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A Guide to the Endometriosis Diet

June 12, 2018
endometriosis diet

As we well know, endometriosis is a condition that cannot (yet!) be cured. When I see patients in my private practice, diet plays a huge role in terms of treatment plan, as it can often be easier to maintain than simply taking supplements. In this article, I’ve outlined what the latest research (2010 – present) has to say about food and its relationship to endometriosis. 

FODMAPs and Endometriosis

A 2017 study looked at the association between the FODMAP diet and endometriosis, because many people with endometriosis experience symptoms similar to those of IBS. They found that women who follow the FODMAP diet, experience an alleviation in their gut symptoms and endometriosis-related pain. Check out this post to learn more about the FODMAP diet (and get a free meal plan!). 

Fruit and Endometriosis

A 2018 prospective study looked at the association of fruit intake and endometriosis. Researchers observed a non-linear inverse association between higher fruit consumption and risk of laparoscopically-confirmed endometriosis. In particular, they discovered that citrus fruits conferred a 22% lower risk of endometriosis, when women consumed over 1 serving of citrus fruits per week. 

When purchasing fruit, it’s best to choose organic if the particular fruit you’re interested in is on the Dirty Dozen list. For example, if purchasing strawberries – be sure to purchase the organic version as strawberries are highly sprayed with pesticides. Some pesticides can act as endocrine disruptors, and affect estrogen levels within the body. As of 2018, no citrus fruits appear on the Dirty Dozen list, so purchasing the non-organic version is fine. 

Vegetables and Endometriosis

The same 2018 study assessed the relationship between vegetables and endometriosis. Surprisingly, no association was observed between total vegetable intake and endometriosis risk. However, researchers did notice that women consuming over 1 serving of cruciferous vegetables (broccoli, kale, Brussels sprouts, cabbage, etc.) per day, had a 13% increased endometriosis risk.

But before you swear off these veggies for good, this might have been related to the FODMAPs symptoms as mentioned above. If you don’t experience any negative gut symptoms when eating cruciferous veggies – keep eating them! They contain a wide array of important nutrients including DIM, which helps to metabolize estrogen. Obviously this is important as estrogen is one of the theorized causes of endometriosis. 

Fish and Endometriosis

The Nurses Study examined the association between fish intake and endometriosis. They observed that consumption of poultry, fish, shellfish, and eggs were unrelated to endometriosis risk.

The Nurses Health Study II also looked at fish consumption (polyunsaturated fatty acids, PUFA) and observed women in the highest fifth of long-chain omega-3 PUFA consumption were 22% less likely to be diagnosed with endometriosis. Another study did not observe this association. 

Omega-3 PUFA help in the regulation of prostaglandin and cytokine physiology, especially when it involves inflammation. 

Eggs and Endometriosis

The Nurses Study examined the association between egg intake and endometriosis. They observed that consumption of eggs were unrelated to endometriosis risk. Choose organic and cage-free (chickens that are able to roam around in their environment) if possible. 

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Chicken and Endometriosis

The Nurses Study examined the association between poultry intake and endometriosis. They observed that consumption of poultry was unrelated to endometriosis risk. Nevertheless, choosing antibiotic-free chicken products may be the best choice to keep ‘extras’ out of the diet. 

Red Meat and Endometriosis

The same Nurses Study assessed the relationship between meat and endometriosis. They observed that women consuming  more than 2 servings/day of red meat/day had a 56% higher risk in endometriosis, compared to women eating 1 serving or less. This was highly noted in non-processed red meats (ie. beef, lamb, pork, hamburger) especially in women who had not reported fertility troubles. Women in the highest category of processed red meat intake (ie. bacon, hot dogs) also had a higher risk of endometriosis. The study did not mention if the women consumed grass-fed, antibiotic and hormone-free meat.

A 2013 review assessed the results from three studies assessing endometriosis risk and meat intake. Unfortunately no definitive conclusion was made. 

Meat eaters may want to choose grass-fed, antibiotic and hormone-free meat may be the preferred choice. While it’s true that cows inherently have hormones (just like humans), you may want to avoid any ‘extras.’

Soy and Endometriosis

Soy is a highly contentious food as some of its compounds act as phytoestrogens. Phytoestrogens are all structurally similar and have estrogenic activity and include both isoflavones (found in soy and soy products) and lignan metabolites (found in flax seeds, nuts, grains, and cruciferous vegetables). They can bind to estrogen receptors, and may elicit both estrogenic and anti-estrogenic effects. 

A 2017 study assessed the relationship of phytoestrogens and endometriosis, and found no evidence that urinary phytoestrogen concentrations were associated with a higher risk of an endometriosis diagnosis in both a general population and operative sample (women scheduled for a laparoscopy). That said, the women studied were not told to consume more soy products for the purpose of this study. Their regular diet was simply followed. 

A 2015 study looked at endometriosis risk and early life factors such as prenatal exposure to diethylstilbestrol (DES), cigarette smoking, and soy-formula ingestion. They observed an association between exposure to regular soy formula feeding during infancy and increased risk of endometriosis (especially in women born after 1965). In animal models, the early exposure to genistein and daidzien many change the uterus and hypothalamic-pituitary-ovarian axis (which continue to develop rapidly after birth, and may be susceptible to hormonal disruption). This study did not have detailed infant feeding data including information on the timing of initiation, duration, and exclusiveness of soy formula feeding as well as information on other sources of infant nutrition such as non-soy formulas and breastfeeding.

Soy does not have to be the enemy, and in fact can be rather helpful – especially when it comes to estrogen metabolism. Be sure to choose products that are organic and non-GMO.

Coffee and Endometriosis

The 2013 looked at four studies involving coffee and endometriosis risk. Two studies showed an increase risk of endometriosis in women who reported coffee consumption. It’s thought that concentrations of early follicular phase estrogens and concentrations of estrone were found to be higher in women with high caffeine intake. Nevertheless more data is needed. 

An interesting note about coffee is that it can act as a laxative. It helps to stimulate the movement of the colonic muscles, and promote a bowel movement. This is great because estrogen is able to leave the body, and does not recirculate leading to a relative excess. 

Gluten Free Diet and Endometriosis

A small 2015 study demonstrated the relationship between gluten and endometriosis. Results showed that a gluten-free diet could improve pelvic pain, and may in fact improve the management of deep-infiltrating endometriosis. 

Final Thoughts

It’s certainly difficult to avoid some of the above foods

Have any of the foods in this article surprised you? Let me know in the comments below. 

References

Moore J, Gibson P, Perry R, Burgell R. Endometriosis in patients with irritable bowel syndrome: Specific symptomatic and demographic profile, and response to the low FODMAP diet. Australian and New Zealand Journal of Obstetrics and Gynaecology. 2017;57(2):201-205. doi:10.1111/ajo.12594.

Harris H, Eke A, Chavarro J, Missmer S. Fruit and vegetable consumption and risk of endometriosis. Human Reproduction. 2018;33(4):715-727. doi:10.1093/humrep/dey014.

Yamamoto A, Harris H, Vitonis A, Chavarro J, Missmer S. A prospective cohort study of meat and fish consumption and endometriosis risk. Am J Obstet Gynecol. 2018. doi:10.1016/j.ajog.2018.05.034.

Mumford S, Weck J, Kannan K, Buck Louis G. Urinary Phytoestrogen Concentrations Are Not Associated with Incident Endometriosis in Premenopausal Women. J Nutr. 2016;147(2):227-234. doi:10.3945/jn.116.238840.

Upson K, Sathyanarayana S, Scholes D, Holt V. Early-life factors and endometriosis risk. Fertil Steril. 2015;104(4):964-971.e5. doi:10.1016/j.fertnstert.2015.06.040.

Parazzini F, Viganò P, Candiani M, Fedele L. Diet and endometriosis risk: A literature review. Reprod Biomed Online. 2013;26(4):323-336. doi:10.1016/j.rbmo.2012.12.011.

Missmer S, Chavarro J, Malspeis S et al. A prospective study of dietary fat consumption and endometriosis risk. Human Reproduction. 2010;25(6):1528-1535. doi:10.1093/humrep/deq044.

Marziali M, Capozzolo T. Role of Gluten-Free Diet in the Management of Chronic Pelvic Pain of Deep Infiltranting Endometriosis. J Minim Invasive Gynecol. 2015;22(6):S51-S52. doi:10.1016/j.jmig.2015.08.142.

5 Free Endometriosis Apps

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December 13, 2017
free endometriosis apps

I love all things tech, especially apps that can track things for me (because I don’t always carry around a separate notebook with me all the time). Because I see many clients living with endometriosis and I often have them track their symptoms for me (in conjunction with their treatment plans), I’m always on the lookout for apps that make tracking as simple as possible. 

I searched ‘endometriosis’ on the app store, and discovered these free endometriosis apps. Not all were created equal, or did the same thing! So, I’ve gone ahead and highlighted how each app works and if it would be helpful for women with endo. 

Flaredown

This app was created for people suffering with chronic illness, not just endometriosis. It requires a log-in, and then has you track the conditions you select for. Once you select endometriosis, it will have you track the symptoms. That said, there isn’t a pre-populated list of symptoms to track. Which might be difficult for women who have just become aware of endometriosis. However, it states that you can change this later. 

Furthermore, you are able to track your treatments, which you may also modify later. It does have a check-in reminder, which will send you an email at the time you choose. It also has a journal and a tag system – although I don’t know its purpose. 

Flutter

Out of all of the apps that I downloaded, this one was my favourite. It’s a period and symptom tracker app. Once you download it, it has you create an account and enter when you last experienced your menstrual cycle. Like most period tracker apps, it indicates when you may be ovulating, but we know that your specific signs in your body will give you a better indication.

What I really liked about this app is that there is an option for you to learn about what endometriosis is, there’s a quiz that will tell you how likely it is that you might have endo (although this doesn’t replace the gold standard test – the laparoscopy). For Canadian users, there aren’t any doctors listed on this app, but it does give you many questions to ask your doctor. 

While premium features include its ovulation and medication log, the free app does list recipes for the endo diet, videos for pain management, and the ability to export your journal and share with your doctor.   

free endometriosis apps

My Endometriosis Team

This is a social network for women with living with endometriosis. So while there is no ability for you to track your symptoms, you are able to share photos, post updates and get answers to your questions! 

Endo Empowered

This app is actually a 21 day challenge, designed to get you into a state in wellness. The first day has you take note of the 5 things that you’re putting up with and that you want to change While day 2 has you write down what could make your life better. 

Phendo

This is an app created by Colombia University to conduct observational research and catalog the signs and symptoms of endometriosis. They invite all anyone with endometriosis to join, but do require consent for those under the age of 18. You are eligible to participate in the study if you’ve had at least one menstrual cycle, and have experienced symptoms of endometriosis in the past 3 months. 

Final Thoughts

Many of these apps turned out to be incredibly different from one another. If you’re looking for a symptom tracker, I would choose Flutter or Phendo (if you want to join a research study). If you’re hoping to join a community, Facebook has tons of groups (including my own – which I just started!)

Let me know in the comments below if you use any of these apps, or is there a particular one that you recommend? If you found this information helpful, please sign up for my monthly newsletter called The Flow for great and informative content like this!

Endomentriosis Gift Guide

December 1, 2017
endometriosis gift guide, endo gift guide, toronto naturopath, naturopath toronto, endometriosis naturopath

I love the holidays and love working with women who have endometriosis! So whether you or someone you know has been recently diagnosed or suffering from endo for a long time – I’ve created an endometriosis gift guide that they’ll surely love. 

Because endometriosis is now being considered an inflammatory disease, as well as a disease that involves excess estrogen, I often create treatments focusing on nutrition and healthy habits. Oftentimes my clients will change aspects of their diet and incorporate more eco-friendly products into their routine. That’s why I’m sharing some of my favourite products that will help make their lives easier, cleaner and less inflammatory (how glamorous is that?). 

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1. THE FIRST MESS / I usually recommend going gluten and dairy-free to most of my endo clients. This is because both gluten and dairy can be quite inflammatory in the body, therefore we want to minimize external sources of inflammation – such as these common foods. I recently purchased this cookbook, and have really enjoyed it so far. While it’s not 100% gluten-free, it’s plant based! This is important because the fibre not only keeps you regular, but helps estrogen leave the body. 

2. ILIA MASCARA / Over the past couple of years, I’ve been slowly transitioning to cleaner beauty products. Because mascara is a product I use almost every day, I knew that I needed to switch up my old favourite to something new. I personally have been using this mascara and have no complaints. Plus, I actually think my lashes have never looked better!  

3. THE 5 MINUTE JOURNAL / A few years ago I came across an article about gratitude, and writing out a few things you were grateful for each day. Because I was experiencing a low mood at the time, I began this practice and after a few weeks I began to notice a shift in perspective. I started looking for the positives in my day (as small as they may be). While you can use any notebook to practice gratitude, I like the 5 minute journal because it helps you identify things you are grateful for, things that would make that day great, and how things that could have made the day better. Practising gratitude can actually help improve mood and decrease stress both of which are critical for someone experiencing endo. 

4. BITE AGAVE LIP MASK /  You’ve probably heard what people say about any lip product – we end up eating it by the end of the day. Because lip gloss and mascara are my everyday essentials (ND’s want to look good too!), I opt for products with clean ingredients. I’ve been using this mask for the last 6 months and not only does it stay on for a long time, a little goes a long way! 

5. MUSE / If you’ve been keeping up with the news lately, then you know that meditation can do wonders for the brain. I’ve had this meditation headband for over a year now, and I love it because it can sense your brain during mediation and provides instant feedback (though calm waves, or busy winds), that help guide you to a zen state of mind. 

6. BODY BLITZ WATERS / If I can’t get out of the city, enjoying the waters at Body Blitz is one of my favourite things to do for an adrenal reset. While you can also enjoy massage treatments and cool offerings like body scrubs (which are my absolute favourite), I like the waters because it’s affordable and you’re still getting a great treatment. If you’ve never done a water circuit before, cycle through a dead sea salt pool, eucalyptus steam room, infrared sauna, epsom salt pool and a cold plunge pool. The cold plunge is the hardest part – but you can do it (even if you’re just cold water stomping!). 

7. TURMERIC WINTER TEA / This turmeric and ginger tea has two key ingredients that have been shown to be helpful for both inflammation and dysmenorrhea. While you’re not getting therapeutic doses of curcumin (active compound in turmeric) or ginger, this tea will keep you nice and toasty and help liver detoxification (which is great for estrogen!). 

PS. If you’re using well.ca for the first time, get $10 your first order using the code: DRALEXSIA

8. THINX PERIOD UNDERWEAR / While you might not be getting a pair of period underwear for your bff, they might be great for you! If you menstruate and are hoping not to ruin another pair of your favourite underwear, think about switching to a pair designed for you to bleed. These heavy duty underwear can absorb up to 2 tampons worth of fluid (about 10mL), or be paired with a menstrual cup, tampon, etc. I just ordered a pair a few weeks ago and am eagerly awaiting them and my period!

PS. Get $10 off your first order using this link

9. SWELL COFFEE TUMBLER / I ask all my clients about their plastic usage – from the products that are being reheated at lunch to what they’re drinking out of! I have every one switch over to glass or stainless steel bottles/containers to not only decrease their environmental footprint, but to minimize their toxic exposure. So many environmental toxins are endocrine disruptors (and mimic estrogen!), so making the switch is a no-brainer. I’ve been using a Swell water bottle since 2015 and it’s travelled everywhere with me (including overseas!). It keeps my drinks at it’s desired temperature, so I got really excited once they added a new coffee tumbler to their product lineup!

PS. If you’re using well.ca for the first time, get $10 your first order using the code: DRALEXSIA

10. THE FOUR TENDENCIES / I love this book because it’s all about improving your life based on your personality. For people who have endometriosis, they will likely have to incorporate some new habits in their lives – and may have trouble doing so. Knowing your tendency can guide you in forming those sustainable habits, and seek help from others if that’s something you need! Her other book Better than Before is also fantastic for creating habits, but isn’t as in depth. You can check out my review here

PS. Why wait for the book? Find out about your tendency here!

11. AROMAOM / While I love candles, it can be difficult finding one that’s not burning toxic ingredients (did you know that ‘fragrance’ can actually be 200 different chemicals?). That’s why I often choose to diffuse essential oils instead. If I’m craving a sense of calm and peace (when stress is at an all-time high), I’ll add in a couple drops of lavender essential oil because lavender is a powerful anti-anxiety herb (in some studies, encapsulated lavender essential oil can be as effective as an SSRI – but talk to your doc about that) and when you’re smelling it it actually crosses the blood-brain barrier rather quickly and leads to automatic zen. 

Love periods? 

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