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Endometriosis and the FODMAPs Diet

June 9, 2018
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Women who live with endometriosis often report symptoms of abdominal bloating, diarrhea, constipation and of course pain. It’s been suggested that IBS (irritable bowel syndrome) may happen in about 90% (!!!) of women with endometriosis. Since almost all women are affected, it seems obvious that diet can play a huge role in pain and overall health, highlighting the need for an endometriosis diet. 

The above symptoms may happen because of the location of endometriosis (ie. near the sigmoid colon or rectovaginal space). Moreover, endo may affect nervous system function and lead to changes in sensitivity and movement in the GI space.

How is IBS Diagnosed?

IBS is often a diagnosis of exclusion –  aka. many conditions need to be ruled out before IBS can be ruled in. Nevertheless, IBS is diagnosed by the the Rome IV criteria. 

You may have IBS if you have recurrent abdominal pain on average at least one day/week in the last three months, associated with two or more of the following criteria:

  • related to defecation

  • associated with a change in frequency of stool

  • associated with a change in form (appearance) of stool

Endometriosis and FODMAPs

Because IBS is so common in women with endometriosis, focusing on nutrition and diet makes total sense. Ultimately, we want to see if certain foods are causing pain and bloating, and changes in stool formation. 

The FODMAP diet has a lot of research with respect to improving symptoms of IBS. Therefore, it should be considered for women with endometriosis as it may provide therapeutic benefit. 

FODMAP Diet for IBS and Endometriosis

If you’ve never heard of a FODMAP – that’s okay! It’s an acronym that refers to carbohydrates (ie. sugars) commonly found in food. Here’s what the letters mean:

  • Fermentable

  • Oligosaccharides

  • Disaccharides

  • Monosaccharides

  • And

  • Polyphenols

The Pathway of Food and Gut Bacteria

When we eat, food travels from our mouth down the esophagus, and enters the stomach where the carbs, protein and fats are digested. As it moves through the small intestine, the food will continue to break down into smaller nutrients which will end up being absorbed into the bloodstream. The leftovers will pass through the large intestine, which will remove fluid through absorption. The bacteria in the large intestine will digest any leftover bits of carbs and proteins.

If someone has IBS, then the above carbs (O, D and M) will NOT be properly digested and will move into the large intestine, where the gut bacteria will begin to ferment them. This may cause painful gas, bloating, diarrhea, and other undesirable symptoms.

Therefore when someone chooses to follow a FODMAP diet, they’re choosing foods that are low in fodmaps – PREVENTING fermentation by the bacteria. 

Understanding FODMAPs

Let’s talk about the FODMAPs acronym again – oligo, mono and di are saccharides (which is another name for sugar).

  • Oligo means a FEW sugars linked together – like cellulose and starch

  • Di means TWO sugars linked together – like lactose which is made up of glucose and galactose sugars (monosaccharides)

  • Mono which means ONE sugar like fructose/glucose/galactose

A note about fructose: fructose is only an issue if there’s NOT enough glucose to help with absorption. Which means that anything with high fructose corn syrup or foods that have excess fructose (ie. apples) should be AVOIDED if you’re on a FODMAPs diet.

Lastly, polyphenols are sugar alcohols – basically any sugar that has –ol at the endo of it, such as xylitol, mannitol, etc.

How does the diet work?

This diet is similar to an elimination diet, with 3 phases: 

Phase 1: Low FODMAP

Eating a low-FODMAP diet. You would accomplish this by going through the FODMAP list and designing your meals around foods that you can eat, and foods you should avoid. For instance, if you’re used to eating an apple at 11am (to obviously keep the doctor away), you’ll want to switch it up for an orange. 

To make sure you get all the FODMAPs out of your system, you’ll want to follow this for about 2-6 weeks.  

Phase 2: Challenge

This is where you introduce FODMAP rich foods back into your diet (although not all at once!) to determine which foods trigger symptoms. If you do experience symptoms once you re-introduce a particular food into your diet, it’s best to avoid introducing another for a few days to let your gut get back to baseline. 

Based on how many foods you’re introducing and which symptoms keep popping up, this may take about 6-8 weeks. It’s best to go through this phase with a Naturopathic Doctor’s help.  

Phase 3: Adaptation

Now that you’ve gone through re-introducing all the foods that may cause unwelcome symptoms, you’ll know which foods you can safely eat and which you should avoid. In the adaptation phase, you can also re-challenge foods that previously cause you pain to again determine if they’re safe or should be avoided – this is because tolerance may change as time progresses. 

Final Thoughts of the Endometriosis Diet & Additional Resources

Monash University has an easy to use app highlighting FODMAP foods, as well as a great blog that provides additional information and FODMAP-friendly recipes. One particular article that I like is eating out on a FODMAP diet – because it’s always a huge limitation for everyone 

If you found this information helpful, I would encourage you to download my FREE EndoDiet meal guide and plan. It goes through everything we discussed: foods that are safe and that should be avoided, and a 7 day meal plan and preparation guide!

Endometriosis and Ca125

April 16, 2018
endometriosis and ca125

Endometriosis is a disease diagnosed via laparoscopic exam. This exam is the gold standard of diagnosis, where doctors examine the pelvic cavity and its surroundings looking for endometrial tissue. If found, they will also remove it during the procedure.  

While a non-invasive gold standard of diagnosis does not currently exist, however there is a promising biomarker known as Ca125 that may help in ruling in endometriosis as a potential cause for painful periods. 

What is Ca125

Ca125 (cancer antigen 125) is a biomarker traditionally used for ovarian cancer – monitoring therapies and to assess recurrence. It’s shown to be increased in women with endometriosis, and has therefore been proposed as a biomarker for endometriosis. This may help to reduce diagnostic time, offer treatment options, reduce progression of disease, and may even provide reassurance to women that they are not living with endometriosis. 

A 2017 study examined Ca125 levels in women who had symptoms of endometriosis (painful periods, painful sex and chronic pelvic pain). Ca125 levels and a laparoscopic exam (to confirm a histological diagnosis of endometriosis) were assessed in these women to determine the accuracy of Ca125 in the presence of endometriosis. Results showed that women with a high Ca125 level were also found to have endometriosis (in the absence of any other potential causes for disease). Moreover, they determined that a level of Ca125 greater than or equal to 30IU/mL would rule in endometriosis, while a measurement less than that would not rule out endometriosis. 

Next Steps

Measuring Ca125 levels may be a good first step in examining if endometriosis could be a cause of painful periods, painful sex and chronic pelvic pain. While it will not rule out endometriosis, it may lead to faster diagnostic times (the average time is 7-10 years), and help with its management. Naturopathic Doctors and Medical Doctors are able to run this test if you are hoping to rule endometriosis in before scheduling a laparoscopic exam. 

References

Hirsch M, Duffy J, Deguara C, Davis C, Khan K. Diagnostic accuracy of Cancer Antigen 125 (CA125) for endometriosis in symptomatic women: A multi-center study. European Journal of Obstetrics & Gynecology and Reproductive Biology. 2017;210:102-107. doi:10.1016/j.ejogrb.2016.12.002.

Karimi-Zarchi M, Dehshiri-Zadeh N, Sekhavat L, Nosouhi F. Correlation of CA-125 serum level and clinico-pathological characteristic of patients with endometriosis. International Journal of Reproductive BioMedicine. 2016;14(11):713-718. doi:10.29252/ijrm.14.11.713.

Oliveira M, Raymundo T, Soares L, Pereira T, Demôro A. How to Use CA-125 More Effectively in the Diagnosis of Deep Endometriosis. Biomed Res Int. 2017;2017:1-6. doi:10.1155/2017/9857196.

Your Endometriosis Health Team

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If you are living with endometriosis, you’re likely aware that it’s a complex condition that can benefit from a health team (#endometriosisdreamteam). Because I believe in integrative medicine and the value of different wisdom and experiences, I wanted to share a few of health practitioners (aside from your Ob/Gyn) that can help you alleviate pain and improve your quality of life!

 

Who should be on your team

Pelvic Floor Physiotherapist

Pelvic floor physiotherapy is more than just kegels! Within the pelvic region, endometriosis can cause inflammation, scar tissue, adhesions, pain and muscle tightness. Muscle tightness may occur when women are curled up in fetal position or because of anticipation of painful sex. Pelvic floor physiotherapists are able to assess the pelvic floor muscles and release any trigger points as well as help release scar tissue. 

Moreover, the alignment of pelvic organs and ligaments may be distorted due to pain or other factors, and pelvic floor physios are able to help bring back a healthy alignment to the pelvic region. 

When the body has a pelvic floor dysfuntion, it may lead to the following symptoms:

  • Pain in the back, hips, and sacroiliac joint
  • difficulty urinating, increases urination, burning or pain with urination
  • constipation or diarrhea
  • painful bowel movements and faecal incontinence
  • painful sex
  • inability to tolerate a speculum during a gynaecological exam
  • pain with wearing tampons and menstrual cups

Massage Therapist

Massage therapy is one of those gentle, yet effective treatments that can have big results. Abdominal massage is designed to stimulate and increase the flow of blood, lymph and qi to everything in the pelvic region (such as organs, ligaments and tissues). Moreover, some treatments can gently shift the uterus and other organs into a healthier alignment – which may lead to the reduction of uterine spasms and adhesions. 

Sex Therapist 

Sexual therapy can aid people who are experiencing sexual difficulties, with the goal of promoting physical intimacy. Many women with endometriosis suffer from sexual dysfunction, specifically when it comes to deep penetrative sex (likely due to the area inhabited by endometrial lesions). Down the line, this may lead to negative effects on relationships, mental and emotional well-being, a decrease in quality of life. 

Because fear and anticipation of pain can inhibit the sexual response (and affect desire and lubrication), a sex therapist may suggest and facilitate communication between partners, help with alternative sexual practices, and provide relaxation techniques.  

Naturopathic Doctor

I might be biased, but Naturopathic Doctors bring a lot to the table! When I work with my endometriosis clients, I like taking a look at the modifiable causes when it comes to guiding treatments. Specifically I take a look at inflammation and estrogen and work on those to help decrease pain within the body. 

Therefore treatments include acupuncture (yes, NDs can perform acupuncture!), nutritional support, lifestyle changes, and smart supplementation. For instance, turmeric can be quite helpful for pain experienced with endometriosis. But before you make yourself a golden milk latte, it’s important to remember dose and duration of treatment is necessary to elicit the desired effects. Lastly additional testing to assess stress and cortisol levels, as well as estrogen detoxification, can be quite useful in helping to guide treatment plans.  

Final Thoughts

It’s obvious that each member of this endometriosis dream team provides something unique in the treatment of this condition. And to be honest, you don’t need to have endometriosis to have a well-rounded group of health practitioners. Most of us have a GP, Optometrist, Dentist – which help us take care of physical components of our body. But don’t underestimate the value of taking care of your emotional and mental states as well!