2025, Responses from Registered Dietitian, Alice Gormack
Omega-3s and fish oils are known for their anti-inflammatory benefits but can fish oil supplements offer me the same support as eating oily fish?
Fish oil supplements can provide the same key omega-3 fatty acids — EPA and DHA — found in oily fish such as tuna, salmon, sardines, and mackerel. Research shows that omega-3s help reduce inflammation and menstrual pain, and may support mood and fertility.
However, oily fish also contain other nutritional benefits like protein, vitamin D, and selenium that supplements don’t provide.
If you don’t eat fish, a high-quality, purified fish oil supplement can be an effective alternative — aim for around 500–1000 mg combined EPA + DHA per day (read the back of the packet to find out the EPA and DHA amounts).
Are omega-3 supplements from algae beneficial?
Algae-derived omega-3s are an excellent plant-based alternative to fish oil. They contain the same active forms of omega-3 (EPA and DHA), unlike flaxseed or chia, which only provide ALA (a precursor that converts poorly in the body).
Clinical studies show that algal DHA and EPA raise blood omega-3 levels just as effectively as fish oil.
Algal oil supplements are a good idea for vegetarians, vegans or those avoiding fish.
I know getting enough fibre can lower circulating oestrogen and keep things moving regularly. But if I’m aiming for 25 g a day, how do I spread that across breakfast, lunch, and dinner?
To meet 25g fibre per day regularly, it requires having foods high in fibre at each of your three main meals. For example:
- Breakfast: 6–8g
- Lunch: 8–9g
- Dinner: 8–9g
If you include high fibre snacks, then it makes it easier to reach your fibre target over the day (e.g., snacks like fruit, vegetables, a slice of wholegrain toast or 1-2 Weetbix can provide 2-4g fibre per serving).
If you have IBS symptoms with endometriosis, prioritise increasing gentle soluble fibre such as chia, oats, psyllium, fruit flesh, and well-cooked veg. Go slow and steady with fibre changes (e.g. stick with small amounts to start with, then build up as tolerated), and make sure to drink plenty of water too.
Simple fibre boosters:
- 1 Tbsp chia or flaxseed in smoothie or porridge = +5g fibre
- ½ cup lentils or chickpeas in salad or soup = +7g fibre
- 1 piece fruit (kiwifruit, pear, orange) = +3–4g fibre
- 1 cup mixed vegetables = +4–5g fibre
- 2 Tbsp seeds or nuts = +2–3g fibre
Even small amounts of these foods added into your usual meals/snacks can help you to reach 25–30g/day comfortably.
Helpful high-fibre breakfast foods:
- Rolled oats, chia seeds, ground flaxseed, psyllium husk, kiwifruit, berries, and wholegrain/seeded bread.
- Breakfast ideas:
- Smoothie: 1 Tbsp chia + 1 banana + 1 cup berries + 1 Tbsp flaxseed + yoghurt + milk
- Porridge: ½ cup oats (made with ½ C milk + ½ C water + 1 Tbsp chia) + 1 kiwifruit + yoghurt/milk
- Toast option: 2 slices seeded bread + avocado + tomato + sprinkle of seeds (e.g. pumpkin/sunflower/sesame).
High-fibre lunch foods:
- Leafy greens, capsicum, cucumber, tomato, capsicum
- Roasted vegetables (kumara, pumpkin, beetroot, carrot)
- Quinoa or brown rice
- Lentils, chickpeas, canned beans (even ¼ – ½ C of lentils adds a good fibre boost)
- Avocado
- Nuts/seeds
- Lunch ideas:
- 1 cup quinoa + 1 cup roasted veg + leafy greens + ¼ cup chickpeas + olive oil dressing.
- Wrap or bowl: Multigrain/wholemeal wrap + chicken/fish + 1 cup salad + 1 Tbsp hummus + 1 Tbsp pumpkin seeds.
- Soup: Lentil + vegetable soup + 1-2 pieces of multigrain/seeded toast.
High-fibre dinner foods:
- Mixed cooked vegetables
- Potato or kumara with skin on
- Use wholegrain carbs like brown rice, quinoa, or buckwheat regularly
- Lentils, chickpeas, canned beans (great for protein and fibre!)
- Seeds/nuts (add flavour + fibre to meals)
- Dinner ideas:
- Fish + mixed roast vegetables + quinoa + 1Tb seeds
- Chicken curry with 1C mixed vegetables + ½ C lentils + ½ C rice
- Vegetable soup: Add lots of different vegetables + ½ can drained beans, serve with 1-2 slices of wholegrain/seeded bread.
Is alcohol (even the low-sugar kind) something we should be limiting — or is it fine in moderation?
Even low-sugar alcohol can worsen inflammation and affect hormone balance if you drink too much or too often.
Research suggests that having alcohol regularly may increase oestrogen levels and worsen symptoms in some people with endometriosis. That said, occasional moderate consumption (e.g. 1–2 standard drinks a few times per month) is unlikely to have a significant impact for most people.
Recommendation: Keep alcohol to no more than 1–2 drinks per occasion. It is a good idea to choose low sugar alcohol drinks as high sugar foods are more inflammatory with endo.
I would recommend that you have at least 2-3 alcohol-free days each week and make sure that you have some food when drinking (e.g. dinner or a snack).
I’ve heard mixed things about caffeine and endo. Do I really need to reduce how much I’m having?
Caffeine is fine in small amounts for most people. However, a high caffeine intake (>300 mg/day, or >2–3 coffees) may potentially worsen menstrual pain and is linked in some studies to higher oestrogen levels.
People with anxiety, sleep issues, or IBS may also find caffeine aggravates their symptoms.
Recommendation: Limit caffeine to around 200mg per day where possible. This is equal to around 1 regular café coffee or 2 cups of tea per day. Avoid energy drinks and pre-workout supplements as these can be high in caffeine. This same caffeine recommendation applies to women looking to concieve too.
Try caffeine-free alternatives such as decaffeinated tea or coffee, rooibos, herbal or fruit-based tea as alternative hot drink options.
Plant-based milks are everywhere — how do I know which one to choose?
For endometriosis, choose milks that are calcium-fortified (at least 100 mg calcium per 100 mL) and unsweetened to support bone health and reduce added sugar.
Recommended: Soy/rice/oat/almond/coconut milk (all unsweetened, calcium-fortified)
Less ideal: Unfortified “natural” nut milks as these are very low calcium and protein, or sweetened plant-based milks which can be higher in sugar (which is more inflammatory with endometriosis). Homemade nut milk will be very low in calcium and protein too.