The Best Foods to Eat and Avoid When You Have Endometriosis
Endometriosis is a disorder that can affect women's entire lives, from their menstrual cycle to their digestion, mood, fertility, and ability to exercise. The painful condition occurs when, for unknown reasons, tissue from the uterus grows outside the uterine walls, often on the ovaries or around the bowels, causing inflammation and irritation in those areas. According to the ENDO study, endometriosis affects 11 percent of American women between the ages of 15 and 44.
Symptoms of Endometriosis
The most common symptom is pain, whether it's in the form of cramps, intestinal pain, or painful urination, that flare up especially during menstruation. "Initial suspicion starts with period pain, that interrupts work or school, in most women or young women," says Jeff Arrington, MD, FACOG, ACGE, an endometriosis excision surgeon at the Center for Endometriosis Care in Atlanta, Georgia.
"There are bowel conditions and back pain that can be symptomatic as well," Dr. Arrington says. Often, it can take years to diagnose, because certain symptoms are either confused for other conditions or have been downplayed as "bad cramps." Now, between celebrities and social media discussions about women's health, there's increased awareness of endometriosis.
Endometriosis Treatment Options
In terms of treatment, the only way to remove endometrial cell growth for good is through surgery, according to Dr. Arrington. (Many patients choose to have a hysterectomy as well.) But if that's not a financial option for patients or they personally choose against it, there are other coping mechanisms.
"Many patients use NSAIDs, pain medications, various types of hormones, and heating pads; some patients will use mindfulness techniques, diet, acupuncture, and the like," Dr. Arrington says.
How Adjusting Your Diet for Endometriosis Can Help
Lifestyle changes, starting with diet, may play a role in taming some of the inflammation that goes along with endometriosis flare-ups. Moving toward clean eating is common, Dr. Arrington says, and many of his patients try an anti-inflammatory diet, full of antioxidants and healthy fats, or a low estrogen diet (the hormone estrogen provokes endometriosis tissue to keep growing outside the uterus).
For endometriosis patients, a shift in diet toward plant-based, low-inflammatory foods can help ameliorate the symptoms. For Jessica Murnane, author of the cookbook One Part Plant and host of the One Part Podcast, who also has endometriosis, making these dietary changes helped her feel healthier in multiple facets of her life, and changed her career as well.
"Endometriosis was the catalyst for a change in my diet, but for cooking as well—I wasn't even cooking before. I was thinking about a hysterectomy or drugs to treat my endo. A friend suggested a plant-based diet, so I decided to try that as a last resort," Murnane says.
Not only did she see a change in her symptoms once she made plants the focus of her meals, but she also noticed other health benefits. "The food is the starting point […] When I changed to an anti-inflammatory diet, I was in less pain, I had more energy to work out again, and I felt less sad. It started with food and led to all these lifestyle changes," she adds.
Choosing the Best Food for Endometriosis
We spoke to experts to find out which ten foods may help the painful symptoms of endometriosis, and which ten to steer clear of in order to feel your best in our endometriosis diet guide.
The 10 Best Foods To Eat On An Endometriosis Diet
One essential nutrient to the endometriosis diet is omega-3s. "Healthy fats provide anti-inflammatory benefits. Fatty fish, such as salmon, mackerel and tuna, are rich in these omega-3 fatty acids," says Jessica Jones, RD at Food Heaven Made Easy.
RELATED: Your guide to the anti-inflammatory diet that heals your gut, slows the signs of aging, and helps you lose weight.
Chia seeds, and even ground flaxseeds, are super anti-inflammatory because they also contain omega-3 fatty acids, explains Aumatma Shah, ND, a holistic fertility specialist who also has her Master's degree in Nutrition. They're great to incorporate into your breakfast, Dr. Shah says, to top cereal or smoothies.
Small fish such as mackerel have just as many Omega 3 benefits as larger fish, Dr. Shah says. In fact, a 3-ounce serving of cooked mackerel has 1,705 milligrams of omega 3 fatty acids (EPA, DHA, and DPA), according to the USDA National Nutrient Database.
If you choose non-animal sources of protein, almonds can be an excellent option. Plus, they pack antioxidants too, another goal for endometriosis patients. "Almonds contain the antioxidant Vitamin E as well as polyphenols," Jones says.
Dark, Leafy Greens
The darker the veggies, the more anti-inflammatory power they pack, Jones says—kale, spinach, and chard are the winners in that category, so ditch the romaine or iceberg lettuce when you make your salads.
Broccoli is another great staple to have in the diet because it contains the inflammation and cancer-fighting antioxidants lutein and sulforaphane. (Though in some cases, women who suffer from endometriosis-related digestive issues could have sensitivities to cruciferous veggies like broccoli, so it's important to experiment with different whole foods to see what works best with your digestive system).
One beneficial drink for endometriosis patients is green tea, according to Dr. Shah. "The compound EGCG, found in green tea, has been studied for cancer treatment, but also applies to endometriosis because it can limit endometrial cell growth," Dr. Shah says.
Turmeric is known for its immune and heart health benefits. "It's also been studied for its anti-inflammatory effects," says Dr. Shah. The key to absorbing it into the body is mixing it with a fat, like hemp seed oil, she explains. She suggests drinking a mixture of turmeric, hemp seed oil, and almond milk as a hearty vegan golden milk.
Just like vegetables, the darker the berries, the richer the antioxidant content, and blueberries, especially wild ones, happen to beat strawberries and raspberries in that respect. Make sure they're an ingredient in your daily smoothie.
RELATED: We found the best smoothie recipes for weight loss.
Because estrogen helps Endometrial tissue to grow, it's smarter to stick to foods that can potentially lower estrogen levels in some way. "It's important to eat things that support the liver in detoxing excess estrogen, including artichokes, parsley, and even lemons, all of which can stimulate liver function," Dr. Shah says.
10 Foods To Avoid On An Endometriosis Diet
Too much sugar isn't healthy in any diet, but it can be especially damaging to those who suffer with endometriosis. "White and brown sugar have been hugely inflammatory for me," Murnane says. In her recipes, she incorporates natural sweeteners: honey, dates, and maple syrup. "When I eat foods with a lot of those sugars I will notice the effects, but not to the extent of processed sugars," she adds.
You don't have to completely restrict your diet if you have endometriosis, Jones says, but, she points out, "Excessive consumption of certain foods has been linked to an increased risk of chronic disease. These foods include refined carbohydrates (such as white bread and pastries), soda, and other processed foods."
Many endometriosis patients choose to go vegetarian or vegan, though white, lean meats such as turkey or chicken are totally fine to keep in the diet, Dr. Shah says. One inflammatory red flag though, according to all the experts we spoke to, is red meat and any other kind of processed meat—a Journal of the American College of Nutrition study found them to cause inflammation, bloating, and weight gain.
Dairy is a major culprit of inflammation many women with endometriosis, including herself, Murnane says. There might be interesting reasoning behind this, Dr. Shah explains. "Dairy can be inflammatory for everyone, but especially negative for women with endometriosis because products like cow's milk contain a fair amount of estrogen." It's best to substitute dairy products to eat less dairy with nut and other plant-based milks, cheeses, and dairy-free yogurts, and to avoid foods that are injecting excess estrogen into the body, Dr. Shah says.
"Eggs have caused many of the women I know with endometriosis a lot of additional discomfort," Murnane says. This, a Frontiers in Neuroendocrinology study shows, could also be explained by the high estrogen content in eggs, so focusing on more plants and plant-based sources of protein might be beneficial to some women.
Unlike the healthy omega-3 fats found in tuna and salmon, margarine contains fats that are on the other side of the spectrum. Margarine is worth avoiding, says Jones, because it often contains trans fats, which have been known to increase inflammation throughout the body, as well as raise bad cholesterol.
No one wants to be told to skip out on their cup of coffee, but slashing your caffeine intake, even by a little, may help endometriosis symptoms. "Caffeine will trigger more inflammation in the body," Dr. Shah says, and Dr. Arrington advises the same.
Another habit that many people don't want to break is drinking, but it could also make a difference in endometriosis symptoms. Murnane says she cut out alcohol after realizing it made her feel unwell, and only has a basic, low-sugar cocktail on a rare occasion. Dr. Arrington supports scientific claims that it can make inflammation, and therefore endometriosis, worse.
Italian researchers have found that eliminating gluten could potentially help lessen the pain of endometriosis—it depends on the patient, though. "Following a gluten-free eating plan may be helpful for many people with endometriosis, but not all. It's important to start with a careful elimination diet and see if symptoms improve. If there is no improvement in symptoms, gluten is likely not a culprit," Jones says. Dr. Shah's rarely instructs patients to eliminate gluten and opt for gluten-free foods if they don't already have a digestive intolerance or Celiac Disease; instead, she advises them to focus their diet in on whole grains as opposed to refined grains.
Monash University researchers found that lowering or eliminating FODMAPs from the diet can be beneficial to women who suffer from IBS in addition to endometriosis, which isn't all that uncommon if endometrial tissue affects the bowels. "FODMAPs are short-chain carbohydrates found in several fruits, vegetables, and grains," Dr. Arrington says. They can also be found in common food seasoners, such as onions and garlic. However, for patients without digestive issues, this elimination may not be necessary. If you'd like to learn more, see whether a low-FODMAP diet can help you find digestive relief.