Keto Diet And Endometriosis: Is There A Link?

Endometriosis is a chronic inflammatory condition that affects the uterus and other organs in the body. It is a painful condition that can cause infertility and severe pain. The exact causes of endometriosis are not well understood, and there is currently no cure. However, dietary changes have been shown to help alleviate symptoms.

Some women with endometriosis have reported improvements in their symptoms by following a keto diet. The keto diet is a low-carb, high-fat diet that can help reduce inflammation in the body. For example, one woman with severe endometriosis reported that after starting the keto diet, her pain disappeared and her swelling went away. She also lost weight and felt better overall.

Other diets that have been reported to help with endometriosis symptoms include the anti-inflammatory diet, the Mediterranean diet, and the gluten-free diet. These diets focus on reducing inflammation and including more anti-inflammatory foods, such as fruits, vegetables, and omega-3 fatty acids.

It is important to note that dietary changes may not work for everyone with endometriosis, and more research is needed to understand the specific dietary interventions that can help with this condition.

The anti-inflammatory diet: reducing inflammation in the body may help relieve endometriosis symptoms

Endometriosis is a chronic, inflammatory, hormone-dependent gynaecological condition that affects 1 in 10 women during their reproductive years. It involves cells similar to the uterine lining growing outside the uterus, attaching to organs and causing inflammation and pain. While there is no cure, an anti-inflammatory diet may help to reduce symptoms.

What to eat

An anti-inflammatory diet for endometriosis should include:

• Leafy greens and colourful fruits and vegetables, which are packed with antioxidants that help to lower oxidation, a process in the body that leads to inflammation.
• Nuts and seeds, which are full of nutrients like vitamin E and zinc, which help to reduce inflammation and balance hormones.
• Omega-3 fatty acids, which can be found in fatty fish, nuts and seeds, and plant oils. Omega-3s have been shown to ease painful periods and reduce pain and the size of lesions in mice.
• Monounsaturated fats, found in nuts, seeds, olive oil, avocados and coconut oil.
• Whole grains, such as buckwheat, amaranth, teff, quinoa and gluten-free oats, which are rich in anti-inflammatory and hormone-supportive nutrients.
• Wild-caught fish, organic eggs, beans and legumes, and moderate amounts of grass-fed, organic animal meat.
• Herbs and spices, especially turmeric and ginger, which have been shown to aid with endometriosis and painful periods.

What to avoid

To reduce inflammation and balance hormones, it's best to avoid:

• Sugar and alcohol, which can cause further inflammation and hormonal imbalances that can worsen symptoms.
• Gluten, which has been linked to increased pain in women with endometriosis.
• Red meat, which has been associated with an increased risk of endometriosis.
• Processed foods, which are often high in sugar, saturated fat and trans fat, and low in fibre, zinc, magnesium and healthy fats.

Other tips

• Keep a food journal to help identify any foods that trigger symptoms.
• Consider meeting with a registered dietitian to develop a personalised meal plan.
• Try a low-FODMAP diet, which has been shown to improve symptoms in some women with endometriosis.
• Take supplements like vitamins C, E and D, curcumin, and calcium and magnesium, which may help to reduce inflammation and pain.

The gluten-free diet: removing gluten from the diet has been linked to a reduction in pain symptoms

Gluten is a type of protein found in grains such as rye, barley, and wheat. It is present in most bread, pasta, and other baked goods unless they are labelled gluten-free. Gluten intolerance or sensitivity can cause inflammation and pain, particularly in the hands and feet.

A gluten-free diet is the only effective treatment for celiac disease, but it may also benefit other ailments. A 2018 preliminary study by the American Academy of Neurology found that a strict gluten-free diet may help protect against nerve pain caused by gluten sensitivity. The study involved 60 people with an average age of 70 who had gluten neuropathy. 55% of the participants were experiencing pain. The study found that those following a strict gluten-free diet experienced an 88.7% to 89% reduction in risk for neuropathic pain.

The study also found that people with painful gluten neuropathy scored significantly worse on mental health assessments. Those with painful gluten neuropathy had an average score of 76, compared to an average score of 87 for those with painless gluten neuropathy. This indicates that a gluten-free diet may not only reduce pain but also improve mental health for people with gluten neuropathy.

Another study found that people with rheumatoid arthritis (RA) may benefit from removing or lowering gluten from their diets. RA is an inflammatory autoimmune disorder that affects the joints. Like celiac disease, RA has been linked to gluten intolerance, and some people may find that eating gluten makes their RA symptoms flare up.

Gluten has also been associated with a variety of other inflammatory illnesses beyond celiac disease, wheat allergy, or gluten intolerance. These include polycystic ovary syndrome (PCOS) and endometriosis. Obesity, which can be caused by a diet high in gluten, is a risk factor for both PCOS and endometriosis.

A gluten-free diet may not be a cure-all, and more research is needed to confirm the link between gluten and pain. However, for people with gluten intolerance or sensitivity, removing gluten from the diet may be an effective way to reduce pain and improve overall health and well-being.

The Mediterranean diet: the anti-inflammatory effects of extra virgin olive oil and fish may help alleviate the inflammatory effects of endometriosis

The Mediterranean diet may be a promising strategy to alleviate the symptoms of endometriosis. The anti-inflammatory effects of extra virgin olive oil and fish, which are key components of the Mediterranean diet, may help reduce the inflammatory effects of endometriosis.

The Mediterranean diet is rich in fruits, vegetables, legumes, and whole grains. It is characterised by a high consumption of extra virgin olive oil and fish rich in fat, and a low consumption of red meat, sweets, and animal fats. This diet has well-known anti-inflammatory effects and is associated with a range of health benefits, including a reduced risk of cardiovascular disease, improved cognitive function, and better overall health and well-being.

A study by Cirillo et al. (2023) found that the Mediterranean diet was associated with a significant reduction in pain in women with endometriosis. The study involved 35 women with endometriosis who were asked to follow the Mediterranean diet for three months. The results showed a significant decrease in pain related to dyspareunia, non-menstrual pelvic pain, dysuria, and dyschezia. The study also found a negative correlation between oxidative stress and pain intensity, suggesting that the anti-inflammatory effects of the Mediterranean diet may play a role in reducing pain.

Another study by Ott et al. (2012) examined the effects of the Mediterranean diet on 68 women with endometriosis. The participants were asked to adhere to a specific nutrition plan that included fresh vegetables, fruit, white meat, fish rich in fat, soy products, whole meal products, and foods rich in magnesium. During the intervention, participants were asked to avoid sugary drinks, red meat, sweets, and animal fats. The study found a significant relief in general pain, dysmenorrhea, dyspareunia, and dyschezia, as well as an improvement in the general condition of the participants.

The anti-inflammatory effects of the Mediterranean diet may be attributed to the presence of omega-3 fatty acids and oleocanthal in extra virgin olive oil and fish. Omega-3 fatty acids are known to have anti-inflammatory properties and can help reduce inflammation associated with endometriosis. Oleocanthal, a compound found in extra virgin olive oil, has a similar structure to ibuprofen and can help inhibit cyclooxygenase, an enzyme involved in pain and inflammation.

In addition to its anti-inflammatory effects, the Mediterranean diet can also provide a eupeptic effect, which can help improve gastrointestinal symptoms associated with endometriosis. The high fiber content of the diet can help regulate bowel movements and reduce constipation, which is a common symptom of endometriosis.

Overall, the Mediterranean diet may be a promising approach to alleviate the symptoms of endometriosis. However, more well-designed randomized controlled trials are needed to accurately determine the short-term and long-term effectiveness and safety of the Mediterranean diet in managing endometriosis.

The low FODMAP diet: removing high FODMAP foods may help to reduce abdominal distension and other symptoms

The low FODMAP diet is a temporary eating plan that helps people with irritable bowel syndrome (IBS) and/or small intestinal bacterial overgrowth (SIBO) figure out which foods are problematic and which foods reduce symptoms. FODMAP stands for fermentable oligosaccharides, disaccharides, monosaccharides and polyols, which are short-chain carbohydrates (sugars) that the small intestine absorbs poorly. The low FODMAP diet is a three-step elimination diet: first, you stop eating certain foods (high FODMAP foods); next, you slowly reintroduce them to see which ones are troublesome; and finally, once you identify the foods that cause symptoms, you can avoid or limit them while enjoying everything else worry-free.

FODMAPs are a problem for some people because they draw more fluid into the intestine and create more gas. The combination of additional fluid and increased gas can slow digestion, resulting in gas, bloating, pain, or diarrhoea. Endometriosis is often misdiagnosed as IBS, and removing high FODMAP foods may help to reduce abdominal distension and other symptoms. The low FODMAP diet is not intended to be a long-term diet, but rather a temporary approach to help manage symptoms while identifying specific FODMAP triggers.

The three steps of the low FODMAP diet are:

• Elimination: In this phase, you eliminate all FODMAP carbs for several weeks. Your symptoms may improve immediately or over several weeks.
• Reintroduction: In this phase, you introduce FODMAPs one at a time to identify which foods you can tolerate and in what amount.
• Personalisation: In this phase, you modify your diet to increase variety while adjusting the type and amount of FODMAP carbs you eat, based on what you learned in the second phase.

High FODMAP foods to avoid include:

• Fructose: Fruits (including apples, mangos, pears, and watermelon), honey, high-fructose corn syrup, and agave.
• Lactose: Dairy (milk from cows, goats, or sheep), custard, yogurt, and ice cream.
• Fructans: Rye and wheat, asparagus, broccoli, cabbage, onions, and garlic.
• Galactans: Legumes, such as beans, lentils, chickpeas, and soybeans.
• Polyols: Sugar alcohols and fruits that have pits or seeds, such as apples, apricots, avocados, cherries, figs, peaches, pears, or plums.

Low FODMAP foods to enjoy instead include:

• Dairy: Almond milk, lactose-free milk, rice milk, coconut milk, lactose-free yogurt, and hard cheeses.
• Fruit: Bananas, blueberries, cantaloupe, grapefruit, honeydew, kiwi, lemon, lime, oranges, and strawberries.
• Vegetables: Bamboo shoots, bean sprouts, bok choy, carrots, chives, cucumbers, eggplant, ginger, lettuce, olives, parsnips, potatoes, spring onions, and turnips.
• Protein: Beef, pork, chicken, fish, eggs, and tofu.
• Nuts/seeds: (limit to 10-15 each) Almonds, macadamia nuts, peanuts, pine nuts, and walnuts.
• Grain: Oats, oat bran, rice bran, gluten-free pasta, quinoa, white rice, and corn flour.

The elimination diet: removing trigger foods may help to reduce inflammation and identify food intolerances

The Elimination Diet: Removing Trigger Foods to Reduce Inflammation and Identify Food Intolerances

The elimination diet is a short-term dietary approach that can be employed to identify and treat food intolerances, allergies, and other disorders. It involves removing specific foods or groups of foods from your diet for a period of time, typically 2-3 weeks, and then slowly reintroducing them one at a time while monitoring for any adverse reactions. This process can help pinpoint which foods may be triggering uncomfortable symptoms such as bloating, gas, diarrhoea, constipation, nausea, rashes, headaches, changes in breathing, and stomach pain or cramps.

The elimination diet has been found to be particularly beneficial for people with irritable bowel syndrome (IBS), a common gut disorder that affects around 11.2% of people worldwide. It can also help with eosinophilic esophagitis, a chronic condition where allergies trigger inflammation of the oesophagus, making it difficult to swallow food. Additionally, the elimination diet may reduce symptoms of attention deficit hyperactivity disorder (ADHD), skin conditions like eczema, and chronic migraines.

The most common foods eliminated during this process include:

• Nuts
• Corn
• Soy
• Dairy
• Citrus fruits
• Nightshade vegetables (tomatoes, peppers, eggplants, white potatoes)
• Wheat
• Gluten
• Pork
• Eggs
• Seafood

It is important to note that restrictive diets can lead to nutritional deficiencies, so it is recommended to consult with a medical professional or dietitian before starting an elimination diet, especially if you suspect a food allergy.

The Elimination Diet and Endometriosis

Endometriosis is a hormone-dependent, chronic inflammatory gynaecological condition that affects reproductive-age women, causing pelvic pain and impacting their physical, mental, and social well-being. It is estimated that endometriosis affects between 6-10% of women. The pathogenesis of endometriosis involves repeated tissue injury and repair, leading to neoangiogenesis (the formation of new blood vessels) and neoneurogenesis (the growth of new nerve fibres). This results in visceral hypersensitivity, where the gastrointestinal nerves exhibit an exaggerated response to inflammatory stimuli.

A connection between dietary factors and endometriosis onset has been suggested due to the influence of diet on the physiological and pathological processes of the disease. Endometriosis is an estrogen-dependent disease, and certain dietary choices can affect insulin and estrogen levels, which in turn impact ovarian function and pain associated with the condition.

The keto diet, a popular dietary approach that involves severely restricting carbohydrates and inducing a state of ketosis, has been anecdotally reported by some individuals with endometriosis to reduce pain and swelling. However, others have found it unsustainable due to its restrictive nature and the potential for nutritional deficiencies.

The elimination diet, on the other hand, offers a more tailored approach to identifying trigger foods that may exacerbate endometriosis symptoms. By removing and then gradually reintroducing specific foods, individuals can pinpoint which dietary choices may be contributing to their discomfort. This process can help reduce inflammation and improve overall wellness in people with endometriosis.

It is important to consult with a healthcare professional before starting any new diet, especially if you have an existing medical condition like endometriosis. Working with a nutritionist or dietitian can help ensure that your dietary choices support your overall health and well-being.

Frequently asked questions