Red meat, dairy and gluten intake and its effects on the management of pelvic pain from endometriosis: a literature review
Key-words: Endometriosis; diet therapy; red meat; dairy products; gluten-free diet
Endometriosis is a multifactorial, chronic, benign and estrogen-dependent pathology in which ectopic endometrial tissue is implanted outside the uterine cavity, being the most common sites the retrocervical region and the ovaries, leading to inflammation, pain and other consequences, such as conceiving issues and infertility. These lesions seem to be related to the menstrual cycle as the endometriotic tissue proliferation is triggered by estrogen levels response. Also, the endometriotic cells produce more estrogen, which enhances their own development. Typical symptoms of this pathology are dysmenorrhoea, dyspareunia and chronic pelvic pain. The leading diagnostic method is laparoscopic inspection with histological confirmation after biopsy concomitant with the clinical history. Such condition requires a multidisciplinary approach and the treatment is usually hormonal, aiming at suppressing and delaying its recurrence and progression. Given its still unclear physiopathology, an effective treatment is yet under study, and the ones currently available are mainly focused at mitigating the symptoms such as pelvic pain, rather than its prevention. Besides, current studies have tried to associate diet to endometriosis risk and pelvic pain relief. Therefore, this work is aimed at reviewing the literature related to diet and endometriosis symptoms, with emphasis on red meat, dairy products and gluten from the national and international bibliography, between 2010 and 2020, using online databases Scielo and Google Scholar and applying the keywords endometriosis, diet therapy, red meat, dairy products and gluten-free diet. The adoption of a diet therapy focused on monitoring the intake of those foods might be able to offer better results in symptoms related to endometriosis and even improving life quality in patients affected by this disease, working as an adjuvant treatment for this multifactorial pathology. Through a recent cohort study it was possible to infer the association between red meat intake and the risk of endometriosis in a dose-response way, in which it was concluded that a diet based on reducing red meat intake could improve symptoms such as pelvic pain. The red meat intake could be responsible for: oxidative stress and DNA damage; catalysis of endogenous formation of N-nitro carcinogenic compounds; metabolic dysfunctions and increased endogenous estrogen levels, although the true pathophysiology of red meat intake remains unclear. In addition, the intake of dairy products seems to contribute to the relief of symptoms, and may reduce levels of oxidative and inflammatory stress markers. Finally, a gluten-free diet may be linked to inhibition of immunomodulation and inflammatory response mediated by a cytokine network. Besides this inflammatory factor, recent research suggests that one of the manifestations of sensitivity to gluten is sensory ganglionopathy, evidencing the hypothesis that the mechanisms of nociceptive pain are involved with endometriosis related pelvic pain. In conclusion, diet therapy performs an important role in the management of painful symptoms of endometriosis, considering that the implementation of a diet focused on reducing the intake of red meat and gluten and increasing the consumption of dairy products may be linked to a decrease in observed levels of inflammatory response. However, further experimental studies are needed to fully understand its role.
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