How Do I Eat with Endometriosis?

If you’ve been diagnosed with endometriosis, or you know someone with endometriosis, you know it’s so much more than "just a bad period." It’s a chronic inflammatory condition and it affects more than just the reproductive system (while also coming with variable levels and timing of pain).

This is the area of care where I see the most patients, using nutrition science to heal inflammation and putting a healthy relationship with food at the centre of it all. While diet isn't a "cure" for endometriosis, our eating habits offer the fuel and resources we need to prioritize tissue integrity and overall wellness. And we know that nutrition can be supportive for a variety of other needs in endometriosis, like low energy, poor appetite, disordered eating and digestive symptoms like constipation or bloating.

But nutrition information around endometriosis can be fraught with misinformation and anecdotal content, potentially adding to the confusion and overwhelm - not to mention the risks that come from following nutrition and medical advice that isn't backed by science.

Antioxidants act as support staff, fighting free radicals by donating electrons and stabilizing cells so they can repair damage and protect DNA. Foods rich in antioxidants become a priority, especially when variety is made to be the shining star! Foods like spinach, kale, blueberries, raspberries, walnuts, and chia seeds offer polyphenols to act as these inflammation fighters.

Endometriosis lesions are capable of producing their own estrogen and inflammatory compounds, which allows them to perpetuate and cause other tissue damage. Fibre has the capacity to “sweep” excess estrogen out via the digestive system, while certain soluble types can actually bind with it to escort it out. Think cruciferous vegetables, legumes and whole grains - don’t worry if the fibre isn’t well tolerated. There are tons of modifications to reduce bloating and discomfort when introducing these, and alternatives to consider when gluten is a sensitivity for you.

While the biggest focus is on adding foods in, instead of restricting, some foods may contain compounds that can be inflammatory when consumed in large quantities and regularly - trans fats from highly processed foods, fatty red meats, and alcohol can put extra pressure on the liver and trigger production of inflammatory compounds. It can be helpful to think about replacing these foods or choosing them less often, unless you are alcohol - alcohol is always good to just avoid.

Research does not consistently show a link between pelvic pain of endometriosis and gluten or dairy, but some individuals experience overlapping digestive issues that feel better in removing these two food groups. It’s important to talk to a dietitian before doing this, as your tolerance might be greater than you think, and you do need to replace these foods with a nutrient-dense alternative.

You may feel like keeping a food journal to track your intake and symptoms is helpful, and for some people, it can be. If you have a history of disordered eating or an eating disorder, it’s okay if this tracking method doesn’t feel safe or comfortable. It can be more effective to notice trends in digestive regularity, energy levels, sleep quality and exercise recovery, as well as the number of pain days while you are making nutrition changes versus the specific kinds of foods you are or are not eating. Don’t be discouraged if the idea of food tracking feels overwhelming - I rarely use this in practice because it doesn’t give me much information other than what recipes you eat the most!

At its absolute core, nutrition for endometriosis needs to be about nourishing tissues, not depriving them. You deserve informative and flexible nutrition information to make decisions about eating that are in line with your values and health-promoting for the long-term. If you’re ready to take that step in your journey and see a practitioner, ask me - I offer 1:1 nutrition counseling virtually across Ontario!