Endometriosis is a complex disease where tissue similar to the uterine lining grows outside the uterus, causing pain and/or infertility. It affects about one in ten women of reproductive age. Treatment includes medications which may have unpleasant side effects and/or surgery which is invasive and costly. Thus, it is understandable that many women seek help on alternative treatment such as herbal supplements, acupuncture and dietary interventions.
During a consult for a second opinion, G, a 35-year-old lady with 3 previous surgeries for endometriosis and was currently on hormonal medication, asked whether dietary modifications were effective in treating the disease. She was told by her friend that giving up dairy products and eating gluten-free food can cure the condition. “I would like to eat the food I love if there is no medical evidence of such dietary changes,” she said..
In the social media and internet, there are many articles or blogs which claim that the symptoms of endometriosis are cured or subside after dietary modifications. Such information can undoubtedly offer hope to those facing devastating pain and infertility. So, is there any scientific evidence to substantiate such claims?
What are the foods that have been suggested to affect endometriosis negatively?
Observational studies have found that the following foods are associated with increased risk of endometriosis development. They include:
Alcohol and caffeine
High FODMAP diet (fermentable oligosaccharides, disaccharides, monosaccharides and polyols, which are short-chain carbohydrates (sugars) that the small intestine absorbs poorly). These foods include milk, ice-cream, cereal, beans, lentil, asparagus, garlic, apple and pears
What are the foods that purportedly may impact endometriosis positively?
Animal and observational studies have indicated that foods promoting anti-inflammatory response in the body may benefit patients with endometriosis. They include:
Colorful fruits and vegetables, such as oranges, berries, spinach, and beets
Legumes, and whole grain
Oily fish like salmon
Walnuts, chia, and flax seeds
Vitamin A, C, E, D, calcium and magnesium
What is the latest scientific evidence as of 2021?
Studying the cause-effect relationship between foods and disease is very complicated and difficult as it is not easy to restrict or control patients on the intake of certain foods. Most studies of the effects of nutrition on endometriosis are based mainly on observational and animal studies with very few well controlled randomized trials. The numbers of subjects are usually small and the results are often difficult to replicate. Although there appears to be a link between diet and endometriosis, the evidence is still inconclusive at present. Further well-designed trials are needed to accurately determine the influence of diet on endometriosis.
Some studies have advocated diets excluding certain food products e.g. grains and dairy. This may result in nutritional deficiencies if the nutrients are not adequately replenished. Furthermore, adherence to a certain diet can be costly and failure to adhere to it can cause patients feeling stressed and guilty.
It should be noted that foods that purportedly impact endometriosis positively are healthy foods. They may relieve the symptoms but not the progression of the disease. Besides, they may not work for every patient. At present, no universal dietary intervention has been proposed and patients are advised to eat a well-balanced healthy diet.
G appeared to be happy with my explanation and was referred to the dietitian to check her nutritional needs.