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Endometriosis


Endometriosis is a chronic, painful disease characterized by endometrial tissue growing outside the uterus. Dietary strategies to reduce oxidative stress, inflammation, and estrogen exposure may improve symptoms.

 

Overview

Endometriosis is a chronic disease characterized by endometrial tissue growing outside the uterus, such as in the ovaries, Fallopian tubes, ligaments supporting the uterus, or elsewhere. It can lead to pelvic pain, fatigue, impaired fertility, and digestive symptoms.  Endometriosis is estimated to affect 10 to 15% of women of reproductive age.1

The causes of endometriosis and how it develops are not completely understood. However, oxidative stress and inflammation are known contributors. Endometriosis is an estrogen-dependent condition, as estrogen is a growth-promoting signal for endometrial tissue. Having low levels of progesterone available to oppose the growth-promoting actions of estrogen may also contribute to endometriosis. Genetic factors are also involved.1 In addition, higher consumption of red meat and saturated fats is associated with a greater risk of endometriosis.2

Over-the-counter pain medication, hormonal treatments, and surgery are the conventional treatments for endometriosis. However, studies suggest that more than half of patients continue to have painful symptoms despite treatment.3 Although very few randomized controlled trials on diet have been conducted in endometriosis, the available evidence suggests dietary strategies to reduce oxidative stress, inflammation, and estrogen exposure may improve symptoms.3,4

Despite limited scientific research on the nutritional treatment of endometriosis, I have treated scores of women suffering with this condition with excellent results.  Most sufferers have been able to completely resolve their endometriosis symptoms within one year of initiating this protocol.  

 
References
  1. Tsamantioti ES, Mahdy H: Endometriosis. In StatPearls. Treasure Island (FL) 2024
  2. Arab A, Karimi E, Vingrys K, et al. Food groups and nutrients consumption and risk of endometriosis: a systematic review and meta-analysis of observational studies. Nutr J 2022, 21:58.
  3. Barnard ND, Holtz DN, Schmidt N, et al. Nutrition in the prevention and treatment of endometriosis: A review. Front Nutr 2023, 10:1089891.
  4. Nirgianakis K, Egger K, Kalaitzopoulos DR, et al. Effectiveness of Dietary Interventions in the Treatment of Endometriosis: a Systematic Review. Reproductive Sciences 2022, 29:26-42.

Action Plan

Diet

  • The Nutritarian diet is based on foods that are  high in fiber, high in antioxidants, and have anti-inflammatory effects. 
  • Estrogen is produced by the ovaries and fat tissue, and endocrine-disrupting chemicals can have estrogen-like effects. Increasing the intake of fiber-rich foods helps reduce circulating estrogens by removing it via the digestive tract.1-3 Soluble fiber, as found in foods such as beans, chia seeds, and flax seeds, may have additional beneficial effects on estrogen metabolism.4,5 This protocol uses a tablespoon of these ground seeds twice daily. 
  • Excess fat tissue produces estrogen and pro-inflammatory cytokines. Reaching a healthy weight will reduce the contribution of fat tissue to estrogen exposure and reduce inflammation. Achieve one’s ideal weight is necessary for improvement and resolution of symptoms. 
  • Cruciferous vegetables, minimally processed soy (yellow soybeans, edamame, tempeh), flax and chia seeds, and mushrooms all contain phytochemicals that oppose estrogen activity.6-12
  • Although it is impossible to avoid all endocrine-disrupting chemicals in the environment, minimizing animal foods, plastic food packaging, and fragranced personal care products reduces your exposure to these substances.13-16
  • Avoid alcohol. There is evidence that alcohol raises estrogen levels.17
     

Supplements

  • •Omega-3 fatty acids are important for regulating the body’s level of inflammation. A higher intake of long-chain omega-3 fatty acids (DHA and EPA) is associated with a lower risk of endometriosis.18  We strive for an omega-3 index between 6 and 8, and utilize a plant-based DHA-EPA that is refrigerated for freshness. 

  • Patients with endometriosis often have lower vitamin D levels than control groups, and lower vitamin D levels correlated with greater endometriosis severity.19 

  • Dr. Fuhrman’s general supplement protocol for adults (see Vitamin Advisor for details) includes:

 
References
  1. Aubertin-Leheudre M, Gorbach S, Woods M, et al. Fat/fiber intakes and sex hormones in healthy premenopausal women in USA. J Steroid Biochem Mol Biol 2008, 112:32-39.
  2. Aubertin-Leheudre M, Hamalainen E, Adlercreutz H. Diets and hormonal levels in postmenopausal women with or without breast cancer. Nutr Cancer 2011, 63:514-524.
  3. Goldin BR, Adlercreutz H, Gorbach SL, et al. Estrogen excretion patterns and plasma levels in vegetarian and omnivorous women. New England Journal of Medicine 1982, 307:1542-1547.
  4. Haggans CJ, Travelli EJ, Thomas W, et al. The effect of flaxseed and wheat bran consumption on urinary estrogen metabolites in premenopausal women. Cancer Epidemiol Biomarkers Prev 2000, 9:719-725.
  5. Kasim-Karakas SE, Almario RU, Gregory L, et al. Effects of prune consumption on the ratio of 2-hydroxyestrone to 16alpha-hydroxyestrone. Am J Clin Nutr 2002, 76:1422-1427.
  6. Monteiro R, Azevedo I, Calhau C. Modulation of aromatase activity by diet polyphenolic compounds. J Agric Food Chem 2006, 54:3535-3540.
  7. Williams DE. Indoles Derived From Glucobrassicin: Cancer Chemoprevention by Indole-3-Carbinol and 3,3'-Diindolylmethane. Front Nutr 2021, 8:734334.
  8. Sturgeon SR, Heersink JL, Volpe SL, et al. Effect of dietary flaxseed on serum levels of estrogens and androgens in postmenopausal women. Nutr Cancer 2008, 60:612-618.
  9. Adlercreutz H. Lignans and human health. Crit Rev Clin Lab Sci 2007, 44:483-525.
  10. Adlercreutz H, Bannwart C, Wahala K, et al. Inhibition of human aromatase by mammalian lignans and isoflavonoid phytoestrogens. J Steroid Biochem Mol Biol 1993, 44:147-153.
  11. Low YL, Dunning AM, Dowsett M, et al. Phytoestrogen exposure is associated with circulating sex hormone levels in postmenopausal women and interact with ESR1 and NR1I2 gene variants. Cancer Epidemiol Biomarkers Prev 2007, 16:1009-1016.
  12. Messina M. Soy and Health Update: Evaluation of the Clinical and Epidemiologic Literature. Nutrients 2016, 8.
  13. Schecter A, Haffner D, Colacino J, et al. Polybrominated diphenyl ethers (PBDEs) and hexabromocyclodecane (HBCD) in composite U.S. food samples. Environ Health Perspect 2010, 118:357-362.
  14. Stadion M, Hackethal C, Blume K, et al. The first German total diet study (BfR MEAL Study) confirms highest levels of dioxins and dioxin-like polychlorinated biphenyls in foods of animal origin. Food Chem X 2022, 16:100459.
  15. Muzeza C, Ngole-Jeme V, Msagati TAM. The Mechanisms of Plastic Food-Packaging Monomers' Migration into Food Matrix and the Implications on Human Health. Foods 2023, 12.
  16. Martina CA, Weiss B, Swan SH. Lifestyle behaviors associated with exposures to endocrine disruptors. Neurotoxicology 2012, 33:1427-1433.
  17. Hartman TJ, Sisti JS, Hankinson SE, et al. Alcohol Consumption and Urinary Estrogens and Estrogen Metabolites in Premenopausal Women. Horm Cancer 2016, 7:65-74.
  18. Missmer SA, Chavarro JE, Malspeis S, et al. A prospective study of dietary fat consumption and endometriosis risk. Hum Reprod 2010, 25:1528-1535.

Qiu Y, Yuan S, Wang H. Vitamin D status in endometriosis: a systematic review and meta-analysis. Arch Gynecol Obstet 2020, 302:141-152.

Ask The Doctor

The following are sample questions from the Ask the Doctor Community Platinum and higher members can post their health questions directly to Dr. Fuhrman. (All members can browse questions and answers.)

Q.

I have severe endometriosis. I do eat well but admittedly dairy, a bit of oil, alcohol and caffeine do slip in on a daily basis. Through a cleaner diet and some supplements and yoga, I feel that I have managed the symptoms of this condition somewhat though PMS still comes back with a vengeance every month.

My question to you is if you have evidenced recovery from this condition through your strict nutritional approach (and anything else?).
 

A.

Yes, I have seen patients make amazing strides in this condition. Mostly a raw vegetable-based diet, watching carefully for foods that raise insulin, seems to work the best. That means fruit juice, dried fruits, and bread, potato and rice are contraindicated, mostly staying slim with raw veggies, nuts, beans and steamed greens mushrooms and onions. Cruciferous vegetables aid in the conversion of estrogen from its endometriosis-promoting form to a beneficial form. Lose weight to lower your estrogen.  Alcohol has to be avoided too.

 
Women's Health

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