Dietary modification doesn’t cure Endometriosis, but it can assist in significantly reducing the associated symptoms and spread of the disease. The main areas that nutrition plays a role in are altering the hormone balance, reducing inflammation and minimising bowel symptoms that can aggravate the pain of the Endometriosis.
Oestrogen is one of the key drivers in Endometriosis. It is formed through a variety of steps, predominantly in the ovaries, from cholesterol. Once formed, oestrogen is secreted into the blood and is either 'free' or 'bound'. Once the oestrogen is formed, the liver plays a role in metabolizing it (in other words changing it) and then excreting the excess from the body.
What we eat can affect the amount of oestrogen produced, the availability of it in the body to target organs (e.g. in Endometriosis and breast cancer), and the amount of oestrogen that is then metabolized and excreted via urine and stool. As oestrogen is one of the key drivers in Endometriosis, making it less available to target susceptible organs is desirable.
Dietary factors play a role in oestrogen production, availability and excretion. These factors are: our weight; certain fats; an adequate intake of certain nutrients and substances in vegetables, which help in the preparation of oestrogen for removal from the body; adequate, but not excessive fibre and minimizing refined sugars and excess fructose intake.
Fats play a particularly important role as they aid the formation of oestrogen, but also increase the amount of oestrogen that becomes 'free'. When oestrogen is bound to sex-hormone binding globulins, it is more difficult for the oestrogen to influence additional Endometriosis formation.
Prostaglandins are lipid compounds involved in many functions and depending on the type or series that are formed (from fatty acids found in our food) the effects on the body are different. By balancing the prostaglandins that promote a reduction in inflammation with the ones that promote the prostaglandins involved in increasing pain stimuli we can minimise the severity of inflammation and pain at the site of the Endometriosis and therefore the pain and spread. Certain nutrients also play a role in the conversion into the 'helpful' prostaglandins from fatty acids, so adequate nutrient intake is essential to ensure the balance between the different prostaglandins is right.
As the bowel wall is one of the places where Endometriosis can grow, ensuring adequate digestion and minimising bowel symptoms like bloating, diarrhoea and constipation can be really critical.
Ensuring the diet is low in foods that are hard to digest, but including sufficient fibre is important. Examples of foods that are hard to digest include onions, garlic, certain fruits and legumes. Some of these foods are helpful with the oestrogen balance however, so the diet needs to be modified once triggers are established to ensure that foods that assist with hormonal imbalances and inflammation are re-introduced.
The Endometriosis diet needs to be tailored to suit each individual, based on their current food intake, the symptoms they experience, and then modified as symptoms change.
Diane Stride is a New Zealand-registered dietitian and nutritionist, working out of the Village Health Centre in Havelock North, Hawke's Bay.
NB: This article is unabridged from the article titled Diet & Endometriosis that appeared in Hawke's Bay Today's Indulge magazine on the 19th September 2015.