At the same time, endo belly may also emerge from not-so-inflammatory gut conditions that often crop up alongside endo, like irritable bowel syndrome (IBS) and small intestinal bacterial overgrowth (SIBO)—both of which are known to cause GI issues and respond to changes in diet.
Researchers think endo might put you at high risk for IBS by messing with your nervous system in a way that causes you to perceive normal gut sensations, like food moving through it, as uncomfortable. In this case, following a low-FODMAP diet, which cuts out certain carbs that tend to create more gas and fluid in your GI tract, can minimize pressure on your intestines and the painful bloaty feeling that comes with it. (Just note: Low-FODMAP is restrictive and can throw off your microbiome if you adopt it long-term, so it’s key to work with a dietitian if you’re planning on trying it.)
As for SIBO? It’s possible that inflammation from endo can slow down the movements of your gut, Dr. Aliabadi says, leading bacteria to overpopulate your small intestine. And in this scenario, limiting carbs (e.g., cutting back on gluten, dairy, and sugar) or going low-FODMAP can restrict the fuel you’re feeding that bacteria, taming some of the belly cramping and GI upset.
So which types of food are best for alleviating endometriosis symptoms?
Fruits and vegetables
Plants are anti-inflammatory powerhouses, so it’s no wonder they’re among the top recommendations from both Dr. Aliabadi and Dr. Khalil, and they are consistently highlighted in endo-diet research. In particular, you want to load up on fruits and veggies that are rich in antioxidants. Foods packed with vitamin C (like citrus fruits, brussels sprouts, and red pepper) or vitamin E (e.g., mango, spinach, and avocado) fit the bill. Berries, dark leafy greens, tomatoes, carrots, and apples also contain a bunch of antioxidants with anti-inflammatory capabilities.
There’s also ample reason to consume a big variety of plants. Different plants supply you with different antioxidants that can pack a greater anti-inflammatory punch together. Plus, research suggests your gut microbiome can really flourish when you feed all those bugs a diverse diet. Just note: Some fruits and vegetables are also high in those potentially tough-to-digest FODMAPs. These include asparagus, apples, pears, mangos, and peas, for starters. So if you’re dealing with endo belly (or have IBS or SIBO too), it may be worth digging into possible fruit or veg triggers with a registered dietitian.
Fatty fish, like salmon and tuna
These protein sources are full of a healthy fat called omega-3, which Dr. Aliabadi suggests loading up on. The reason why? It’s a potent inflammation-buster, shown to reduce certain pro-inflammatory compounds while elevating anti-inflammatory ones. Research suggests increasing omega-3 consumption may be linked with less pain in folks with endometriosis, and multiple studies have pointed to a lower risk of endometriosis in people who take in higher amounts of the healthy fat.
Oily fish (which, BTW, also includes mackerel, sardines, anchovies, and trout) contain a good deal of vitamin D too, which may have its own anti-endo effects, perhaps via tamping down on inflammation or acting on cells in a way that slows the growth of endometriosis tissue.
Nuts and seeds
Like fatty fish, nuts and seeds—particularly walnuts, flaxseeds, and chia seeds—are rich in omega-3s, delivering a healthy dose of the anti-inflammatory benefits noted above. These foods, as well as sunflower seeds, almonds, peanuts, hazelnuts, pine nuts, and pistachios, are also great sources of the aforementioned antioxidant superstar vitamin E.
A note on supplements…
Could you get the nutrients highlighted above in supplement form? Sure. And there’s a bit of research to suggest popping a fish oil capsule (rich in omega-3) or supplementing with either vitamin D or a combo of vitamins C and E could help mitigate pelvic pain from endo—but all of these results either weren’t significantly different from the placebo or occurred in small studies that haven’t been replicated, or both. It’s notoriously tough to know if you’re actually getting what the label promises for any supplement, given they’re not regulated by the FDA. And experts agree, you’re always better off getting nutrients from food, where they’re found in their most usable form. (This way, you’re also getting other healthy components of the whole food that might contribute to its endo-busting effect versus just a single isolated nutrient.)
Which foods and drinks could worsen endometriosis symptoms?
Red meats and processed meats
A handful of studies have identified links between consumption of red meat or processed meats (like hotdogs, salami, and bacon) and endometriosis risk. The largest and most recent one found that eating two or more servings of red meat a day was associated with a 57% spike in risk of endo (compared to people eating a max of one serving a week), while eating five or more servings of processed red meat a week was linked with a 20% increase in risk relative to people who ate virtually none. These results don’t prove that red meat causes or worsens endometriosis—but researchers suspect it could exacerbate it by notching up inflammation and estrogen levels, in part due to its high amount of a saturated fat called palmitic acid.
Ultraprocessed foods
Engineered for can’t-have-just-one palatability, ultraprocessed foods (UPFs) are packaged items (like instant noodles, cookies, and chips) typically infused with a lot of sugar, salt, and saturated fat—all of which can drive up inflammation and may in turn exacerbate endo symptoms. What’s more, some commonly used sweeteners in UPFs, like high-fructose corn syrup and sugar alcohols, fall in the FODMAP bucket and so could pile on the bloating and discomfort in folks with endo belly.
There are also foods and drinks that fall into the “maybe, for some people” category.
Dairy
Dairy often gets villainized—but to set the record straight, there’s no good evidence that it causes inflammation in folks without a milk protein allergy. It can trigger a great deal of bloating and GI upset in people with lactose intolerance, but again, that’s not indicative of any inflammatory effect writ large. In fact, dairy intake, specifically yogurt and cheese, might even help lower inflammation and lessen endo symptoms by upping your levels of vitamin D and calcium. Research shows that consuming roughly three servings of dairy a day is linked with lower risk of the condition.
