Welcome to Part II of our series on Endometriosis and Fertility. Last week we explored the basics of what this condition is and how it affects our ability to conceive. This week we explore practical strategies for managing endometriosis and improving fertility potential by discussing how diet can make things better or worse.
Now… perhaps you clicked on this blog post because you thought it would provide you with a definitive list of food do’s and don’t – one diet to rule them all! Well, I hate to disappoint, but there is no such thing (and if anyone tells you there is, you should run in the other direction). There is no ONE diet for everyone because not everyone is the same. What may work for one person will not work for another. Our genetics, biology, any imbalances unique to our body, experience, tastes and preferences, values, beliefs, lifestyle – these all play a role in what diet will work best for you and your body. That being said, there are specific trigger foods that have been shown to make symptoms worse for many people. Also there are guiding principles that have shown to help women with endometriosis manage their symptoms.
Before we dive in, I also want to make clear that I believe managing symptoms is only part of the equation. With endometriosis, (as with many conditions), it’s important to address root causes and imbalances. For example, if you find that a specific food triggers your endometriosis (let’s say it’s wheat), then removing wheat form your diet will may decrease your symptoms, but unless you address WHY wheat is a trigger food – whether it’s a depleted immune system, dysbiosis, leaky gut, or a number of other factors – you’ll be destined to keep wheat off your menu forever. Finding and addressing the root causes of inflammatory triggers, therefore, is key for long-term management of endometriosis as a sustainable lifestyle change.
Highly Processed Foods: While it is not true for all, a great deal of processed foods are a mixed bag of inflammatory ingredients. Many contain artificial sweeteners, colours, preservatives, processed sugar, trans fats, refined carbohydrates, gluten, casein, etc… While your body may not react to all of these, there’s a good chance it could react to at least one of these. Whenever possible, its best to stay clear of foods that come in a box. And if you must buy something processed, pay attention to what it says on back of that box. If it has more than a handful of ingredients, and/or has ingredients you cannot read or pronounce, chances are it’s not going to do your endometriosis any favours.
Transfats: Hydrogenated and transfats (aka trans-fatty acids) are highly inflammatory. They can make endometriosis worse by creating an inflammatory response and adding to hormone imbalance. These fats are most commonly found in sunflower oil, deep fried foods (like fries, chips, etc…) and are hidden in many processed foods.
Processed Sugar: Another highly inflammatory food is processed or white sugar. The obvious places you’ll find this are cookies, cakes, pastries, and candies. But don’t forget all of the hidden places too like ketchup, soups, sauces, and processed carbs. Sugar is a major trigger food for endometriosis for several reasons. Besides its immediate inflammatory response, it can also lead to long-term complications like insulin-resistance, decrease liver detoxification, increased estrogen production, ad decreased progesterone production.
Nightshades: Nightshade foods are food that grow at night, by the light of the moon (I know, cool right?) The most common foods in this group (this is not a complete list) area: potatoes, eggplant, peppers, and tomatoes. For most people, these are perfectly notorious and healthy food choices. However, for some, particularly people with digesting imbalance, they can trigger an inflammatory response.
Gluten and/or Wheat: The number of people in North America with non-celiac gluten sensitivity continues to grow each year. The theories as to why that is vary but it has a lot to do with the fact that the gluten grains today (particularly wheat) are not farmed the same way that they were a couple of generations ago. Between GMO grains, and some specific pesticides that are used, and other factors, these grains can cause an inflammatory response in some people, which is increasingly common with people with endometriosis. If you suspect this may be the case for you, you may want to try some other grain options. Start with other gluten, non-wheat grains like barley or rye. If that still gives you trouble, try completely gluten-free options like wild rice, amaranth or quinoa.
Diary: Eating dairy does not cause issues for all women with endometriosis, but it has shown to be a problem for many, so it is important to know your body and identify if this is a trigger food for you. Keep in mind, daily intolerances can be caused by either a lactose intolerance or casein intolerance. Lactose is a sugar found in milk, while casein is a protein. If lactose is the issue, there is lactose-free milk. If casein is the problem, there are dairy options which are less inflammatory than others. Most of the milk found in stores contains both A1 and A2 casein. A1 is the one that can cause an inflammatory response, however A2 does not. There are some cow milk’s that you can buy with contain just A2 casein (these are also referred to as “jersey cows”). If that is challenging, goats and sheep’s milk are also A2 only dairy options. As are dairy alternatives like nut and seed “milks” (almond milk, coconut milk, cashew milk, etc…)
Soy: The soybean is another food that’s developed a bad rap. But soy is not evil. If it were, all women in Japan would have hormone imbalances and fertility issues. What’s important to know about soy is that not all of it is created equal. Some soy products, like raw soybean, and fermented soy (like tempeh and miso), can be perfectly fine. It is PROCESSED soy (or rather, over-processed soy) which tends to give people the most trouble. Processed soy strips the soybean of its fiber and nutrients, and what’s left is a molecule which can bind to the estrogen receptors in our bodies. This can create an imbalance of estrogen in relation to progesterone. For women with estrogen-receptor endometriosis, this can be particularly troublesome.
Grain-Fed Meats: Conventionally farmed beef, chickens and other animals can be fed grains that contain gluten, and or soy. For women who are particularly sensitive to these ingredients (for the reasons listed above), it is best advised to stick to grass-fed, free-range and organic meat and eggs.
Legumes: Some women with endometriosis report their symptoms can get worse when eating legumes (beans & peas). Some believe this is because many legumes contain something called “lectins” which can can be difficult to digest and can create an inflammatory response in some people. That being said, in most cases, the hard-to-digest properties of lectins can be removed if the food is properly prepared. In the case of almost all legumes (and whole grains for that matter), it is best practice to soak them before cooking them. That means taking the dry beans, washing them and soaking them in water overnight. The next day, disposing of the soak water before cooking them. It also means making legumes from scratch (from the dry bean) not out of a can. Canned beans are pre-cooked and are rarely (if ever) soaked by the manufacturer.
So with all of these no-go foods, what is there left to eat? Lots! There are so many healthy, anti-inflammatory whole foods that can help to manage endometriosis and support your fertility potential. As a simple guideline, prioritize the following 10 food groups/types:
Now that we’ve covered the basic do’s and don’t of what may be triggering, and which foods to focus on, let’s explore some guiding principles for how to use this information to create sustainable, long-term change in your life.
When it comes to endometriosis, reducing inflammation is the #1 factor when it comes to managing symptoms. For that, it’s important not just to eat anti-inflammatory foods, but also to remove foods that trigger an inflammatory response. As I mentioned earlier, while some foods (like trans fats, processed sugar) will cause inflammation for everyone, many other foods (like dairy, gluten and/or wheat, nightshades, etc…) will be triggering for some, and perfectly fine for others. It is important to respect your biodiversity and find out what foods YOU should avoid.
The easiest way to do this is with an elimination diet. Make a list of all of the POSSIBLE trigger foods for you, then remove them completely from your diet. After a couple of weeks, start to introduce them one at a time. First introduce one food on your list, wait 3 days (minimum) and make notes about how you feel in a food journal. After 3 days, add another food. After another 3 days, another food, etc… If you notice any symptoms along the way, do not continue eating that food before adding a new one. You can do this on your own. Working with a nutritionist can also help you with this process and can allow you to do further in depth with your investigative journey.
A fertile body is a nourished body. By filling your plate with quality, nutrient-dense foods, you are increasing the number of vitamins, minerals and other nutrients vital for fertility. Prioritizing quality means focusing on whole foods like fresh fruits and vegetables, whole grains, legumes (for some), nuts and seeds. If eating dairy (in moderation), buying grass-fed (ideally A2 casein dairy). If eating eggs, choosing free-range organic. If buying meat, choosing local, hormone free, grass-fed (if talking about beef), free-range (if talking about chickens), wild caught (if talking about fish). Remember, choose whole, fresh, local, and organic whenever possible.
As I mentioned earlier, removing trigger foods is only part of the equation. Identifying imbalances and working with a professional to address those imbalances over time. The most common imbalances that I help clients who suffer from endometriosis in my practice include digestive imbalance (most commonly candida and/or leaky gut), histamine intolerance, estrogen dominance, and decreased liver function or “lazy liver”, amongst others. If you think working with a nutritionist can help you to address your imbalances, I encourage you to contact me for a free assessment.
I find that the word “craving” has earned a bad rap, but cravings are not always a bad thing. Sometimes cravings are our bodies way of telling us that we are depleted in some macro or micro nutrient. For example, if you are suddenly craving cookies, maybe your brain is feeling depleted and is in need of some carbs (it’s preferred energy source) in which case reaching for some complex carbohydrates is the right choice. If you are craving chocolate, maybe your body is depleted in magnesium - which is highly common in times of stress. If you are suddenly craving a steak, it’s possible you are low in iron and/or protein. The point is, do not brush off cravings. Try to listen and understand what your body may be telling you, and then try to make healthy choices based on that information.
The fastest and surest way to fail is to strive for perfection. Eating perfectly all the time is just not realistic. There will be birthdays, office parties, holidays, and days you fall off the wagon just because. It’s life. Your best chance at success is to embrace progress over perfection and as a guideline, aim for the 80:20 rule – where you try to follow your dietary protocol at least 80% of the time. And most importantly, be gentle with yourself. One of the worst things you can do for your endometriosis is to add additional stress (which has shown in multiple studies to make symptoms worse), so try not to be hard on yourself when you don’t do all the perfect things. We are only human, and no one is perfect. Take it one day at a time, and just do your best.
Finally, remember that these are just guidelines. Everybody is different and needs will vary from one person to the next. That’s why working with an expert can help. If you struggle with endometriosis of fertility challenges connected to endometriosis and are not sure which diet is best for you, I encourage you to reach out to me with questions.
Start at the beginning, with the first part of our series Endometriosis & Fertility; an overview of what this condition is and how it affects fertility.
Ewa Reid is a Registered Holistic Nutritionist, certifying Fertility Support Practitioner, nutrition & fertility educator, wife, and mother. You can learn more about Ewa on our About page.
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