Endometriosis is often accompanied by excessive inflammation, further exacerbating the symptoms and progression of the disease. Whilst surgery is the gold standard for diagnosis and treatment, symptoms can still persist. Perth Dietician, Claudia Coombes, presented the topic of Endometriosis, Diet, and Nutrition to our support group members in 2021. In this article, we’ll summarise how nutrition can play a role in managing endometriosis and mitigating its impact on those affected.
IBS & endometriosis
Firstly, Claudia highlighted some of the similarities between IBS and endometriosis. Both conditions share common symptoms like pelvic pain, bloating, constipation, and diarrhea. However, endometriosis also presents unique challenges such as fatigue and heavy periods. Studies have shown that dietary changes can have positive effects on managing these symptoms, including reducing fatigue, and pain, improving physical function, and even enhancing fertility in people with endometriosis. To achieve these benefits, the focus is on reducing inflammation, addressing excess estrogen levels, and managing IBS-like symptoms that affect individuals’ quality of life. Individualised management is crucial, focusing on identifying triggers and symptoms. For some people, stress and sleep management are essential as they can exacerbate gut sensitivity and inflammation. Others may find reducing gut irritants such as caffeine, artificial sweeteners, spices, and alcohol can alleviate symptoms. Gut hypnotherapy, a relatively new area of research, also shows promise in reducing hypersensitivity and symptoms associated with both IBS and endometriosis.
Low FODMAP diet
In terms of diet, a low FODMAP diet has proven to be effective in reducing gut irritants for individuals with sensitivities related to conditions like endometriosis and IBS. FODMAPs are poorly absorbed carbohydrate foods that bacteria in the gut break down, drawing water into the bowel and leading to gas production, pain, and bloating. While high FODMAP foods are generally healthy for the bowel, they can exacerbate symptoms for those with gut sensitivity, making the low FODMAP diet a favourable option to alleviate symptoms. However, this diet can be quite restrictive and not really meant for long-term use. If considering it, consulting with a dietitian is recommended to ensure it’s properly tailored to individual needs and doesn’t create unnecessary stress around eating.
Reducing excess estrogen
Whilst dietary interventions like the low FODMAP diet can alleviate symptoms such as bloating, constipation, and diarrhea in both endometriosis and IBS, they don’t directly address the underlying causes of disease progression. Research suggests that the gut plays a pivotal role in eliminating estrogen from the body, highlighting the importance of maintaining good gut health in endometriosis.
Consuming a diet rich in fibre is vital, as studies have shown that diets high in saturated fats and low in fibre can increase estrogen levels in the body. Increasing fibre intake entails incorporating a variety of plant-based foods into the diet. Soluble fibre, one of the types of dietary fibre, plays a role in regulating digestion by absorbing water in the bowel and forming a gel-like substance. This gel helps with regular bowel movements and has the added benefit of binding to estrogen, preventing its reabsorption in the body.
Improving gut flora
A diverse community of healthy gut bacteria helps break down and eliminate estrogen from the body, reducing its circulation. Additionally, a healthy gut plays a vital role in reducing overall inflammation, a known factor in endometriosis. To support beneficial gut bacteria, people with endometriosis may benefit from incorporating prebiotic foods like onion, garlic, chicory root, artichoke, asparagus, kefir, and sauerkraut into their diet. These foods help nourish the gut microbiome, but it’s important to note that some prebiotic foods are also high FODMAP foods, which could trigger symptoms for some people.
Inflammation & endometriosis
Inflammation plays a significant role in the progression of endometriosis, and dietary patterns can either promote or mitigate this inflammation. Consuming a diet resembling the typical Western diet, characterised by frequent alcohol consumption, highly processed and takeaway foods, and refined carbohydrates, can lead to systemic inflammation and oxidative stress, exacerbating the growth and progression of endometriosis. To combat inflammation, incorporating anti-inflammatory foods is crucial. These include a variety of plant-based foods such as fruits, vegetables (especially blueberries, grapes, and green vegetables), beans, legumes, nuts (like pistachios, peanuts, and walnuts), extra virgin olive oil, oily fish (sardines, salmon, herring, and mackerel), whole grains (intact grains like quinoa), herbs, spices, turmeric, and green tea. Creating a dietary pattern that includes these foods regularly can help reduce inflammation, potentially alleviating symptoms.
The Mediterranean diet
The Mediterranean diet, often referred to as the anti-inflammatory diet, is another popular diet that shows promising results in managing endometriosis. It emphasises plant-based foods, aiming for at least five servings of vegetables daily, with a focus on green leafy veggies and tomatoes. The Mediterranean diet involves incorporating fruits, legumes, nuts, seeds, and oily fish like salmon. Extra virgin olive oil would be the primary fat source, and whole grains such as quinoa are preferred carbohydrates. The Mediterranean diet involves cooking from scratch, limiting processed foods, and reducing chemical exposure to pesticides and additives. It encourages physical activity and embraces the social and cultural aspects of shared meals.
Gluten, dairy & soy
Many people think to cut out either gluten, dairy, or soy. But do you really need to? The answer is it depends! Several dietary factors can affect endometriosis, and it’s important to consider individual tolerance and preferences. Dairy contains lactose, a FODMAP, which can cause digestive discomfort for some. Soy, while containing phytoestrogens, would require excessive consumption to significantly affect estrogen levels to exacerbate endometriosis. Some studies even associate specific compounds in soy with reduced endometriosis risk and lesion size! Finally, there is some evidence to suggest that gluten may impact endometriosis, particularly in individuals with a certain gene linked to celiac disease. Removing gluten from the diet might reduce pain and improve fertility. However, before deciding to eliminate foods like this from your diet, it’s recommended to work with a dietitian to avoid causing more stress from restrictive eating patterns. A dietitian can help you create a well-balanced diet that addresses your specific needs and symptoms while ensuring you get essential nutrients.
You can watch the full online presentation from Perth Dietician, Claudia Coombes here.