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Nutritional aspects related to endometriosis
Rev Assoc Med B ras 2015; 61(6):519-523 519
REVIEW ARTICLE
Nutritional aspects related to endometriosis
Gabriela Halpern1*, Eduardo Schor2, Alexander Kopelman3
1MSc – Nutritionist at the Division of Pain and Endometriosis, Department of Gynecology, Escola Paulista de Medicina, Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brazil
2Habilitation (BR: Livre Docência) – Head of the Division of Pain and Endometriosis, Department of Gynecology, Escola Paulista de Medicina, Unifesp, São Paulo, SP, Brazil
3PhD in Medical Sciences – Physician at the Division of Pain and Endometriosis, Department of Gynecology, Escola Paulista de Medicina, Unifesp, São Paulo, SP, Brazil
Summary
Studed conducted at Setor de Algia
e Endometriose, Departament of
Ginecology, Universidade Federal de
São Paulo, São Paulo, SP, Brazil
Article received: 7/3/2014
Accepted for publication: 3/23/2015
*Correspondence:
Address: Rua Loefgreen, 1570
São Paulo, SP – Brazil
Postal code: 04040-002
This literature review analyzed the evidence on nutritional aspects related to the
pathogenesis and progression of endometriosis. Diets deficient in nutrients re-
sult in changes in lipid metabolism, oxidative stress and promote epigenetic ab-
normalities, that may be involved in the genesis and progression of the disease.
Foods rich in omega 3 with anti-inflammatory effects, supplementation with N-
acetylcysteine, vitamin D and resveratrol, in addition to the increased consump-
tion of fruits, vegetables (preferably organic) and whole grains exert a protective
effect, reducing the risk of development and possible regression of disease. Di-
etary re-education seems to be a promising tool in the prevention and treatment
of endometriosis.
Keywords: endometriosis, fatty acids, omega-3, diet, feeding, food habits, vita-
min D.
Introduction
Changes in eating habits occurring since the domestication
of animals, by the end of the nomadic era and with the ad-
vent of agriculture, have brought consequences for the
health of humankind in general, especially if we consider
that the human body is still metabolically programmed to
the hunter-gatherer diet (leanmeat of wild animals and un-
cultivated plants) and a more active lifestyle.1
In recent decades, there has been a change in the di-
etary pattern, once rich in natural foods with mono and
polyunsaturated fatty acids, fiber, vitamins, minerals, an-
tioxidants and phytochemicals to refined, processed and
canned foods, with a large amount of pesticides, colo-
rants, preservatives, acidulants, flavorings and stabilizers.
Western diets often have a high energy and low nutrition-
al content (high intake of refined foods, fast food and low
consumption of fruits, vegetables and whole grains).2
Factors such as anxiety, stress, pollution, sedentary
lifestyle, environmental toxins, pesticides, dioxins and
phthalates, polychlorinated biphenyls (PCB’s) and xeno-
biotics, among others, generate imbalances in the body, as
they increase circulating free radicals, favoring oxidative
stress with increased nutritional demand. Given that the
current diet is already deficient in nutrients, the established
imbalance may contribute to the onset or worsening of dis-
eases, such as endometriosis, recurrent miscarriages, pre-
mature menopause, unexplained infertility, and more.2
Copious evidence suggests that oxidative stress is in-
volved both in the pathogenesis and the pathophysiolo-
gy of endometriosis.3 Genetic, environmental and life-
style factors appear to be associated with the development
and maintenance of endometriosis. Among the environ-
mental aspects, nutrition has been little studied, despite
evidence showing its impact on the origin and progres-
sion of the disease.4,5
The first scientific article that addresses the subject
was published in 2004, by Parazzini et al. The authors
evaluated 504 women aged between 20 and 65 years, us-
ing a food frequency questionnaire. They found that the
highest weekly intake of fruits and vegetables was inverse-
ly associated with risk of developing the disease (vegeta-
bles: RR 0.3; 95CI 0.2-0.5, p=0.002; and fruits: RR 0.6;
95%CI 0.4-0.8, p=0.002). In contrast, consumption of red
meat, cold cuts and sausages has been identified as a risk
factor for the development of the disease.6
In this field, studies have faced difficulties arising
from differences in dietary habits in different regions,
the different composition of the same food in certain
countries and a lack of homogenization to evaluate eat-
ing habits (food frequency questionnaire, habitual recall,
seven-day recall, weighing of food, etc.).4 Another obsta-
cle is the influence of pain on the eating habits of wom-
en affected by changing appetite, and consequently the
choice of diet.