A dietitian decodes the relationship between food and endometriosis. And why it matters.

One in 10 Aussie women are living with Endometriosis right now.

She could be your boss or your work wife. Your mother, sister or daughter. She might be you.

The disease, which involves tissue similar to tissues found in the uterine lining growing in places it shouldn’t, feels different for every woman.

You might experience heavy and irregular bleeding or periods that never go away. You could feel pain in your pelvis and lower back, during sex, after sex, going to the bathroom, during your period. Or pain all the time, so excruciating you can’t move. You might feel tired or bloated, or be struggling to conceive. Or, you mightn’t have any symptoms at all.

But the one thing connecting every woman living with endo is we haven’t found a cure for you, yet. All you can do is manage the disease and get on with living your life the best you can.

Here’s a quick snapshot of what endo looks like. Post continues after video.

Having worked as a Dietitian with endometriosis clients for many years, I’ve personally seen the improvements nutrition has made to their lives.

The role of nutrition in endometriosis is a relatively new concept, but when we consider that the way we eat has a broad influence on all functions of the human body it is easy to see how nutrition may help alleviate symptoms in those who suffer endometriosis.

So how do nutrition and endo relate?

How does gut health affect Endometriosis?

Endometriosis often coincides with bowel irregularity either constipation, diarrhoea or both, as well as bloating and gastrointestinal pain.

Managing this gut dysfunction helps improve symptoms and the quality of life in those with endometriosis.

Because many women with endometriosis also fit the criteria for Irritable Bowel Syndrome, improvements in symptoms often occur with the implementation of a low FODMAP diet, or simply manipulating their fibre intake, whether that be increasing fibre, decreasing fibre, or modifying the types of fibre in the diet.

Studies have shown differences in the gut microbiome (bacteria found in the large intestine) in those with endometriosis compared to those without which raises questions as to the role our gut may play in the development of endometriosis.

Our gut microbiota may also influence the regulation of oestrogen cycling. Dysbiosis, a bacterial imbalance of bacteria in the bowel, can increase circulating levels of oestrogen which may stimulate the growth of endometriotic lesions.

As a dietitian specialising in gut health, I am very interested in the role our gut microbiome may have in the development, treatment and progression of any disease but in particular diseases that tend to also coincide with gut symptoms, like endometriosis.

Not only is our gut responsible for digestion and excretion of waste, our gut is a major regulator of the inflammatory processes in our body, even processes outside the gastrointestinal tract.

How does inflammation affect Endometriosis?

Endometriosis is associated with increased inflammatory activity and elevated inflammatory markers in the blood.

Further, symptoms of endometriosis are often resolved or improved by anti-inflammatory drugs supporting this contribution of chronic inflammation to the pain experienced in endometriosis.

If we consider endometriosis an inflammatory disease it opens the pathway for dietary regulation of total body inflammation through both improved gut health and following an anti-inflammatory diet.

Dietary strategies to reduce inflammatory markers in the blood such as including healthy fats, fruit and vegetables, omega-3 fatty acids and reducing refined carbohydrates and processed foods may lead to a reduction total body inflammation and also help to alleviate symptoms of endometriosis.

Unfortunately the research isn’t at this level yet so while I’ve personally seen improvements with my clients we don’t have the rigorous studies to show the effects of an anti-inflammatory diet in endometriosis.

But what we do know is there is no harm from an anti-inflammatory diet, so why not try it.

Consider your diet if you’re living with Endometriosis

Women with endometriosis may also be at higher risk of iron deficiency due to heavy or long duration of mensuration.

Simple dietary changes to include more iron rich foods can alleviate symptoms of fatigue and weakness in those with iron deficiency.

Many people believe that soy being a phytoestrogen (plant oestrogen) may increase the risk of endometriosis or worsen endometriosis.

However, there is no evidence to support this and in fact one study showed a protective effect of soy consumption and development of advanced endometriosis.

Research into managing Endometriosis with nutrition

So, where is the research at?

Unfortunately the research lacking when it comes to not only nutrition and the treatment of endometriosis but the lifestyle management of endometriosis in general.

When we consider endometriosis as an inflammatory disease that may have gut origins we also need to consider other lifestyle management strategies in addition to nutrition like sleep and stress.

While we currently have glimpses of hope in the research in animal studies and studies looking at associations between gut health and endo, more research needs to be done.

I think it is a very exciting time for research in this area, especially with the increase in research in the area of gut health. In the mean time many dietary strategies to thought to improve endometriosis symptoms are unlikely to cause harm so implementing these strategies is generally recommended.

What to eat (and avoid) if you have Endometriosis

I have endo, so what should I eat and avoid?

• Minimise trans fats and include healthy omega-3 fats in the diet by including oily fish like salmon or tuna three times per week.
• Avoid pro-inflammatory foods inducing highly refined carbohydrates, saturated fats, and processed meats.
• Include fibre rich foods like fresh vegetables, fruit, whole grains, nuts and seeds on a daily basis.
• Include anti-inflammatory foods like leafy green vegetables, olive oil, nuts, fatty fish and berries.
• Limit caffeine and alcohol intake.
• If you experience IBS symptoms such as bloating, constipation or diarrhoea see a dietitian who specialises in IBS to look into your individual triggers, trial a low FODMAP diet or develop an individual plan to address your symptoms.

Marika Day is an Accredited Practising Dietitian and Nutritionist and runs a Gut Health Clinic in Kensington, Sydney. She also is a qualified PT and trains out of Sydney's Base Body Studio. For bookings and inquiries contact her via email nutrition@basebodybabes.com or via her website marikaday.com or follow her on Instagram.

This article should not be substituted for professional, personalised medical advice. If you are living with endometriosis or are concerned about your health, please visit your GP or specialist.

Mia Freedman speaks to her cousin Syl about discovering she had endometriosis, how it affected her period, and how she’s making changes for other women. You can listen to the full episode of No Filter here.