March was indeed Nutrition Month but it was also Endometriosis Awareness Month, and fact which I unfortunately seemed to have overlooked.
In fact, endometriosis is a topic which I’ve not yet given proper attention to on the blog yet.
I hope to make up for that today, however.
Endometriosis affects 1 in 10 women of reproductive age ( appx 15-50) and is an inflammatory ailment characterized by the growth of tissue that lines the uterus starts to also grow outside of the uterus.
Those living with endometriosis may experience chronic pain in the pelvic region and abnormal pain during their periods and/or during sexual intercourse.
It may also increase the risk of fertility issues, a topic of I’ve briefly discussed in a previous recent post.
There is no doubt that endometriosis is a complex condition and one for which today’s post will clearly not have all the answers.
In fact, I was not particularly compelled by the overall state of the evidence as it relates to the connection between dietary choices and endometriosis.
I do hope, however, to scratch the surface of the connection between specific foods and nutrients as it relates to the potential prevention and/or management of this common condition and provide you with the best dietary guidance that I can within the limitations of the current state of the evidence.
Let’s get right to it.
Endometriosis & Diet – Which Foods Help?
If you are living with endometriosis and on the fence as to whether or not you believe dietary factors have a role to play in improving your quality of life, the information to come should help to clarify things.
In a recently conducted qualitative study, a set of individuals aged 28-44 were interviewed about they felt customized dietary and lifestyle guidance affected their endometriosis.
The participants left the study feeling empowered that they could affect their health because they observed a decrease in symptoms and increased energy levels following the dietary intervention.
For the sake of brevity I won’t explore the article further but I strongly encourage you to take a closer look at this study which now leaves us the question we must ask – what can we change from the dietary perspective to make things better?
Vitamin D & Omega-3 Fatty Acids
I’ve combined Vitamin D & Omega-3s into one grouping because they are both relatively elusive from the dietary perspective yet also highly valued for their potential anti-inflammatory and/or autoimmune benefits.
Both of which, as you might imagine, are considered relevant in the progress and management of multiple human conditions.
Vitamin D is found in largest supply mostly just in fish (such as salmon, sardines), where omega-3s can also be found ( as well from certain plant-based sources such as flax, chia, hemp and walnuts and in smaller amounts in certain eggs and some soy products).
If you’ve read my article on Vitamin D, you will know how easy it can be for a Canadian to have insufficient blood levels of this elusive Vitamin.
This is problematic as it relates to general health but endometriosis specifically because observational data suggests that women living with endometriosis are more likely to have lower circulating vitamin D levels.
Multiple observational studies ( 1,2) have also pointed to the fact that women with higher omega-3 intakes were less likely to end up with an endometriosis diagnosis which suggests a potential protective role for this essential fatty acid.
And yet when women living with endometriosis were provided a Vitamin D/Omega-3 in a 2020 study out of the American Journal For Clinical Nutrition, there was not an overwhelming positive effect observed, making it hard to draw firm conclusions.
Even so, maintaining an optimal vitamin D and omega-3 intake, whether through food or supplementation, remains a cornerstone of good health and dietary balance and may be of particular relevance to women living with endometriosis.
Dietary Antioxidants ( Beta-Cryptoxanthin , Vitamin C, Vitamin E)
Antioxidants exist naturally in a wide array of primarily plant-based foods and serve the primary purpose of protecting human tissue from harms including the negative effects of inflammation (including in endometriosis!).
A 2018 study out of the Human Reproduction journal found that the antioxidant compound Beta-Cryptoxanthin which is found primarily in citrus and tropical fruits (ie; papaya) may have a protective role to play against endometriosis.
In a separate study, women living with endometriosis were provided a supplement containing dietary antioxidants Vitamin C & E which appeared to have a positive effect on reducing pelvic pain and inflammatory markers.
The citrus and tropical fruits already mentioned, in addition to items such as strawberries, kiwis, brussel sprouts and bell peppers, are all high in Vitamin C.
Equally so, Vitamin E is a fat soluble antioxidant found in largest supply in almonds, sunflower seeds and avocados.
It may be advisable for women living with endometriosis, or who those who want to reduce their risk of ever being diagnosed, to increase their intake of these foods.
Lactobacillus (Probiotics, Yogurt, Kefir)
There is evidence to suggest that one of the physiological characterizations of endometriosis is an excess quantity of certain species of “unhealthy” bacteria in the GI tract.
It is, in this regard, similar to PCOS.
We know that a favourable gut bacterial environment plays an important role in the body’s inflammatory response and so it is perhaps no surprise that probiotics have garnered attention in the world of endometriosis management.
From the research I’ve encountered, it does appear that the Lactobacillus family of probiotics have been most well studied in endometriosis with a 2019 study out of the International Journal Of Fertility & Sterility demonstrating a pain-reducing effect using using a blend of Lactobacillus acidophilus, Lactobacillus plantarum, Lactobacillus fermentum and Lactobacillus gasseri ( for which future evidence exists specifically relating to the L. gasseri OLL2809 strain).
Bonus Topic – Melatonin, Curcumin & Other Compounds Of Interest
While it is almost exclusively associated with circadian rhythm and sleep support, melatonin is also a powerful anti-inflammatory and antioxidant compound.
In a 2013 an experimental study out of the Pain journal, women living with endometriosis provided a melatonin supplement experienced nearly 40% reductions in self-reported pelvic pain.
While prolonged melatonin usage may not be advisable, it may offer a short or medium-term alternative to other pain relief strategies and could be worthy of future discussion with your healthcare team.
For those interested, I’ve provided a link to a 2018 study which discusses a few other supplemental interventions which have been tested and may potentially have some role to play in endometriosis pain and inflammation management.
One of the notable components discussed was curcumin (the bioactive compound found in turmeric) which has a potent anti-inflammatory and anti-oxidant capacity and seems to be considered a potentially useful supplement as part of a broader endometriosis management strategy.
Quercetin, a naturally occurring antioxidant compound found in rich supply in onions, apples, cauliflower and lettuce, was also among the formulation used in that study and could once again be a compound of interest due to a potentially significant anti-inflammatory capacity.
Are There Foods To Be Wary Of?
I’ve given you quite a bit to think about in terms of what to include in your diet, but as I draw closer to my self-appointed 1500 word cap for this article, I wanted to take a moment to briefly discuss some of the dietary selections which may be “less useful” when it comes to endometriosis.
Red & Processed Meat
While I’m not here to demonize any specific food groups, I do have to present some observational data which suggests women who consumed the most red ( >2 servings per day) and processed ( >5 servings per week) had a significantly higher risk of endometriosis than those who consumed red meat no more than once a week and processed meat no more than once a month.
If you’d like to learn more about why this relationship might exist, I offer up this article as an intriguing resource.
Given a potentially important (but certainly not concrete) role for fish intake (Vitamin D + Omega 3) in endometriosis, there is perhaps justification for heavy red/processed meat consumers to consider a slight shift in there protein pattern to incorporate more fish.
It’s not clear whether alcohol consumption worsens the symptoms of endometriosis or is directly related to the severity of the disease, but a 2012 study out of the American Journal Of Obstetrics & Gynecology found that more frequent drinking may increase one’s risk of endometriosis.
The state of the evidence surrounding the dietary management of endometriosis is not necessarily complete or compelling, but there is enough here to suggest that certain positive changes can be made with meaningful potential to improve the pain and quality of life of those living with this condition, as well as to perhaps modestly reduce the risk of ever being diagnosed with it in those who aren’t.
I hope you found the information presented in today’s post both intriguing and insightful.
If you’d like to read up on more topics within the world of women’s health, please do have a look at my other posts in this subject area.
Until next time,
Andy De Santis RD MPH