Plant-based diet may aid in preventing, treating endometriosis
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Diet may play an important role in the pathophysiology of endometriosis, with a plant-based diet and vitamin D possibly beneficial in preventing and treating the disease, according to a review published in Frontiers in Nutrition.
“The prevalence of endometriosis in North America, Australia and Europe is [about] 1% to 5% in women of reproductive age, and some have suggested that the true figure is closer to 10%,” Neal D. Barnard, MD, adjunct associate professor of medicine at the George Washington University School of Medicine and Health Sciences in Washington, D.C., and president of the Physicians Committee for Responsible Medicine, and colleagues wrote. “The disease leads to substantial medical costs for laparotomy, laparoscopy, oophorectomy, hysterectomy and other procedures, estimated in 2018 at [about] $10,000 annually per patient in the U.S., in addition to indirect costs related to the interference with work and other obligations.”
The researchers reported that current treatment options for endometriosis include over-the-counter NSAIDs for acute endometriosis pain, but these agents have limited effectiveness and adverse outcomes that limit their use. In addition, hormonal treatments, such as progestins, combined oral contraceptives, gonadotropin-releasing hormone agonists and antagonists, testosterone analogs and aromatase inhibitors, aid in suppressing endogenous estrogen production. Another treatment option is surgery, such as laparoscopic excision and ablation to remove pathological lesions or hysterectomy, which reduces pain and symptom recurrence in endometriosis but ends fertility.
According to the researchers, fat quality and quantity in an individual’s diet may be modulating factors for endometriosis. Specifically, animal fats are a focus, as high consumption has previously been linked to other gynecologic diseases such as ovarian cancer. However, certain fats may play protective roles against endometriosis, as premenopausal women were less likely to be diagnosed with endometriosis if they consumed omega-3 fatty acids, according to the researchers.
Dietary factors modulating estrogen activity may be clinically important, and reducing dietary fat and increasing dietary fiber may reduce estrogen concentrations in about 10% to 25% of women, the researchers wrote.
The Nurses’ [JR1] Health Study II found that women who consumed more than two servings of red meat per day had a 56% greater risk for endometriosis compared with women who consumed less than one serving per week (RR = 1.56; 95% CI, 1.22-1.99). The study also found that increased consumption of poultry was associated with higher endometriosis risk (RR = 1.14; 95% CI, 0.88-1.49).
Because reducing dietary fat and increasing dietary fiber may benefit endometriosis, a plant-based diet has been of interest, the researchers wrote. Several studies have demonstrated that consumption of a strictly plant-based diet resulted in less inflammation and increased plasma concentrations of sex hormone-binding globulin and reduced the risk for endometriosis. The researchers also noted that consumption of seaweed may result in estrogen effects, as a previous trial found an inverse dose-response relationship between seaweed consumption and serum estradiol concentrations among postmenopausal women.
In addition, consuming vitamin D might aid in preventing and treating endometriosis, as researchers have previously reported that low levels of vitamin D were associated with an increased endometriosis risk and increased symptom severity. Other findings report that consumption of vitamin C and E also resulted in a lower risk for endometriosis.
“Eating meat and fatty foods may lead to excess estrogen in the body, which can cause endometriosis pain to flare, while fiber — found only in fruits, vegetables, grains and beans — may help reduce pain by flushing excess estrogen out of the body,” Hana Kahleova, MD, PhD, director of clinical research at the Physicians Committee for Responsible Medicine, said in a related press release. “Seaweed may also help suppress estrogen levels.”
According to the researchers, future research should involve randomized clinical trials to aid in elucidating the role of diet in endometriosis.