.
Because April was very determined to make changes asap so she could hopefully conceive, it was easy to ask her to make a complete diet change so she could detoxify her liver, repair her gut, balance her hormone pathways and support her adrenal glands which are important for hormones.
After three months on a diet for endometriosis, as well as specific probiotics, extra vitamin and mineral supplements, no alcohol or caffeine or chemical products, April felt great and wanted to go off the pill. I told her it was important to try and fall pregnant as soon as possible to avoid any possible re-growth.
There was no issue with the trying side, as both her and hubby were very keen to make a baby. April was pregnant by the second month and there was no apparent sign of endometriosis (no pain). Time passed and one day I received an email with a lovely photo of a bouncy baby boy along with a thank you. The endometriosis never returned and April later became pregnant again and gave birth to twins.