As a Nutritional Therapy Practitioner, I receive a lot of questions about doing an elimination diet for endometriosis. How to approach them, what to eliminate, how long to eliminate foods, why they are necessary. So I am here to answer all those questions today in one place to help you to bring clarity into your decision making process.
Why should I do an elimination diet for endometriosis?
This is always the question to start with. Anytime you are making any decision for your body, it is so important to know why you are doing it.
Endometriosis is, at its root, an immune system dysfunction. Basically, the body is not able to mount an immune response to the endometrial-like tissue that ends up forming endometriosis lesions. These lesions then induce inflammation in the body. This cycle continues, the inflammation becomes chronic, and basically the immune system has gone haywire.
I have a previous article all about endometriosis and inflammation that I will link to at the end if you would like to know more about this topic.
So what do food sensitivities have to do with it?
Well, the body also mounts an immune response to certain foods that it recognizes as foreign. This can happen because the gut lining is weakened (hello, leaky gut).
Think of the immune system like an army. You only have so many troops available. If all of the troops are busy battling foreign food invaders, there may not be much left in the reserves to clean up something like endometrial tissue in the peritoneal cavity. Chronically fighting off foreign food invaders also leads to chronic inflammation, which can also contribute to your endo pain and symptoms.
Are you starting to see the connection? Great! Then let’s dive in.
Where to begin
I will start off by saying that there is not one right way to do an elimination diet for endometriosis. We are all unique individuals.
The gold standard for elimination diets that I use with my clients in my practice is starting with an MRT Food Sensitivity test PLUS a GI-Map stool test which helps us to see some clear data on gut imbalances and dysfunction.
I would not recommend any other food sensitivity tests and I would also never recommend a food sensitivity test by itself without also addressing gut health. If you are not addressing the compromised gut lining and digestive dysfunction, it is likely that when you reintroduce foods, your immune system will flare all over again. The MRT also takes out the guesswork when it comes to figuring out exactly which foods to eliminate.
If this is not an option for you right now, my best recommendation is the foods that are most known to cause immune response and inflammation: gluten, dairy, sugar, soy, and possibly corn or eggs.
When to remove each food in an elimination diet for endometriosis
This is a question I get asked a lot. People think it seems simpler to remove one food at a time for a period of time, reintroduce it, and then move on to the next. But if you want to truly heal, this is a problem.
For starters, if you remove only one food that is contributing to your inflammation, you are not really calming the overall immune response and inflammation in your body. You are also still allowing your gut lining to be damaged by the other foods. Therefore when reintroducing the one food you eliminated, you will likely not get a clear response and reaction from your body, leaving you just as confused as when you started.
Secondly, it makes the process take so much longer!!!! Not to mention so much more painful. We all know what endometriosis feels like. It is intensely painful in so many ways. You are approaching this elimination diet to help you feel better in the long run, right? So why make the process longer and more drawn out than it needs to be?
This is another reason that I started using functional tests like the MRT food sensitivity and GI-Map in my practice. It takes out the guesswork so that you can actually start to feel better! Why does this process have to be hard??
How long to remove foods and how to reintroduce them
The standard is three months and then reintroduce foods one at a time from there. That means removing all of the foods completely, getting rid of all possible sources to allow your body to heal AND working on your gut health at the same time. With my clients, that means creating a full gut healing protocol.
If you are doing this on your own, even doing things like eating bone broth and supplementing with a high quality collagen powder supplement can be of huge benefit to healing and sealing your gut lining.
When reintroducing foods, you want to reintroduce just one food at a time. Have a significant portion of it, without changing anything else. Then wait 72 hours to keep an eye on any responses or symptoms in your body. Nothing? Good to go! You can slowly reintroduce it to your diet, although I recommend only consuming that food every 3-4 days at first to avoid your body trying to mount an immune response all over again.
Did you have a negative reaction? Remove that food for another 3 months and then try again, while still focusing on healing your gut!
After the 72 hours have gone by, you can proceed with reintroducing the next food. Yes, this process is a little slow and painful. BUT we are looking at the long game here and being able to truly heal your body.
Troubleshooting and sticky spots
This process all sounds great on paper. But then we all go and live our lives and we can run into hurdles along the way. Maybe we forgot one day that we were supposed to be eliminating a certain food. Or we went out to dinner with friends and didn’t know every one of the ingredients in the food you were eating.
The goal here is consistency. Do your best. If you mess up here and there, give yourself grace and try to live by the rule not to let it happen twice in a row.
Avoiding food fear and disordered eating
This is a big topic and one that truly is better suited for a therapist to discuss, so I am just going to touch base on it so we can all go into this process with some awareness.
We all have an emotional connection with food. Some of us may have some past trauma or past experience with disordered eating and that is something that should absolutely be taken into consideration. Perhaps some work with a therapist might be warranted before diving into a protocol like this.
When going into an elimination diet, it is so important to keep in mind your relationship with food along the way. You are not eliminating these foods because they are “bad.” In fact, our goal is to be able to eat as many foods as possible in the long run. Severely limiting your diet in any way long term leads to nutrient deficiencies which can end up worsening your endo symptoms, amongst other things.
When you are eliminating foods, try to think of it like a scientist. We are simply doing an experiment to determine which foods nourish your body and which foods maybe aren’t serving you as well.
When you are eating foods that are not a part of the elimination, see if you can focus on how they are nourishing your body and helping you heal. We truly do become what we eat, from the inside out. The food that we eat becomes every cell in our body and every bit of energy that we use to live our lives. That is a powerful thing and that is a relationship that needs to continue to be nurtured for the long haul.
My final thoughts on elimination diet for endometriosis
Elimination diets are a very powerful tool for helping our bodies to calm the immune response and inflammation. In turn, this leads to less pain, less fatigue, and more time spent living our best lives. At the end of the day, that is what we all want!
It is of course not the only tool and it is one that should be used with much thought, consideration, commitment, and intention.
My hope is that this article has brought you some clarity around this often confusing and daunting topic.
Much love to you on your healing journey, my friend!
Other Articles You Might Enjoy:
Pahwa, Roma; Goyal, Amandeep; Jialal, Ishwarlal. (2022). Chronic Inflammation. Retrieved from: https://www.ncbi.nlm.nih.gov/books/NBK493173/
Donnez, Jacques; Cacciottola, Luciana. (2022). Endometriosis: An Inflammatory Disease That Requires New Therapeutic Options. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8836207/
Ahn, Soo Hyun; Monsanto, Stephany P.; Miller, Caragh; Singh, Sukbhir S.; Thomas, Richard; Tayade, Chandrakant. (2015). Pathophysiology and Immune Dysfunction in Endometriosis. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4515278/
Agostinis, Chiara; Balduit, Andrea; Mangogna, Alessandro; Zito, Gabriella; Romano, Federico; Ricci, Giuseppe; Kishore, Uday; Bulla, Roberta. (2021). Immunological Basis of the Endometriosis: The Complement System as a Potential Therapeutic Target. Retrieved from: https://www.frontiersin.org/articles/10.3389/fimmu.2020.599117/full