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:
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.
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!