Anti-Inflammatory Eating for Endometriosis

If you’re struggling with endometriosis, you’re certainly not alone. It can be discouraging to know that an endometriosis diagnosis does not come with a cure, but there are certainly ways to manage and improve the symptoms that it comes with. Let’s look at how diet can play a role in helping to manage endometriosis.

What is endometriosis?

Endometriosis is characterised by endometrial-like cells that grow outside of the uterus, and it affects 10% of the female population [1]. While the full effect of the disease is not fully understood, its effects extend beyond the pelvis, and it is considered a whole-body disease that is hormone-related and involves low grade chronic inflammation [1].

What is chronic inflammation?

Inflammation is our body’s protective response to irritants, as our immune system sends out cells to fight invaders or heal from an injury.  In a nutshell, it’s our body’s defence system which works to protect us. Once the job is done, this response is then shut off. In the case of chronic inflammation, this response doesn’t shut off. There’s a slow and long-term inflammatory response occurring in the background that can disrupt normal processes and contribute to several health conditions, including endometriosis.  

What role does the gut play?

As mentioned, endometriosis is a hormone-related disease where there are increased levels of oestrogen. In the gut, there’s a collection of bacterial microbes which metabolise oestrogen, called the Estrobolome. If the gut is out of balance, less oestrogen is excreted from the body and can lead to increased levels of circulating oestrogen and inflammation, which may drive endometriosis onset and progression [2,3].

Anti-inflammatory eating

 In inflammatory conditions like endometriosis, incorporating anti-inflammatory foods may help to reduce inflammation and improve symptoms. Let’s look at some key nutrients you can include that have anti-inflammatory properties, as well as those with the opposite effect.

• Include Omega-3 Fatty Acids

Healthy dietary fats may help to reduce pain and inflammation associated with endometriosis [4]. In a study of 70,709 pre-menopausal women, it was found that women consuming more omega-3 fatty acids were less likely to be diagnosed with endometriosis [5]. Sources of omega-3s include extra virgin olive oil, avocados, nuts, seeds, and oily fish.

• Have a High Fibre Intake

Nutrition which supports healthy oestrogen levels may help to combat inflammation in the disease. Fibre is important for a healthy and balanced gut microbiota, and it can help to reduce oestrogen reabsorption in your gut and increase the amount that is excreted in your stools. Some research has found that women who reduced their intake of fat and increased their intake of dietary fibre had a reduction in circulating oestrogen levels by 10-25% [6,7]! Additionally, the fibre found in wholegrains has been found to be beneficial for fighting inflammation, supporting the gut, and supporting the immune system. Whole grains include brown rice, millet, sorghum, rolled oats, barley, buckwheat, teff, and quinoa. Try to aim for a high fibre intake of more than 25g per day.

• Reduce Foods that Encourage Inflammation

While there is room for all foods in moderation, there are some foods which you may want to limit to help reduce inflammation. This includes ultra-processed and high-fat foods that are typically found in a Western diet. These types of foods are proinflammatory and include baked goods like cakes and donuts, chips, sugar sweetened drinks, refined grains, lollies, red and processed meats, and fast foods. Some research has examined how these types of inflammatory foods may impact endometriosis. In the Nurses’ Health Study II consisting of 81,908 participants, it was found that women who consumed more than two servings of red meat per day had over a 50% increased risk of developing endometriosis than those who had one serving a week [8].

Putting It All Together

Endometriosis is a chronic hormone-related and inflammatory condition. Dietary patterns which emphasise vegetables, fruits, wholegrains, fish, and legumes while limiting ultra-processed foods can help fight inflammation and support good gut health. The Mediterranean Diet is an excellent example of an anti-inflammatory pattern of eating as it is rich in omega-3s and high in fibre and antioxidants, and may help to manage symptoms of endometriosis.

References

[1] Taylor HS, Kotlyar AM, Flores VA. Endometriosis is a chronic systemic disease: clinical challenges and novel innovations. Lancet. 2021 Feb 27;397(10276):839-852. doi: 10.1016/S0140-6736(21)00389-5. PMID: 33640070.

[2] Qin R, Tian G, Liu J, Cao L. The gut microbiota and endometriosis: From pathogenesis to diagnosis and treatment. Front Cell Infect Microbiol. 2022 Nov 24;12:1069557. doi: 10.3389/fcimb.2022.1069557. PMID: 36506023; PMCID: PMC9729346.

[3] Aguilera M, Gálvez-Ontiveros Y, Rivas A. Endobolome, a New Concept for Determining the Influence of Microbiota Disrupting Chemicals (MDC) in Relation to Specific Endocrine Pathogenesis. Front Microbiol. 2020 Nov 30;11:578007. doi: 10.3389/fmicb.2020.578007. PMID: 33329442; PMCID: PMC7733930.

[4] Khanaki K, Nouri M, Ardekani AM, Ghassemzadeh A, Shahnazi V, Sadeghi MR, Darabi M, Mehdizadeh A, Dolatkhah H, Saremi A, Imani AR, Rahimipour A. Evaluation of the relationship between endometriosis and omega-3 and omega-6 polyunsaturated fatty acids. Iran Biomed J. 2012;16(1):38-43. doi: 10.6091/ibj.1025.2012. PMID: 22562031; PMCID: PMC3614254.

[5] Missmer SA, Chavarro JE, Malspeis S, Bertone-Johnson ER, Hornstein MD, Spiegelman D, Barbieri RL, Willett WC, Hankinson SE. A prospective study of dietary fat consumption and endometriosis risk. Hum Reprod. 2010 Jun;25(6):1528-35. doi: 10.1093/humrep/deq044. Epub 2010 Mar 23. PMID: 20332166; PMCID: PMC2873173.

[6] Rose DP, Goldman M, Connolly JM, Strong LE. High-fiber diet reduces serum estrogen concentrations in premenopausal women. Am J Clin Nutr. 1991 Sep;54(3):520-5. doi: 10.1093/ajcn/54.3.520. PMID: 1652197.

[7] Pundir J, Omanwa K, Kovoor E, Pundir V, Lancaster G, Barton-Smith P. Laparoscopic Excision Versus Ablation for Endometriosis-associated Pain: An Updated Systematic Review and Meta-analysis. J Minim Invasive Gynecol. 2017 Jul-Aug;24(5):747-756. doi: 10.1016/j.jmig.2017.04.008. Epub 2017 Apr 26. PMID: 28456617.

[8] Yamamoto A, Harris HR, Vitonis AF, Chavarro JE, Missmer SA. A prospective cohort study of meat and fish consumption and endometriosis risk. Am J Obstet Gynecol. 2018 Aug;219(2):178.e1-178.e10. doi: 10.1016/j.ajog.2018.05.034. Epub 2018 Jun 2. PMID: 29870739; PMCID: PMC6066416.