Living with Endometriosis can feel exhausting and overwhelming, especially with all the conflicting advice you see online about which diet is best for reducing your endo symptoms. So, today I am going to break down the evidence behind some of the most commonly talked about diets including gluten-free, low FODMAP and anti-inflammatory eating and give you my advice on which I think is the best diets for managing endometriosis! (Spoiler, there’s no ONE diet for Endo as we are all so different).
Many Endo warriors experience symptoms such as pain, fatigue, bloating and gastrointestinal upset and evidence does show that diet does play a role in either worsening or improving these symptoms (in SOME people). However, it is really important to remember that there is NO cure for endometriosis (YET!) and diet can not cure or put your endo into ‘remission’.
What dietary management of endo can do is help to reduce inflammation in the body, increase energy levels, address nutrient deficiencies, support hormone health, optimise fertility (if you are trying to conceive), improve gut health for regular bowel movements and reduce that #endobloat
Ok now let's get into it!
1. Are Gluten-Free Diets one of the best diets for managing endometriosis?
What is a gluten-free (GF) diet?
A gluten-free diet involves avoiding foods that contain gluten, a protein found in wheat, barley, and rye. For those with gluten sensitivity or coeliac disease, consuming gluten can trigger gastrointestinal symptoms or damage the gut. If you have been diagnosed with Coeliac disease it is VERY important that you completely eliminate gluten from your diet to prevent further damage to your small intestine and reduce your risk of health concerns in the future.
Gluten is found in bread, pasta, baked goods and pastries made with wheat, as well as other foods that might contain hidden gluten e.g. sauces, sausages, soy sauce and ice cream to name a few. There are also many naturally gluten-free foods such as fruits, vegetables, nuts & seeds, meat, fish, and grains such as corn, rice and quinoa.
There is evidence to suggest that some people with endometriosis may see improvements in their symptoms while following a gluten-free diet. However, foods containing gluten also commonly contain other components such as FODMAP’s which can also cause gastrointestinal symptoms. This is why I don’t recommend trialling a gluten-free diet as a first-line treatment for Endo as a GF diet can be quite restrictive.
A gluten-free diet can also sometimes be lower in fibre, which is essential for good gut health. Many high-fiber foods, such as whole grains like wheat, barley, and rye, are excluded from a gluten-free diet. Not meeting your fibre requirements can lead to issues like constipation and can also negatively impact gut health by reducing the diversity of beneficial gut bacteria. This imbalance can, unfortunately, exacerbate symptoms such as bloating and discomfort, making it important to find alternative, fibre-rich foods to ensure you're supporting your digestive system effectively while following a gluten-free diet.
However, if you already know that gluten is a trigger for you we will work with you to make sure you are still meeting all of your nutrient requirements while managing your endometriosis symptoms.
2. Is The Low FODMAP Diet one of the best diets for managing endometriosis?
FODMAP’s are a group of fermentable carbohydrates that are not completely digested in the intestines. In those with Irritable Bowel Syndrome (IBS) or gut hypersensitivity, these cause a range of gastrointestinal symptoms such as abdominal pain, bloating, gas, diarrhoea and/or constipation.
People living with endo are twice as likely to be diagnosed with IBS. However, IBS symptoms are similar to those of other GI conditions such as coeliac disease, inflammatory bowel disease (IBD) and bowel cancer so it is important to have these ruled out and IBS officially diagnosed prior to commencing a low FODMAP diet.
A low FODMAP diet consists of 3 phases:
The elimination phase
Reintroduction phase
Personalisation phase
It is not recommended to follow a low FODMAP diet for an extended period of time as it may increase your risk of nutrient deficiencies and it should not be followed without the support of a dietitian due to it’s restrictive nature.
A low FODMAP diet has been shown to be beneficial for some people living with endometriosis assisting them to identify which FODMAP’s are triggering their gastrointestinal symptoms.
However, it would not generally be the first line of treatment for endo in our clinic as there are other strategies we can implement first that are less restrictive and can have very similar results. If you have tried other things though and want to follow the low FODMAP diet, we can support you through this process.
3. Anti-Inflammatory Eating
An anti-inflammatory diet focuses on incorporating a variety of antioxidant-rich and fibre-packed plant foods into your diet. This means including plenty of fruits and vegetables, legumes, nuts, and seeds, Omega-3 fatty acids, found in fish like salmon and in plant sources such as chia seeds and walnuts, lean proteins and low GI carbohydrates like whole grains and of course, Extra virgin olive oil.
Anti-Inflammatory foods are important for playing a role in reducing chronic inflammation in the body, lowering the risk of developing chronic diseases, improving mental health, antioxidant benefits which help protect cells from damage and prompting healthy gut microbiome for improved gut health.
Endometriosis is associated with increased levels of inflammation in the body and research has found that following an anti-inflammatory eating pattern may help to reduce pain associated with endometriosis including pelvic pain, bladder and bowel pain and pain with sex.
The Mediterranean diet is considered an anti-inflammatory diet and is one of the most researched eating patterns for good health. It has also been found to reduce the risk of many chronic diseases such as cancer and diabetes. This is why I incorporate Mediterranean-style eating into my recommendations for endometriosis.
Conclusion
As we know, there is limited good-quality research into endometriosis in general and there is not enough evidence to support one specific eating pattern in the management of endometriosis. While I wish there was, there is no “one” diet for endometriosis as each person's triggers and preferences are different. What works for one may not work for another. This is why it is important to get individualised advice from your dietitian if you feel you're not managing your endo symptoms.
Exploring a gluten-free, low FODMAP or anti-inflammatory diet can provide insights into what might help alleviate your symptoms. Gluten-free diets may offer relief for those with gluten sensitivities, though they can be low in fibre. The low FODMAP diet might help identify triggers for gastrointestinal discomfort, but it's best approached with professional guidance over a short period of time. Anti-inflammatory diets, such as the Mediterranean diet, can support overall well-being by reducing inflammation and offering a balanced, nutrient-rich approach. BUT remember, each person's experience with endometriosis is unique, so it’s recommended to work with a dietitian to find the best strategy for your individual needs before commencing these diets alone.
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This blog post was written by Endometriosis Dietitian and Co-Founder of Hera Nutrition - Rachel Gearon.
References:
Marziali M et al 2012:. Gluten-free diet: a new strategy for management of painful endometriosis related symptoms? Minerva Chir; 67(6): 499–504.
Alencar L, Oliveira I, Paulino B, Vieira J, Torres R. Anti-inflammatory effect of the Mediterranean diet in women with endometriosis: a literature review. (RIMA). 2024;6:e246.
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