Eating for Endo

Endometriosis is a chronic menstrual health disorder that affects 1 in 9 Australian women, and an estimated 200 million globally. It occurs when tissue that normally lines the uterus (endometrium) grows in other areas of the body such as the intestines, ovaries, and fallopian tubes.

For those suffering with endo, it is no easy road. Many women experience debilitating period pain in the stomach, back and hip areas for up to 6 years before they are diagnosed and encouraged to seek support from health professionals, including Obstetricians and Gynaecologists, GPs, Pelvic Floor Physiotherapists, Psychologists and Accredited Practising Dietitians and Nutritionists, to name a few.

Unfortunately, there is no cure. However, depending on the stage or grade of endometriosis, there are three treatments that can be recommended:

1. Medical (e.g., paracetamol, ibuprofen, the pill, etc.)

2. Surgical (keyhole, laparoscopy, hysterectomy, bowel surgery, etc.)

3. Complementary (physical, psychological and dietary interventions to manage pain and reduce risk or regrowth)

In relation to nutrition intervention, APD’s and Accredited Nutritionists can work with endo patients to reduce the risk of further endometrial growth (outside of the uterus), help to alleviate pain and improve overall quality of life.

This is usually achieved by assessing for potential food allergies or intolerances (e.g., gluten, FODMAPS etc.), detecting nutritional deficiencies and reducing inflammation in the body.

Here are some of our dietary focus areas:

ANTI-INFLAMMATORY FOODS

1. Omega-3 Fats

Prostaglandins are an inflammatory, hormone-like and pain-inducing substance, that are reported to be elevated in the abdominal fluid of some endo patients.

Interestingly, omega 3-rich foods such as fatty fish (mackerel, salmon and sardines), some seeds (linseeds, chia seeds, pumpkin seed) and nuts (walnuts, almonds) can reduce prostaglandins by targeting inflammation and subsequently reducing pain.

It is reported that endo warriors typically consume a diet low in omega 3-rich fatty acids and vegetables, so increasing these foods is something that we normally look for to initially reduce and manage endo symptoms.

2. Fruits and Vegetables

Research suggests that a high overall consumption of fruits and vegetables is beneficial for our health and can reduce the risk of endometriosis. While they provide an excellent source of anti-inflammatory and antioxidant-rich flavonoids and polyphenols, some studies have demonstrated that a high intake of vegetables from the brassica family (e.g., broccoli, cauliflower, cabbage, Brussel sprouts, etc.) can increase the risk of endometriosis. A nutrition professional can investigate this with you to determine whether this may be related to a potential intolerance or directly related to endometrial growth.

We also know that by consuming more than one serve of citrus fruit per day, women can reduce their risk of endometrial growth.

In this way, it's important that all endo patients are consuming the recommended two serves of fruit and five serves of vegetables to manage symptoms and reduce the risk of flare-up.

INFLAMMATORY TRIGGERS

3. Red Meat

We know that a high consumption of red meat can raise inflammatory biomarkers such as C-reactive protein. However, cutting our red meat altogether doesn't necessarily need to be the answer. Research suggests that by simply reducing our red meat consumption to less than twice per week, that we can not only limit our carbon emissions, but also reduce endometriosis-related pain.

It's also important to note that endo warriors usually experience heavier periods, which subsequently increases their iron requirements. While red meat provides a rich source of bioavailable heme iron, there are many other sources including oysters, chicken and sardines, as well as non-heme sources such as red lentils, beans and dried apricots.

6. Trans Fats 

Trans fats can be naturally-occurring (e.g., meat and dairy from ruminant animals), or artificial.

Artificial (industrial or partially hydrogenated) trans fats are often added to baked goods (e.g., cakes, cookies, pies, etc.) as they are great at increasing shelf life. But unfortunately, in consuming these foods, our own shelf life is decreased with artificial trans fats reported to be detrimental toward our health, and contributing to an increased risk of endometriosis.

So if you're eating for endo, it's best to steer clear of packaged foods and stick to a Mediterranean-style diet that is rich in fatty fish, nuts and seeds, fresh fruit (mostly citrus), colourful vegetables (limit cruciferous if intolerance suspected), fermented dairy, wholegrains (unless gluten intolerant or Coeliac) legumes and iron-rich foods.

Please note that this is generalised information. Please speak to an Accredited Practising Dietitian, Specialist or GP to discuss your treatment and/or management strategy before making significant changes.

WHAT TO WATCH

4. Dairy

It's important to acknowledge the nutritional profile that this food group provides. Milk, cheese and yoghurt are excellent sources of protein, low GI carbohydrates, calcium, phosphorus, B12 and riboflavin, to name a few. Additionally, fermented dairy such as Greek yoghurt and milk kefir contain beneficial bacteria that can promote gut balance and immune health.

Please note that everyone is different. However, research does indicate the milk can increase IGF-1, a protein that may contribute to promoting lesion growth. Conversely, in one of the largest investigations into the risk factors for major chronic diseases in women, The Nurses Health Study, it was reported that approximately three serves of dairy per day reduced the risk of endometriosis by 18 percent.

Once again, a nutrition professional will be able to review your food intake and symptoms to ensure that you're not excluding this beneficial food group.

5. Gluten

Grains such as wheat, rye, barley, farro, couscous and spelt, all contain gluten as well as gut-loving fibre. However, research shows that many women with endometriosis also have undiagnosed Coeliac Disease, which can exacerbate endometrial pain in some individuals.

If you notice that your endo symptoms tend to worsen after consuming gluten-containing foods, it’s recommended that you discuss this with your practitioner who may be able to refer you for a coeliac gene test. If your test is negative however, you may still like to follow a gluten-free diet which may assist in reducing pain, specifically in relation to intercourse, periods and generalised pelvic pain.