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Nutrition For Endometriosis

Endometriosis is one of the most common female reproductive disorders, affecting between 10 and 15% of women of reproductive age worldwide. However, the condition is still not fully understood in that the exact cause of the condition has never been established. What is fully understood is that the condition is an oestrogen dependant condition driven by hormonal imbalances and it is also a chronic inflammatory disorder characterised by the presence of elevated pro-inflammatory markers. A nutritional approach to supporting the condition can take both of these imbalances into account and support them through a combination of dietary and lifestyle changes.

Endometriosis and your Fertility

30-50% of women with endometriosis may experience fertility issues and the condition can impact fertility in a number of ways. Endometrial adhesions can lead to distorted anatomy of the pelvis, scarred fallopian tubes and impaired implantation. While hormonal imbalances and inflammation can alter immune system functioning and potentially impact egg quality.

How Nutrition can help

As stated above, nutritional therapy can address the two main imbalances that are driving endometriosis: oestrogen imbalances and inflammation. Specific foods and key nutrients can support the body to promote healthy metabolism and detoxification of oestrogen while also helping to balance the production of pro-inflammatory messengers.

Diet and lifestyle for Oestrogen Balance

The body metabolises and removes oestrogen via the liver and bowel and we know that certain foods can support this process thereby promoting hormonal balance and potentially supporting endometriosis symptoms. Ensuring that your diet is supporting healthy oestrogen metabolism and removal from the body is a key nutritional goal for women with endometriosis.

Eat your Greens (especially Broccoli)

The Broccoli family of vegetables (including broccoli, kale, cabbage, Brussel sprouts, rocket and watercress) contain special compounds that support oestrogen balance. A substance called indole-3-carbinol is found in these vegetables and it promotes the healthy metabolism and detoxification of oestrogen in the body. So eating 2 serving of greens every day, especially greens from the broccoli family is an important dietary habit to help ensure healthy oestrogen levels. 1 serving = 1 large handful.

What the research shows:

Research has shown that women who had a high intake of green vegetables (13 servings a week) were around 70% less likely to develop endometriosis compared to women with the lowest intake (6 or less servings a week).

Sulphur-rich foods

Sulphur is a little known nutrient with major health benefits, especially in supporting oestrogen detoxification. Sulphur plays a key role in supporting liver function as it is used to produce a substance called glutathione. Glutathione is an important antioxidant (so helps support female reproductive health by promoting good egg quality) but also works to support the detoxification of oestrogen in the liver.

Sulphur rich foods include: onions, garlic, leeks, cabbage, kale, cauliflower broccoli and eggs. Try and incorporate these foods into your diet daily.

Fill up on phytoestrogens

Certain foods contain plant chemicals called phytoestrogens. The term phytoestrogen literally means plant oestrogen and that is because these substances are structurally similar to oestrogen to the extent that they can actually lock into oestrogen receptors in the body’s cells. These chemicals exert a mild oestrogenic activity that is weaker than our own hormones, so when oestrogen is out of balance these plant chemicals can displace excess oestrogen and have a milder impact on the body.

Phytoestrogen-rich foods include: soya (tofu, tempeh, edamame beans), beans and lentils, flaxseeds, hummus, tahini. Try and introduce a serving of beans or lentils into your diet every day as a source of phytoestrogens and fibre (see below).

Fibre

We all know the main reason why fibre is important for our bodies in keeping us regular, but did you know that having a regular bowel motion is important to ensure healthy oestrogen detoxification? To remove oestrogen from the body the liver packages oestrogen into bile, which is then transferred to out gut via the gallbladder. It is important that we have enough dietary fibre to ‘mop up’ this bile and remove this oestrogen from the body via our bowel motion. If you aren’t having a regular bowel motion (at least once a day) this oestrogen can be reabsorbed into the bloodstream.

Increasing dietary fibre (in combination with plenty of water) can support healthy bowel motion and removal of oestrogen from the body. Fibre-rich foods include: whole grains, beans and lentils, vegetables, fruit, milled seeds and nuts. Not only will fibre help promote a regular bowel motion but it will promote a healthy population of good gut bacteria, our gut microbiome. A healthy gut microbiome also plays an important role in oestrogen detoxification.

Include Aromatase-inhibiting foods in your diet

A key finding of the research on endometriosis is that endometriotic tissue actually produces its own oestrogen through activity of an enzyme called aromatase (aromatase can convert androgens into oestrogen), in contrast normal endometrial tissue does not have this ability. Medical support for endometriosis now focuses on the role of this aromatase enzyme and aromatase inhibitor medications can bring about significant improvements in symptoms.

Certain foods also act as natural aromatase inhibitors in the body so including a variety of these foods into your diet daily could support hormonal balance in endometriosis.

Aromatase inhibiting foods:

  • Berries
  • Mushrooms
  • Broccoli family of vegetables (broccoli, kale, cabbage)
  • Citrus fruits
  • Celery
  • Flax seeds
  • Soya
  • Nettle
  • Quercetin-rich foods: capers, onions, apples, tea, red grapes

What not to eat (and drink)

Your diet can also promote aromatase activity, we know that sugar and alcohol can increase aromatase activity in the body so eliminating alcohol and sugar based foods from the diet as much as possible is key when trying to address hormonal imbalances in endometriosis. The more sugar we consume we produce more of a hormone called insulin, insulin has been shown to stimulate aromatase in the endometrial tissue, therefore sugar and insulin may be one of the strongest dietary factors driving oestrogen production in endometrial tissue.

Alcohol can also negatively impact the detoxification of oestrogen via the liver and alcohol consumption is a risk factor for the development of endometriosis. It is recommended that alcohol is completely eliminated from the diet when trying to support endometriosis.

Hormone Balancing Multi-Taskers

You may have noticed that some key foods seem to come up time and again in the list of recommended foods and I like to think of them as hormone balancing  multi-tasking foods because they can promote healthy hormone balance by a variety of mechanisms (for example flaxseeds act as phytoestrogens, aromatase inhibitors and a source of soluble fibre). It makes sense to concentrate on eating these foods every day.

  • Broccoli family of vegetables (broccoli, kale, cabbage, watercress, cauliflower, Brussel sprouts, rocket, Pak choi, watercress, radish, kohlrabi, turnip, wasabi).
  • Flaxseeds
  • Soya based foods – tofu, tempeh, edamame
  • Beans and lentils

A note on the broccoli family of vegetables: IBS can be a common symptom of endometriosis and if that is the case for you may find that vegetables such as cabbage and Brussel sprouts aggravate your digestive symptoms. If this is the case you can still enjoy rocket, watercress, Pak choi and turnip without irritating your digestion.

Avoid Environmental Oestrogens

Dietary changes are not the only way we can rid our body of excess oestrogen, lifestyle changes can make a big difference. Many of the environmental chemicals we are exposed to on a daily basis are known to be environmental oestrogens, or XENOOESTROGENS, these chemicals are structurally similar to oestrogen and can lock into oestrogen receptors in the body. BUT xenoestrogens have a stronger effect than out own body’s oestrogen so can drive and worsen hormonal imbalances. Some researchers believe that modern-day xenoestrogen exposure is one of the root causes of endometriosis.

Xenoestrogen chemicals are found in plastics, pesticides, cosmetics, body care, sanitary protection and even in household furnishings. One specific group of chemicals, called phthalates, have been found to drive endometriosis and have a stimulatory effect on endometrial tissue. Phthalates are found in perfume, nail varnish, air fresheners, soft plastics and even chewing gum. You can read our comprehensive guide on how to reduce exposure to xenoestrogens HERE.

 Get your fats right to control inflammation

Endometriosis is a chronic inflammatory condition characterised by increased production of pro-inflammatory messengers. These pro-inflammatory messengers drive the condition and also contribute to the development of a pro-inflammatory environment in the reproductive organs that can negatively impact fertility.

Our diet can strongly influence the production of these pro-inflammatory messengers, most importantly the type of dietary fat we consume.

Increase omega-3 fats

The good omega-3 fats found in oily fish are converted into anti-inflammatory messengers in the body and can help resolve inflammatory activity. Most of us do not have enough omega-3 fats in our diet and this deficiency can contribute to inflammation in our bodies. Increasing omega-3 intake from oily fish such as salmon, mackerel and sardines is an important dietary change, if you find oily fish unpalatable a quality supplement can take their place.

What is really important when trying to increase your omega-3 stores in the body is to also focus on reducing omega-6 fats in the diet. Omega-6 fats block the absorption and activity of omega-3 fats so eating a diet rich in omega-6 fats will hinder any benefit you might see from consuming more omega-3 fats.

Omega-6 fats include vegetable oil, sunflower oil and corn oil. So avoid cooking with these foods and always read the label on foods as these fats are found in most processed foods including crisps, crackers, biscuits and breakfast cereal.

What the Research shows:

Women with the highest intake of omega-3 fats were 22% less likely to be diagnosed with endometriosis compared to women with the lowest omega-3 intake.

Avoid pro-inflammatory fats

In the same way that omega-3 fats can reduce the activity of pro-inflammatory messengers in the body certain fats can increase the activity of these pro-inflammatory messengers. The fat found in red meat (arachidonic acid) and trans fats found in margarine and processed foods can directly drive inflammation, potentially exacerbating inflammatory conditions such as endometriosis. So eat red meat no more than 2 times a week and choose lean cuts.

What the research shows:

Women with the highest intake of trans fats were 48% more likely to be diagnosed compared to those with the lowest intakes.

A high intake of red meat can increase the risk of developing endometriosis. Women who had the highest intake of red meat were 2 times more likely to develop endometriosis compared to women with the lowest intake.

Feed The Gut Microbiome

The Gut microbiome plays a fundamental role in the metabolism and excretion of hormones in the female body. If we don’t have enough good bacteria in our digestive system the activity of an enzyme that helps break down and detoxify oestrogen, so an important dietary focus is to ensure that we eat in a way that feeds the good bacteria in our gut.

Factors such as frequent antibiotic use, consumption of processed foods and a low fibre diet can negatively impact the health of our gut microbiome, but dietary changes and probiotic supplementation with a quality probiotic such as NuaBiome Women can easily address this.

To support the gut microbiome you should:

  • Include live and fermented foods in your diet including kefir, sauerkraut, live yoghurt and kimchi – try and eat 1 serving of fermented food daily.
  • Try and eat a wide variety of plant foods – you should aim for at least 30 a week.
  • Eat plenty of foods rich in soluble fibre including root vegetables, beans and lentils and whole grains.
  • Antioxidants promote healthy gut bacteria so include olive oil, berries, olives, pomegranates into your diet daily.

Should you cut out gluten?

Gluten is a protein that naturally occurs in the grains wheat, rye and barley. Gluten intolerance often accompanies chronic inflammatory conditions because the body’s reaction to gluten consumption can promote an inflammatory cascade. Research shows that eliminating gluten can bring about significant benefits for women with endometriosis, in one study of 207 women eliminating gluten from their diet brought about a significant decrease in pain for 75% of these women.

If you have a personal history of IBS, or a family history of coeliac disease you may benefit from eliminating gluten from your diet. It is important to seek advice on how to eliminate gluten from your diet in a healthy manner, focusing on naturally gluten free whole foods as many shop bought gluten-free foods are heavily processed.

References

Chantalat E, Valera MC, Vaysse C, Noirrit E, Rusidze M, Weyl A, Vergriete K, Buscail E, Lluel P, Fontaine C, Arnal JF, Lenfant F. Estrogen Receptors and Endometriosis. Int J Mol Sci. 2020 Apr 17;21(8):2815. doi: 10.3390/ijms21082815. PMID: 32316608; PMCID: PMC7215544.

Chou YC, Tzeng CR. The impact of phthalate on reproductive function in women with endometriosis. Reprod Med Biol. 2021 Jan 11;20(2):159-168. doi: 10.1002/rmb2.12364. PMID: 33850448; PMCID: PMC8022091.

Marziali M, Venza M, Lazzaro S, et al. Gluten-free diet: a new strategy for management of painful endometriosis related symptoms? Minerva Chirurgica. 2012 Dec;67(6):499-504. PMID: 23334113.

Marziali M, Capozzolo T. Role of Gluten-Free Diet in the Management of Chronic Pelvic Pain of Deep Infiltranting Endometriosis. J Minim Invasive Gynecol. 2015 Nov-Dec;22(6S):S51-S52. doi: 10.1016/j.jmig.2015.08.142. Epub 2015 Oct 15. PMID: 27679268.

Parazzini F, Chiaffarino F, Surace M, Chatenoud L, Cipriani S, Chiantera V, Benzi G, Fedele L. Selected food intake and risk of endometriosis. Hum Reprod. 2004 Aug;19(8):1755-9. doi: 10.1093/humrep/deh395. Epub 2004 Jul 14. PMID: 15254009.

Smolarz B, Szyłło K, Romanowicz H. Endometriosis: Epidemiology, Classification, Pathogenesis, Treatment and Genetics (Review of Literature). Int J Mol Sci. 2021 Sep 29;22(19):10554. doi: 10.3390/ijms221910554. PMID: 34638893; PMCID: PMC8508982.

Stacey A. Missmer, Jorge E. Chavarro, Susan Malspeis, Elizabeth R. Bertone-Johnson, Mark D. Hornstein, Donna Spiegelman, Robert L. Barbieri, Walter C. Willett, Susan E. Hankinson, A prospective study of dietary fat consumption and endometriosis risk, Human Reproduction, Volume 25, Issue 6, 1 June 2010, Pages 1528–1535,

Santanam N, Kavtaradze N, Murphy A, Dominguez C, Parthasarathy S. Antioxidant supplementation reduces endometriosis-related pelvic pain in humans. Transl Res. 2013 Mar;161(3):189-95. doi: 10.1016/j.trsl.2012.05.001. Epub 2012 May 31. PMID: 22728166; PMCID: PMC3484190.

Zengul AG, Demark-Wahnefried W, Barnes S, Morrow CD, Bertrand B, Berryhill TF, Frugé AD. Associations between Dietary Fiber, the Fecal Microbiota and Estrogen Metabolism in Postmenopausal Women with Breast Cancer. Nutr Cancer. 2021;73(7):1108-1117. doi: 10.1080/01635581.2020.1784444. Epub 2020 Jun 26. PMID: 32590914; PMCID: PMC7875566.

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

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