The human body is metabolically programmed for life as an active hunter-gatherer, but contemporary dietary habits are notably low on nutrition and high on energy — further hampered by largely sedentary lifestyles and environmental toxins. This dietary imbalance exposes the body to oxidative stress and likely contributes to the onset or worsening of diseases such as endometriosis, according to a review study “Nutritional aspects related to endometriosis,” published in the journal Revista da Associação Médica Brasileira.

Endometriosis, in turn, has been connected to problems that include miscarriages, premature menopause, and infertility.

The first scientific research that addressed the dietary aspect of endometriosis was published in 2004, by Parazzini et al., and showed that a high weekly intake of fruits and vegetables was inversely associated with the risk of developing the disease.

Despite some disagreements among its authors, this review assessed evidence regarding nutrition and eating habits in relation to endometriosis. The authors reported that diets deficient in nutrients result in changes in lipid metabolism and oxidative stress, and promote epigenetic abnormalities. In contrast, foods rich in omega 3 have anti-inflammatory effects, especially if supplemented with N-acetylcysteine, vitamin D, and resveratrol. If eaten in conjunction with a healthy regular mix of fruits, vegetables and whole grains, these foods exert a protective effect and reduce both the risk of developing endometriosis and likelihood of the disease progressing.

Copious evidence suggests that oxidative stress is involved both in the pathogenesis and the pathophysiology of endometriosis, as are genetic, environmental, and lifestyle factors. Endometriotic lesions are cells that grow outside the uterus and retain their ability to respond to hormonal proliferative stimuli. Excess estrogen also stimulates the formation of large amounts of prostaglandins, promoting inflammation. During disease progression, changes resulting in abnormal immunological antigen-antibody reactions lead to the increase of pro-inflammatory agents. The release of reactive oxygen and nitrogen species also rises, causing further oxidative stress.

Hormonal medications are currently used to treat people with endometriosis, but their therapeutic success is uneven and they can carry notable side effects. According to the review, dietary nutrients are more effective at influencing both the pathogenesis and progression of the disease, leading to the possibility of alternative, adjuvant treatments for patients. Nutrients rich in folic acid, vitamin B12, zinc, and cholin (vegetables, legumes, and whole grains) help avoid increases in the levels of estradiol and prostaglandin E2 (PGE2), which favor inflammation and cell growth. Researchers note that pesticides and organochlorine used during agricultural cultivation can interfere with the antioxidant capacity of fruits, and with hormonal pathways — acting on estrogen and androgen receptors. However, their presence should not contraindicate consumption of these foods.

Nutrients like calcium, zinc, selenium, vitamin C, vitamin E, and other bioactive compounds in food (phytochemicals like carotenoids, flavonoids, indoles, and isothiocyanates) influence the pathophysiology of endometriosis. Polyphenols such as anthocyanins, hydroxybenzoic acids, flavones, isoflavones, lignans, resveratrol are present in foods that have strong antioxidant properties. Resveratrol, found in the skin of dark grapes and  jabuticaba (Myrciaria cauliflora), particularly, has demonstrated strong antineoplastic, antiinflammatory, and antioxidant action. Finally, the consumption of red meat and omega-6 fatty acids contributes to the maintenance of the disease, while omega-3 fatty acid (fish oil, flaxseed) has a preventative effect.

Because endometriosis treatment is multidisciplinary, incorporating nutritionists into therapeutic teams may assume an important role in disease prevention and management.