‘I’m a dietitian with endometriosis. Here’s what I’d love you to know.’

In April this year, Amanda Smith officially became part of a club that counts around one in nine women among its members. On waking from keyhole surgery and hearing that she did indeed have endometriosis, she burst into tears. “It was a relief that it wasn't all in my head for the past 14 years,” Amanda tells Mamamia. “I felt validated.” 

Amanda had faced painful and heavy periods since her teens, but it took more than a decade of seeing different doctors for her to be diagnosed with this chronic condition – where cells similar to those that line the uterus grow in other parts of the body, which can spark symptoms including pain, bloating, heavy periods, bowel issues and fatigue. Her experience fuels her work as a dietitian specialising in women’s health, and she’s passionate about the role nutrition can play in helping people to manage symptoms of conditions like endo.

Watch: The definition of Endometriosis and its symptoms. Post continues after video.

It's still early days in the science stakes and there’s not yet a concrete ‘best diet’ for endometriosis, she caveats. Plus, what makes a difference for you might not for someone else. “It’s a very exciting space and there are a few different areas we have research for in terms of dietary approaches that can help, so it's about modifying that to the individual,” Amanda says. “Nutrition is a valuable piece of the puzzle, but it's just that – one piece. Like with any condition, we look at it through a holistic lens.”

Intrigued? From the power of plants and gut TLC to navigating misinformation, Amanda shares the latest intel and what she wants us all to know.

Get around anti-inflammatory foods.

As endo is linked with chronic inflammation, it’s worth plating up a fire-fighting approach. “We have research around the benefits of an anti-inflammatory style diet – or a Mediterranean-style diet – for helping to reduce endometriosis-related pain,” Amanda explains. “We've seen this demonstrated with other inflammatory conditions as well.” 

Plants take centre stage for their natural antioxidants, as well as extra virgin olive oil and oily fish for its omega-3 fatty acids. Think: fruit, veggies (including cruciferous queens like broccoli and cauliflower), whole grains, legumes, nuts, seeds, herbs and spices. 

A 2023 review in Frontiers in Nutrition suggests a plant-forward approach may benefit those with endo, while Amanda points to a 2021 Japanese study in Nutrition which “found that following an anti-inflammatory diet during preconception [was associated with a] reduced risk of preterm birth and low birth weight for women with endometriosis.”

There's also some science around supplements, she adds, such as vitamins C and E and omega-3 – a 2021 review by Germany’s University Hospital of Düsseldorf found fish oil capsules have been linked with a positive impact on symptoms like painful periods. “But suitability and dosage [of supps] will vary, so it's really important to see a dietitian for an individualised plan and not to self-prescribe,” cautions Amanda.

Show your gut some love.

“Some evidence suggests there are alterations in the gut microbiome in individuals with endometriosis,” says Amanda. “So, strategies to optimise it may assist in reducing inflammation, as well as any pain and gut symptoms associated with endo.”

Eating a diversity of plant foods (yep, that lot again) as well as minimising ultra-processed eats is a winner for gut health, she notes. “During times where I've not been as on top of my nutrition, I definitely notice a difference in terms of pain and nausea associated with my endo,” says Amanda, adding that alcohol is also a trigger for her.

Oh, and heard of the low FODMAP diet? Typically used under expert guidance to manage irritable bowel syndrome (IBS), this short-term approach involves temporarily restricting certain foods that can trigger symptoms – and it may benefit some people with endo, too. 

“An Australian study of women with endo and IBS found that 72 per cent experienced an improvement in bowel symptoms of more than 50 per cent after following a low FODMAP diet for four weeks,” Amanda explains. “It's not what I or most practitioners would go to as a first-line management, but it's a tool we can use for clients who seem to have some FODMAP intolerances. More often, I use a modified approach that’s less restrictive.

Seek advice before cutting things out.

It’s no wonder many of us are game to try anything to feel better, but Amanda urges caution around ditching whole food groups. 

“It’s important not to get hyper-fixated on nutrition and cut out lots of different foods unnecessarily, which is what I commonly see in practice,” she shares. “Women will have cut out gluten, dairy, soy and this long list. It can be a slippery slope to disordered eating, especially since we know women with endometriosis can have poorer body image. Unfortunately, there's a lot of nutrition misinformation out there, so people restrict things when they don't have to.”

This scenario is something she’s super conscious of as a practitioner: “If a client exhibits a poor relationship with food or body image, any sort of dietary restriction isn't appropriate,” she says, giving the low FODMAP approach as an example. “It’s more about working on their relationship with food and thinking about what we can <add> to help manage the endo rather than take away.” 

Suspect a food intolerance or sensitivity? Check in with a dietitian or healthcare professional for tailored advice. 

If you need support for an eating disorder or body image issue, contact Butterfly’s National Helpline on 1800 334 673 or email support@butterfly.org.au

Post-op preparation is key.

If a surgery is on the horizon, Amanda recommends being proactive in prepping for your recovery. “I stocked up on snacks I'd be able to tolerate for the first few days, since nausea is a prominent symptom with my endo and also a common [side effect] of general anaesthetic,” she says. “So, things like seeded crackers, roasted fava beans, nuts, salted popcorn and whole grain sourdough with Vegemite.”

“Then during the second week, as I started to feel a little better, I focused a bit more on nutrition strategies like increasing my dietary intake of nitrates – with the likes of beetroot, spinach, kale and watermelon – to help with increasing uterine blood flow and the healing process.”

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A post shared by Amanda Smith - Fertility and Gut Health Dietitan (@amanda_smith_dietitian)

Recruit your health team.

While endo is officially confirmed via surgery, Amanda emphasises you can reach out for expert support at any time. “Whether it's a dietitian, a pelvic floor physio or a gynaecologist, it can make a really big difference in terms of symptom management,” she says. “And if you suspect you might have endometriosis, please seek help. You don't have to live in pain and discomfort, and you don't have to wait until you're ‘sick’ enough to investigate further, which is what a lot of us do.” 

As for her own future, Amanda is optimistic. There are still times she gets symptoms and feels the impact of her endo, but she recently enjoyed a milestone – her first low-pain cycle. “There are now many more good days than bad days, so I feel empowered in terms of managing my endometriosis moving forward,” she says. “I’m even more passionate about working in this space and helping my fellow endo warriors.”

Amanda is an accredited practising dietitian (APD) as well as a certified fertility and prenatal dietitian at Verde Nutrition Co. You can follow her on Instagram here.

Feature Image: Supplied

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