Glycemic index, glycemic load, fiber, and gluten intake and risk of laparoscopically confirmed endometriosis in premenopausal women

Authors: Schwartz NR, Afeiche MC, Terry KL, Farland LV, Chavarro JE, Missmer SA, Harris HR.

Publication: The Journal of Nutrition. 2022 Sep 6;152(9):2088-96.


Sub-optimal treatments for endometriosis drive people to explore alternative methods to alleviate their symptoms. Lifestyle modifications and nutrition have been reported to be helpful strategies to decrease the pain levels or perception of pain. It is thought by some that diet may influence the disease development. Authors of this study investigated how nutrition, in particular gluten, carbohydrates, and fiber may be linked to the risk of developing endometriosis.

Key findings:

This study involved a total of 81,961 women, 3810 of whom had laparoscopic confirmation of endometriosis diagnosis. All participants were registered nurses enrolled in an ongoing cohort study collecting health data every four years since 1991. In this publication, the authors analysed information pertaining to people’s nutritional habits and diagnosis of endometriosis over the 25 year follow up period.

Food categories significantly associated with an increased risk of endometriosis diagnosis were:

Intake of fruit and gluten was liked to a decreased risk of endometriosis diagnosis. No clear association was found between endometriosis and total fiber, legume fiber, cereal fiber, and carbohydrates consumption.

Take home message:

Although several food categories were linked with either an increased or decreased risk of endometriosis diagnosis, the authors note that the risk of diagnosis is not equivalent to the cause or reason for endometriosis development. Correlation found between the certain food groups and endometriosis diagnosis may be more reflective of painful symptoms rather than the cause of the disease. This is especially relevant to the finding on the vegetable fiber as its consumption may trigger symptoms of Inflammatory Bowel Syndrome (IBS) - a common illness commonly co-occurring with endometriosis. It is possible that vegetable consumption provokes symptoms (e.g. abdominal pain), leading affected people to seek out health care provider assistance more commonly and eventually get surgical confirmation of the diagnosis. In conclusion, this is the first study that attempted to investigate the link between endometriosis and its diagnosis in an on-going (prospective) manner over the course of a long period of follow up. However, future studies are required to determine how food quality and quantity may affect the results, and whether different food groups influence different symptoms of endometriosis. In addition, replication of the finding while controlling for co-occurring illnesses and access to care will be needed before dietary recommendations can be developed.