Living well with endometriosis
Endometriosis can influence your bodily needs, from your hormones to your skin; your energy levels to your mental health, eating habits to how well your body digests, absorbs, and uses food. Your main priority should be to ensure that your diet meets all of your nutritional needs including energy, fats, protein, vitamins and minerals.
Despite what we see online, there isn’t at present, any known diets or foods that can reliably treat or manage endometriosis. The incorrect information we read online about diets for endometriosis can cause harm in two ways.
The first is that by cutting out food groups like grains, dairy and/or meat, while we are unlikely to see any benefit from an endometriosis perspective, we are at higher risk of nutritional deficiencies.
The second reason is that attempting to cut out food groups is generally unsustainable and when we inevitably struggle, it can lead to feelings of shame and guilt that we’re not as disciplined as we “should be”.
Of course, everyone is different and if removing something from your diet is working for you, then you should be supported to continue with it, while ensuing your diet still meets all of your nutritional needs. We will discuss the nutritional deficiencies to look out for later in this article.
The good news is that there are proactive things that you can do to support your health with endometriosis which are likely to have a positive impact on your condition.
The main goals of diet and lifestyle advice is to reduce inflammation, to help your body to cope with inflammation better and to support hormone regulation. This may help to persevere fertility and reduce your symptoms.
Here's what we suggest:
1. Research suggests that being within a healthy weight range can be beneficial when you have endometriosis but we know that not everyone is at their healthiest mentally and physically when trying to fit into what is considered to be a healthy weight. If this applies to you then we would strongly advocate a Health at Every Size (HAES) approach where you look after your body the best way you can without worrying about your weight.
2. Reduce foods that we know are linked with inflammation such as trans-fats which are found in processed foods, red meat and alcohol. Studies have shown a negative effect on symptoms from these foods.
3. On balance, while the evidence is limited, it is very likely that foods that are anti-inflammatory in nature such as fruit and vegetables, oily fish, olive oil and nuts are important to include. While we don’t have convincing evidence that these foods will fight inflammation in endometriosis directly, we have a lot of evidence that they are protective of inflammation in healthy people. If you don’t eat or like oily fish, an omega-3 supplement is recommended.
4. Vitamin D has been shown to be important in managing inflammation in the body and many people in the UK are vitamin D deficient. You can have your vitamin D tested by your GP but everyone should take a supplement in winter months and anyone with darker skin should take one all year round.
5. Magnesium can have an anti-spasmodic effect by helping with muscle relaxation. Research has shown that magnesium may support pain management in endometriosis. We would recommend bathing in magnesium salts or taking a magnesium complex supplement.
6. Caffeine has been shown to increase the availability of oestrogen in the follicular phase of the menstrual cycle. This supports the suggestion that caffeine is best avoided in those with endometriosis. Decaf tea and coffee are still a great source of anti-inflammatory polyphenols so there’s no need to cut out your favourite drink all together.
7. Stay hydrated. You should aim to consume a minimum of 2 litres of water per day to ensure your body is doing its job to excrete any build up of harmful particles. Try adding ingredients like mint leaves or cucumber to your water to keep it interesting. Be careful with citrus fruit and other fruits because they can cause harm to your teeth if you’re constantly sipping them. Staying hydrated with an overactive bladder. Drinking too much water can make an overactive bladder worse, however, not drinking enough water can be equally problematic. Try reducing your intake of fruit juices and drinks containing alcohol and caffeine and carbonated drinks. If you can, avoid consuming fluids after 6pm or 2 to 3 hours before bedtime to reduce the likeliness of needing to pass urine throughout the night.
8. Low FODMAP diets have been suggested to be helpful in managing the symptoms of endometriosis. This is because, low FODMAP diets can help to reduce fermentation in the colon, meaning it doesn’t get inflated by gas as much. Excess gas in the colon causes bloating and may make pain from endometriosis worse. The low FODMAP diet has many down sides so it is best undertaken with a registered dietitian and it certainly won’t work for everyone so don’t keep going with it if it doesn’t make you feel better.
9. Follow a Mediterranean style diet. This is known to be in keeping with general healthy eating guidelines and to have plenty of anti-inflammatory foods. Trying to keep processed foods and refined sugars to a minimum, as per the Mediterranean diet is always a good idea.
10. Most people will benefit from eating plenty of fibre but if your bowel is involved in your endometriosis, this can make the symptoms worse. If you find that you experience a mix between constipation and diarrhoea and you get a distended stomach followed by diarrhoea, it may be that the poo isn’t moving through your bowel properly and it’s a good idea to seek advice from your endometriosis specialist in conjunction with a specialist dietitian.
11. If you have cut out food groups, particularly meat and/or dairy, it is easy to become iron deficient and deficient in things like B12, zinc and calcium and vitamin D. Any nutritional deficiencies can exacerbate inflammation in the body as you have to work hard to compensate for the lack of those nutrients. Symptoms of these deficiencies include breathlessness, tiredness, hair loss or poor hair quality, softer nails, skin changes, bone aches and pains, mood changes and depression and changes to taste, smell and sensation. If you have any of these symptoms, ask your GP for a blood test and consider taking a good quality A-Z multivitamin.
12. Chew your food well and try to sit down to eat. This can help you to digest your food better and significantly reduce symptoms like bloating and gas.
Other lifestyle measures
Regular exercise is really important for our general health and for balancing hormones, improving mental health and reducing stress hormones. This doesn’t mean that you need to be up at 5am doing a HiTT class everyday. Exercise and movement should include things that make you feel good and that you enjoy. In fact, HiTT exercise can increase our stress hormones which are associated with increased inflammation. Write down a list of exercise you enjoy like walking, yoga, swimming or just dancing around your living room and try to do something most days when you’re well enough. Pelvic floor exercises are always a good idea for anyone with endometriosis.
While exercise and movement are important, rest and sleep are equally important. Lack of sleep causes inflammation in the body so do your best to optimise your sleep hygiene where you can. Listen to your body and rest when you need to while making the most of the days or times in the month when you feel better.
Worry and stress can influence not only your mind, but it can have a negative impact on your body. When you are feeling stressed, your body releases adrenaline along with a hormone called cortisol. This hormone creates a fighting response in the body which can often result in the feeling of having an upset stomach and can also increase inflammation. Some people can experience diarrhoea and stomach cramps, feeling nauseas and a loss or increase of appetite. In the case of chronic stress, our appetite can be increased, leading to comfort eating. Have a look online for stress management strategies such as guided meditation and breathing exercises. Talking honestly about your worries and concerns is important for everyone and can help significantly with stress and anxiety. If you are finding it difficult opening up and telling those closest to you what is bothering you, why not join a online or a local support group where you can connect with others going through similar experiences, helping you feel less alone.