Endometriosis diet: What to eat if you have endometriosis

If you have endometriosis, you know it can be frustrating to live with. You also know there’s a lot of information available out there about how to manage it—but what’s really helpful and what’s not?

As a registered dietitian, I’m often asked if any nutrition changes or supplements can make a difference. To answer that question, let’s break down what research currently shows about nutrition for endometriosis.

What foods and supplements can improve endometriosis?

Omega 3 fatty acids

Omega 3 fatty acids are already known to help reduce inflammation, improve HDL cholesterol (the good kind) and protect heart health. Some research also shows that omega 3’s may help in reducing endometrial tissue and endometrial inflammation in the body, especially in those diagnosed with stages 3 or 4. 

Healthy sources of omega 3 fatty acids:

• Some seafood (salmon, tuna, pacific oysters, trout, sardines, herring, swordfish, anchovies, mussels, mackerel)
• Nori (seaweed)
• Walnuts
• Some seeds (flax seeds, chia seeds, hemp seeds, pumpkin seeds)
• Canola oil
• Soybeans
• Some fortified foods (eggs and vegan products)

Increased protein variety

Research has shown that many westernized diets have increased amounts of saturated and trans fats and not enough omega 3’s and unsaturated fats. Red meat in particular may increase estradiol and estrone sulphate levels, which can impact steroid hormone concentrations (aka estrogen) and disease maintenance.

Getting a variety of protein sources (both animal and plant based) and a variety of fats can help ensure balance and potentially decrease endometriosis progression. Opt for these protein sources:

• Chicken
• Turkey
• Fish
• Shellfish
• Beef
• Pork
• Beans
• Peas
• Nuts and seeds
• Dairy and eggs
• Soy products (tofu, tempeh, TVP)
• Seitan
• Protein powders
• Other vitalized wheat gluten products

Vitamin D

Research has shown those with autoimmune diseases tend to be deficient in vitamin D. This in itself can lower immunity in the human body. Research specifically in endometriosis has seen that vitamin D supplementation may also reduce inflammation and endometrial lesions.

Food sources of Vitamin D include:

• Salmon, tuna, mackerel,
• Irradiated (UV treated) mushrooms
• Fortified dairy and non-dairy milks (check the food label)
• Fortified OJ, yogurts and cereals (check the food label)
• Sunlight
• Egg yolks
• Cheese

N-acetylcysteine (NAC)

NAC comes from the amino acid L-cysteine and is an approved drug by the FDA often used for acetaminophen overdose. It is also seen as an important compound that helps produce the antioxidant glutathione, which may be helpful for DNA health and cancer prevention.

In endometriosis research, human trials have seen a reduction in endometrial cysts when taking NAC. NAC is not approved for supplemental use since it is an approved drug, but it is found in many supplements. Consuming foods high in cysteine can give a similar effect to taking NAC.

Food sources of cysteine:

• Beans
• Peas
• Peanuts
• Chicken
• Turkey
• Eggs
• Yogurt
• Sunflower seeds
• Cheese

Flavonoids

Flavonoids—which are a type of antioxidant—like quercetin, resveratrol and sulforaphane have been found to positively impact endometriosis. One randomized trial looked at infertile participants with stages 3 and 4 endometriosis. They received supplemented resveratrol for 12-14 weeks and this reduced two inflammatory compounds (TNF alpha genes and vascular endothelial growth factor) within ectopic endometrial tissues when compared to the placebo group. Other studies with quercetin, resveratrol and sulforaphane have been done mainly in animal models, but these studies have shown similar results to the human trial mentioned above.

You can find flavonoids in these foods:

• Resveratrol: blueberries, cranberries, peanuts, red wine, grapes, grape juice, cocoa and bilberries
• Sulforaphane: kale, broccoli, brussels sprouts, cabbage, broccoli and cauliflower
• Quercetin: cherries, berries, apples, citrus, kale, broccoli, scallions, onions, olive oil, olives, tea, grapes, red wine, parsley, sage and garlic

Vitamins C and E

Vitamins C and E are already well known for being antioxidants. Some endometrial research has supported vitamins C and E reducing inflammation, dysmenorrhea and pelvic pain. These studies used supplemental versions of the vitamins, but both of these micronutrients are abundant in food.

Food sources of vitamins C and E:

• Vitamin C: oranges, grapefruit, clementines, red and green bell peppers, kiwi, tomatoes, broccoli, potatoes, strawberries, cantaloupe, passion fruit, guava, goji berries, durian and mango
• Vitamin E: olives, olive oil, avocados, avocado oil, peanuts, seeds, nuts, spinach, broccoli, sunflower oil and safflower oil

Green tea and curcumin

EGCG (a catechin found in green tea) and curcumin (found in the spice turmeric) have both been shown to reduce inflammation in the body. With regards to endometriosis research, only in vitro and animal studies have currently been published, but they have shown improvements in reducing inflammation. Both compounds currently have human trials underway.

So, what can we learn from this?

Eating a variety of foods from all food groups is important. Focus on a balanced diet of proteins, fruits, veggies, whole grains, nuts and seeds. Getting your vitamin D levels checked annually can help prevent deficiency, so ask your doctor about getting them checked at your next visit.

If financial constraints or food access is a concern for you, here are a few tips:

• Canned or frozen produce and proteins are always great options. If you live in a food desert, buying canned foods online may be something to consider. Certain online retailers accept SNAP benefits.
• Consider applying for food stamps (SNAP).
• Seek help from food pantries and other food assistance programs like Brighter Bites.
• Look for options in restaurants and convenience stores with fruits, veggies, whole grains, legumes, chicken, turkey, fish or plant-based proteins.

Keep in mind, supplements are not regulated by the FDA and may interact with medications. Make sure to talk with your doctor before taking supplement forms of any of these nutrients. Unless supplementation is recommended by your doctor, all of these nutrients listed above are available in foods and easy to include in your daily diet.

Questions about nutrition? Find a registered dietitian near you.