Nutrition/ The “Endo Diet”

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Remember, this is educational information only and not medical advice (and I am not a doctor nor an expert on endometriosis). Always check with your qualified medical professional before making any changes to your treatment plan.

Nutrition/The “Endometriosis Diet”

This page is specific to tips for eating with endometriosis. It’s not meant to feed into diet/wellness culture. I talk here about the toxic beliefs imposed on us by diet/wellness culture, as well as feeling shame and guilt, social determinants of health, and “healthism” in society.

I’ve been following what’s typically considered a restrictive diet for 18 years, since I was 19 years old. I talk about how I’ve embraced my way of eating and improved my relationship with food in my podcast episodes (listed at the end of this page) and in my article Improving My Relationship with Food.

There is no such thing as an Endometriosis Diet.

While there is no such thing as an official “endometriosis diet,” for many people eating an anti-inflammatory diet individually tailored to their needs improves their symptoms and quality of life. This doesn’t mean they become symptom free, but rather that by eating a certain way, they may have less diarrhea, or less fatigue compared to when they eat a different way. For me, food is one of the biggest contributors to my symptoms, so I personally eat the way I do because there is a marked improvement in how I feel: I have more energy and less pain, and I’m less incapacitated by my flares.

What we need is individual. For some people, this could be cutting or limiting out their primary trigger food. For others, it could be improving the overall nutritional quality of their diet. For others, it could be learning to cook.

What is an anti-inflammatory diet?

Some people with endometriosis choose to follow an anti-inflammatory diet, so what exactly is that? Abby Langer is one of my favorite sources of quality info on nutrition, and she has an article on her website called Does the anti-inflammatory diet really exist? It’s in response to a graphic Harvard put up stating that certain foods are anti-inflammatory and others are pro-inflammatory. My understanding of this article is that it’s more about diet and lifestyle pattern than one specific food or another. She says: “What most dietitians and scientists believe to be true is that overall diet – not individual foods – plus good genetics and lifestyle, may predict how much or how little inflammation you have in your body. It’s not that you shouldn’t believe that certain foods may be beneficial. It’s that you should avoid drilling what you eat down into single foods or nutrients.”

Registered dietitian Adrian Chavez, PHD, is also a great resource for dietary guidance. He said on a recent Instagram post:

“Inflammation is a normal process in our body and we can’t eliminate all inflammation. Every food that we eat technically drives some level of inflammatory response when it’s broken down and used for fuel. Diet can contribute to higher levels of inflammation but that depends on a number of factors like overall dietary pattern, total energy consumption, individual immune responses to specific foods. That’s why labeling a food as ‘inflammatory’ makes absolutely no sense.”

A diet high in plants, healthy fats, whole grains, legumes, and fruits, and low in ultra-processed foods and refined carbs is generally considered anti-inflammatory. But the specific foods one eats on this eating pattern will be different to each individual. There are many websites, books, and recipes out there available on eating in an anti-inflammatory way for endometriosis, but remember that there is no correct way to eat with endometriosis. 

Diet culture and demonizing foods

Many people want a list of foods they should eat and should avoid, but no one can tell us that. Unfortunately, diet culture often tells us what is “healthy” or “good” or “bad” for us, but in reality, all foods can be part of a balanced nutrient dense diet because it’s about our overall eating pattern. It’s about what we do consistently: if consistently we are eating nutrient dense foods, but we also eat a serving of desert once a day, then that can still be an overall nutritious diet!

Diet culture has brainwashed us to think this isn’t true because it’s demonized so many foods as “poison”. But we shouldn’t be labeling food as “toxic”, “unclean”, “poison” etc. Some foods that have been incorrectly villianized by diet culture are seed oils, gluten, carbs, dairy, and more.

It’s already hard to eat with chronic illness because many of us have nausea, diarrhea, constipation, pain after eating, and individual food intolerances. So we might already be struggling to eat, and then diet culture incorrectly terrifies us from eating various food groups, and that combo can make it even harder or actually impossible to find something to eat! Even with foods that we know we shouldn’t base our diets on, such as ultra-processed foods, we can still include as part of a balanced, nutritious dense diet. Our health is not going to crumble before our eyes if we occasionally have some cookies or a bag of chips!

Understanding this is vital because it allows for flexibility, gives us permission to enjoy food, and takes the onus off us to meet some made up impossible standard of perfection around eating which only leads to shame and guilt!

Conversely, there are many foods that are nutrient dense, so we don’t need to force ourselves to eat some “superfood” or food deemed as “healthy”, “anti-inflammatory” or “clean” that we don’t like but we think we have to for our health. (“Clean” food also means nothing – this is a wellness culture term.)

What should we eat?

Again, this is individual as there is no correct way to eat with endometriosis. We should look at the whole picture:

  • Are we eating enough?
  • Is the food providing us with enough nutrients?
  • Are we physically and emotionally satisfied with the majority of our meals?
  • Are certain foods causing us symptoms?
  • Do we have disordered eating?
  • Is our way of eating sustainable?

There’s many ways to have a nourishing diet.

I cannot recommend enough the book Good Food, Bad Diet by registered dietitian Abby Langer. It completely rejects diet culture and gives loose guidelines for nutrition and variety that is affordable, accessible, and makes sense. She has an entire section to help us explore our core beliefs around food and chapters on carbs, fats, proteins, beverages, etc.

I particularly loved Abby’s ideas on what she calls high value eating [Source: Good Food, Bad Diet by Abby Langer]:

“High value eating means eating a diet of food that nourishes, not only physically, but emotionally. It satisfies you and makes you happy, and has a zero tolerance for guilt and shame. Instead, high-value eating honors our most primal instinct: to feed ourselves, to gather around food, and to find pleasure in flavor and taste.

A high value meal is satisfying, and it often contains proteins, healthy fats, fiber, and plants. Not always, though: some high value meals contain Oreo cookies and pizza. That’s because high-value eating doesn’t operate from a place of restriction; instead it adds food to your diet and recognizes that some foods may not be the most physically nourishing, but still bring us joy.

I truly believe that we don’t have to stop eating any certain type of food in order to be healthy. When we restrict we just fall hard eventually. So these foods can be consumed responsibly, but are not excluded from our routines. No food is excluded. High value eating doesn’t count calories or macros, or assign labels to food like clean or good. It spits in the face of diet culture and rejects all of its principles. So there!”

(Note that she does say that if you have a medical condition, your doctor or allergist may have recommended cutting out certain foods).

I love her focus on balance and the complete rejection of diet culture. These are some loose guidelines that I’ve understand from following her as well as other registered dietitians:

-To eat whole or minimally processed foods over ultra-processed foods as much as possible. Whole foods are foods in their original natural form like fruits and vegetables, fresh or frozen.

Minimally processed foods have been altered lightly, like hummus, nuts, dairy, canned tuna. Meats/fish, eggs, beans, seeds, spices, herbs, and whole grains are considered whole or minimally processed.

Ultra processed foods have been completely altered from their original ingredients and often have additives (added sugars, fats, flavorings, preservatives, colors, texturizers etc), such as deli meat, crackers, packaged soups, soft drinks, sweetened breakfast cereals, and microwavable meals. Have ultra-processed foods as little as possible, but you don’t need to eliminate them entirely or demonize them.

-Base your meals on protein and plants. Eat a protein source at each meal whenever possible. Eat a wide variety of plant foods.

-Choose whole grains carbs over refined carbs as much as possible. Look for products with a 100% whole-grain on the packaging. Whole grains should be first or second on the ingredients list.

-Eat enough fiber, which is found in foods like vegetables, fruits, nuts, seeds, beans, and whole grains.

What we eat varies depending on our access to food, our budget, our community, our culture, our religion, our preferences, and so much more. Whether we are omnivorous or vegan, whether we follow a Mediterranean diet or a Mexican diet (or any other way of eating), there’s so many ways to have a nutritious and balanced diet, which can include the foods that we love and that are important to our culture. Our way of eating doesn’t have to fit the cookie cutter mold that’s often presented to us by social media. We don’t have to have these diet culture wars about “This is the best way to eat!” “No this is!” Eat lots of plants, but also go ahead and eat deserts and ultra-processed foods occasionally too – don’t build your diet around them, but don’t be scared of them either. This is also going to help us feel emotionally nourished and not deprived, which can help repair our relationship with food as well as sustain our way of eating.

Flexibility is important

Not every meal is going to be nourishing or have vegetables or protein in it. Sometimes we might just be trying to have a warm meal to fill our bellies. Sometimes we’re just trying to eat anything that we can keep down because we’re so nauseous. Sometimes we are going to eat to celebrate, enjoy ourselves, or soothe our feelings. 

The overall goal is to eat in a way that serves our body and helps us feel our best.

Focus on adding foods in vs cutting them out

While we may decide to cut out foods that contribute to our individual symptoms and pain, it’s also important to add in a variety of nutrient dense foods such as a variety of vegetables, adequate protein, and healthy fats so that we are satiated and have energy.

This can help you crowd our your trigger foods or eat less ultra-processed foods since you are eating more of other foods. You may find that by improving the nutritional quality of your diet, you are naturally limiting certain foods and don’t need to cut them out.

When I first changed my diet 18 years ago, I didn’t know how to cook. I was living on pastas, sandwiches, ultra-processed foods, and a lot of packaged foods like crackers, ego waffles, pop tarts, etc. When I cut out gluten, I felt like I was starving because my entire diet was based on gluten. My concept of whole and minimally processed foods was very limited. Even though I didn’t live in a food desert and there was a huge selection available in my local supermarket, I was completely unaware of the majority of foods I eat today: unaware of most salad greens, nuts and seeds, nut butters, different cuts of meat, or the wide variety of fruits and vegetables available.

When I cut out gluten, I had no clue what to eat, and for the first few years, I struggled to eat enough. Suddenly, I was constantly hungry and weak. I wasn’t getting enough nutrients, and I was angry, bitter, and depressed because I felt deprived since everything I ate at that time was gone from my diet. Had I spent 6 months first learning to cook and adding in new foods to my diet, it would have made the transition to being gluten free much easier for me both physically and emotionally.

There’s many ways to add in more variety. There’s fresh, frozen, jarred, and canned (try to find a lower sodium canned veggies and rinse before you use them) fruits and vegetables. We could add an extra vegetable into a meal, like adding in mushrooms to a lasagna or corn to your meat stew. Or we could swap out foods, like defrosting frozen fruit in the microwave for desert (which leaves them sweet and naturally a bit syrupy) instead of having a cookie.

Learn to cook

This can help you control the ingredients in your meals (helpful if you have a lot of food intolerances), bring up the nutritional quality of your diet, and save money. Cooking doesn’t have to be anything fancy: learn to roast meat and/or vegetables in the oven, learn a few quick recipes for when you are too hungry or sick to meal prep for more than 10 minutes (salads, smoothies, pasta, oatmeal, etc).

You can try out a new recipe each week, or commit to cooking a few nights a week and work your way up in frequency. There’s so many ways to cook different foods. A vegetable roasted doesn’t taste the same as steamed, in a soup, or raw. Tomato sauce, cheese, garlic, herbs, or spices can drastically change the flavor of a meal. You can also try different types of cuisine. It turns out that I love Indian food and it’s now the majority of what I cook, even though I didn’t grow up eating it!

Get to know your cooking style. For example, for some people, batch cooking their weekly meals works great for them. For me, I loathed being in the kitchen for 3 hours, and cooking multiple recipes was overwhelming. Plus there was so much clean up after. I realized I’d rather just cook for each meal.

How do I figure out my trigger foods?

It’s true that for some of us, there may be foods that trigger our symptoms or that we feel much better cutting out. I personally have several foods I don’t eat because that helps me feel my best. But I put this section last to reiterate that eating with chronic illness isn’t only about cutting out certain foods, but rather upping the nutritional quality of our diet and having a healthy relationship with food. You may not even have trigger foods and find that food doesn’t have a huge impact on your symptoms!

-Working with a registered dietitian, especially one that is familiar with food intolerances or digestive problems, can be a great start.

-Some people do an elimination diet, but these can be hard to follow or triggering for people with disordered eating. This is where you typically cut out a food or food group for a month or so and see how you feel with and without it in your diet. Don’t base your decisions off of the first time a food makes you flare – look for a pattern: does it consistently flare you, even under different circumstances?

A focus prior to doing an elimination diet could be to improve the overall nutritional quality of your diet, or learn to cook more. This may help you feel less deprived if you choose to eliminate certain foods.

-Some people keep a food journal. For a month or so, you write down what you ate and your symptoms throughout the day, and see if you can spot patterns. For example, you may notice that every time you eat dairy, you have diarrhea, or that dark chocolate consistently gives you a headache.

I found a food journal to be helpful to figure out my best times to eat foods. I noticed that meat keeps me my fullest and give me no gas, so I eat lamb or chicken before meeting friends. Broccoli give me horrible gas but also gives me energy, so I eat it when at home alone. Dessert foods like cookies or cake give me brainfog, so I like to eat those as a treat on the weekend before relaxing and watching a movie, but not when I’m out at celebrations because I don’t like feeling foggy when I interact with people. 

What are some of the most common trigger foods for people with endometriosis?

These are some common trigger foods for people with endometriosis, but that doesn’t mean that these are your trigger foods, nor that you have to cut out all of these. You may be fine with all of these foods, so you should figure out your specific triggers (if you have any at all). What you don’t want to do is needlessly cut out foods and make your diet unnecessarily restrictive and harder.

-Gluten. Some people may find gluten is a trigger. If cutting out gluten helps you, it could be because of gluten, or it could actually be because of the fructans in wheat. Or it might not be gluten but rather that by removing gluten, you removed many snack foods and increased the nutritional quality of your diet. These can be options to explore further if cutting out gluten improved your quality of life.

-Alcohol. Some people find that alcohol makes them tired, interferes with their sleep, causes body pain, easily makes them hungover, etc. Some find that it’s only a certain type of alcohol, others find that going alcohol free is best for them.

-Added sugar. Like with gluten, it could be the added sugar itself, or it could be that by cutting it out, you improved the nutritional quality of your diet.

-Dairy. A1-casein in dairy from cow’s milk can drive inflammation and immune dysfunction in some people. Dairy can also contribute to histamine. Some people find that their pain, PMS, menstrual symptoms, headaches, sleep, etc, improves when cutting out cow’s dairy. However, they may be able to have dairy that has only A2 casein, like in Jersey cow’s, goat, and sheep dairy.

-High histamine foods. For some people, histamine intolerance plays a role in their body symptoms and switching to a lower histamine diet can help.

Some tips around cutting out foods

Of course, the best case scenario is that we don’t have to cut out any foods, but for some of us, it is a reality that certain foods trigger symptoms for us. However, in cutting our certain foods, it’s not about chasing being symptom free because that may not be possible. If we chase that, we could lead to our diet being more and more restricted, which ultimately hurts us both physically and emotionally in the long run.

For me, cutting out my trigger foods is about making individual food choices that I want to make (not that I think I have to make) because I’ve learned how to support both my physical and mental health. For me, completely cutting out certain foods – like dairy – supports my physical and mental health, because while I loooove dairy, the symptoms it causes me from even a small amount are so disruptive to my life that it negatively affects my mental health. So I said goodbye to dairy in my life.

But there are other foods that don’t cause me such intolerable flares. Although they still cause me to flare, I eat them because I like them and because if I avoided every food that caused me to flare I would be starving. 
For me it comes down to:

  • how does having or not having this food impact my physical health? Impact my mental health?
  • how nutrient dense is this food?
  • how often do I want to eat it?
  • do I want to fully cut this out, or can I just reduce how often I eat it?
  • can I replace this food with something else?

I’ve learned to ask myself those questions without diet and wellness culture looking over my shoulder, but as an individual figuring out how to support myself best. It’s important to know ourselves:

  • We might find that restricting a certain food can lead to obsession or binging around it, and therefore it’s better to limit it vs cut it out.

  • We might find that certain foods are not always a trigger, but only if we eat them regularly. (Gluten does this for me. I can eat it a few times a month but any more frequently and I start to get chronic diarrhea).

  • We might find that we can better tolerate certain foods during different phases of our menstrual cycle or on days when we have low stress and have gotten enough sleep. (This is the case for me and many of my MCAS food triggers. Depending on how full my histamine bucket is, I may or may not tolerate it that day.)

I think it’s good to revisit foods you’ve cut out once in a while and see if you can tolerate them again. Our bodies change depending on various factors, and something that made you flare a few years ago be fine for you now!

What if all foods are making me sick?

I hear that. There were 3 times in my life when all foods made me sick. The first at 19 years old when I had chronic diarrhea 25 times a day for 2 years, the second at 27 years old when I had severe gastritis, and the third at 34 years old when I first had the onset of mast cell activation syndrome.

It’s an awful place to be where everything makes you sick, and can lead to fear of food, disordered eating, and nutrient deficiencies. There is hope to be able to bring our bodies up to a better state of health, broaden the range of foods that we eat, and get back joy from eating again. When I was in this situation the first time, I didn’t realize that just because something makes me sick now, that doesn’t mean it will make me sick forever. Seeing how I was able to improve my body’s tolerance to food when I was dealing with the chronic diarrhea helped me have hope years later when my other two health problems began, and maintain the goal that I would be able to improve my food situation and get to a place where only some foods (not all) trigger me.

If you are down to eating very few foods because they all make you sick, please reach out for help with your doctor or a registered dietitian, especially one who has experience with food intolerances, IBS, or chronic illness. They can help you to figure out what your trigger foods are, while also making sure you are getting the protein, fiber, fats, and nourishing food that you need.

You may need to work on your gut health, which can help some people immensely when it comes to digestive problems. Things like digestive enzymes, supplements to help stomach acid, addressing SIBO or gut dysbiosis, getting tested for food allergies, and more can often help us have less symptoms and better digestion. We may need to address our blood sugar so that we are not in crisis every time hunger arises. We may have another co-condition that needs addressing, like IBD, gastroparesis, mast cell activation syndrome, or something else.

Eating a variety of food not only helps with getting the nutrition we need, but also with gut health. I’ve spent the last few years broadening the variety of foods I can eat by buying frozen fruits and vegetables, and eating a spoonful of a different fruit or vegetable alongside my meal, rotating through them over several days. While there’s still a few foods I don’t tolerate, over time this seemed to allow my body to build up tolerance to different foods and also satisfy my taste buds as well!

It’s not just about the food

A lot of different foods cause me triggers, but over the years I’ve learned it’s not just about the food itself. It’s also about my relationship with food, and little things that are often overlooked:

  • Chewing my food thoroughly to help with digestion.

  • Eating in a state of relaxation: not rushing when eating, not being on the go, sitting down to eat slowly.

  • The way the food is cooked: For example, I can only eat boiled potatoes but not roasted ones. Boiled eggs are fine for me but not fried ones. I can’t have raw vegetables but roasted is fine. Etc.

  • The time you eat and frequency can affect how you feel. Some people feel their best eating 6 small meals a day, others eat 2 big meals. Some find eating a huge early breakfast gives them the most energy, others find that waiting to eat until mid-morning is better for them. By paying attention to our bodies and hunger cues, we can find what works best for us.

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