Gluten & Endometriosis: Everything you need to know
Endometriosis is a chronic inflammatory disease that can be extremely difficult and painful to live with. In fact surveys have shown that the majority of women with endometriosis experience chronic abdominal and back pain, with 4 in 10 dealing with pain every day (1).
Inflammation is often linked to endometriosis pain, and understanding what triggers or worsens endo pain can be an important part of managing endometriosis. There are many factors that can be considered an ‘inflammatory trigger’, and gluten may be one of them. In this blog we will explain everything you need to know about gluten and endometriosis and help you decide if going gluten-free is the answer to managing your endometriosis symptoms.
What is gluten
Gluten is a naturally occurring protein found in grains like wheat, rye and barley. These grains are often added to foods to give texture and flavour, or to work as a binding agent due to their gluten content.
In those who are intolerant to gluten, have gluten sensitivity or have coeliac disease, undigested and poorly processed gluten, can have inflammatory effects within the body which may lead to bloating, diarrhoea and/or abdominal pain symptoms (2).
This isn’t the case for most people with a healthy gut, and for the majority of people, having gluten in the diet is not normally a problem and won’t trigger these symptoms.
Sources of gluten
It can be hard to determine whether certain foods contain gluten as many foods may not be explicitly labelled as containing gluten, but instead will list the ingredients which contain gluten. Therefore in order to know if a product contains gluten, you’ll need to become an expert at reading food labels! Head over to the ingredients section and if you see any of these ingredients then the food product will contain gluten:
Wheat
Wheat derivatives eg.spelt, semolina, emmer, durum
Rye
Barley
Triticale
Malt
Brewers Yeast
Common food products that contain gluten include bread, pasta, baked goods, cereals, grains and sauces/gravies which often use wheat flour as a thickener (3).
So you now know how to identify if foods contain gluten, but can excluding these foods be beneficial to your health?
Does gluten impact health?
Interestingly, one study showed that consuming gluten can lead to raised inflammatory markers within the body, not only in those with Coeliac disease, but also in those who have no intolerance to gluten (4).
We know that endometriosis is a chronic disease where inflammation is rife, so could consuming gluten lead to a heightened state of inflammation in those with endo, and thus lead to more severe and painful symptoms? Ultimately, would a gluten free diet be beneficial for endometriosis?
Can gluten affect endometriosis symptoms?
Although theoretically removing gluten from the diet might help endometriosis symptoms, there are actually very few studies looking specifically at the impact of gluten on endometriosis management.
One study in people with endometriosis, found that pelvic pain was reduced more in those having a combined treatment of medication and a gluten-free diet, compared to having medication alone (5).
Pain reduction was also observed in another study after following a gluten free diet for 12 months, as well as improvements in mental health and health perception (6).
Overall these studies show promising results for pain and endo symptom management, however, this last study was just an observational study and so a firm conclusion that a gluten-free diet reduces pain in endometriosis patients cannot be drawn. Due to the myriad of factors at play in observational studies it’s almost impossible to determine if excluding gluten actually causes this pain reduction and so further research i.e. randomised controlled studies (gold standard for nutrition research) are needed.
Do I need to follow a gluten free diet
Following a gluten free diet when living with endometriosis may be beneficial in some individuals. Although it is not going to reverse/heal the endometriosis itself, it may help some individuals with the management and reduction of endo pain.
But, evidence related to gluten free diets and endometriosis are ambiguous as few studies exist and those that do have not all generated significant findings - so more research is definitely needed to fully understand this topic and improve the quality of life for endometriosis patients (7).
If you are interested in trying a gluten-free diet to manage your endometriosis, then the following are all important factors that you must consider.
If other treatments are successful and working for you, then going gluten-free may not be necessary.
Getting support from a women’s health dietitian to make changes to your diet will help to prevent any nutritional deficiencies and ensure your diet is as complete and nutrient rich as possible
Before committing to a gluten-free diet, try it out for a short time period of time, slowly replacing gluten-containing foods, making sure to record positive and negative symptoms using a symptom diary, AND communicating regularly with a dietitian. If no improvements are seen then it is likely that a gluten free diet may not benefit you. However, if you notice significant improvements then discuss the next steps about how you can incorporate this into your day-day life with a dietitian.
Nutritional risks
Although gluten-free diets may be helpful, micronutrient deficiencies such as iron, calcium,magnesium, vitamin D & E are commonly experienced when removing gluten containing foods. Many wheat/gluten-containing foods also naturally contain fibre and so it is important to be mindful of incorporating wholegrains, seeds, nuts, pulses, fruits and vegetables (with skin, pips and seeds!) to maximise the benefits and avoid becoming fibre deficient.
In addition, going gluten free may mean you end up eating fewer carbohydrates in your diet (gluten-containing foods tend to be carbohydrate rich).
If your carbohydrate intake drops too low this may lead to a state of ketosis, where the body relies on fat stores in the body to offset the lack of carbohydrates providing energy, leading to weight loss.
Therefore, consulting with a registered health professional is essential to fully optimise the benefits of a gluten-free diet whilst ensuring your diet remains balanced without the risk of any nutrient deficiencies (8).
The Bottom Line : Should you follow a gluten-free diet for endometriosis?
So although there is a potential link between gluten and inflammation for some people, which in those with endometriosis may lead to worsening of their symptoms, the minimal evidence we have is not conclusive enough to say that adopting a gluten-free diet will definitely help improve endometriosis related pain.
As endometriosis and the use of gluten-free diets is such an under researched field and there are potential nutritional risks when cutting out foods from your diet, we need lots more good quality studies to be carried out before we can confidently recommend a gluten free diet for endometriosis. However, the studies that we do have show promising results, so if you wanted to trial a gluten free diet in the short term to see if you personally experience any changes to your endometriosis symptoms then it might be worthwhile doing so with the support of a registered dietitian who can help you ensure your diet is nutritionally complete.
If you wish to discuss this further why not book a free discovery call with a registered and specialist women’s health dietitian.