When researching my new book on endometriosis, something became surprisingly clear: those of us with endometriosis appear to be more undernourished than our non-endo counterparts. Moreover, under-nutrition, blood sugar dysregulation, and food intolerances may be partly to blame for your endo pain, progression, severity, infertility, hormone imbalance, brain fog, immune system dysfunction, and more.

After analysing the effects of nutrition and endometriosis, one paper even concludes that diet is “a promising tool in the prevention and treatment of endometriosis.”[1] Yes, you heard right: prevention and treatment.

This coincides with thoughts from longtime endometriosis researcher Dr. Dan Martin, who writes, “But surgery is not the only answer, particularly for earlier endometriosis in primary care, especially in the teens, and potentially for those with deep nodules. For those, the use of hormonal suppression, diet, lifestyle modification, anti-inflammatory therapy, antioxidants control of oxidative stress, and an integrative framework are necessary considerations to address the chronic inflammation and immune dysfunction that drive the disease… Control of these factors may stop or limit endometriotic lesions if started early, when lesions are small and before they have time for significant inflammation, fibrosis, angiogenesis, epigenetic modifications, and genetic mutations. Alleviating the chronic inflammation and immune dysfunction that contribute to the disease may potentially prevent disease progression, scar tissue formation, and adhesions.” [2]

These are two points of many found in both research and patient experiences that support the notion that dietary interventions are more than just symptom management. Research knows nutrient intake, mineral, vitamin, and antioxidant levels, and blood sugar regulation may actually influence disease itself. I talk about this at length in my book.

Personal stories range from helping reduce terrible pain or infertility, to complete resolution of endometriosis symptoms (i.e. remission). This is why I lobby so hard for nutrition to be considered a clinically significant treatment strategy in healing from endo, one of many treatment options we should all consider.

What’s the best endometriosis diet?

In researching diet and endometriosis, there was one obvious point that stood out time and time again: there is no such thing as an endometriosis diet for everyone.

Hearing this would have annoyed me 10 years ago when following the latest “fad” diet or food hack was my thing—I wanted to be told a diet to stick to! I’m not alone, diet books are some of the best-selling books on the market, always selling something elusive about health, weight, beauty, and happiness…if you can just get through the next 30-day plan. They sure are appealing to those of us who are always seeking health but never quite getting there.

Sigh.

Luckily, the endometriosis diet information supported by the literature is also supported by proper human health (which cannot be marketed in any 30-day plan). This is the same dietary approach our ancestors followed, no matter where your own ancestors lived, we could assume they were eating a whole food, nutrient-dense diet, they had balanced blood sugar, they weren’t eating a slew of processed, refined, and thus inflammatory foods, and their gut microbial communities were in balance.

These four factors are the pillars of human health and the endometriosis diet foundation we should all be leaning into! When these 4 pillars are out of whack (as nearly all of ours are today), chronic disease, oxidative stress, chronic inflammation, immune dysfunction, and hormonal imbalance ensue.

Sound familiar? Me too… truth be told, that was so me.

Using this framework, our goal is to create an endometriosis food plan based on our unique needs. And “UNIQUE” is the keyword! Just because Martha doubles over in pain with dairy doesn’t mean Gertrude will need to stop eating it. And just because Laksmi got her energy back by reversing her iron deficiency doesn’t mean Leilani will need to supplement with iron. Some may do well with lots of fiber, some may not. Some may crave red meat, some may not.

However, here are the main priorities we should all keep in view:

1) Nutritional Status for Endometriosis

Deficiency in many nutrients is associated not just with increased progression of endo once you have it but even endo establishment in the first place!

To reverse nutrient deficiencies, we need to shift our focus away from an old “endo-diet” belief in restricting foods to a new perspective that will start to heal our bodies: eating as many nutrient-dense foods as possible.

Nutrient density refers to the number of nutrients found per calorie of food. For example, 500 calories of cookies will have a very different impact on your genetic expression and immune function than 500 calories of salmon since there are simply more vitamins and minerals per bite in salmon.

When you use nutrient density to guide your food choices, it means you can be eating far more nutrients while consuming the same number of calories. This is the mindset needed to reverse under-nutrition: replace the foods that have little to low nutrient density (toast, pasta, chips, baked goods, desserts, cereals, rice, etc.) with the most nutrient-dense foods on the planet: cold-water fatty fish, seafood, organ meats, seaweed, healthy fats, egg yolks, bone broths, a few fruits, and tons of vegetables.

You may be alarmed to realize that you don’t eat many of these foods, either in quantity or at all. Please stick with me as I explain exactly why these foods are pivotal to healing through the lens of nine nutrients, which I call “The Endo-9”. These nine nutrients are particularly essential for immune system re-regulation, antioxidant status, anti-inflammatory support, and healing from endo. I explain this at length in my book, and here on the site as well.

2) Healthy Blood Sugar Balances Endometriosis

Discovering the direct effect blood sugar dysregulation has on endo behavior (not just symptoms) surprised me. Turns out high levels of glucose and insulin, or too low levels of glucose, are all associated with endo-ing (progression of endo, scar tissue, or adhesions in the body). This means if you have blood sugar dysregulation (like 80% of Americans), you may be unwittingly fostering endo with each meal.

I talk about this at length here.

3) Inflammatory Nutrition Promotes Endometriosis

Talking about inflammatory foods is the trendiest thing and the big reason behind a long list of “foods to avoid if you have endometriosis.” Unfortunately, most of these lists are totally misleading—based on endometriosis dietary myths rather than research. For example, I debunk the myths that recommend removing red meat and saturated fat here, dairy here, eggs here, and many more in my book.

As I discuss in all these posts, the issue with many of these healthy foods isn’t the food itself but rather our personal reaction to them. So yes, dairy may provoke inflammation in some (or many), although others can tolerate it just fine—same for eggs, or certain veggies, fruits, and more.

However, these foods get all the focus when it’s one big colossal food group that’s BAD. Really Bad. And it’s not really a “food group,” although we often treat it as one: processed, refined foods stuffed to the brim with sugar, starch, and vegetable oil, deplete of fiber, vitamins, minerals, healthy fats, and more. These, along with alcohol and seed oils, are the foods we should do our best to avoid.

4) Microbial Nutrition for the Endometriosis Diet

Gut health is intricately linked to endo in every way, from establishment to progression. I write about that extensively here. Dysbiosis in the gut and/or reproductive tract may, in fact, be triggering the inflammation surrounding your endo as we speak.

On a bright note, by implementing targeted diet and lifestyle strategies, your own unique dysbiosis patterns may be tipped back into balance. Indeed everything from increasing fiber, omega 3s, phytonutrients, and movement, to decreasing sugar, inflammatory triggers (like sugar and alcohol, or foods you react to such as gluten and dairy), chemicals, and stress can have a profound impact on your microbial health.

Still, there is a large number of endo sufferers who will need deeper interventions than a balanced diet alone to address the microbial imbalances we face. I know many women who had great success with diet, but without deeper investigation and treatment, wouldn’t have been able to get their full health back. I talk about this in-depth in my Endo Belly Ebook.

Optimal Diet for Endometriosis

Let’s officially shift our perspective from one that restricts foods to a new view that will start to heal our bodies: eating as many nutrient-dense foods as possible, balancing blood sugar, uncovering if we have food intolerances, and eating for the gut.

If you want to see some food inspo, click here for 100 pictures of what I eat. If you want a food plan, check out my recipe book, The 4-Week Endometriosis Diet Plan. And if you want the research behind it all, check out Heal Endo: An Anti-Inflammatory Approach to Healing from Endometriosis.

1) Halpern, G., Schor, E., & Kopelman, A. (2015). Nutritional aspects related to endometriosis. Revista da Associacao Medica Brasileira (1992), 61(6), 519–523. https://doi.org/10.1590/1806-9282.61.06.519

2) Martin DC. Endometriosis Concepts and Theories. Resurge Press, Richmond, Virginia, revised April 16, 2023, https://www.danmartinmd.com/files/endotheory.pdf. Accessed [4/18/23]