What is Endometriosis?

Endometriosis (or endo) is a chronic inflammatory condition that affects around 1 in 7 people assigned female at birth. It occurs when tissue similar to the lining of the uterus grows in other places around the body. Symptoms can vary between each person; no-one with endometriosis will experience it the same way. However, some commonly reported symptoms associated with endo includes heavy periods, pelvic pain, fatigue, bloating and bowel changes, low mood or depression and some may experience infertility.

With limited research into the disease, many people who live with endo have had their experiences dismissed or invalidated by their trusted health professionals, leading to a delayed diagnosis of 7-10 years. 

There is currently no cure for endometriosis but there are ways you can nourish yourself to feel and manage better!

Endometriosis as a Risk Factor for Eating Disorders

A recent study showed that womxn with endometriosis had a 3 times higher risk of developing an eating disorder1. The onset of eating disorders may be related to a range of complex factors associated with endo. Genetics is one factor found to contribute to this increased risk and is also linked with other mental health conditions faced by those living with endometriosis, including anxiety and depression. 

Nutrition Misinformation

There is a lot of harmful nutrition misinformation floating around on social media, and sometimes unfortunately, these messages can be reinforced by health professionals. Oversimplified dietary advice and nutrition misinformation has been marketed as a “cure” to endometriosis. You may have heard things like:

• Cut out gluten because the body can’t digest it,

• Remove dairy as it is “inflammatory”, 

• Follow this restrictive diet (e.g. Low Carb or Low FODMAP) and your symptoms will be gone. 

The avoidance of foods and food groups along with the increased stress of preventing symptoms flare ups can lead to eating disorders as a means to control or prevent flares. 

IBS and Endometriosis combined 

IBS is also very tightly linked with endometriosis. There is a 3 times higher risk of developing IBS in those living with endo2. IBS presents unique challenges that can contribute to the development or trigger pre-existing eating disorders. Uncomfortable gut symptoms like bloating can lead to poor body image and result in dietary restriction to prevent IBS symptom flares. The low FODMAP diet, whilst one way to manage IBS, is a restrictive elimination diet that may trigger symptoms when reintroducing foods back into the diet. This further reinforces the idea that restriction is a way to manage symptoms and can spiral into disordered eating behaviours and eating disorders. 

Side Effects of Endometriosis 

 Body changes related to hormonal treatments, fatigue, and chronic pain limiting daily activities can impact body image and ultimately lead to engaging in disordered eating behaviours. Endo can often leave you feeling helpless, or like your body isn’t your own, so turning to restrictive eating can be a way to attempt to regain control over your body. 

How to Manage Endometriosis whilst Maintaining a Positive Relationship with your Food and Body

Nutrition can be a helpful tool in managing endo symptoms, but it is definitely not a cure (you should run far away from anyone who claims it is). Adopting an individualised, non-diet approach to endo management can help to ease symptoms, improve quality of life, and prevent the onset of eating disorders. Here are some strategies that have been shown to be helpful for those living with endometriosis:

• Eating Regulary: Ever heard of the term “if you don’t use it, you lose it?” Well this can be applied to our gut function. Our gut is a muscle, so if we aren’t feeding it regularly, it can decrease our ability to digest foods well, leading to bloating, pain, discomfort and even nausea. Eating enough food and often can train our gut to work well and overtime will ease gut discomfort associated with restrictive eating. 

• Eating Adequately: A nourished brain and body are a happy brain and body! Getting enough nutrition to meet our body needs helps to maintain its usual functions and signals to our body that we’re safe. This means that our energy is used more efficiently, our hormones can stabilise and our nervous system regulates to help us function at our best. 

• Adding anti-inflammatory foods: foods with anti-inflammatory properties can help to reduce pain and inflammation associated with endo.

• Olive oil contains a compound called oleocanthal that has similar effects in the body to ibuprofen, a pain medication used to treat pain and inflammation3. 

• Omega 3 fatty acids found in oily fish and some plant foods including chia seeds and walnuts can help with pain management and have proven benefits for mental health. 

• Working 1:1 with a dietitian to make sure your individual needs are met, taking into account any history of restrictive dieting/disordered eating behaviours, food allergies or intolerances, or other medical conditions, all in a safe and supportive environment. 

You deserve to manage your symptoms without being sold empty promises that are tied to diet culture! 

References:

1. Koller D, Pathak GA, Wendt FR, et al. Epidemiologic and Genetic Associations of Endometriosis With Depression, Anxiety, and Eating Disorders. JAMA Netw Open. 2023;6(1):e2251214. doi:10.1001/jamanetworkopen.2022.51214 (https://jamanetwork.com/journals/jamanetworkopen/article-abstract/2800556)

2. Salmeri N, Sinagra E, Dolci C, Buzzaccarini G, Sozzi G, Sutera M, Candiani M, Ungaro F, Massimino L, Danese S, Mandarino FV. Microbiota in Irritable Bowel Syndrome and Endometriosis: Birds of a Feather Flock Together-A Review. Microorganisms. 2023 Aug 15;11(8):2089. doi: 10.3390/microorganisms11082089. PMID: 37630649; PMCID: PMC10458414. (https://pmc.ncbi.nlm.nih.gov/articles/PMC10458414/)

3. Lucas L, Russell A, Keast R. Molecular mechanisms of inflammation. Anti-inflammatory benefits of virgin olive oil and the phenolic compound oleocanthal. Curr Pharm Des. 2011;17(8):754-68. doi: 10.2174/138161211795428911. PMID: 21443487. (https://pubmed.ncbi.nlm.nih.gov/21443487/)