There are many great sources of information about being diagnosed with endometriosis and how it can impact your life, including your family doctor, gynecologist and medical resources and blogs, such as this one. In this blog post, we will answer frequently asked questions about Endometriosis, with a focus on Endometriosis and your diet with practical tips at the end.
What is Endometriosis?
Endometriosis is a chronic inflammatory, hormone-dependent condition that affects approximately 10% of women of reproductive age. It occurs when clumps of tissue similar to the lining of your uterus, called “implants,” is found outside of your uterus. These implants usually grow on the ovaries, the fallopian tubes, the outer wall of the uterus, and occasionally, the intestines, or other organs in the belly.
When you have endometriosis, the implants of tissue outside your uterus act just like the tissue lining your uterus. During your menstrual cycle, they get thicker, then break down and bleed. However, since the implants are outside your uterus, the blood cannot flow out of your body. The implants can get irritated, inflamed and painful. Sometimes they form scar tissue or fluid-filled sacs (cysts), which may make it difficult to get pregnant.
What causes Endometriosis?
Various factors, including genetic, environmental and lifestyle, can contribute to the development of endometriosis. While the exact cause is not yet known, there are many theories that propose a possible explanation, the most common being a process called “Retrograde Menstruation.” This happens when menstrual blood flows back through your fallopian tubes and into your pelvic cavity rather than leaving your body. We also know that endometriosis is related to higher levels of the estrogen hormone in the body. Other theories point to the involvement of our immune systems, as well as abnormal transport of cells in our body, or development of cells, involving genetic expression*.
What are the symptoms of Endometriosis?
Typical symptoms of endometriosis can include pelvic pain, painful menstruation, difficult/painful sexual intercourse, difficult/painful urination and bowel movements usually during menstruation, digestive issues such as constipation, diarrhea, nausea and bloating, as well as infertility. Some women also experience menstrual irregularities, such as heavy and/or long periods and bleeding between cycles. However, symptoms and levels of pain vary greatly, with some women experiencing very few symptoms or mistake endometriosis for regular menstrual pains.
What are the treatments for Endometriosis?
Depending on the stage and severity of your symptoms, your doctor may recommend various treatments, ranging from pain and other medications to birth control pills to surgery. For those who are or will be trying to conceive, quite often fertility treatment is often recommended.
How can diet help with Endometriosis?
The great news for those with endometriosis is that current scientific evidence suggests that the diet and lifestyle may play a part in relieving symptoms and even treatment. The foods consumed can impact the presence of inflammation in the body, estrogen activity and the menstrual cycle. Diets deficient in key nutrients result in changes in inflammation and promote abnormalities that may be involved in the progression of endometriosis. Including the Top 10 Foods below in your diet can help to fight inflammation, help in proper hormone metabolism and aid in managing endometriosis.
Top 10 Eating Tips to Help with Endometriosis
- Eat to achieve and maintain healthy body weight. Excess body fat can lead to increased estrogen activity and inflammation, which may make endometriosis symptoms worse. If you are overweight, aim for a healthy weight loss of 1-2 lbs per week by a combination of healthy eating and physical activity. A great first step is to increase your vegetable intake at meals, which help to fill you up on less calories.
- Eat plenty of vegetables, especially leafy greens. Have at least 7 servings per day of vegetables by making at least one-half of your plate vegetables at lunch and dinner, and packing sliced veggies to snack on during the day. Leafy, green vegetables are high in B vitamins, which help the body and liver break down estrogens. One serving is equal to 1 cup raw or ½ cup cooked.
- Increase your antioxidant intake. Antioxidants are compounds that protect the body against oxidative stress, which damages cells, alters cell function and the potential development of endometriosis. Consume 1-2 servings of berries and at least 1 serving of citrus fruit (think oranges or grapefruit) per day. In addition include foods high in vitamin C, such as red peppers, and vitamin E, such as almonds, sunflower seeds and avocado, to increase your antioxidant intake. A good tip is to “eat the rainbow” and consume various colours of fruits and vegetables to ensure a variety of antioxidants in the diet. One serving of berries or fruit is equal to ½ cup.
- Consume more sources of omega-3 fats. Omega-3 fats have anti-inflammatory properties that may control inflammation causing the progression of Endometriosis. Include at least 7oz/200 grams per week of fatty fish, such as wild salmon, tuna and halibut, as well as add walnuts as a snack and ground flax seeds to smoothies and meals will ensure adequate omega-3 fats. Consider supplementing with omega-3s if you don’t consume enough.
- Eat whole grains and high fibre starches. Consuming fruits, vegetables, nuts, seeds and legumes, as well as choosing whole grains, such as oats, whole grain bread, brown rice keeps the intestinal tract healthy by providing fibre and ‘prebiotics’** and promotes the excretion of excess estrogens.
- Reduce saturated and trans-fat intakes. A higher amount of unhealthy fats in the diet promotes more estrogen production. Limit red meat consumption to 1-2 servings per week (5oz or 150 grams maximum), reduce processed and fast foods and substitute olive oil in place of butter to help to reduce your unhealthy fat intake.
- Include high calcium and vitamin D foods. Research has shown that foods containing calcium and vitamin D lower risk for developing Endometriosis and may control inflammation. Have at least 2 servings per day of low-fat dairy or dairy free alternatives, such as almond milk, and include wild canned salmon and sardines (with the bones!) to increase calcium and vitamin D. Consider supplementing if needed. One serving of dairy is equal to 1 cup of milk or alternative or ¾ cup of yogurt.
- Include cruciferous vegetables. Cruciferous vegetables, such as broccoli, cauliflower, Brussels sprouts and cabbage, are high in B vitamins and aid in estrogen detoxification. While the jury is out on the actual amount per day to eat, we recommend consuming at least one serving per day. One serving is equal to ½ cup cooked or 1 cup raw.
- Limit foods that contain polychlorobiphenyls (PCBs) and pesticides. It is suggested to eat as organic as possible and to be aware of potential sources of pesticides, which may interfere with hormone metabolism. Try to choose organic fish/shellfish, meat, poultry, milk and dairy products. When choosing fruits and vegetables, be sure to buy organic for those listed as “The Dirty Dozen,” or the types of produce most exposed to pesticides, which can be found here: https://www.ewg.org/foodnews/dirty-dozen.php
- Moderate soy intake Moderate amounts of soy intake may be helpful in managing Endometriosis. Despite conflicting data, there is no reason to avoid soy consumption. However, unprocessed or minimally processed soy products, such as tofu, tempeh and edamame, are suggested over processed soy products, such as soy sauce, as they contain less of the beneficial compounds and potentially more sodium, sugar and other additives.
**Prebiotics are types of fibre and fibre-like compounds in our diet that act as fuel for our healthy intestinal bacteria. Think of eating prebiotics like fertilizing your lawn 🙂
Will a daily supplement be beneficial for me?
It is believed that supplements for nutrients may not be as effective in preventing endometriosis (and other chronic diseases) as natural food sources, as they do not contain the various bioactive compounds found in food sources that interact in the diet. However, supplementing with the following may be beneficial:
- Omega-3 fatty acids: These essential fatty acids have an anti-inflammatory effect. In addition to eating im for 1000 mg per day of EPA+DHA (the 2 active compounds), such as this one: https://nutriprocan.metagenicscanada.com/omegagenics-epa-dha-1000
- DIM (Diindolylmethane) This is a compound found in Brassica vegetables (cabbage, cauliflower, Brussel sprouts) that helps our bodies detoxify estrogen. Our favourite supplements is Metagenics I-3-C, found here: https://nutriprocan.metagenicscanada.com/meta-i-3-c
- Always consult your health practitioner before starting any supplementation as each patient and case is different.