A Guide to the Endometriosis Diet

February 5, 2018
endometriosis diet, endometriosis treatment, IBS diet, toronto naturopathic doctor, endometriosis naturopath

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

The Endometriosis Diet

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, polyols 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!

Iron: the most common nutritional deficiency in women

December 4, 2017
iron deficiency

The most common nutritional deficiency in women is iron, as most women and people who menstruate lose blood each month. In fact, iron deficiency is the most common cause of heavy periods. Iron is a necessary part of our body as it transports oxygen throughout the body, and helps with thyroid production.

As mentioned, you’re at risk for this deficiency if you experience heavy periods. If you use a cup to track blood loss, anything over 80mL is considered a risk. Similarly if you are changing pads or tampons every 2 hours or less, you are at risk for deficiency. 

Signs & Symptoms of an iron deficiency

An iron deficiency can lead to many symptoms including:

  • Mental and physical exhaustion

  • Hair loss

  • Brittle nails

  • Mouth ulcers and oral tongue 

  • Headaches

  • Paleness

  • Shortness of breath

  • Cold hands and feet

Testing your iron status

Finding out your iron levels is very simple. A doctor will run your serum ferritin levels (the storage form of iron), and ensure that they are optimal. Depending on if you choose to supplement or increase dietary sources of iron, your ferritin levels may take more than 3-6 months to improve. 

Food sources of iron

There are two types of iron – heme and non heme. Heme iron is found in animal products, such as meat – and is generally better absorbed. While non-heme is found in plant-based products like lentils and leafy greens. Iron is best absorbed with vitamin C. So if you’re going to make yourself a kale salad, squeeze some lemon on top! Dairy can actually inhibit iron absorption, so try to avoid pairing these two. 

Moreover, if your iron levels are quite low, it’s usually best to supplement with a quality iron product. Iron bisglycinate is a highly absorbable and is quite gentle on the stomach.

Final Thoughts

If you are experiencing heavy periods and are noticing any signs and symptoms of iron deficiency, getting your iron tested and ensuring that it’s optimal (not normal!) – it would be a great idea to get your ferritin levels tested! 

If you love learning about your hormones and your period, be sure to sign up for my monthly newsletter called The Flow for great and informative content like this. 

Sugar, a carb of many names

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November 2, 2015

November is National Diabetes Month. Why is this important? Well more than 60% of Canadians are overweight or obese, thereby increasing their diabetes risk. Moreover, not only have diabetes rates doubled over the past decade, it’s been estimated that diabetes and its health impact will cost our nation about $16 BILLION dollars by 2020.

Diabetes can occur due to various reasons and can have various health impacts on the body, but studies have shown that the best way to prevent and treat diabetes is through diet and exercise. So before you get up to take a walk and enjoy the beautiful autumn weather, let’s talk about sugar – the seemingly biggest perpetrator of this disease.

Sugar, a carbohydrate, can come in many forms, and go by many names – 56 in fact. Oftentimes it’s one of the top 3 ingredients in processed foods – and will occur more than once on food labels. One of my family members started to change their diet (which is wonderful), and proceeded to purchase products that where advertised as healthy. However, a simple look at the ingredient list was shocking as sugar (in its many names) was found multiple times in the list.

I’m privileged to have sat through many hours of nutrition class to learn about vitamins and minerals, types of fat, optimal proteins, and the different names of sugar. Many people don’t have that luxury – making it incredibly important to learn about what you are buying and eating to help make the best and healthiest choice for you and your family.

My primary message is this: Question what you eat and drink – is this something you can reproduce at home? (where you have better control over the ingredients). Analyze the ingredients list (if there’s one readily available). I like to indulge in a sweet treat (read: chocolate + peanut butter), every now and then – but I try to do so in moderation. Have you though of incorporating more whole foods into your diet – since added sugars can be found in so many forms in packaged and processed foods.

For more information, please watch this video below. I personally love TED videos, and this educational piece is no exception. And if you love to read, may I suggest this article that breaks down the various forms of sugar.