While Heal with Haley has taken on new life in my endometriosis and creative journeys, my roots on this blog are in eating disorder recovery. If you read my recent blog post, you know that I recently suffered an orthorexia relapse triggered by my endo diagnosis. That brings me to the topic of this blog post…. do you really need to restrict what you eat with endometriosis?
Of course, my answer — as someone in E.D. recovery — is that you should never need to restrict what you eat. But, I also understand that when you have endometriosis, like I do, and are experiencing chronic pain, you’re willing to do anything to feel better, including give up your favorite foods.
People who follow a strict endo diet often quote evidence showing that foods like gluten and dairy are inflammatory, and inflammation plays a big part in endometriosis. Even so, there’s little evidence to show, specifically, that avoiding certain foods improves endo symptoms.
So, what’s the deal? Should you really be avoiding gluten and dairy, like I once did, on the endo diet? Here’s what you need to know about food restrictions and endometriosis.
Do I Need to Avoid Gluten and Dairy with Endometriosis?
If you have endometriosis, you’ve likely heard of the “endo diet.” As far as I’m able to tell, the endo diet is not a legitimate medical intervention. Instead, it seems to be based on this book, The 4-Week Endometriosis Diet Plan, by Katie Edmonds, NTC.
Katie runs a blog called Heal Endo and sells coaching for womxn with endo (her list is currently full). But the problem I have with the endo diet isn’t with Katie herself. It’s with large groups of womxn following nutrition recommendations by someone without real credentials.
NTC is, technically, a “credential,” but it stands for Nutritional Therapy Consultant. The credential is overseen by the Nutritional Therapy Association. There are no prerequsites (i.e. no need for an undergraduate degree in the sciences). Anyone can sign up for $4,000, and anyone can earn the credential with an 80% on the exam. You can actually access a sample reading list — which, by the way, has no books by M.D.s or D.O.s (a.k.a. medical doctors) on the list — and get access to everything they learn in the program for free.
I’m not here to rip on individuals who get the NTC certification, but I am here to call out the fact that “nutritional therapy” is rooted in pseudoscience. This becomes problematic when it sends a ripple of orthorexia through the endo community. The idea of the “endo diet” has sparked a harmful (in my opinion) belief within the endo community that gluten and dairy should be considered off-limits. In reality, the relationship between endometriosis and diet is much more complicated, and cannot be boiled down to a single “endo diet.”
Most studies investigating food and endo (like this one and this one) produced results that were either inconclusive or could not be replicated. But there are a few things the research has taught us. In many cases, it doesn’t back up the extreme restriction supported by the endo diet. Here are some sample studies and the conclusions they drew about endometriosis and food:
- Hansen and Knudsen (2013) evaluated 12 studies examining a total of 74,708 women. They found that consuming fewer trans fats and more omega-3 fatty acids lowered the risk of developing endometriosis.
- Parazzini et. al. (2013) conducted a meta-analysis of 11 studies. They found that while women with endometriosis appear to consume less omega-3 fatty acids and vegetables, and more red meat, coffee, and trans fats, these findings could not be consistently replicated.
- Trabert et. al. (2010) studied 660 women between the ages of 18 and 49 with newly diagnosed endo. They found that increased total fat consumption was associated with decreased endometriosis risk. While not statistically significant, the study results also suggested that consuming dairy actually decreased the risk of developing endometriosis.
- Parazzini et. al. (2004) studied 504 women with laparoscopically-confirmed endometriosis. They found that a higher intake of fresh fruits and leafy greens, and a lower intake of red meat, reduced the risk of endometriosis. They did NOT find a statistically significant link between consuming dairy, coffee, fish, raw carrots (commonly touted as an estrogen-absorbing food), or whole grains and developing (or not developing) endometriosis.
- Marziali et. al. (2012) found, in a study of 207 patients with chronic pelvic pain, that 75% reported reduced pain, better mental health, and increased functioning on a gluten-free diet.
- Marziali and Capozzolo (2015) found in another study of 300 women with a definitive diagnosis of deep infilitrating endometriosis (DIE) that a majority reported improved pelvic pain on a gluten-free diet.
In short, we have evidence to show that fresh fruits and veggies, and omega-3 fatty acids, can prevent endometriosis, and that trans fats and red meat can increase your risk. We also have limited evidence to show that some womxn with endo may be gluten-intolerant, but we do NOT have any evidence to show that you shouldn’t eat dairy, nightshades, or any other category of “inflammatory” foods. And, we know from other studies that consuming gluten-free products when you aren’t gluten-intolerant or celiac can actually harm your nutritional health.
As someone who’s fallen for pseudoscience in the past, I’m not here to shame you. I get it: the temptation to do anything, try anything, that might relieve your pain can be overwhelming. And there is some truth to the idea that science can’t tell us everything. But if you’re going to undertake a restrictive diet for endometriosis, you should understand that the risk to your mental health when you fall for diet culture is as important as how well you feel physically without certain foods. To boil it down to one sentence, the “endo diet” is not evidence-based medicine, and may actually put you at risk for disordered eating.
So, if the endo diet isn’t supported by research, then whose advice should you trust? My advice is to find an endometriosis specialist (an M.D. or D.O.) and/or registered dietician (R.D.) YOU trust. Speak to them first before making any dietary or lifestyle changes, but also don’t be afraid to trust your gut. If you feel better on a gluten-free or dairy-free diet, go for it. But, if you’re considering cutting foods out of your diet for endometriosis, consider the effect on your mental health as well as your physical wellness when evaluating whether it’s worth it.
What I Eat in a Day (with ZERO Restrictions)
Now that we know how I feel about the endo diet — what, exactly, do I eat for my endometriosis? In short, I try to follow an overall healthy diet. To me, that means ZERO restrictions, because mental health is just as important as physical health!
Right now, I’m focusing on low-fat foods at the recommendation of my doctor, due to some liver test results I received at my annual physical, but I view that as a lifestyle change rather than a true “restriction.” I still drink half-and-half in my coffee and eat a buttery chocolate croissant from my favorite bakery once or twice a week.
While I’m still lactose intolerant and have non-celiac gluten sensitivity (NCGS), I’ve loosened my restrictions around gluten. I now include small portions of my favorite foods, like Goldfish, that I can tolerate (hot tip: sprouted grain bread and sourdough are easier to digest!), and take Lactaid whenever I want to eat dairy products.
As for my vegetarianism, I regretfully have given it up. I say regretfully because I truly undertook it for ethical reasons. However, I made the conscious choice to begin eating meat again when I realized how stressful meal-planning had become for me. As someone in eating disorder recovery, I feel that food should be easy, and finding new vegetarian recipes that sounded good to me was becoming a chore.
If you’re looking for ideas for healthy meals you can eat on an “endo diet” without restrictions (and without stress), then keep reading to check out some examples of what I eat in a day:
- Oatmeal with peanut butter and strawberries
- Smoothie with frozen fruit, peanut butter, and Lactaid milk
- Half a turkey, swiss, lettuce, and mayo sandwich on gluten-free or sprouted-grain bread, with low-sodium vegetable soup, or a whole sandwich by itself
- Trader Joe’s premade salads: I like the Chinese chicken, spicy broccoli slaw, and edamame and cranberry ones
- One-pan roasted chicken breast, carrots, and potatoes with butter and rosemary
- Green goddess turkey burgers with a side salad made from lettuce, feta cheese, bell peppers, and cucumbers
- Blue corn chips and Trader Joe’s reduced fat guacamole dip
- Whole-grain Goldfish crackers
- KIND bars: I like the cherry chocolate cashew and chocolate cinnamon pecan flavors best
- Part-skim string cheese
- Microwave popcorn: the light butter flavor is my favorite
- Yasso frozen Greek yogurt pops: my favorite is mint chocolate chip