A comprehensive, integrative approach to endometriosis with a variety of highly trained health professionals appears to offer the most effective care. Expert excision surgery, pelvic floor physical therapy and dietary therapy among other integrative treatments all play very important roles in the holistic care of endometriosis patients. While diet is neither the cause of nor the cure for endometriosis, it often makes a significant impact in the way we feel. Today we will explore the impact our food choices have on how we feel and some of the most common food triggers among endometriosis patients.
It is important to remember that dietary change isn’t an overnight process and that everyone’s needs are different. One patient’s food triggers will be different from another’s and other food sensitivities exist that are not discussed in this article. While it may take a little trial and error, some time and some effort, many find that eating an overall anti-inflammatory diet while avoiding their personal food triggers makes a significant improvement in their quality of life. Symptoms of other conditions that endometriosis patients often additionally suffer from such as interstitial cystitis, polycystic ovarian syndrome and irritable bowel syndrome also tend to improve with dietary therapy targeted specifically to each disorder.
Most people are aware that inflammation causes a variety of symptoms, most noticeably significant pain. What many people aren’t aware of is that what we eat can directly increase or decrease inflammation and associated symptoms depending on our food choices. This is excellent news as it gives us the opportunity to take back some control of our health and pain, something that all too many endometriosis patients feel is out of their hands.
But which foods are inflammatory, increase pain and increase the risk of countless inflammatory lifestyle diseases? Processed, refined and synthetic foods are the number one food category to avoid. Packaged and prepared meals and snacks, soft drinks, fried foods, smoked and/or processed meats, breakfast cereals, baked goods, white flour and refined grains, sugar/corn syrup, soy, artificial sweeteners, poor quality fats (more on this later) and a variety of additives, colours and chemicals all contribute to the inflammatory and toxic burden on the body. Avoiding these foods and sticking with fresh, unprocessed ingredients (organic whenever possible) with a strong emphasis on fresh produce forms the backbone of any anti-inflammatory diet.
Gluten is a protein found in glutinous grains (including wheat, rye, barley, spelt, kamut, triticale, graham, bulgur and controversially oats) that many people with endometriosis have difficulty with. In fact, a recent study found that 75% of the endometriosis patients studied had reduced pain while following a gluten-free diet.1 It can be very difficult to digest, leading to increased bowel symptoms, bloating and increased pain. Some people find the problem is specifically wheat and tolerate other glutinous grains just fine. The key to going gluten-free is to choose foods that are naturally gluten-free, like brown and wild rice, quinoa, millet, amaranth, legumes, sweet potatoes and squash instead of processed gluten-free bread, pasta, baked goods, breakfast cereals, bars and crackers which are typically highly refined and fall into the inflammatory category. Also be aware that many condiments contain hidden gluten, so read labels or better still make your own salad dressings, sauces, salsas and marinades to avoid gluten and other inflammatory ingredients.
Soy has exploded in popularity over the last fifteen years or so. Although soy is often built up to be a powerful super food, in reality it does not live up to the media hype. Contrary to popular belief, soy really hasn’t been a staple of the human diet for all that long. It is a very tough plant that was long thought to be inedible and traditionally was only consumed in fermented forms such as miso, tempeh, natto and Nama Shoyu in condiment sized portions. Raw, unfermented and highly processed soy is extremely difficult to digest and quite inflammatory. Furthermore it contains phytic acid, an “anti-nutrient” that inhibits absorption of a variety of essential minerals and acts as a goitrogen interfering with thyroid function. Soy is also high in isoflavones, a natural type of plant estrogen that can increase estrogen levels in humans. This is particularly concerning for many endometriosis patients as it can be a potential dietary trigger of pain.
Modern soy is one of the most heavily sprayed crops on the planet and is almost always genetically modified. In fact as soon as GM soy hit the mass processed food market in the hidden in processed foods around 1997 severe peanut allergies in children jumped 200% in five years.2 A recent study demonstrated that pigs fed a diet of genetically modified soy had an average of 25% heavier uterine weight and were 2.6 times more likely to have severe stomach inflammation than pigs not fed genetically altered foods. These pigs- both female and male- were also found to have reduced fertility.3
This type of soy is commonly listed as soy protein, soy isolate, defatted soy flour, soy lecithin and soy oil, in a variety of dairy substitutes and meat analogues, tofu, soy sauce/tamari, condiments, packaged and premade meals, side dishes, soups and snacks, baked goods, crackers, protein supplements and meal replacements, baby formula and desserts. If one tolerates some soy, I recommend sticking to occasional condiment-sized servings of 100% certified organic and non-GMO products that are traditionally fermented such as miso, natto, tempeh, tamari and Nama Shoyu.
Dairy, similar to soy can be quite inflammatory, can contain significant amounts of hormones and can be quite difficult to digest for many leading to an exacerbation of symptoms. Lactose is a sugar found in milk that most teens and adults have difficulty breaking down, which leads to pain, bloating and other GI symptoms when bacteria in the intestine start eating the undigested sugar and fermenting. Casein is a protein found in milk which can trigger severe allergic reactions or more commonly intolerance symptoms similar to those of lactose intolerance. An unhappy bowel can irritate endometriosis lesions on the bowel wall itself or elsewhere in the pelvis leading to increased pain, bowel symptoms and nausea.
Unfortunately much like soy, dairy has become increasingly adulterated over the years. Cows are routinely fed antibiotics which in addition to the growing problem of antibiotic resistance can over time lead to IBS-like symptoms. In addition, dairy cattle are often injected with natural and genetically modified growth hormones. Some of these hormones elevate IGF-1 levels causing cells (including potentially some endometriosis cells) to grow and become more active.4 This is in addition to the cow’s own natural hormones, increasing the body’s overall estrogen level and potentially increasing pain and symptoms. Regularly consuming low fat and fat-free dairy products has also been strongly associated with ovulatory infertility.5
Choosing non-dairy alternatives such as unsweetened almond, coconut or rice milk, yogurt and raw nut cheeses are good options. Some people tolerate some organic grass-fed goat or sheep’s dairy (particularly unsweetened low fat yogurt or other fermented products), so consider giving it a try if cow’s dairy is a problem for you. It is important to ensure one is getting enough calcium when eliminating dairy, so adding more high calcium non-dairy foods such as green leafy vegetables, blackstrap molasses, raw almonds, BPA-free canned wild salmon with the bones, raw sesame seeds/tahini and broccoli and possibly a quality calcium and magnesium supplement to your daily diet.
Dietary fats and oils are probably the greatest area of confusion when it comes to nutrition. There is so much misinformation out there and yet getting the right fats and oils in the right balance is critical in the management of inflammation and overall health. The right oils will keep your cell membranes flexible, your hormones balanced and help to keep inflammatory hormones and substances under control.
Unfortunately the most commonly consumed fats and oils are highly refined, highly processed, profoundly damaged and extremely inflammatory. Yes, those “healthy” vegetable oils such as canola, safflower, sunflower, corn, cottonseed, and soy oils and “heart healthy” non-hydrogenated spreads are highly inflammatory, increase pain, reduce fertility and increase your risk of death due to heart disease, cancer and other serious diseases.6 During processing these exceedingly fragile oils are exposed to excessive heat, light and air, many chemicals to degum, deodorize and bleach the oil and then packaged in large clear plastic bottles where they continue to degrade under the light.
To add insult to injury, because they are so processed many use these oils to cook over high heat, damaging the oil even more. Furthermore these oils generally contain far more of the often inflammatory omega 6 than they do of the anti-inflammatory omega 37 which increases systemic inflammation and pain. Trans fats, such as hydrogenated or partially hydrogenated vegetable oils, margarine, shortening and some frying oils should also be avoided completely.
What to eat instead? Choose more oils and foods higher in omega 3; first cold pressed raw organic flax, hemp, chia, walnut or pumpkin seed oils in small dark glass tightly closed bottles that can be used quickly and store in the fridge. Use these oils in only cold applications such as salad dressings, dips or added to smoothies. Raw ground chia, flax, whole hemp hearts, walnuts and pumpkin seeds can be added to salads, raw nut butters, smoothies, trail mix or on top of main dishes. Wild salmon, herring, sardines, anchovies, Atlantic mackerel and some sea vegetables are excellent sources of omega 3.
First cold pressed extra virgin olive or avocado oil stored in small dark glass bottles in a cool dark place that can be used quickly are great in cold applications and in cooking up to medium-low heat. Saturated fats such as first cold pressed extra virgin pure coconut oil, organic grass-fed butter or ghee can be used in moderation and are the most heat stable of all the fats and oils so they are a good choice for cooking. A high quality daily fish oil supplement (such as Nordic Naturals or Nutritional Fundamentals of Health) may be considered.
Red meat is a problem for some of the same reasons as dairy. It is also can be quite inflammatory, difficult to digest and slows digestion time leading to bowel symptoms. Livestock in North America are typically fed an unnatural diet of corn, other grains or “cattle feed” instead of their natural grass diet which increases the amount of omega 6 relative to omega 3 in the meat significantly. They are also typically sedentary which increases the amount of fat and potentially hormones in the meat. If you tolerate some red meat in moderation, choose lean cuts of certified organic, free range and grass-fed meat.
Soluble fibre is important to keep food moving through the bowel smoothly and helping the body to naturally expel excess hormones instead of reabsorbing them to be continuously recycled in the body. Unlike insoluble fibre, soluble fibre dissolves into a gel in the GI tract to keep food moving without excess bulk or scratchy irritation which can increase pain. Foods such as apples, pears, plums, legumes (beans, lentils and peas), whole oats, okra, citrus fruits, ground raw chia and flax seeds and psyllium husk powder are good sources of soluble fibre.
Alcohol is extremely inflammatory, hard on the liver and is an extremely common dietary trigger of pain. Consider eliminating alcohol altogether or only indulging in a drink on special occasions. Caffeine also often increases pain as well as PMS symptoms, although some women can tolerate small amounts of caffeine such as in green or white tea or a small cup of coffee. Try eliminating coffee, soft drinks, energy drinks, black tea, chocolate and other sources of caffeine for a month or two and see how you feel.
So how does one transition to an anti-inflammatory diet and incorporate all of these habits into their daily life? The first step is to start working with a qualified nutritionist who has a strong understanding of endometriosis and will guide and support you through the process. This helps to ensure that you are changing your diet in a healthy way and getting all of the nutrients you need to be healthy while providing an excellent resource for alternatives and meal ideas. It is very important to remember that this is a process that will take some time, effort and commitment and it won’t happen overnight. But that being said, diet changes often prove to be a very important component in many endometriosis patients’ overall care. They feel much better in terms of endometriosis symptoms, energy and overall well-being; results that are very much worth the effort.
© 2013 Nutritionista. Erin Luyendyk RHN.