Endometriosis is an inflammatory pelvic pain condition that occurs in 10-15% of women (read more here). Many women suffering from endo come to me with questions about what they should or shouldn’t be eating to help support their condition and reduce their symptoms. As part of a comprehensive treatment plan, I often recommend an anti-inflammatory focused diet to help reduce dietary factors that could be exacerbating pain and inflammation. Read on to learn the foods to focus on, and which foods to avoid in endometriosis.

Foods to Avoid

Packaged, synthetic and refined foods that contain dyes, artificial sweeteners, trans fats, or un-pronounceable chemicals. The number one thing to eliminate in your diet are the packaged/processed/synthetic foods, and particularly those that contain long lists of chemicals in the ingredients list. For example, microwave dinners, meals from a box, sugary drinks (including diet sodas), sugary snacks, or commercially-prepared baked goods. These foods are unhealthy, generally inflammatory, and displace the vegetables, healthy grains, and other unprocessed, natural foods that should form the foundation of your diet and will help manage your symptoms. Instead, do more cooking from home, get comfortable shopping the produce section of the grocery store, and check out some new whole food based recipe blogs for inspiration (I’ll include some suggestions at the end of this article).

Red meat. There is a connection between consumption of red meat and endometriosis. A study showed that women that ate red meat 7 or more times a week were more likely to have endometriosis than those who ate red meat 3 times per week or less. Commercially raised red meat often contains dioxin, xenoestrogens, and antibiotics; if you do choose to eat red meat, be sure to choose organic and grass-fed.

Pork. The same study as above showed that women who ate ham 3+ times a week were 80% more likely to have endometriosis. Pork is one of the most fatty meats, which means it stores more toxins than lean meats.

Gluten. Regular ingestion of gluten has been directly associated with endometriosis pain. A 2012 study demonstrated significant improvement in pain after 1 year of following a gluten-free diet in 75% of patients with endometriosis. Avoid commercially baked goods, wheat, and gluten-containing grains (rye, barley, spelt, kamut, tricale, bulgur, non-certified gluten free oats). See the “foods to focus on” section for gluten-free grain options to replace them with.

Dairy. Because of dioxin content and naturally occurring hormones in dairy products, dairy intake should be limited to only a couple times a week at most (ideally eliminated), and should definitely be organic with no added hormones, preferably from pastured cows.

Unhealthy oils. Eliminate your intake of trans fat and hydrogenated oils. These unhealthy fats have been shown to increase ‘bad’ cholesterol and your risk of heart disease. These fats are found in foods such as vegetable oil shortening, hard margarine, commercial prepared baked goods, potato and corn chips, crackers, microwave popcorn, and deep-fried foods. In fact, Health Canada proposes that we completely ban trans fats and partially hydrogenated oils from Canada’s food supply. Further, eliminate the use of processed, highly refined omega 6 vegetable oils such as canola, safflower, corn, cottonseed, soy oils, margarine and partially-hydrogenated plant oils.

Caffeine. Caffeine has been shown to exacerbate PMS symptoms in some women, and can increase pain symptoms in others. Consider doing a trial of 2-3 months of no caffeine (no coffee, black tea, green tea or sodas) to see if this helps your symptoms. Other studies have shown that the healthy compounds in green tea and matcha may be beneficial for endometriosis, so after your caffeine-free period, try adding these back in first.

Alcohol. Alcohol is inflammatory, depletes B vitamins, and increases the load on the liver, which is responsible for detoxing your body from chemicals, toxins, and old hormones. Consider eliminating your alcohol intake completely or limiting to only special occasions.

Sugar and white refined flour. Sugar is highly inflammatory; avoid added sugar, and “white” foods (ex. white rice, white flour, white baked goods) which have a high glycemic index. A high glycemic index means your body rapidly converts those white carbs to glucose in the bloodstream compared to complex carbohydrates or lower glycemic index foods. Choose unsweetened food items as much as possible, reduce the sugar in your baking recipes, and utilize honey, dates or maple syrup as sweetener alternatives.

Non-organic foods. Pesticides, herbicides, fertilizers, hormones, and other toxins found in non-organic food can interfere with normal regulation of hormones and other bodily functions. As much as possible, choose organic; see the list below for some resources to help guide you in which foods are most important to buy organic, and which are more safe to buy non-organic.

Foods to emphasize

Fresh, Organic Vegetables and Fruits. A study from 2004 showed that women who ate green vegetables roughly twice a day or more were 70% less likely to have endometriosis than those who ate green vegetables less than 6 times a week. I recommend aiming for at least 5 servings (= 5 cups raw) per day. The green leafy veggies are full of vitamins, minerals and healthy fibre that support your hormones, liver and overall health. Increasing the rainbow of colours that you eat (reds, orange, yellows, etc.) will increase your antioxidant status; some studies suggest that antioxidants such as those from resveratrol (the purple component of red wine grapes) and EGCG (from green tea and matcha) may help in the treatment of endometriosis.

High-fibre foods. Fibre helps the body get rid of excess estrogens by binding them to waste-carrying bile and removing them through the digestive tract. Focus on insoluble fibres such as those from apples, pears, plums, legumes (beans, lentils and peas), whole gluten-free oats, citrus fruits, ground raw chia, ground raw flax seeds and psyllium husk powder.

Dairy alternatives. Dairy is a common source of “IBS”-type digestive discomfort, and can worsen endometriosis pain for some women. Choose non-dairy milk alternatives such as almond, coconut, or cashew milk, and non-dairy yoghurts such as coconut. Some people tolerate goat or sheep milk/cheese.

Gluten-free grains. Focus on quinoa, wild rice, brown rice, basmati rice, amaranth, buckwheat, gluten-free oats, millet or other starches such as sweet potatoes, yams, or squash.

Vegetarian, poultry and fish protein sources. Focus on increasing your intake of beans, legumes, peas, vegetable protein powders for your smoothies (rather than whey), chicken, turkey, wild salmon, herring, sardines, anchovies, and Atlantic mackerel.

Liver-supporting foods. Certain foods help the liver process and break down estrogens and cleanse your body of toxins. Increase your intake of cruciferous vegetables (broccoli, kale, cauliflower, boy choy, arugula), beets, lemon, beets, onion, garlic, turmeric (like in this turmeric tea latte) and ginger. Did you know that the chemicals in your products and environment impacts endometriosis? Read more in this article.

Omega 3 Fatty Acids. Essential fatty acids, especially omega-3s, help reduce inflammation in the body, which can lessen the pain that comes with endometriosis. A study found that the women with the highest consumption of long-chain omega-3 fatty acids were 22% less likely to be diagnosed with endometriosis. Use cold pressed raw organic flax seed oil, avocado or extra virgin olive oils stored in small dark glass containers in the fridge. Use them cold, meaning instead of cooking with them, add them on top of cooked foods, or in salad dressings, dips, or added to smoothies. Also increase your intake of chia seeds, hemp seeds, walnuts, pumpkin seeds wild salmon, herring, sardines, anchovies, and Atlantic mackerel. For cooking, use coconut oil, organic grass-fed butter or ghee in moderation, as these are heat stable oils.

Anti-inflammatory herbs. Certain herbs, particularly turmeric, have amazing anti-inflammatory properties. Increase the use of turmeric in your diet by adding a teaspoon to smoothies, incorporating into your cooking, or try adding turmeric tea lattes to your routine. Ginger is another lovely warming and anti-inflammatory herb to incorporate into your dietary routine.

What about soy?

I am often asked about soy from my patients with endometriosis, or women with other hormone concerns. Soy contains compounds known as phytoestrogens, which can be further broken down into groups of compounds called isoflavones and lignans. Interestingly, phytoestrogens can have either an “estrogenic” or an “anti-estrogenic” effect in the body, depending on: hormone status, reproductive history, the dose of phytoestrogens, how long they’ve been taken for, and at what point in the lifespan they are taken. There are a LOT of differing opinions about soy, and it can be confusing to get a straight answer about soy. I searched for the available research specifically on soy and endometriosis, and this is what I found:

Current dietary soy intake is NOT associated with the diagnosis of endometriosis. A 2017 study examined soy intake and the diagnosis of endometriosis using urinary metabolites of soy isoflavones and self-reported dietary questionnaires. They took urine samples from women who were undergoing laparoscopic surgery to investigate for or treat endometriosis, and analyzed the urine for 6 different isoflavone metabolites. The results found that urinary concentration of soy metabolites were not associated with the diagnosis of endometriosis. Further, there was no association between self-reported high soy intake and diagnosis of endo.

Soy may decrease the risk of endometriosis (at least in Japanese women). A small study on Japanese women found that soy intake was associated with a reduced risk of endometriosis, particularly those women who had a specific estrogen receptor 2 gene variant.

However, women who were fed soy infant formula as babies are more likely to be diagnosed with endometriosis later in life. There appears to be a link between early life exposure to soy and the diagnosis of endometriosis in adulthood. This association was stronger for women born after mid-1960 compared to women born prior to that date. This may because at this point in time, commercially available soy formulas switched from using soy flour to using the highly digestible isolated soy protein. Perhaps the concentrated nature of the isolated soy protein given in infancy has an impact on a highly sensitive and quickly developing hormonal system and uterus.

So, can you eat soy? A cautionary tale…

Overall, having soy in your diet does not technically appear to be associated with being diagnosed with endo (except in the use of soy infant formulas), according the the above studies. However (and this is a big “however”) I have some caveats.

The study on Japanese women mentioned above should probably not be generalized to the North American population. Japanese people eat more traditionally prepared soy in the form of miso, tempeh, natto and Nama Shoyu, while North Americans tend to have more raw soy, soy milk, and soy protein extracts and isolates. Further, soy is one of the most heavily sprayed crops in North America and is very often genetically modified. Soy is also one of the most common food allergens in humans. For these reasons, I often suggest caution with dietary soy intake for endometriosis patients. If you are sensitive to soy, ingesting it may worsen your symptoms. If you do choose to eat it, always choose organic and non-GMO soy, and aim for traditionally fermented soy products (such as miso, natto, tempeh, tamari), and avoid excessive intake of questionable processed foods containing soy protein isolates or derivatives.

I hope this forms a helpful guide to slowly transition your dietary habits to in favour of reducing inflammation and pain for endometriosis. A nutrient dense, whole food diet forms the foundation of your health; read this article here for to learn which supplements you might want to check out and how this traditional medicine technique can help reduce endo pain and help balance hormones.

As promised, here are some links to a few of my favourite recipe blogs and resources that will help you achieve the dietary goals outlined above:

• Oh She Glows – plant based recipes, vegan, with many gluten-free options
• The Minimalist Baker – plant based, vegan, easy recipes with 10 ingredients or less
• Meghan Telpner – plant based, and will help you understand why what you eat really matter to your health
• The Nutritionista (Erin Luyendyk) – plant based nutritionist who is going through her own endometriosis health journey
• My New Roots – plant focussed, mostly gluten-free recipes
• Environmental Working Group Guide to Pesticides in Produce – download this guide to help choose the foods you should prioritize buying organic, versus the ones you can save money on and buy non-organic.

Explore, and enjoy! 🙂

If you found this article helpful, you may be interested in the following:

• Reducing Endometriosis Pain with Acupuncture

• Endometriosis, Environmental Toxins and Your Liver Detox

References:

Missmer, S. A., Chavarro, J. E., Malspeis, S., Bertone-Johnson, E. R., Hornstein, M. D., Spiegelman, D., . . . Hankinson, S. E. (2010). A prospective study of dietary fat consumption and endometriosis risk. Human Reproduction,25(6), 1528-1535.

Luyendyk, E. (2013) Nutrition for Endometriosis. Obtained online from http://www.centerforendometriosiscare.com/nutrition-for-endometriosis/

Parazzini F, Chiaffarini F, Surace M, et al. Selected food intake and risk of endometriosis. Hum Reprod. 2004;19(8):1755-1759.

Marziali M, Venza M, Lazzaro S, et al. Gluten-free diet: a new strategy for management of painful endometriosis related symptoms? Minerva Chir. 2012;67(6):499-504.

Kong, S., Zhang, Y., Liu, C., Tsui, I., Guo, Y., Ai, B., & Han, F. (2014). The Complementary and Alternative Medicine for Endometriosis: A Review of Utilization and Mechanism. Evidence-Based Complementary and Alternative Medicine,2014, 1-16. doi:10.1155/2014/146383

Frank, P. (2013) Endometriosis: Theories, evidence and treatment. Obtained online from NDNR at http://ndnr.com/womens-health/endometriosis-theories-evidence-and-treatment/

Dietitians of Canada. https://www.dietitians.ca/dietitians-views/food-regulation-and-labelling/trans-fats.aspx

Dietitians of Canada. https://www.dietitians.ca/getattachment/de95e92c-3fb3-40db-b457-173de89bdc3a/FACTSHEET-Food-Sources-of-Omega-3-Fats.pdf.aspx

Upson, K., Sathyanarayana, S., Scholes, D., Holt, V. (2015) Early-life factors and endometriosis risk. Fertil Steril. 2015 October ; 104(4): 964–971.e5. doi:10.1016/j.fertnstert.2015.06.040.

Tsuchiya, M., Miura, T., Hanoaka T., Iwasaki, M., Sasaki, H., Tanaka, T., Nakao, H., Katoh, T., Ikenoue, T., Kabuto, M., Tsugane, S. (2007) Effect of soy isoflavones on endometriosis: interaction with estrogen receptor 2 gene polymorphism. Epidemiology, 18(3):402-8.

Mumford, S., Weck, J., Kannan, K., Buck Louis, G. (2017) Urinary phytoestrogen concentrations are not associated with incident endometriosis in premenopausal women. Journal of Nutrition, 147(2):227-234.