Endometriosis Diet: What Foods To Eat And What Foods To Avoid

When it comes to endometriosis, pelvic pain is just one of the many symptoms patients unfortunately experience. For years, scientists were convinced there were limited lifestyle and dietary factors that could influence the severity or symptoms associated with endometriosis. In fact, even just ten years ago, researchers were convinced that diet had no influence on pelvic pain. 


Luckily, in the last ten years, there has been some progress in terms of the quantity and quality of research available on endometriosis. Although there is still so much for us to learn in terms of the exact root cause of endometriosis, we are learning more and more everyday about the way in which endometriosis presents and what factors can influence endometriosis the most. One of those factors is our diet and lifestyle. Now, before you assume you have to cut everything out of your diet, if you have endometriosis, it’s important we review what the research actually says and take a more evidence-based approach to your care. It’s time we tune out the influencers and social media B.S, and actually talk about the facts. 


Our Environment + Our Diet 

When it comes to endometriosis, we are learning more and more about how our environment plays an important role in the severity and prevalence of endometriosis-related symptoms. In fact, we are learning that many women with endometriosis appear to struggle to detoxify from certain environmental chemicals. [Rumph (2020)]. Women with endometriosis can often experience a higher body burden of chemicals than women who do not have endometriosis. They appear to concentrate these environmental chemicals in specific areas including their follicular fluid and pelvic cavity. Women with endometriosis appear to struggle more often with the environmental impacts of modern day living and therefore, have been found to have a higher risk of developing endometriosis, as well as, an increased risk of worsening their symptoms. We have also learned that endometriosis is an estrogen-dependent condition. This does not mean estrogen caused your endometriosis, but it does mean that estrogen can contribute to your symptoms. This is extremely important to mention because it isn’t the estrogen itself that is causing your symptoms, but instead researchers believe that exposure to estrogen-containing chemicals, like xenoestrogens, are often a contributing factor to endometriosis. Xenoestrogens  can make it more difficult to complete natural detoxification. This is why women who are exposed more frequently to xenoestrogen-containing chemicals, appear to have worsening of their endometriosis-like symptoms. 


Avoiding Xenoestrogen 

For those who may be unfamiliar with the term xenoestrogens. Xenoestrogens are considered “foreign estrogens”, they are chemicals found in our environment that closely resemble the molecular structure of our own estrogen and can even bind and stimulate estrogen receptors in our body in a similar fashion as our naturally occurring estrogen. Although we often think of xenoestrogen as chemicals found in plastics, pesticides and even our water system, the most common source of xenoestrogens that appears to have the biggest impact on patients with endometriosis is dioxins. Dioxins and dioxin-like compounds are a group of chemical substances that are persistent organic pollutants commonly found in our environment.

Want to guess where we are most commonly exposed to dioxins?

Our diet.

Dioxins are particularly difficult to avoid because they most commonly come from dietary fat and bioaccumulate most often in animal-based proteins. Does this mean that patients suffering from endometriosis should avoid all animal-based meats? Not really. In fact, the quality and type of animal-based proteins make a significant difference in our exposure to dioxins. We are also learning that it may not be solely animal-based proteins that is the problem but, more so, the exposure to saturated fats and the inability to properly detoxify dioxins. [(Muzembo 2019)]. This means that according to recent research, our goal should be to lower saturated fat consumption as well as helping patients reduce their total body burden of dioxins. Not only can saturated fats be inflammatory, which is likely contributing to the worsening of endometriosis-related pain, but saturated fats appear to be an important contributing factor to our body's burden of dioxins. 


Should you go dairy-free? 

This is a specifically controversial nutritional recommendation because although you might see influencers and wellness “experts” swear that everyone with endometriosis should avoid all forms of dairy, the reality is, that’s not exactly what the research says. In fact, even to my surprise, an observational study done on adolescence actually found there was a significant decrease in the likelihood of developing endometriosis in adolescents who had dairy in their diet versus those that did not. [Qi (2021)]


Shocking, I know.


Now although this is where the current data sits, since dairy can often be a major source for saturated fats, which we know impacts endometriosis, it is often recommended to consume lower fat dairy options including 0-2% fat yogurts. 


Another interesting fact we have learned about endometriosis and dairy is that although most dairy appears to have no negative impact on patients with endometriosis, butter did.  


Bottom line: dairy doesn’t seem to negatively impact the development and severity of endometriosis, aside from butter. 


Should I avoid red meat?

As we discussed previously, when it comes to disease severity and symptom management, we know that saturated fats and dioxin exposure appear to be the most problematic for patients with endometriosis. So should you avoid all meats? Most likely not. Animal-based proteins are an important way we can consume both essential and non-essential amino acids involved in the production of our hormones. That being said, the type of animal-based protein you choose to consume does appear to matter. In particular, researchers have found that diets rich in red meat seem to negatively impact on patients with endometriosis. Now the exact reason why red meat is such a problem is still up for debate but we do believe that the elevated saturated fat content, as well as, dioxin content are most likely the cause for the negative impact on patients with endometriosis. We also know that whether you have endometriosis or not, women who consume higher levels of red meat in their diet, also have higher levels of estrogen, specifically estradiol, the active form of estrogen. So even if your red meat is “grass-fed” and/or organic, if you suffer from endometriosis, the current data says it’s most likely something to strictly avoided. [Yamamoto (2018)].


Bottom line: Red meat should be avoided in women with endometriosis.


Should I increase my fish intake? 

Fish is a wonderful source of protein and can be a great source of omega-3 fatty acids which can be anti-inflammatory. That being said, the research currently believes that although consuming fish is a wonderful part of a well balanced diet, the omega-3 content found in fish isn’t specifically lowering endometriosis-related pain. This means that although fish is a wonderful and highly recommended animal-based protein, consuming fish multiple times a week simply for the omega-3 content hasn’t been shown to reverse the symptoms of endometriosis. [Khanaki (2012)].


Bottom line: Fish is good but likely isn’t reducing your symptoms. 


Should I eat more vegetables?

Overall, we know that vegetables provide us with a variety of health specific nutrient value. In fact, studies have found that patients who consume more vegetables have a lower risk of developing endometriosis. We also have studies that have shown that patients who increase their vegetable consumption after laparoscopic surgery had a lower reported recurrence rate and they even saw a lower severity in their pain. In other words, just because you haven’t been eating a high vegetable- containing diet up until this point, doesn’t mean you can’t start today! Try to incorporate vegetables with your breakfast, lunch and dinner.. Waiting to consume all of your vegetables with your dinner is likely going to be ineffective and unsustainable. Making sure the majority of your vegetables are lightly steamed or sauteed will also make it easier to digest. Avoid consuming all raw vegetables to avoid the development of gas and bloating. [(Parazzini 2018, Afrin 2021)]


Bottom line: Vegetables are great! 


Should I avoid soy-based products? 

This has been a hot topic among the wellness “experts”, especially because there was in fact a study that showed that soy increased the risk of endometriosis. However, this exact study has since been refuted. In fact, the more recent research has shown that there is likely no impact with the consumption of soy in the development, progression and worsening of endometriosis. [(Helbig 2021)].


Bottom line: Soy doesn’t worsen endometriosis 


Should I follow a low FODMAP Diet? 

For those who may be unfamiliar, a low FODMAP diet involves the restriction of all fermentable carbohydrates and has been widely used as a dietary intervention for patients specifically with IBS who experience gas and bloating. The reason it has also been used with patients suffering from endometriosis is because it appears that patients with endometriosis are  be more likely to be diagnosed with IBS. The two disease processes appear to often co-exist. Now although a low FODMAP diet isn’t to be used for all patients suffering from endometriosis, it does appear to not only improve gas and pelvic pain caused by IBS, but it could also improve the symptoms of endometriosis in patients who have also been diagnosed with IBS. In fact, in a recent study in 2017, researchers found that of the 160 women in their study who met the criteria for IBS, 36% also met the criteria for endometriosis. 72% of these women reported a greeted than 50% improvement in bowel symptoms after just four weeks of a low FODMAP diet compared to 49% in those with no known endometriosis.  [Moore (2017)].


Bottom line: If you have endometriosis and IBS, low FODMAP diets may be extremely beneficial. 


About the Author: Meet Dr. ZenAlissia Zenhausern- Pfeiffer, NMD, FABNE, (commonly known by her patients as Dr. Zen), is a licensed naturopathic doctor board certified in naturopathic endocrinology and the founder of NMD Wellness of Scottsdale, a premier naturopathic medical practice that focuses on helping women to take a proactive approach to their hormone and fertility health. Dr. Zen has been featured as a lead expert in Forbes, Shape Magazine, and Instyle and is deeply passionate about bridging the gap between traditional and natural medicine in the world of fertility. She works with a variety of hormone related issues including PCOS, endometriosis and unexplained infertility. Her goal is to help more women get back into the driver’s seat of their own health to make lasting transformational changes to their health to bring more cute and adorable babies into this world. Read More About Dr. Zen...