Do You Need to Avoid Foods with Endometriosis? + Updated What I Eat in a Day with No Restrictions

While Heal with Haley has taken on new life in my endometriosis and creative journeys, my roots on this blog are in eating disorder recovery. If you read my recent blog post, you know that I recently suffered an orthorexia relapse triggered by my endo diagnosis. That brings me to the topic of this blog post…. do you really need to restrict what you eat with endometriosis?

Of course, my answer — as someone in E.D. recovery — is that you should never need to restrict what you eat. But, I also understand that when you have endometriosis, like I do, and are experiencing chronic pain, you’re willing to do anything to feel better, including give up your favorite foods.

People who follow a strict endo diet often quote evidence showing that foods like gluten and dairy are inflammatory, and inflammation plays a big part in endometriosis. Even so, there’s little evidence to show, specifically, that avoiding certain foods improves endo symptoms.

So, what’s the deal? Should you really be avoiding gluten and dairy, like I once did, on the endo diet? Here’s what you need to know about food restrictions and endometriosis.

Do I Need to Avoid Gluten and Dairy with Endometriosis?

If you have endometriosis, you’ve likely heard of the “endo diet.” As far as I’m able to tell, the endo diet is not a legitimate medical intervention. Instead, it seems to be based on this book, The 4-Week Endometriosis Diet Plan, by Katie Edmonds, NTC.

Katie runs a blog called Heal Endo and sells coaching for womxn with endo (her list is currently full). But the problem I have with the endo diet isn’t with Katie herself. It’s with large groups of womxn following nutrition recommendations by someone without real credentials.

NTC is, technically, a “credential,” but it stands for Nutritional Therapy Consultant. The credential is overseen by the Nutritional Therapy Association. There are no prerequsites (i.e. no need for an undergraduate degree in the sciences). Anyone can sign up for $4,000, and anyone can earn the credential with an 80% on the exam. You can actually access a sample reading list and get access to everything they learn in the program for free.

I’m not here to rip on individuals who get the NTC certification, but I am here to call out the fact that “nutritional therapy” is rooted in pseudoscience. This becomes problematic when it sends a ripple of orthorexia through the endo community. The idea of the “endo diet” has sparked a harmful (in my opinion) belief within the endo community that gluten and dairy should be considered off-limits. In reality, the relationship between endometriosis and diet is much more complicated, and cannot be boiled down to a single “endo diet.”

Most studies investigating food and endo (like this one and this one) produced results that were either inconclusive or could not be replicated. But there are a few things the research has taught us. In many cases, it doesn’t back up the extreme restriction supported by the endo diet. Here are some sample studies and the conclusions they drew about endometriosis and food:

  • Hansen and Knudsen (2013) evaluated 12 studies examining a total of 74,708 women. They found that consuming fewer trans fats and more omega-3 fatty acids lowered the risk of developing endometriosis.
  • Parazzini et. al. (2013) conducted a meta-analysis of 11 studies. They found that while women with endometriosis appear to consume less omega-3 fatty acids and vegetables, and more red meat, coffee, and trans fats, these findings could not be consistently replicated.
  • Trabert et. al. (2010) studied 660 women between the ages of 18 and 49 with newly diagnosed endo. They found that increased total fat consumption was associated with decreased endometriosis risk. While not statistically significant, the study results also suggested that consuming dairy actually decreased the risk of developing endometriosis.
  • Parazzini et. al. (2004) studied 504 women with laparoscopically-confirmed endometriosis. They found that a higher intake of fresh fruits and leafy greens, and a lower intake of red meat, reduced the risk of endometriosis. They did NOT find a statistically significant link between consuming dairy, coffee, fish, raw carrots (commonly touted as an estrogen-absorbing food), or whole grains and developing (or not developing) endometriosis.
  • Marziali et. al. (2012) found, in a study of 207 patients with chronic pelvic pain, that 75% reported reduced pain, better mental health, and increased functioning on a gluten-free diet.
  • Marziali and Capozzolo (2015) found in another study of 300 women with a definitive diagnosis of deep infilitrating endometriosis (DIE) that a majority reported improved pelvic pain on a gluten-free diet.

In short, we have evidence to show that fresh fruits and veggies, and omega-3 fatty acids, can prevent endometriosis, and that trans fats and red meat can increase your risk. We also have limited evidence to show that some womxn with endo may be gluten-intolerant, but we do NOT have any evidence to show that you shouldn’t eat dairy, nightshades, or any other category of “inflammatory” foods. And, we know from other studies that consuming gluten-free products when you aren’t gluten-intolerant or celiac can actually harm your nutritional health.

As someone who’s fallen for pseudoscience in the past, I’m not here to shame you. I get it: the temptation to do anything, try anything, that might relieve your pain can be overwhelming. And there is some truth to the idea that science can’t tell us everything. But if you’re going to undertake a restrictive diet for endometriosis, you should understand that the risk to your mental health when you fall for diet culture is as important as how well you feel physically without certain foods. To boil it down to one sentence, the “endo diet” is not evidence-based medicine, and may actually put you at risk for disordered eating.

So, if the endo diet isn’t supported by research, then whose advice should you trust? My advice is to find an endometriosis specialist (an M.D. or D.O.) and/or registered dietician (R.D.) YOU trust. Speak to them first before making any dietary or lifestyle changes, but also don’t be afraid to trust your gut. If you feel better on a gluten-free or dairy-free diet, go for it. But, if you’re considering cutting foods out of your diet for endometriosis, consider the effect on your mental health as well as your physical wellness when evaluating whether it’s worth it.

What I Eat in a Day (with ZERO Restrictions)

Now that we know how I feel about the endo diet — what, exactly, do I eat for my endometriosis? In short, I try to follow an overall healthy diet. To me, that means ZERO restrictions, because mental health is just as important as physical health!

Right now, I’m focusing on low-fat foods at the recommendation of my doctor, due to some liver test results I received at my annual physical, but I view that as a lifestyle change rather than a true “restriction.” I still drink half-and-half in my coffee and eat a buttery chocolate croissant from my favorite bakery once or twice a week.

While I’m still lactose intolerant and have non-celiac gluten sensitivity (NCGS), I’ve loosened my restrictions around gluten. I now include small portions of my favorite foods, like Goldfish, that I can tolerate (hot tip: sprouted grain bread and sourdough are easier to digest!), and take Lactaid whenever I want to eat dairy products.

As for my vegetarianism, I regretfully have given it up. I say regretfully because I truly undertook it for ethical reasons. However, I made the conscious choice to begin eating meat again when I realized how stressful meal-planning had become for me. As someone in eating disorder recovery, I feel that food should be easy, and finding new vegetarian recipes that sounded good to me was becoming a chore.

If you’re looking for ideas for healthy meals you can eat on an “endo diet” without restrictions (and without stress), then keep reading to check out some examples of what I eat in a day:

Breakfast

  • Oatmeal with peanut butter and strawberries
  • Smoothie with frozen fruit, peanut butter, and Lactaid milk

Lunch

  • Half a turkey, swiss, lettuce, and mayo sandwich on gluten-free or sprouted-grain bread, with low-sodium vegetable soup, or a whole sandwich by itself
  • Trader Joe’s premade salads: I like the Chinese chicken, spicy broccoli slaw, and edamame and cranberry ones

Dinner

  • One-pan roasted chicken breast, carrots, and potatoes with butter and rosemary
  • Green goddess turkey burgers with a side salad made from lettuce, feta cheese, bell peppers, and cucumbers

Snacks

  • Blue corn chips and Trader Joe’s reduced fat guacamole dip
  • Whole-grain Goldfish crackers
  • KIND bars: I like the cherry chocolate cashew and chocolate cinnamon pecan flavors best
  • Part-skim string cheese
  • Microwave popcorn: the light butter flavor is my favorite
  • Yasso frozen Greek yogurt pops: my favorite is mint chocolate chip

Can You Lose Weight in Eating Disorder Recovery?

Trigger Warning: This post deals with weight loss, eating disorders, calorie counting and other topics that could be upsetting to someone with a history of an ED. Please proceed with caution. Remember, I am not a medical professional, so consult your doctor before making any changes to your diet or exercise routine.

It’s been awhile since I talked about eating disorder recovery, but with the emphasis on weight gain during quarantine in the media lately, I think this blog post is overdue. Although I titled this blog post “can you lose weight in eating disorder recovery?” I think the better question is “should you try to lose weight in eating disorder recovery?”

I’m turning 22 in July, which means I’ve officially been in eating disorder recovery for almost five years now. Those of you who know my story know I suffered from orthorexia / EDNOS on-and-off from ages 14 to 17. Since then, I’ve had relapses — especially when I was first diagnosed with IBS and began skipping meals to control my symptoms — including attempts to purge, but thanks to the help of a dietician at my alma mater, Boston University, and a long stint in an intensive outpatient program (IOP), I now have a healthier relationship with food than I have had in a long time.

As someone in eating disorder recovery, I’m no stranger to fluctuations in my weight. In high school, when I first began eating intuitively, I gained so much weight that my prom dress no longer fit. (Even though I’d taken the tags off, my mom took me to the store and helped me lie about receiving the gown as a gift so we could exchange it for a larger size.) But this year, I experienced weight gain in a different way than I ever had before.

I’m going to mention some numbers here, so if you’re triggered by that specifically, I recommend you skip this paragraph! I believe in set-point theory, and my set point weight has always been 115 to 120 pounds. However, this year, I started taking progesterone to help with my suspected endometriosis and soon found myself gaining almost 15 pounds in a matter of months. Weighing in at 132 pounds, I was three pounds away from being classified as “overweight” for my height — not to mention, I’ve spent hundreds of dollars replacing clothes that no longer fit, and coping with the blow that’s inflicted on my self-esteem.

I believe in Health at Every Size (HAES) and that weight gain is natural at certain points in our lives, especially when it’s a result of age or a side effect of a medical condition or treatment. I’m even okay living in my larger body (though I do miss some of my clothes that no longer fit), especially given that it means freedom from debilitating cramps. Nor do I believe that food should ever, ever be about guilt. But to me, becoming almost overweight served as an important sign that I should pay more attention to the way I am treating my body.

For me, that raised an important question: is losing weight in a quest for better health going to trigger a relapse? Here’s what my experience has been and what I’ve learned from doing some research on the subject.

You Need to Be Fully Recovered.

Do you consider yourself fully recovered from your eating disorder? To me, this is a tricky question. I’ve been in eating disorder recovery five years and I think some part of me will always struggle with the urges to restrict and purge. Yet at the same time, I’ve also achieved a milestone in my recovery where I can look at the scale objectively. Gaining weight isn’t a measure of whether I am a good or bad person, nor is it a death sentence. It’s just a number.

Viewing my weight as just a number allows me to weigh myself and track my weight without my daily mood being tied to what I see. I still struggle with the urge to weigh myself more often than I probably need to, but with the exception of the occasional bad day, my weight no longer has such immense power over me. To me, this is what it means to be “fully recovered.” The worst of my EDNOS days feel so far behind me that I feel comfortable pursuing a small amount of weight loss for the sake of improving my diet and exercise routines.

If you are new to recovery or not fully weight-restored, then weight loss should be the last thing on your mind right now. Whether or not you are overweight or obese (because no, “skinny” people aren’t the only ones who get eating disorders), your main focus should be on maintaining healthy eating patterns and overcoming your ED thoughts and behaviors. Methods used to lose weight, even in a “healthy” way — i.e. weighing oneself or tracking calories consumed and burned — can lead to a relapse if you are not firmly set in your eating disorder recovery.

You also need to be honest with yourself about your reasons for wanting to lose weight. Wanting to fit into your favorite pair of jeans because you miss wearing them? Wholesome reason to lose weight. Believing that weight loss will make you happier and fix your life’s problems? Insidious eating disorder urge. When you have not been in recovery very long, you may not be able to tell the difference between these two types of thoughts, which I like to call your “eating disorder self” and your “genuine self.”

That’s why it’s imperative that you consult your treatment team, and potentially seek the support of a nutrition and/or mental health professional, if you want to lose weight in eating disorder recovery. They may be able to better grasp whether or not your reasons for wanting to lose weight reflect a healthy self-esteem or stem from your eating disorder.

You Need a HAES Approach.

In my humble opinion, if you’re going to pursue weight loss as a person in eating disorder recovery, losing weight should be your secondary goal. You need a primary goal to drive your behavior that doesn’t stem from a place of self-loathing or food policing. For me, that goal is wanting to improve my food and exercise habits and wear my favorite clothes again. Losing weight is simply a side effect of that larger, overarching goal.

Weight loss on its own will not help you achieve health, happiness or even body satisfaction. In my experience, if you want to lose weight for the sake of losing weight, it’s more likely to come from a place of insecurity and self-judgment than from a place of holistic health and self-love. But that’s not the only reason why I feel that weight loss should not be your primary goal. As a person in eating disorder recovery, I also firmly believe in the HAES movement, which tells us that weight is not, in fact, a true measure of health or wellness.

Conventional doctors read the number on the scale, classify patients into categories based on our BMI (such as “overweight” or “obese”) and make suggestions about how much weight to lose accordingly. Their sole goal is to force you to fit neatly into the “normal weight” box, because that’s all many doctors are taught in medical school: maintaining a normal weight helps minimize health risks. I would know, because I helped my doctor boyfriend study for all his board exams!

But as I’ve learned in my eating disorder recovery, correlation does not equal causation; being overweight does not directly lead to death or disease. And I’m not even going to get into the unethical relationships between the diet industry and the so-called pioneers of studies that promote the false idea of the “obesity epidemic.” All I’ll say is that doctors shouldn’t look at a patient’s weight or appearance to make final judgments on their health status. Better measures of health include blood pressure, fasting blood sugar, cholesterol and other biomarkers that tell us what’s actually going on inside our bodies.

That being said, I think it’s important to consider all perspectives, without engaging in fear-mongering. We can and should be able to appreciate fat bodies and end weight discrimination while still promoting a healthy population. At the same time, one would argue that when eating healthfully and exercising, a person is unlikely to remain morbidly obese, regardless of whether weight loss was an actual goal of theirs. Currently, the empirical research does seem to suggest that weight loss in obese populations reduces disease risk and mortality rates (though admittedly, many of these studies are sponsored by companies promoting weight loss drugs or boasting other links to the dieting industry). HAES healthcare providers recognize this, and have identified the need for more quantitative studies to support their work.

Personally, I believe in the importance of physical and psychological health, which is why I support HAES over the lose-weight-at-all-costs approach triggered by obesity alarmists. Initial studies have found that people who are satisfied with their weight are healthier both mentally and physically — which is a pretty great start if you ask me. So, how do you follow a HAES approach to nutrition? According to HAES and intuitive eating, the most important thing is that we avoid fad dieting (which has been shown to fail 95 percent of the time) and focus on foods that make us feel good. You can lose weight with an HAES approach, as long as you love yourself the same whether you weigh 400 pounds or 150 pounds and avoid unsustainable patterns of eating. Linda Bacon and Michael Pollan, founders of the HAES movement, outline the following guidelines for following a healthy diet with an HAES approach:

  • Enjoyment should take first priority. Don’t force superfoods into your diet if you hate eating them — nor should you force yourself to indulge in something you don’t really want for the sake of “proving” your eating disorder recovery. I also interpret this to mean that you should pay attention to the way foods make you feel in addition to the way they taste. For example, I love macaroni and cheese and will always have days when I choose to eat it — but most of the time, I avoid dairy because the satisfaction of cheese doesn’t outweigh the physical side effects of my lactose intolerance.
  • Variety is the best way to ensure you are getting all the macro- and micronutrients your body needs to stay healthy. Pay attention to building a colorful plate, as bright colors signify the presence of different vitamins and minerals.
  • Plant-based foods should be the centerpiece of your diet. That doesn’t mean you have to follow a prescriptive diet, such as vegetarianism or veganism, but meat and dairy should be considered side dishes.
  • Not too much means grasping your hunger cues and only eating until you are comfortably full. You should avoid distractions while eating (though I’ll be the first to admit that I’m frequently guilty of snacking and scrolling!) and distinguish between physical and emotional hunger.
  • Most of the time is the final tenet of the HAES approach to food. In short, it means that there are no hard-and-fast food rules. You should strive to follow the healthful approach described above whenever you can, but also accept that sh*t happens! Some days, you’re only going to have time to eat a granola bar while driving on your way to picking up the kids, meaning you’re going to need to eat while distracted. Other days (like Thanksgiving, for one), you might choose to eat beyond full because you love what you’re eating. AND THAT’S OKAY! It’s about moderating, not avoiding, your consumption of processed and so-called “unhealthy” foods. As Linda Bacon says, “there’s plenty of room for Twinkies in the context of an overall nutritious diet.”

To bring this discussion to a close, because I know it’s been a long one, weight loss isn’t your primary goal when following a HAES approach. But, you may find that when you begin to focus on eating plant-based foods, following your body’s hunger cues and enjoying treats in moderation, your body settles in at a set point weight that’s lower than you thought it would be. That doesn’t mean you should view HAES or intuitive eating as a “diet,” per se. However, if you’re someone who’s been stuck on the yo-yo dieting rollercoaster for years and struggles to lose weight, you’ll likely have more luck achieving your weight loss goals while following a truly satisfying intuitive eating approach than a strict fad diet.

You Need Support.

The first thing I did when I decided to lose a few pounds? Tell David. Our conversation went a little something like this….

HALEY: Hey, can I talk to you about something?

DAVID: Sure.

HALEY: So, I’ve been dissatisfied with the weight I’ve gained on my medication because a lot of my clothes aren’t fitting and I’ve decided to try to lose a few pounds. I’m going to be tracking my weight and calories to help me out. I’m telling you this because of my history of disordered eating, so that if this triggers my old habits, you can knock some sense into me.

DAVID: Okay. Thank you for telling me that. I will be sure to let you know if I notice anything.

If you have a history of an eating disorder, you cannot and should not go about weight loss on your own. You need the support of your medical team, as well as your friends and family, to keep you on track and prevent you from relapsing during your journey to lose weight. Alternatively, if your weight loss is something you feel the need to conceal from others, that might be your first cue that it’s coming from a place of disordered thinking, rather than a genuine concern for your health and well-being. You shouldn’t need to hide your goals if you are truly acting from a place of self-compassion.

It’s absolutely essential to be open and honest about any disordered feelings or thoughts that arise during your weight loss journey, and to be prepared to abandon your goal in the event that this pursuit leads to a relapse. Having the support of a registered dietitian and/or mental healthcare provider can provide you with an outlet to discuss your relationship with food and addresss any disordered thoughts or behaviors you’re still struggling with. If you’re not comfortable with this approach to weight loss, that’s a clear sign that your weight loss may not be coming from a healthy place and that you should wait until you are further along in your recovery journey to reassess whether losing weight is the right move for you.

I’ve also found it incredibly important to support myself by monitoring the types of content I’m taking in online. Despite my goal to lose a few pounds, I’m not following fitness influencers or searching for “flat belly tips” on Pinterest, because I know thsoe are things that trigger me. Instead, I’ve been watching a lot of videos by the dietitian Abbey Sharp on YouTube, where she criticizes fitness influencers’ “What I Eat in a Day ” videos for both nutrition content and any disordered eating patterns she notices, and searching for recipes that follow the plant-based, DASH diet or Mediterranean diet approaches, which emphasize overall nutrition and heart health over weight loss.