Flours and cereals: which to choose, and why, if you have endometriosis

Author of the blog I Love Being Healthy

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FLOURS AND CEREALS: which to choose, and why, if you have endometriosis

Today’s topic is extremely important. Bread and pasta are almost inevitable elements of every weekly menu; thus, it is good to understand how they can be included in an anti-inflammatory diet. If you want to know more about the relationship between diet and endometriosis (in case you missed my article), have a look qhere/a> [1]! And remember, the diet must always be combined with proper dietary supplements, such as Endoplus, and physical training, if you want to raise your chances of good results!

First of all, as you probably know, cereals (and their flours) can be:

  1. REFINED: the refining process includes a series of transformations that eliminate some substances or parts of a food product. For example, during the refining of the common commercial white flour, the germ and the external part of each kernel are removed. However, although this process has undoubtedly some advantages (the starch is made completely available, promoting the dough leavening), it also depletes the cereals of fibres, vitamins and proteins. Here are some practical examples of refined products: 00 flour; white bread and pasta; non-wholegrain breadsticks, crackers, sandwich bread and similar; polished or parboiled rice.


  1. WHOLEGRAIN: these cereals are mainly rich in fibres, which are important for several reasons (bowel regularity, prevention of some cancer types and control of weight, glycemia, cholesterol and arterial pressure). If you are interested, you can discover here [2] all the benefits of fibres! Besides, wholegrain cereals contain plenty of B vitamins and mineral salts (involved in various physiological processes), proteins, vitamin E and essential fatty acids (localised in the germ and important for skin wellness).

“Refined wheat flours have been stripped of their slow-digesting fibres and nutrients, which means that the body can break down these foods very quickly”, said Christopher Hollingsworth, an endovascular surgeon of the New York City Surgical Associates [3]. The faster the digestion of these carbohydrates (which contain glucose), the higher the blood sugar levels; this, in turn, induces an insulin peak, associated with a pro-inflammatory response.

On the contrary, as regards wholegrain cereals, it has been demonstrated that their higher consumption contributes to significantly reducing the concentration of inflammatory markers [4].

For those who suffer from endometriosis, it is especially important to keep the inflammation level as low as possible. This implies that, in the daily diet, refined flours should be avoided in favour of wholegrain cereals.

We can then make a second big distinction:

  1. GLUTEN-CONTAINING CEREALS: such as wheat, spelt, rye, barley and kamut.
  2. GLUTEN-FREE CEREALS (or pseudocereals): such as rice, corn, buckwheat, millet, quinoa, amaranth, manioc (or cassava), teff and sorghum.

In this regard, let’s see which investigations have been conducted. Marziali et al. [5] carried out a study that involved 207 women suffering from endometriosis and exhibiting severe and painful symptoms associated with this condition; these women were made to follow a 100% gluten-free diet for 12 months. At the end of the year, 156 patients (75% of the sample group) reported a significant reduction of their pain level (while the remaining 51 women showed no improvement of the symptoms).

Thus, it seems that a gluten-free diet might effectively help (not in every case, though) managing the pain perceived.

However, not everyone agrees on this point. In the absence of coeliac disease or a specific intolerance, it is unnecessary to completely exclude gluten from the diet. Therefore, I suggest to look for the support of your doctor and/or nutritionist to understand which is the best approach for you and whether to completely avoid gluten for a given time, to verify if this could actually benefit your condition.

Wheat deserves a more in-depth discussion.

In the last 100 years, wheat has undergone several changes. I found this out by reading the book written by Michael Vernon e Dian Shepperson Mills about endometriosis, fertility and nutrition[6] ((available only in English: https://amzn.to/2K1MrxW).

First, the genetic selection came into play in favour of the high-productivity wheat types; in other words, it has been ensured that each spike contained more kernels. But this made the spike too heavy; it folded in on itself, especially in the presence of wind or rain. Next, in the ’70s, the gamma-ray irradiation technique allowed the thickening and shortening of the stalk, which was too long and thin. Then, a fungus started to grow on the stalks, which were planted too close to each other in order to increment the productivity; this led to new modifications (and new chemical fertilizers) to face this problem. Therefore, due to these multiple adjustments, what we have today is not the same type of food that our grandparents consumed. It is still unclear whether there is an actual relationship between wheat and endometriosis, as well as whether the hormone profiles of the endometriosis patients might be influenced by its excessive consumption [5]: therefore, new studies on this direction are absolutely necessary. Nevertheless, the correlation between the consumption of wheat-based products and the exhibition of chronic inflammation or other auto-immune diseases has already been demonstrated [6].

I decided to reduce my consumption of wheat, even the wholegrain varieties, to the minimum. There are plenty of alternatives and, thus, I don’t really feel the need for it. If you choose to not exclude it, though (as long as you will still avoid the refined flours, such as the 00 and 0 types, for the reasons explained above), I suggest opting for products realized with ancient grains. Qui This [7] is an interesting article that could guide you for their selection!

After this introduction, a little bit “theoretical”, let’s try to understand at the practical level which cereals and flours to consume daily, and how!!

  1. First of all, rice! It is naturally gluten-free. I prefer the wholegrain, basmati, and black rice types. They are delicious when combined with legumes and vegetables; I often use them as a side dish. Although it is not an Italian habit (yet), it is spreading little by little. A typical recipe? 50 g of basmati rice, vegetables roasted along with herbs and spices, and 2-3 spoons of hummus! I find it convenient to prepare a lot of rice during the weekend and keep it in glass jars in the fridge for some days, so as to have it always ready for preparing the office lunch! I occasionally eat white rice (I haven’t given up totally on a good risotto!), but I definitely prefer the other varieties mentioned above. The same is valid for the flour; I use principally the wholegrain-rice flour (mixed with others to prepare bread and savoury cakes), while the one of white rice (which I utilize rarely) is suitable for homemade pastries and cakes.
  2. Millet and buckwheat: they are good as both kernels added to soups and fillings of roasted vegetables. Their flours are great, especially for bread and savoury preparations, but also for crepes and pancakes.
  3. Quinoa and amaranth: they are pseudocereals. Quinoa is slightly bitter due to the residues of saponin on the kernel surface; however, this problem can be easily solved by washing it in a tight-mesh sieve under running water! It is fine in salads but also to prepare porridge in the morning. Quinoa and amaranth are also available in their puffed version, perfect to be added to yogurt along with dried fruits or for homemade muesli, bars and granola.
  4. Corn (careful, try it in moderate quantities because it might induce some intolerance effects): as kernels for salads, in the form of cornmeal mush or as a flour for crunchier breading.
  5. Tapioca flour (derived from tapioca roots and rich in starch): its function is similar to that of potato and corn flours. I usually put small quantities of it in the doughs to obtain better results thanks to its high starch content.
  6. Spelt flour: the only gluten-containing flour that I use quite regularly. I buy pasta made with it or directly use the spelt flour to prepare flatbreads and leavened products, usually mixed with other flours.

These are the cereals and flours that I utilized the most and about which I feel comfortable in giving some advice. As regards the others, you are free to try! Remember that the flours derived from legumes (you will have probably seen pasta made with chickpea, pea or lentil flour at the supermarket; after all, how good is the chickpea bread?) or dried fruits (such as almond or hazelnut flour), although these are not cereals, could be added in plum cakes, muffins and pastries.

Have you seen how many alternatives there are? Before approaching this type of diet, I had no idea of all these possibilities!

What about you? Which flours and cereals do you usually eat?
Tell me about it in the comments!:-)

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[1] Endometriosis and anti-inflammatory diet? What you need to know… https://endo-plus.com/endometriosi-e-dieta-anti-infiammatoria-ecco-cosa-devi-sapere/. URL consultato l’8 novembre 2019.

[2] Fibre alimentari solubili ed insolubili: cosa sono e dove si trovano https://www.benessere360.com/fibre-alimentari-solubili-ed-insolubili-cosa-sono-e-dove-si-trovano.html. URL consultato l’8 novembre 2019.

[3] 12 Foods That Make Inflammation Worse https://www.thehealthy.com/nutrition/foods-cause-inflammation/. URL consultato l’8 novembre 2019.

[4] Xu, Y., Wan, Q., Feng, J., Du, L., Li, K., & Zhou, Y. (2018). Whole grain diet reduces systemic inflammation: A meta-analysis of 9 randomized trials. Medicine97(43). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6221555/

[5] Marziali, M., Venza, M., Lazzaro, S., Lazzaro, A., Micossi, C., & Stolfi, V. M. (2012). Gluten-free diet: a new strategy for management of painful endometriosis related symptoms?. Minerva chirurgica67(6), 499-504. https://www.ncbi.nlm.nih.gov/pubmed/23334113

[6] Vernon, M., & Mills, D. S. (2017). Endometriosis: A Key to Healing Through Nutrition. HarperCollins UK. https://amzn.to/2K1MrxW

[7] De Punder, K., & Pruimboom, L. (2013). The dietary intake of wheat and other cereal grains and their role in inflammation. Nutrients, 5(3), 771-787. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3705319/

[8] Grani antichi: quali sono, dove trovarli e perchè sceglierli https://goingnatural.it/grani-antichi-quali-sono-dove-trovarli-e-perche-sceglierli/. URL consultato l’8 novembre 2019.

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