Red meat is a deeply misunderstood food source within the endometriosis community. Labelled as a endo-enemy #1, we’ve been told red meat makes endometriosis worse, aggravates symptoms, and may even be associated with increased endo risk (like, if you eat it, you’re more likely to get endo). It’s tied to many bad feelings about endo, almost seen as a “dirty” food that will make your “dirty” endo worse.

I understand this sentiment better than most. I was a passionate (and yes, annoying) vegetarian crusader for 12 years, vegan on and off, who just knew red meat was terrible for the body and terrible for the earth. I knew knew knew it and verbally crucified others who were ignorantly living in the Dark Ages of red meat consumption. “How they be so dumb??” asked righteous 15-year old me.

Fast forward ten years and I started to eat meat again. And once I started I couldn’t stop - my boyfriend hunted wild game and I found I was starving for animal protein. I felt ashamed at first, and deeply embarrassed, but the truth is I start to feel better in many ways. More energy, more stamina, less aches and pains, I was less hungry all. the. time. This was shocking to me - truly shocking - because I didn’t associate meat with well-being. Why were my exhausted vegetarian cells suddenly so … happy?

Fast forward another 10 years and here I am helping my endo clients do the same thing - reintroduce responsibly-sourced red meat - but this time while knowing the why.

We now have liberal amounts of research on why red meat is nutritious, how it affects the body positively, and even how it’s a myth that red meat (on the whole) is bad for endo. Red meat is rich in many nutrients many of us endo gals desperately need. It’s the best source of iron, B vitamins, vitamin A, vitamin D, coQ10, and zinc in the modern American diet, which makes red meat and organs nutrient dense foods.

This blog is not about the morals of killing animals for food. It took a while and I’ve made peace with that, but not everyone is. That’s okay. It’s not about saying you have to eat red meat. You don’t, not if you focus on other nutrient-dense foods. It’s not about policy debates or climate change, although I could write a whole book on why 100% grass-fed animals are desperately needed to fight climate change (here, here, here). It’s just about the big question: is red meat bad for endometriosis?

NOTE: If you are 100% morally and ethically opposed to eating meat, this blog is not for you - please stop reading now :)

What is Red Meat, and why do I support eating it?

Red meat is more than beef, it’s an umbrella term for all meat from mammals - beef, pork, bison, venison, lamb, and even the dark meat on chickens. It also includes organ meats. So now we have this huge food source that has kept humans alive for millennia - and that’s no drop in the pond when we’re talking time. Humans have hunted mammals, and eaten them without endometriosis, for a very long time.

Red meat is one of the best sources of iron and zinc in our modern diet, and research shows that women with endometriosis may be extremely deficient in these minerals. In fact, deficiency may be making your endo pain worse.

Zinc

Zinc is powerful antioxidant and anti-inflammatory mineral necessary for quelling inflammation, scavenging free radicals, supporting the immune system, and fertility. Yet, women with endometriosis have been found to be shockingly deficient in comparison to their non-endo sisters (1). A 2014 study even found that women with endo are so low in zinc it could be used to help diagnose endo!(2) A deficiency this severe will contribute to menstrual pain, decrease egg size, and prohibit eggs from properly dividing after fertilization(3,4).

So yah, we need a lot of zinc.

To reverse deficiency, know that zinc is best absorbed from animal foods, especially red meat and shellfish. Plant-based options like seeds, nuts, and certain grains and legumes aren’t as easily absorbed—why vegetarians are recommended 12 mg/day, instead of 8/mg day (5). To meet this basic vegetarian requirement of 12mg daily, you’d have to consume 1 cup of pumpkin seed or 11 servings oatmeal or 6 1/2 cup kidney beans, every single day. This is hard, and why long-time vegetarians and vegans have consistently been found to be significantly lower in zinc status than omnivores (6).

Red meat, on the other hand, offers your entire daily need in one large serving of beef.

Iron

Iron is essential for energy production to make hemoglobin, a protein in blood cells that shuttles oxygen around. No iron - no oxygen to muscles or organs, including your ovaries, eggs, uterus, and pelvic cavity—why proper levels are necessary for healthy ovulation and immune function (7,8). Just a few reasons why iron is uber important to us endo ladies dealing with fatigue, infertility, and immune dysregulation.

Not only are 60% of women in the U.S. not meeting their daily needs, but those with endo may be deficient just from having endo (9). Yup, if you have endometriosis you could be eating enough iron (technically) and still be running a deficiency, meaning we may need more iron than someone without endo to maintain proper iron sufficiency. If you’re wondering why you can thank inflammation, and I write about it here.

Iron deficiency becomes extra problematic when talking about oxidative-stress, since iron deficiency reduces the amount of antioxidants circulating. Since antioxidants are the only thing that can halt oxidative stress, it will continue without end (btw, this is what creates scar tissue and adhesions). In plain speak, low iron = less antioxidants, and why iron supplementation is recommended for those with anemia to heal the antioxidant defense system. In fact, researchers found that by supplementing anemic participants with iron for 6 weeks there was a significant decrease in free radicals! (10,11,12,13,14,15)

To meet just your basic needs, menstruating women are recommended to consume 18 mg iron/day for omnivores, or 32.4 mg/day for vegetarians because plant based iron (called non-heme) is harder to absorb. '

But 32mg/day is a challenge to consume! As an example, this would be akin to 2 pounds tofu per day, the highest known non-heme iron source, or 5 cups cooked spinach (that’s a lot of spinach), or 17 cups of cooked broccoli. This is why vegetarians are consistently found to have lower iron stores than non-vegetarians (16).

So then, why are we Endo-Warriors scared of red meat?

While we often hear red meat is bad for endometriosis, you may be surprised to learn there is actually no controlled study that has ever looked at red meat and endo. There is literally zero solid data to drive a no-red-meat recommendation.

So where does this advice come from? This was my question as well.

Turns out, the only “science” we hear about red meat and endo comes almost exclusively from observational studies. These aren’t the types of fancy studies we often imagine, involving labs, controls and more. No, these studies are basically questionnaires; that’s it. A pencil, some paper, and your own memory.

For example, if you were part of the Nurses Health Study, the most often cited study involving endometriosis and red meat, researchers would only give you a questionnaire every 4 years, asking about what you ate, drank, and did. Do you remember what you were eating and doing for the past four years? I don’t. But, from here we could see that, since you ate a lot of salads over the past 4 years and you have endo, salad consumption may be associated with endo!!!

Wait, what? Don’t worry, observational studies are only the first step in the scientific process, or … they should be. They are not conclusive, they simply offer clues as to what to study next in a controlled lab environment—like, is salad really associated with endometriosis?

The BIG problem in the endo world is that many concrete recommendations stem solely from these observational studies, something I believe is irresponsible (and you’ll soon see why).

Back to The Nurses Health Study, it’s nearly always cited as “proof” of the endo-red meat connection since women who ate more red meat were observed to have a higher risk of endo (17). Yet when we zoom out on this data what we see is that the women with heavy red meat consumption were also much more likely to be sedentary, eat a lot of sugar , smoke, and drink alcohol - giving us zero information about red meat and endo specifically. Heavy meat consumption was also linked to heavily processed meat consumption, which is so different than fresh or grass-fed options.

Moreover, there are also observational studies that have found no link at all between red meat consumption and endo (18,19). Again, why observation is a starting point, but far from the finish.

More Myth Busting

Now that you know that no one should make nutritional recommendations from observational studies alone, you may be wondering if there is other research connecting the dots between red meat and endo. Scouring the net I found four specific accusations: saturated fat, omega-6’s, dioxins, and hormones in meat. Ready to myth bust? Let’s dig in :)

Saturated Fat

If you have endo you may have seen you’re supposed to avoid saturated fat. Umm, why?

I combed the literature to find out and uncovered… one study. An observational one too. This study points out that out of all 37 saturated fatty acids that make up the BIG Saturated fat umbrella, only one (out of 37) was increased in consumption by endo gals. It was palmitic acid. (20)

Queue recommendation to avoid saturated fat and animal products without any more research. OMG. Let’s do some digging to find out much more about this issue.

Palmitic acid is a saturated fatty acid primarily found in palm oil, coconut oil, and animal fats; it’s the most abundant saturated fat in the body (your body stores fat in this form) and is necessary for many essential roles and the proper functioning of your cells. We need palmitic acid. Still, some research finds it may be damaging when over-consumed in isolation—luckily something that never occurs in nature. Eat an animal? Yah, they contain a variety of saturated fatty acids, never palmitic acid alone. (21,22,23,24)

Instead, palmitic acid is isolated from palm oil and added to processed foods, used for that creamy, addictive mouthfeel in the you may crave. It’s packaged into thousands upon thousands of convenient-to-eat foods, added to pizzas, ice cream, cakes, and cookies. Yup, it’s even in organic, vegan, gluten-free, or whatever. Eating an abundance of these foods can cause an overabundance of palmitic acid in your diet that would never be found in nature.

So, still, is endo associated with palmitic acid at all? We don’t know, this was just an observational study. If it is, we need more studies so we can know, then we can recommend things like AVOID PROCESSED REFINED FOODS, not red meat.

Omegs-6’s

We hear a lot about minimizing red meat because it’s high in omega 6’s, and too many omega-6’s (in relation to omega-3’s) is inflammatory. More specifically for endo, one omega-6 ( arachidonic acid, or AA) is a precursor to an inflammatory prostaglandin known to increase endo pain: PGE2. The way it does this is through what is called the “arachidonic acid cascade”, where AA is transformed into PGE2 and - when left unchecked by omega-3 sufficiency - can cause intense endo pain as well as provoke a number of features of endo, including cell proliferation, inflammation, and promote endo roots to grow and take hold (26). Ouch.

This is not an idea fetched from an observational study, this is real. We know there’s an arachidonic acid cascade causing us misery. And since AA is mainly found in animal products, many well-meaning “endo-diet” recommendations advise avoiding red meat since it contains AA, which is also true. But, it turns out eating too much AA is not the problem, not at all.

What to blame then? An omega 3 deficiency! This deficiency intensifies the PGE2 reaction to record levels in what is known as a “arachidonic acid cascade overreaction”, an incredibly intense PGE2 response that’s highly damaging. The only way to stop the overreaction is through dramatically increasing the amount of omega 3’s in your body, not decreasing AA consumption. This is the not-so-secret secret. When omega-3’s are increased, the AA overreaction cascade is suddenly halted. (28)

Unfortunately, our omega 3’s aren’t just low, they’re at an emergency deficiency state. A recent analysis looked at blood levels of omega-3’s and found the majority of the entire world to be in the low range, with all Americans in the very low category (34). In fact, in 2017 not a single American participant tested in the optimal range, with 99% being in the Intermediate to High-Risk deficiency category (35).

Interestingly about this study, while 30% of participants said they prioritized omega-3’s, even they were highly deficient. This may be thanks vegetable oils, not red meat! Vegetable oils contribute 13x more omega-6’s to the American diet than meat, eggs, and dairy all combined (30). COMBINED! Since omega-6’s compete for cellular space, even if you’re eating a healthy dose of omega 3’s, if you’re also eating excessive omega-6’s (veggie oils) they will kick your omega-3’s to the curb.

The other reason could be that we need the real deal to keep our levels optimal: EPA and DHA. While plant-based omega 3’s are great (all those omega-rich flax seeds and walnuts we’re told to eat), it’s hard to convert those to the forms we need to stop AA cascades (humans appear to convert no more than 6% to EPA or 3.8% to DHA).(39) So if you’re stuffing yourself with omega-3 rich plants, you can assume you’re deficient.

In order to get EPA and DHA, you have to eat animal-based foods (there one vegan DHA + EPA exception being an algae supplement). EPA and DHA are best found in cold water fatty fish, seafood, oh, and smaller amounts in 100% grass-fed red meat.

How much? While there’s no US-recommended amount, other organizations recommend a minimum combined dose of EPA + DHA between 200-500 mg/day (36,37), and many of us may only be meeting about 1/4 of that. But wait, is a 200-500 mg/day recommendation enough? When checking research on certain Paleolithic diets, we see estimates for DHA + EPA at ranges between 660 mg to 14.2 g/day, which is 1.5 to 31x more than current recommendations or 5x to 113x more than we are actually eating today (38). So, yah, we’re REALLY FAR AWAY FROM OUR MARK.

Dioxins

Dioxins are one of the most feared environmental contaminants worldwide. They are nasty byproducts of industrial processes and linger in the environment for years, potent endocrine disruptors, and linked to a variety of diseases, including endometriosis.

The biggest source of human contamination today is food unless you’re exposed at a job or town near an unregulated industry - but for most of us it’s food. Because dioxins just sit in the environment without breaking down, they land on plants and animals through wind, dust, soil and water. They’re ubiquitous. And, because animals can bioaccumulate dioxins, you’re told to avoid eating animals.

Is there truth to this fear? The answer isn’t what you’d think!

While it’s true that animals eating dioxin-contaminated foods will bioaccumulate the dioxins, the theory that animals are the most dioxin-laden food is not wholly true. Instead, contamination levels vary widely between food.

For example, a 2002 Greece food sampling, rice was shown to have 10x more dioxins than beef (40). A 2004 study from the Netherlands observed the contribution of dioxins from different foods was pretty evenly distributed, with 23% from meat products, 27% from dairy, 16% from fish, 13% from vegetable products, and 17% from vegetable oils (41). Even more, a recent 2016 analysis of dioxin consumption within the Italian diet showed that vegetable-based foods contributed more than twice as many dioxins as meat (42).

Dioxin levels can also vary depending on where food was produced. For example, in one study a steer from Iowa was found to have 45x more dioxins than one from Alabama (43). And rice from Greece had 11x more dioxins than that Alabama steer.

Big Point: Dioxins are in our food supply, and although they technically bioaccumulate in animals, it doesn’t mean all animals have them, or plants are free of dioxins. But … we all have to eat

Before you consider becoming a breathe-a-tarian, there’s good news. Dioxin exposure has radically dropped in the past 50 years, with a 90% reduction in air emissions (44). It’s the reason that food contamination has become our biggest contributor, not because there’s more dioxins in food than ever, but because the majority of our other exposures have been cleaned up (which is a great thing).

Dioxin levels in food is similarly witnessing a continued global downward trend. A 2013 survey of animal products observed overall levels of dioxins are now between 1/3 to 1/12 of what they were in the 1990’s (45). In Japan we see people consuming 1/3 of the levels of dioxins as they did 20 years ago (46). And, like I said, we have to eat.

So is there anything we can do about dioxins since they’re everywhere?

Yes, there awesome helpful tidbits! When it comes to avoiding dioxin exposure in your food, be it rice or your beef, there’s a cool little trick: Eat it with chlorella. Chlorella is a specific type of seaweed - a single-celled, fresh water algae to be exact - that is a potent supporter of liver function and detoxification. It comes in pills and capsules, and you may consider adding it to your life.

Supplementing chlorella with dioxin-contaminated food may prevent uptake by up to 50%. (47) It may also help you eliminate nearly 10x more dioxins from your body than someone without chlorella, while reducing the amount of dioxins stored in the liver by nearly 1/3 (48).

Chlorella supplementation was also shown to reduce the number of dioxins in breastmilk of breastfeeding mamas, and serum of pregnant mamas. (49,50)

You can also mitigate the damage caused by dioxins by eating more antioxidants. The antioxidants CoQ10 and resversatrol prevent dioxin damage by offering a protective influence from their free-radical scavenging abilities (51). The best source of CoQ10 is heart, which is obviously an animal product.

Antibiotics, Synthetic Hormones, and Chemicals:

If you’re worried about antibiotics and synthetic hormones, know they are only given to commercially raised animals, not organic or 100% grass-fed. So this really only applies to feedlot beef, which I’m not wholly recommending here. But I did some research anyways to help us all be more educated about this topic.

There are limited studies on the exact relationship between estrogen and meat since, again, we have a lot of observational studies linking red meat consumption to women with high estrogen but not a lot of concrete evidence. What I did find was an interesting study from 2014 that analyzed the estrogen in conventionally raised red meat and chicken, and their fats.

What it found was that the animals without synthetic hormones had zero to extremely low amounts, and the animals who were given synthetic hormones did have quite a bit more estrogen in their fat (56). However, the levels in even the most-estrogenic animals still were nowhere near the levels found in hormonal contraceptives. Basically, even the amount of estrogen in feedlot beef would be considered a very negligible amount in the face of everything we endo-gals are dealing with. So although hormone-wise, there appears to be a bump in estrogen from hormonal implants in conventionally raise beef - we can’t say that red meat is “highly estrogenic.”

Scapegoat: Red meat

Can red meat be problematic? Maybe - research shows it’s concerning when it’s highly processed and eaten in excess with alcohol, sugar, processed refined foods, along with a sedentary lifestyle.

But, after weeks and weeks of deep research, there is truly nothing to be found directly implicating healthily-raised red meat to endometriosis (or, even conventionally raised meat for that matter). Seriously, as much as I wish I could knock conventional meat there’s simply no research out there supporting a recommendation to avoid it.

FAQ

What if I felt better removing red meat? This happens. The answer may be that your body needs extra of digestive support, and meat was too hard overall—either too much fat or too complex of protein. I had one client who would vomit after eating meat, but after adding a specific digestive enzyme to her meal she could eat it fine, quite literally, the very next day.

Others of you may have been eating too much red meat and not enough veggies, so you felt better just upping your plants but assumed it was the meat. Or if you went vegan and felt better, it could be because you removed dairy or eggs which you were having a reaction too rather than the meat.

Honestly there are a number of reasons specific to you that you may have felt better cutting meat, but that’s for another investigation :)

What Red Meat Should I Buy Then?

#1 Choice) 100% Grass-fed Meat: have a perfectly healthy fatty acid composition (including less palmitic acid and more omega 3’s), more beta carotene, vitamin D, E, B vitamins, and antioxidants (57, 58, 59). Grass-fed cattle have also found to have less E.coli than grain-eating cows, making this meat safer as well (60). Grass fed cows eat grass, sequester carbon, and are a brilliant part of land-management. If you think you can’t afford 100% grass-fed meat, I implore you to read this article comparing the cost of this meat to popular cookies, candy, fruit, and supplements. You may be shocked to see the breakdown. What I find in a lot of clients is that they can afford to spend more on food if they reprioritize spending elsewhere (like, stop that Amazon one-click buying!!) - something I consider important for healing and you should too.

Second Tier) Organic meat: Less nutritious than grass-fed, but still more nutritious than conventional, organic meat has 32% less fat, 170% more ALA , 24% more vitamin E, 53% more beta carotene, and 34% more coenzyme Q10 than conventional beef (61). Organic farms may also be lower in bacterial contamination (62). Organic meat is often easier to find than 100% grass-fed, although not necessarily cheaper.

Last) Conventional meat: the truth is, I can’t fully negate eating conventional red meat if you are literally too broke to buy organic. Until there’s real scientific research that connects endo with lean feedlot-beef in moderate amount (the least damaging type), I’m going to squeamishly continue to recommend this to my gals living below the poverty line. Yes it’s damaging for earth, yes you may have guilt, yes it has extra chemicals, but… on the whole beef may be one of the more nutritious foods people with limited financial means have access to, rich in the nutrients many of us endo gals desperately need. Without extra money for supplements, beef becomes one of your best sources of iron, zinc, B vitamins, vitamin A, and CoQ10.

Am I saying eat a ton of feedlot beef? No! But worked correctly into a diet with other affordable endo-friendly options (canned salmon and sardines, fresh or frozen veggies, fruit, healthy fats), it becomes part of a healing picture. If it’s all you can afford remember to buy fresh or frozen-fresh meat rather than heavily-processed or canned meat products, buy the leanest meat possible, and always trim off or drain excess fat.

And for advice for everyone: Never make meat the centerpiece of your life, cut the sugar, balance your blood sugar, and remember to walk 3-5 miles per day ;)