Endometriosis is a painful condition that can greatly impact your quality of life.
Diet changes are said to help relieve symptoms, but does the evidence support these claims?
This article explores the role of diet in endometriosis treatment.
Endometriosis occurs when tissue thats normally found inside the uterus grows in other parts of the body.
Endometrial tissues normally build up in the uterine lining each month until the lining is shed during the menstrual period.
For various reasons, these cells are found in other parts of the body in women with endometriosis, causing inflammation and scarring at affected sites.
Tissue deposits (called implants) are most often found in the pelvis, but can also be found in more distant organs like the liver and the brain (1, 2).
Some women with endometriosis have no symptoms.
In fact, its often discovered during medical tests or surgeries for other conditions (3).
However, most women experience symptoms that significantly affect quality of life, including:
The condition affects up to 10% of women. Its typically seen in women of childbearing age, but symptoms may persist into menopause or after hysterectomy if estrogen levels are high enough (4, 5).
Up to half of affected women also struggle with infertility, but its not known whether endometriosis causes infertility or is just associated with it (6, 7).
Interestingly, cases of endometriosis have also been reported in men, but this is incredibly rare. Its most common in men whove received estrogen therapy to treat prostate cancer (8).
Endometriosis is thought to be caused by a combination of genetic, physiologic, immune, and environmental factors (9).
In fact, studies have found that a womans risk increases by up to 7 times if her mother or sister has it (10).
However, not everyone with a family history will develop the disease. Other factors appear to increase the likelihood of endometriosis.
One of the most common theories is retrograde menstruation, which occurs when endometrial cells and menstrual blood travel upward via the fallopian tubes. From there, the cells can implant into the abdominal lining and onto the organs, causing inflammation and scarring (11).
Nearly all women experience some degree of retrograde menstruation, but its been suggested that a higher volume of blood enters the abdomen in women with endometriosis (12).
Two other common theories include:
However, these are just theories for now, and it seems other factors likely play a role as well.
Oxidative stress appears to be a key one. Its a term that describes cellular damage from molecules called free radicals.
Oxidative stress can be caused by exposure to chemicals and pollutants, stress, and other stimuli including the process of ageing itself (14).
Is Endometriosis an Autoimmune Disease?
Recent research also suggests the immune system could greatly influence disease onset and severity.
Autoimmune disease develops when the bodys immune system mistakenly attacks healthy tissues.
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Endometriosis shares several key features with autoimmune disease, including systemic inflammation and the presence of autoantibodies. Theres also a strong overlap between endometriosis and other autoimmune conditions, like celiac disease and Graves disease (15, 16, 17, 18).
These similarities have many experts asking whether endometriosis should be classified as an autoimmune disease instead. Its an emerging area of research that will likely be explored in greater depth in coming years.
Summary: Endometriosis is likely caused by a combination of genetic, immunological, physiological, and environmental risk factors. Its similar in many ways to autoimmune disease, although its not considered to be one at this time.
Diet and Endometriosis
Theres no known cure for endometriosis.
The condition is commonly treated with surgery, hormone therapy, and medications.
No diet has been proven to treat endometriosis either. However, small studies and patient reports suggest that certain diet strategies can help reduce disease risk and lessen symptoms.
This could be because certain foods can help control inflammation and influence levels of certain hormones (estrogen and prostaglandins).
These include omega-3 fats, vegetables, and other foods, which will be discussed below.
Replace Trans Fats with Omega-3 Fatty Acids
Significant research has looked at whether fat consumption affects endometriosis risk and symptoms.
Unfortunately, some studies have found high-fat diets to be more beneficial, while others have found low-fat diets to be better (19, 20).
Its a tricky area for researchers because fat quality is likely just as important as quantity, perhaps even more so (21).
Omega-3 fatty acids appear to be especially beneficial, while trans fats are thought to increase risk. In one study of nearly 71,000 women (21):
Even modest increases in omega-3 fat intake appear to be beneficial. One study found that replacing 1% of calories from trans fats with omega-3 fats decreases risk by 50% (21).
Changes in endometriosis risk seen when 1% of calories from monounsaturated, omega-6, trans, and saturated fats are replaced with omega-3 fats (top bars). Bars that extend further to the left represent larger reductions in disease risk.Image Source
The exact mechanism for this is unknown, but omega-3 fats have been shown to reduce inflammatory chemicals in the body, including cytokines and certain types of prostaglandins (22, 23, 24, 25).
For the record, trans fats are bad for you in many ways so replacing them with omega-3s makes sense regardless of whether you have endometriosis.
Aim to eat at least 7 ounces (about 200 grams) of fatty fish per week, and limit baked goods, fried foods, and packaged items.
Summary: Studies suggest that a diet higher in omega-3 fats and lower in trans fats may reduce endometriosis risk and severity. The recommendation for healthy adults of at least 7 ounces (about 200 grams) of fatty fish per week would also be beneficial for women with endometriosis.
Identify Food Intolerance and Eliminate Trigger Foods
Food intolerance can cause unpleasant reactions to specific foods.
Common symptoms include digestive distress and skin rashes.
Small studies have found higher rates of food intolerance in women with endometriosis compared to healthy controls (26).
Troublesome foods vary widely from person to person, but these are the most common:
Gluten and Celiac Disease
Patient testimonials (reports) suggest that a gluten-free diet is effective in treating endometriosis.
This may be true, as some studies have shown an overlap between celiac disease and endometriosis.
This relationship isnt fully understood, but its been proposed that chronic inflammation from celiac disease may trigger the onset of endometriosis (15, 27)
A gluten-free diet may even provide symptom relief for those who dont have celiac disease.
In one study of 207 endometriosis patients, 75% of participants reported significant reductions in symptom severity after 12 months on a gluten-free diet. They also reported improved mental health, social function, vitality, physical function, and perceived healthiness after following the diet (28).
More studies are needed to understand the relationship between gluten and endometriosis. At the very least, those with celiac disease or a known sensitivity to gluten should strictly avoid it.
FODMAPs
FODMAPs are short-chain carbohydrates that are poorly digested in the small intestine.
They reach the colon largely intact and ferment in the gut, causing bloating, gas, abdominal pain, and other digestive symptoms for those who are intolerant of them.
Studies have established strong links between irritable bowel syndrome (IBS) and endometriosis (29).
A low FODMAP diet has been proven for treating IBS, and recent research suggests that it may be useful for easing endometriosis-related bowel symptoms as well. This is due in part to a high overlap rate between IBS and endometriosis.
In one study that included 58 women with both conditions, 72% of patients saw a great improvement in bowel symptoms after 4 weeks on a low FODMAP diet. The success rate for the low FODMAP diet was also significantly higher for women with endometriosis compared to women with just IBS (30).
Click here for more information on how to start a low FODMAP diet trial.
Autoimmune Protocol
Research has shown strong links between endometriosis and autoimmune disease.
The Autoimmune Protocol (AIP) is a strict elimination diet designed for those with autoimmune disease. Its meant to correct imbalances in gut bacteria and reduce inflammation.
Unfortunately, there have been no scientific studies on it to date. But patients with various autoimmune diseases have reported symptom relief using the AIP in online forums.
Importantly, note that this diet is very restrictive. Its meant to be a short-term fix to help identify food intolerances for those with diagnosed autoimmune diseases.
If you have severe endometriosis and another autoimmune condition, a trial of the AIP may help after discussion with your doctor.
A gentler, easier alternative would be to keep a food and symptom journal for several weeks to identify foods that trigger symptoms.
Summary: Theres a strong overlap between endometriosis and food intolerance. Gluten free or low FODMAP diets may be helpful in improving symptoms for some women. The autoimmune protocol may be helpful short-term for those who also have autoimmune disease.
Eat More Vegetables and Fiber
Everyone can benefit from eating more vegetables.
Among many other advantages, higher vegetable consumption is linked to lower risk of endometriosis.
One large study of 504 women found risk to be significantly lower in women who eat a lot of green leafy vegetables (31).
The mechanism for this isnt fully understood, but many vegetables are high in antioxidants, which help combat oxidative stress.
Vegetables are also high in fiber, which has been said to help rid the body of excessive estrogen.
In one study of 242 women, those who had the highest dietary fiber intake had significantly lower levels of estrone and estradiol (both forms of estrogen) than women who had the lowest fiber intake. The exceptions in this study were grapefruit and avocados, which were linked to higher estrogen levels (32).
Surprisingly, evidence is more mixed when it comes to endometriosis and fruit consumption. One study found higher fruit intake to increase risk, while other studies have found women who eat more fruit to have lower risk (19, 31).
Aim for at least 5 servings of vegetables and 2 servings of fruit per day, endometriosis or not.
Summary: Vegetables contain antioxidants, which may help reverse oxidative stress that comes with endometriosis. Aim for at least 5 servings per day, including leafy greens. Evidence is less clear on fruit intake, but most women would likely benefit from a couple of servings per day.
Endometriosis and Soy
Phytoestrogens are estrogen-like chemicals found in plants.
Soybeans and soy products are the greatest dietary source, but phytoestrogens are also found in flax seeds, oats, fruits, herbs, and other foods.
A certain kind of phytoestrogen (called genistein) thats found in soy products has been said to help convert testosterone into estrogen. Since endometriosis is estrogen-dependent, some have questioned whether soy should be avoided (34).
Few studies have directly examined the relationship between soy and endometriosis, but limited data indicate its neutral, and potentially even helpful.
In one study, women with higher concentrations of soy isoflavones in the urine were less likely to develop advanced endometriosis. This suggests that soy may help protect against the disease (35).
A 2017 study of 495 premenopausal women also found no link between a high soy intake or high urinary phytoestrogens and increased risk of endometriosis (33).
Based on the weight of evidence, soy products do not increase your risk.
Summary: Evidence is not conclusive, but it seems that a high soy intake has no impact on the risk of developing endometriosis. Likewise, it probably does not make endometriosis any worse.
Dont Drink Too Much Alcohol
Moderate alcohol intake of up to 1 drink per day is generally considered safe for most women.
Beer, bourbon, and red wine contain phytoestrogens, which may convert to estrogen in the body. Just like soy, some have questioned whether they increase endometriosis risk (7, 36).
Three large studies have found risk to be higher among women who drink the most alcohol, while 3 other studies found no link between alcohol and endometriosis (31, 37, 38, 39, 40, 41).
Notably, an often-cited study found that a compound found in red wine called resveratrol may limit the growth of endometrial tissue. But the study was conducted on mice, who were given very high doses of the compound. It wouldnt be possible to safely drink the amount of wine needed to see any benefit (42).
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Endometriosis and Diet: What You Can Do About It - Care2.com
