This EndoLife

Today’s episode is part of an end of year special series. I am resharing some of my most actionable episodes to help you reduce pain on your period and pain flares in general, and to balance your hormones for better periods, less PMS and healthier cycles. I am sharing these episodes because this time of year is often when some of our endo management strategies can go out of the window (and understandably so!). We might have more sugar, less sleep, more alcohol and more blood sugar dysregulation, and as a result, these can all raise inflammation and give our bodies a hard time when it comes to clearing old and excess hormones. So come January or maybe sooner, we tend to have more PMS, worse periods and more pain.

So these episodes are designed to provide you with some tips you can quickly implement if you’re worried about your upcoming period, or you’re feeling rough and need some tips to improve your symptoms. Now of course, it’s natural that we want to indulge a bit over Christmas, and so these episodes are not about telling you to be a saint. Instead, they’re about practices you can throw in that can just help lessen some of the impact. I am releasing a couple so you can choose strategies you think will help you most and so you have options, but you certainly don’t have to try them all!

And whilst I’m here, if you find that you want to learn more about how to eat for endo and for hormone balance, or you get to the end of the festive period and you really just want to improve your systems, I now have my Nutrition for Endo Masterclasses, which are available to buy all year round, unlike my courses. Lucky for you, they’re still discounted because I haven’t had time to change the prices, so you can still get each masterclass for £29.99 or you can buy the bundle for £50. You could also ask for them as a Christmas present!

Finally, thank you for listening to this podcast this year, and for sticking with me even with my sporadic release dates as I navigate all of these new courses and offerings with recording my free content. I am wishing you a wonderful festive break (if you celebrate) and a very happy New Year.

So, without further ado, let’s get to today’s episode. I really hope it helps you manage some of your symptoms over this festive period.

Okay so a while ago I ran a poll about PMS and endo, and I wanted to know what symptoms you struggle with. Turns out, the majority of you get low moods during your luteal phase. In fact, out of the hundreds of you who entered the poll, 93% of you said you struggle with low moods and mood swings during your luteal phase.

So today’s episode is the first in a two part series. Today I’m going to take you through one of the key causes of PMS mood swings and I’m going to provide you with my go-to strategy for starting to tackle it, and then in the second episode, I’ll be taking you through the secondary causes and strategies.  

So number one, where we’re starting, is to balance your blood sugar, and truly, this is one of the most important things you can do if you want to improve your moods during this time, lower inflammation and balance your hormones. This is really key and this is why I’m starting here. If you’ve got your blood sugar sorted, then clearly this isn’t your main cause and the next two causes in the future episode will be more relevant, and they are low progesterone and low neurostransmitter levels. But we’re starting with blood sugar because this is foundational to hormone health and plays a really big role in PMS, and could be the reason why you have low progesterone anyway!

So let’s look at what blood sugar has to do with moods specifically.

Blood sugar is the measurement of glucose in our blood. Glucose comes from complex carbohydrates like fruit, vegetables, beans, whole grains, etc. and it is our body’s and brain’s primary fuel. For us to feel energised and have stable energy levels all day long, we need to have a steady drip of glucose filtering into our blood. When we’re eating a diet that consists of complex carbohydrates, that also includes healthy fats, proteins and lots of fibre, this ensures good blood sugar levels. 

But glucose also comes from refined carbohydrates, such as sugars like honey, maple syrup and standard white sugar, and baked processed products like bread, cake and pizza. These foods contain a lot of carbohydrate and little fibre, they are made of simple carbohydrates, meaning that they break down very, very quickly in the gut. Complex carbohydrates are called complex carbohydrates because their chemical structure is made of long chains of glucose linked together, which takes the body longer to break down. In contrast, simple carbs are made up of very short chains of glucose that are easy for the body to break down. This creates a huge surge of glucose that’s pumped quickly into your blood stream.

What then happens is that your body panics. It’s a stressor to the body to have this much glucose in the blood at any one time, so it releases a hormone called insulin. Insulin usually delivers glucose to our cells for fuel, but when we have too much glucose, it’s released in really high amounts and pushes it into the liver and fat cells for storage. This equally happens quickly, in fact, a little too quickly and the insulin accidentally takes too much glucose out of the blood in its rush to clean things up, and our blood sugar levels plummet. This leaves us hungry soon afterwards, and we end up on a blood sugar rollercoaster, needing more refined carbs and sugar to fuel us and get our blood sugar levels back up to a healthy level. Of course, eating more sugar or processed carbs won’t take us to healthy levels, but will spike our blood sugar levels once more – so we’ll temporarily feel good, only to crash again, so the cycle continues.

The result is that we spend our days going through highs and lows, and this blood sugar rollercoaster feels like:

·      Hanger

·      Irritability

·      Anger

·      Moodiness

·      Tearfulness

·      Anxiety

·      Shakiness

·      Feeling sleepy after meals

·      Having mid-morning and mid-afternoon energy slumps

·      Cravings for caffeine, sugar or refined carbohydrates

·      Trouble falling asleep, waking up in the night or struggling to wake in the morning

·      Feeling thirsty a lot

You don’t have to have all of these symptoms, but if you have a few of them, it’s likely your blood sugar levels need improving.

So what’s this got to do with PMS? Well, in the first half of our cycle, from menstruation to ovulation, as oestrogen rises, we’re actually more insulin sensitive because oestrogen actually boosts the effectiveness of insulin. This means we respond well to insulin so we’re getting in glucose and making energy effectively, we’re satisfied more easily and we feel satiated for longer. Basically, we’re more responsive to insulin and that in turns helps us to have balanced blood sugar levels and stops us from craving all the sugar.

But in contrast, in the second half of our cycle, when progesterone rises, we actually become less insulin sensitive because progesterone can dampen the effectiveness of insulin. That means the same meal you ate the week before, may no longer satisfy you because your body is not taking in the glucose from insulin in the same way. It also means, as a result, you may be more susceptible to blood sugar highs and lows and you might end up eating more refined carbs, sugar, etc. because you still feel hungry or less energised, so your body is telling you to eat foods with a quick energy fix. This is likely why 84% of you say you get cravings during this time!

This of course can create those blood sugar crashes that leave you feeling anxious, tearful, irritable, or moody. This is one of the key reasons we can feel low during the luteal phase, which is why we start here. In the follow up episode I’m going to take you through the other causes, but by working on your blood sugar levels, you’ll actually be preventing the other causes from happening in the first place in many cases, so this is the foundation we really want to have in place. Once this is in place, we can clearly and accurately see whether there’s any other issues left over affecting your moods in this part of your cycle.

So there are a few key strategies for balancing blood sugar, but let’s start with the main strategy to get you going. Ideally, we want to practice this all month long because it’s going to lower inflammation and regulate your hormones so your PMS will be better and your pain will be better too, but at the minimum, it will be helpful to bring this strategy in from ovulation onwards until your period so we can manage those blood sugar levels.  

So, the strategy is to eat healthy fats, fibre, complex carbohydrates, and protein with every single meal. And so this looks like:

·      50% of your plate (or half your plate) should be covered with low starchy veggies. This is where your complex carbs and fibre will come from. This is important because the carbs give you energy and the fibre slows down the release of glucose, because it takes longer to digest foods with fibre. So think asparagus, broccoli, kale, tomatoes, peppers, cucumber, aubergine, cauliflower, etc.

·      25% of your plate should be protein (or a quarter of your plate). And that should be equal to the size and thickness of your palm. We need about 20g of protein per meal on average, so that’s not 20g of beans or chicken, but how much protein is actually in the food itself. Don’t worry, you don’t need to be weighing things up, just start with the ratios first, the portion sizes. If you’re still getting hungry after meals, check how much protein you’re actually eating and up it if need be. For meat, it works out at about 3-4 oz of animal protein. If you’re eating beans or a protein rich grain like quinoa or brown rice, you’re probably going to need to up your levels with say a dressing made of nut butter, or an egg, or maybe a tablespoon or two of seeds. Also, remember that beans and grains also count as complex carbs, so keep that in mind for when I get to the complex carbs bit! 

·      Next up, we want the final 25% to be split between more starchier complex carbs and healthy fats. For healthy fats, we’re looking at a two golf ball sized serving, or two heaped tablespoons and that could be equal to half an avocado, two tablespoons of olive oil, two tablespoons of nut butter, etc. Fat helps to slow the blood sugar release down, and is actually essential for hormone production by the way! 

The starchier carbs would consist of a small handful of something like root veggies such as sweet potato or parsnips, or maybe some quinoa or beans if you haven’t had them already as your protein source. And so this is where it has to be very individual as if you already have beans or grains, you might not need that extra starch boost and instead, you could just add some extra veggies so your plate is around 60-65% veg. But if you have say beans on your plate for your protein source and you tend to burn a lot of energy during the day because you’re a very active person, you might need a little sweet potato too or some grains. And if you’ve got meat as your protein source and you’re very active, that serving of starchier carbs might need to be a bit bigger than someone who isn’t very active. It has to be tailored to you and what your body needs. 

For example, my blood sugar cannot tolerate beans and grains in the same meal, I crash and burn hard! But I have a job where for the most part, other than using a standing desk a few times throughout the day and my usual exercise routine, I don’t have a physically demanding lifestyle. But if you’re say a nurse in a busy hospital, a dance teacher or an athlete, you’ll probably feel like you do better with that extra fuel. In fact, one of my clients who’s a dance teacher always needs some kind of grain with her meals or her blood sugar would get too low, because she was always burning it off!

Another thing I want to mention here is how our blood sugar responds to grains is very personal too. Some people find that grains give them a steady release of fuel, others find they spike their blood sugar levels quickly and then crash. That’s me! Especially after oatmeal, I can have a big, filling bowl but find myself starving and shaky an hour later, if not sooner. So if you do respond like that to grains but you want to eat them regularly, you might need to up you fat and protein to really slow down that glucose release.

So, this is where we get started. It might sound a little fiddly, but over time, you’ll gradually grow accustomed to it and notice when one of these food groups is missing! In the show notes, I’ve linked to a great diagram of how this looks on a plate, so you can always print that off and have it on your fridge. 

Now there other steps to balancing your blood sugar, but it can take some time to adjust to this one, so this is where I’d suggest for you to start and then you can revisit my past blood sugar episodes to learn more, or I think I’m probably going to release a standalone workshop on this in the future so you can always sign up to that if you’d like a deep dive and a step by step process. 

But start here, give it at least one cycle and see how you’re doing. Of course, if you’re constantly spiking your levels with chocolate and sweets, then balancing your meals won’t cancel that out, so just be mindful of that!

And I just want to leave you with one last tip, to really get off on the right track, make sure your breakfast is fat and protein rich, don’t skip these two! If you’re just having oatmeal, you’re going to need to add a lot of nut butter, some protein powder or have two eggs on the side to balance out the carb content. Keep that in mind when you start the day and you’ll find balancing your blood sugar levels much easier as go through the rest of your day.

Let's get social! Come say hello on Instagram or sign up to my newsletter.

Sign up to the wait list for my course, Live and Thrive with Endo here.

My new Nutrition for Endo Masterclasses are out now and are on special offer for Black Friday. Get one masterclass for £29.99 (full price £40) or both for £50. Find out more here.

My cookbook

Do you get full body pain? Does it affect your muscles, nerves or joints? Do you find that you need to rest after walking or find you tired more easily than others?

It might not just be endometriosis.

Ehlers-Danlos Syndrome is a group of 13 conditions which all affect connective tissue (collagen) in the body. Most are rare, but one type called hypermobility EDS is common - and out of those with this type of EDS, 6-23% have endometriosis. But that’s not where the connection ends…

• 32-77% of those with EDS have vulvodynia and or pain with sex.

• 33-75% have heavy menstrual bleeding. 

• 73-93% have painful periods.

Additionally, histamine intolerance caused by Mast Cell Activation Syndrome is a co-condition of Ehlers-Danlos syndrome, and we also know that overactive mast cells play a role in endometriosis. Not only can this cause more painful periods, but it can also create problems like allergies and eczema to name a few.

Ehlers-Danlos Syndrome is also a huge risk factor for SIBO, and as you may now know, at present SIBO is estimated as affecting 80% of the endo population.

I could go on with the overlapping symptoms and connections, but instead, I’ll let you hear it first hand from Natalia Kasnakidis who is not only an endometriosis warrior, but is also living with Ehlers-Danlos syndrome, histamine intolerance and potentially postural tachycardia syndrome.

In this episode we talk about:

• What the Ehlers-Danlos Syndromes are and how common they are.

• The signs and symptoms to look out for and Natalia’s own experience with her symptoms.

• The journey she tool to diagnosis and her tips for getting diagnosed.

• The co-conditions of EDS and their symptoms.

• Her key strategies for living well with endometriosis and EDS.

Get my free Christmas endo recipe ebook here. With five delicious endo-friendly recipes, This Endolife, At Christmas, is a mini cookbook to help you live and thrive with endometriosis at Christmas. These recipes are anti-inflammatory, plant-based, gluten-free, dairy-free, egg-free and contain no added sugar! Featuring...

• Sausage, Pecan and Chestnut Stuffing

• Carrot Bacon Pigs in Blankets

• Salted Caramel Cheesecake

• This Isn't Just Custard, This Is Endo-Friendly Very Vanilla Custard

• Christmas Spiced Plum and Blackberry Crumble

   

Let's get social! Come say hello on Instagram or sign up to my newsletter.

Sign up to the wait list for my course, Live and Thrive with Endo here.

My new Nutrition for Endo Masterclasses are out now and are on special offer for Black Friday. Get one masterclass for £29.99 (full price £40) or both for £50. Find out more here.

My cookbook This EndoLife, It Starts with Breakfast is out now! Get 28 anti-inflammatory, hormone friendly recipes for living and thriving with endometriosis. Order your copy here.

If you feel like you need more support with managing endometriosis, you can join Your EndoLife Coaching Programme. A 1-to-1 three month health and life coaching programme to help you thrive with endometriosis. To find out more about the programme and to discuss whether it could be right for you, email me at [email protected] or visit my website.

This episode is sponsored by The Pod Farm. Learn all about how to start your own podcast with the complete course from The Pod Farm. Aimed at beginners, this course takes a simple and straightforward approach to planning, equipment buying, setting up, recording, editing and hosting your own podcast. With hours of audio and video materials, and downloadable guides and useful links, this multimedia approach aims to have something for every kind of learner. From now until April 15, newsletter subscribers get 20% off the course price. Visit www.thepodfarm.com to enroll or find out more

This episode is sponsored by BeYou. Soothe period cramps the natural way with these 100% natural and discreet menthol and eucalyptus oil stick on patches and CBD range. Click here to find out more and to shop: https://beyouonline.co.uk

Do you suffer with the endo belly? Is it accompanied by bloating, diarrhea, constipation or abdominal cramping?

Whilst I’m all about getting to the root cause and find out WHY you’re suffering with the endo belly (not to mention, healing the root cause) I also understand the need for short-term symptom relief whilst we’re on that journey.

Today’s podcast episode offers just that. I am sharing the most effective supplement options that help to relieve endo belly flares in the moment. These are the tools and strategies we use in our SIBO training with Dr. Siebecker, but are safe if you don’t have SIBO but do suffer with IBS symptoms.

You will find all the dose references in the show notes, but remember - as a health coach I cannot prescribe you a treatment protocol, this is education only and the aim is for you to take this information away to discuss your options with your doctor.

Full credit to my tutor Dr. Allison Siebecker for teaching and providing us with these strategy relief tools!

Activated Charcoal

So first up we’re starting with activated charcoal, which is great for: 

• Diarrhea

• Abdominal pain (not pelvic pain)

•  Gas

• Acid reflux

It works by absorbing gases, which reduces pressure in the gut that can lead to cramping and of course, reduces bloating. It’s also absorbs fluid, so reduces diarrhea too. 

The doses are:

• Up to 1000mg, every 1-3 hours for diarrhea.

• Up to 1000mg, every 2-6 hours for bloating/gas/abdominal pain. 

• Up to 1000mg 30 mins before a meal and one hour after for endo belly ‘trigger’ foods. Now what I mean by this, is if you have to eat something that you know is probably going to make you bloat or gassy, or swell you up, but you’re a bit stuck for choices, say you’re at a family thing or wedding, or you’re on holiday, then you could use charcoal. I don’t advise you just use it for every meal so you can eat whatever you want, because you’ll end up very constipated because it absorbs fluid, but I have found it very helpful on holiday and at weddings.

• Up to 500mg every 2-3 hours for acid reflux.

So, some things to consider when taking charcoal:

• Do not consume more than 4000mg per day. 

• It can cause constipation, so reduce the dose if constipation occurs or use with magnesium citrate (which you’ll learn about shortly) or stool softeners, and I’ve listed some natural stool softeners in the handout. If you do use magnesium citrate to avoid any constipation, take it an hour after the charcoal or before bed.

• Your bowel movements may look dark after charcoal - don’t worry, it just stains everything! 

• Absorbs everything, so take it 30 minutes before meals/supplements/meds and/or one hour after.

• Some research has showed that in it can cause vomiting if accidentally inhaled, so if you struggle with small airways or swallowing, be cautious with this. I also personally prefer using capsules, as I have tried using the powder stirred in water and have accidentally inhaled it myself one or two times!

Ginger

Next up is my absolute favourite, and that’s ginger. 

Ginger is effective for:

• Nausea/vomiting

• Gas

• Bloating

• Fullness/food won’t go down

• Abdominal pain

 Ginger is a prokinetic, which means it stimulates the MMC and gut motility, so it moves gas down and out of the small intestine. This therefore helps with gas, bloating, pressure, and abdominal pain, and it helps food to go down as well if you’re feeling like you’re not digesting your food properly. And I’ve mentioned, it’s a great tool for nausea and vomiting.

 The doses are:

• 1000mg an 1-2 hours after meals or at bedtime for nausea/bloating/gas/vomiting/ab. pain. 

• 1000mg 30 mins before meals to aid with appetite if nauseas.  

So, some things to consider when taking ginger are:

• Do not consume more than 2000 mg per day. 

• It can cause something called ginger burn, which feels like heat or acid reflux is the oesophagus or stomach. If that occurs, take less, stand up and move around so it starts to go down (as ginger burn often happens when lying down or reclining in many of my clients) and sip on lots of water.

• In people with interstitial cystitis, as it’s a spice, it might cause some irritation, but this tends to vary from person to person.

• Finally, fresh ginger root is usually not as effective as dried ginger root powder, so we’re going for a 1000 mg in the form of capsules.

Peppermint

Peppermint can be used for:

• Abdominal pain

• Bloating

• General IBS symptoms (there’s LOTS of research on peppermint for IBS)

• Indigestion

• Pain with bowel movements (which I know many of you suffer with) 

Peppermint relaxes the smooth muscle of the intestines, so helps significantly with cramping and abdominal pain, and helps to ease the transition of gas. It’s also been shown to be 67% effective for reducing severe IBS symptoms, pretty impressive stuff!

So, the doses are:

• Use peppermint tea/or tincture (follow label dose) for pain or sensations higher up in the abdomen (this is because peppermint generally works locally, so if you feel symptoms around the stomach area, the peppermint tea or tincture will be able to affect that area because it’s not sealed up in a pill, whereas the pills are coated and are designed to not be released until they exit the stomach).

• Label dose of triple coated tablets for mid to lower abdominal symptoms, as needed or daily. Research has shown that pain and symptoms improve significantly with long-term use with peppermint oil.

• Can also apply peppermint essential oil to abdomen. Follow label instructions as some oils require diluting in a base oil. A quick tip here, is you can use Be You patches, which I share on my podcast, over the abdomen, to ease spasms. You can keep those on for 12 hours and you can wear them daily.

So, some things to consider when taking peppermint are:

• It can cause acid reflux in some people because it relaxes the muscles, it can open up the sphincter connecting the stomach and the oesophagus, so stomach acid can travel up. If this happens to you, try a pill that’s triple coated and designed to bypass the stomach.

• For some people, peppermint can also cause nausea.

   

Magnesium

Magnesium citrate or oxide can be used for:

•  Constipation

These types of magnesium draw water into the colon, helping to create a bowel movement.

The dose is: 

• Up to 2000 mg at bedtime (two hours after food), daily or as needed until you have a bowel movement. However, 1000 mg is normally effective for many, but see what works for you.

So, some things to consider when taking magnesium citrate or oxide are:

• You need to start slowly, beginning at 500 mg and building up until you find the dose that works for you. Generally, increasing your dose slightly each night should be a good pace, but keep in mind it can take a few nights to get to work, so don’t be too hasty. 

•  Too much will cause abdominal cramping, bloating and diarrhea. If that occurs, reduce the dose back down until you get to a dose that creates a healthy bowel movement without watery stools or discomfort.

• Food will reduce the effects, so keep in mind you need to take it two hours away from food.

• And finally, you have to use either magnesium oxide or citrate, other forms of magnesium are not laxatives and will be absorbed in the body, rather than making their way down into the colon.

Partially Hydrolysed Guar Gum

PHGG be used for:

• All IBS symptoms (multiple studies/reviews confirm this)

• Constipation

• Improving stool consistency

• Diarrhea

• Bloating/gas

• Increasing beneficial bacteria

PHGG is a type of soluble, low FODMAP fibre, which is generally safe and well tolerated by even SIBO patients! It’s a longer term symptom management tool, whereas the others bring relief same day, this tends to need about a month to build up to the benefits. It helps to bulk up stools, making it effective for both constipation and diarrhea.

So, the dose is:

• 5-6 g daily, ideally dissolved in hot water on an empty stomach, for at least one month and likely ongoing for maintenance. Some people do put it with tea, coffee, smoothies or even porridge, but many of the labels suggest on an empty stomach.

•  Increase to full dose across one to two weeks, especially if SIBO positive, so start out lower, with say one gram, and then increase by a gram or half a gram a day.

   

  So, some things to consider when taking partially hydrolysed guar gum are:

• Ironically, in some people, likely people who have SIBO or extensive gut issues, it might cause bloating. So, give yourself a month or so on it and see how you respond. If it’s noticeably bad, reduce back down to a level you can tolerate or discontinue. Generally, it is thought to be SIBO safe, but we’re all different and SIBO is so individual, that we can’t guarantee it’ll be well tolerated by everyone.

• And alongside that, it may cause some GI distress, so basically an irritation of your IBS symptoms and if you have SIBO and don’t respond well to it, it could worsen those. However, as I’ve mentioned, on the whole, it’s well tolerated.

   

Most Important Takeaway:

So, that wraps up this module, and I wanted to also let you know, there are multiple other options to help with symptoms, including more supplements and some at home remedies. I’ve linked to a handout in this slide by my tutor Dr. Allison Siebecker, which provides all of them. You don’t need to use them all, but I would recommend you have a read of it, so you know your options, and I also recommend trying some of the simple home remedies before buying expensive supplements! 

But before we do any of that, remember, getting our foundations in place can make a huge difference to gut health - so start off with the first line therapies, before you start spot treating with lots of different supplements.

Let's get social! Come say hello on Instagram or sign up to my newsletter.

Sign up to the wait list for my course, Live and Thrive with Endo here.

My new Nutrition for Endo Masterclasses are out now and are on special offer for Black Friday. Get one masterclass for £29.99 (full price £40) or both for £50. Find out more here.

My cookbook This EndoLife, It Starts with Breakfast is out now! Get 28 anti-inflammatory, hormone friendly recipes for living and thriving with endometriosis. Order your copy here.

If you feel like you need more support with managing endometriosis, you can join Your EndoLife Coaching Programme. A 1-to-1 three month health and life coaching programme to help you thrive with endometriosis. To find out more about the programme and to discuss whether it could be right for you, email me at [email protected] or visit my website.

This episode is sponsored by The Pod Farm. Learn all about how to start your own podcast with the complete course from The Pod Farm. Aimed at beginners, this course takes a simple and straightforward approach to planning, equipment buying, setting up, recording, editing and hosting your own podcast. With hours of audio and video materials, and downloadable guides and useful links, this multimedia approach aims to have something for every kind of learner. From now until April 15, newsletter subscribers get 20% off the course price. Visit www.thepodfarm.com to enroll or find out more

This episode is sponsored by BeYou. Soothe period cramps the natural way with these 100% natural and discreet menthol and eucalyptus oil stick on patches and CBD range. Click here to find out more and to shop: https://beyouonline.co.uk

This episode is sponsored by Semaine. Try their supplement for period pain and daily supplement for hormonal balance and PMS prevention with code ENDOLIFE to get 20% off your first order.

Show Notes

Charcoal

https://pubmed.ncbi.nlm.nih.gov/3717809/

https://pubmed.ncbi.nlm.nih.gov/3521259/

https://pubmed.ncbi.nlm.nih.gov/7015846/

https://pubmed.ncbi.nlm.nih.gov/3717809/

https://pubmed.ncbi.nlm.nih.gov/7949514/

https://pubmed.ncbi.nlm.nih.gov/12516788

https://www.siboinfo.com/uploads/5/4/8/4/5484269/sibo_symptomatic_relief_suggestions_jan_2020.pdf

Ginger

https://pubmed.ncbi.nlm.nih.gov/10442508/

https://pubmed.ncbi.nlm.nih.gov/16865831/

This episode is an IG live where I discuss the endo management habits that are a part of my everyday life and I pretty much couldn’t live without!

Now, it’s definitely not as simple as ‘do these habits and your symptoms will be sorted’, that’s not what this live was about - this was just a little peak into some of my daily habits. When it comes to endo it’s about understanding and treating/managing the root causes behind your symptoms and that will differ for every person. BUT these are habits that have profoundly changed my experience of endo, and I also see work wonders for clients. They are:

Anti-inflammatory nutrition

Blood sugar management

Magnesium spray/baths

Omega 3 fatty acid supplementation

An extra good quality, evidence-backed anti-inflammatory supplement (quercetin, curcumin, glutathione, etc)

Daylight in the mornings

Underneath these it’s also of course important to have the foundations of good health:

Sleep

Movement

Stress management

Good nutrition (but that’s covered above)

Stress management

Hydration

Connection/joy

I also work on the liver, gut, HPA axis, pain signals, pelvic floor health, etc. with myself and clients, but those are longer term strategies for another day and another live! They are integral to the way I approach endo management, but today I just wanted to share some of my daily habits that are part of my standard everyday routine (I think I’ve added that disclaimer enough times now!).

FINALLY I want to say that all of these methods must be tailored to you, and must fit into your life in a way that makes them feel manageable and enrich your life, rather than making you feel stressed and exhausted trying to keep up with them!

If you’re interested to learn more about eating for endo, I’ve just launched two new masterclasses:

Nutrition for Endo: The Foundations Masterclass (anti-inflammatory nutrition)

Nutrition for Endo Advanced Masterclass (blood sugar)

They’re currently on special offer for Black Friday until Tues 10pm GMT. Each class is £29.99 (full price £40) or you can get them both in a bundle for £50. Join here.

Let's get social! Come say hello on Instagram or sign up to my newsletter.

Sign up to the wait list for my course, Live and Thrive with Endo here.

My cookbook This EndoLife, It Starts with Breakfast is out now! Get 28 anti-inflammatory, hormone friendly recipes for living and thriving with endometriosis. Order your copy here.

If you feel like you need more support with managing endometriosis, you can join Your EndoLife Coaching Programme. A 1-to-1 three month health and life coaching programme to help you thrive with endometriosis. To find out more about the programme and to discuss whether it could be right for you, email me at [email protected] or visit my website.

This episode is sponsored by The Pod Farm. Learn all about how to start your own podcast with the complete course from The Pod Farm. Aimed at beginners, this course takes a simple and straightforward approach to planning, equipment buying, setting up, recording, editing and hosting your own podcast. With hours of audio and video materials, and downloadable guides and useful links, this multimedia approach aims to have something for every kind of learner. From now until April 15, newsletter subscribers get 20% off the course price. Visit www.thepodfarm.com to enroll or find out more

This episode is sponsored by BeYou. Soothe period cramps the natural way with these 100% natural and discreet menthol and eucalyptus oil stick on patches and CBD range. Click here to find out more and to shop: https://beyouonline.co.uk

This episode is sponsored by Semaine. Try their supplement for period pain and daily supplement for hormonal balance and PMS prevention with code ENDOLIFE to get 20% off your first order.

I first came across Dr. Ami Kapadia’s work through some presentations she held for an online SIBO conference. Her lectures focused on small intestine fungal overgrowth, yeast disorders and mould - and what I heard resonated with not only my story, but so many of my clients’ stories.

And I’m not alone. Dr. Jessica Drummond often speaks on the connection she sees between chronic pelvic pain and yeast problems, and yeast/SIFO are prevalent issues within the SIBO community. In fact, left untreated, they can really hinder SIBO progress. The trouble is, they’re not easy to diagnose and the symptoms are often identical to SIBO, and at least a quarter of SIBO patients, if not more, also have SIFO.

So, given that research is currently estimating that up to 80% of endometriosis patients also have SIBO, I wanted to invite Dr. Ami onto the show to discuss how to identify and treat years disorders both alongside SIBO and alone.

Dr Ami. Kapadia is a family medicine and integrative medicine physician, with a special interest in yeast and fungal disorders. She is the creator of practitioner course A Minimalist's Approach to SIFO And Mold Related Illness and patient course An Integrative Approach to SIFO: Small Intestinal Fungal Overgrowth And Related Conditions.

In this episode we discuss:

• What are fungal/yeast related disorders and how do they affect the body.

• The connection between yeast/fungal disorders, endometriosis and SIBO.

• The signs and symptoms of fungal/yeast related disorders and how to test for them.

• Dr. Ami’s unique treatment approach and her specific anti-fungal protocols.

• Dietary considerations (it’s not what you think!) and what to do if you find food restriction triggering.

• How to work with Dr. Ami.

This episode was fascinating and I completely geeked out (you' can probably tell!), I hope you enjoy it just as much as I did!

Let's get social! Come say hello on Instagram or sign up to my newsletter.

Sign up to the wait list for my course, Live and Thrive with Endo here.

My cookbook This EndoLife, It Starts with Breakfast is out now! Get 28 anti-inflammatory, hormone friendly recipes for living and thriving with endometriosis. Order your copy here.

If you feel like you need more support with managing endometriosis, you can join Your EndoLife Coaching Programme. A 1-to-1 three month health and life coaching programme to help you thrive with endometriosis. To find out more about the programme and to discuss whether it could be right for you, email me at [email protected] or visit my website.

This episode is sponsored by The Pod Farm. Learn all about how to start your own podcast with the complete course from The Pod Farm. Aimed at beginners, this course takes a simple and straightforward approach to planning, equipment buying, setting up, recording, editing and hosting your own podcast. With hours of audio and video materials, and downloadable guides and useful links, this multimedia approach aims to have something for every kind of learner. From now until April 15, newsletter subscribers get 20% off the course price. Visit www.thepodfarm.com to enroll or find out more

This episode is sponsored by BeYou. Soothe period cramps the natural way with these 100% natural and discreet menthol and eucalyptus oil stick on patches and CBD range. Click here to find out more and to shop: https://beyouonline.co.uk

This episode is sponsored by Semaine. Try their supplement for period pain and daily supplement for hormonal balance and PMS prevention with code ENDOLIFE to get 20% off your first order.

Show Notes

• Website: www.amikapadia.com

• Teachable course for practitioners: https://drkapadia.teachable.com/p/a-minimalist-s-approach-to-mold-related-illness-and-small-intestinal-fungal-overgrowth-sifo

• Teachable course for patients: https://drkapadia.teachable.com/p/sifo-in-integrative-course-for-patient-education

This episode is an IG Live I hopped on to answer your questions in endometriosis and navigating relationships with family and friends.

In this Q&A I answer:
How to have fun with friends again? Feels like endo always gets in the way.
How to handle family not understanding how endo affects my life?
How to explain it to those who don’t get how impactful it is?
What to say or do when a friend questions if you’re really in pain when you say you can’t go out?

Also, a few of the resources I mentioned in the live:
Endometriosis UK
Endometriosis News
Endometriosis News
@vickiewilliams_

Let's get social! Come say hello on Instagram or sign up to my newsletter.

Sign up to the wait list for my course, Live and Thrive with Endo here.

My cookbook This EndoLife, It Starts with Breakfast is out now! Get 28 anti-inflammatory, hormone friendly recipes for living and thriving with endometriosis. Order your copy here.

If you feel like you need more support with managing endometriosis, you can join Your EndoLife Coaching Programme. A 1-to-1 three month health and life coaching programme to help you thrive with endometriosis. To find out more about the programme and to discuss whether it could be right for you, email me at [email protected] or visit my website.

This episode is sponsored by The Pod Farm. Learn all about how to start your own podcast with the complete course from The Pod Farm. Aimed at beginners, this course takes a simple and straightforward approach to planning, equipment buying, setting up, recording, editing and hosting your own podcast. With hours of audio and video materials, and downloadable guides and useful links, this multimedia approach aims to have something for every kind of learner. From now until April 15, newsletter subscribers get 20% off the course price. Visit www.thepodfarm.com to enroll or find out more

This episode is sponsored by BeYou. Soothe period cramps the natural way with these 100% natural and discreet menthol and eucalyptus oil stick on patches and CBD range. Click here to find out more and to shop: https://beyouonline.co.uk

This episode is another live Q&A from Instagram. I had a number of you ask me about the training I did to became an endo health coach and what training is generally required, so I decided to answer some of those questions live on Instagram.

In this Q&A I talk about -
What motivated me to become an endo health coach.
The work experience I had to prepare me to coach.
The certifications I took to qualify as a women’s health coach.
The certifications I took to qualify in endometriosis specifically.
The certifications I then went onto take for SIBO.
My business model (what working with clients looks like on a week to week basis).
My plans for the future (naturopathic doctor)!
My struggles with perfectionism and workaholism during my training and start-up period.

Let's get social! Come say hello on Instagram or sign up to my newsletter.

Sign up to the wait list for my course, Live and Thrive with Endo here.

My cookbook This EndoLife, It Starts with Breakfast is out now! Get 28 anti-inflammatory, hormone friendly recipes for living and thriving with endometriosis. Order your copy here.

If you feel like you need more support with managing endometriosis, you can join Your EndoLife Coaching Programme. A 1-to-1 three month health and life coaching programme to help you thrive with endometriosis. To find out more about the programme and to discuss whether it could be right for you, email me at [email protected] or visit my website.

This episode is sponsored by The Pod Farm. Learn all about how to start your own podcast with the complete course from The Pod Farm. Aimed at beginners, this course takes a simple and straightforward approach to planning, equipment buying, setting up, recording, editing and hosting your own podcast. With hours of audio and video materials, and downloadable guides and useful links, this multimedia approach aims to have something for every kind of learner. From now until April 15, newsletter subscribers get 20% off the course price. Visit www.thepodfarm.com to enroll or find out more

This episode is sponsored by BeYou. Soothe period cramps the natural way with these 100% natural and discreet menthol and eucalyptus oil stick on patches and CBD range. Click here to find out more and to shop: https://beyouonline.co.uk

Okay today I want to now talk about something a little more unusual, and that’s Ehlers-Danlos syndrome and its possible connection to endometriosis.

 Ehlers-Danlos Syndrome is a group of 13 conditions which all affect connective tissue (collagen) in the body. Most are rare, but one type called hypermobility EDS is common.

 Because the intestines are made from soft tissue, EDS affects digestion and often causes IBS symptoms. It is a major risk factor for developing SIBO, because it slows down motility. If you have EDS and SIBO, you will be chronic - but you can still live well! And we’ll get to that in the bonus lesson with Dr Allison Siebecker.

 And just to hammer this point home about the connection between EDS and IBS, one study of 228 IBS patients found 48% also had EDS.

Now the reason why I want to bring EDS to your attention is because I am seeing it more and more in my clients with both endometriosis and SIBO.

Despite these statistics, to my knowledge, most experts do not consider EDS and endometriosis to be significantly connected. At present, it is thought that most of the period pain and menstrual problems of those with EDS is not caused by endometriosis, but EDS itself. 

However, I have spoken to multiple health care practitioners who do see a connection and see the two conditions together in patients, and because EDS can cause gut problems and SIBO, I think it’s worth raising here.  

So, here’s an overview of what we know so far…

•  Current estimation is 6-23% of patients with EDS also have endometriosis. More research is being done into the connection at present.

• 32-77% of those with EDS have vulvodynia and or pain with sex.

• 33-75% have heavy menstrual bleeding. 

• 73-93% have painful periods.

And here are some of the main symptoms of EDS, though there are many and they are often far reaching. You do` not have to have them all to have EDS:

• ·Joint pain/full body pain

• Hypermobility (can be very subtle)

• Stretchy skin

• Soft, velvety skin

• Bruise easily

• Dislocations of joints

• Chronic fatigue

• Dental crowding 

And I wanted to include some signs or clues of EDS as well…

• Unusual symptoms that seem random, so people with EDS often feel like they have lots of symptoms and never really feel well.

• Family has hypermobility - again, this can be very subtle. They might have no idea.

• Tight muscles and stiffness - because your joints are unstable, the muscles overcompensate and are often stiff and tight to try and create some stability in the body.

• Allergies - and this is because MCAS is now being identified as a co-condition of EDS. MCAS is when the mast cells which release histamine are overly sensitive and easily triggered, resulting in a higher amount of histamine being released on a daily basis. Mast Cell Activation Syndrome still isn’t widely acknowledged by conventional medicine, but many functional and naturopathic doctors are leading the way with this. MCAS is now showing up in the research as being a likely co-condition of EDS, as part of a trio with another condition call PoTS, which stands for Postural Tachycardia syndrome.

• Low blood pressure and/or dizziness - because EDS often comes with something called dysautonomia

• Racing heart or palpitations - due to a type of dysautonomia which I mentioned earlier, called PoTs

• IBS - because of how EDS affects the gut

So, following on from that, I just wanted to provide a bit more education around dysautonomia in case you have the signs.  Dysautonomia is a group of conditions that affect the autonomic nervous system, which control involuntary functions of the body.

 Postural Tachycardia syndrome or PoTs is one of these conditions and is part of a trio of EDS-MCAS-PoTs I mentioned earlier, and it affects blood flow and blood pressure in the body, so that too little blood is getting to the heart and the heart rate increases when going from sitting/lying down to standing.

Some of the symptoms of dysautonomia are… 

• Blood sugar dysregulation

• Low blood pressure/fainting

• Chest pain/breathing issues/palpitations/racing heart

• Gut problems and bladder problems

• Dizziness/balance difficulties/vertigo

• Struggle to regulate temperature

 I’ll take you through some ways to get tested in the next lesson.

Now I know this might sound scary, but if you do get a diagnosis, you can manage these symptoms long-term, and your quality of life will dramatically improve!

And just because I found this personally quite helpful, because there’s a lot of symptoms floating around with this, EDS specialist Dr Alena Guggenehim sees loose joints, joint pain and dysautonomia as the main signs/symptoms of hEDS.

Diagnosis for EDS is best done through a rheumatologist, but reportedly this is more frequently being performed by GPs these days. If you can’t get a referral on the NHS (if you’re based in the UK), then I think the best route would be to buy health insurance and get referred to an EDS specialist. I think that would be safest, because not all GPs are fully versed in diagnosing EDS.

For hypermobility EDS, diagnosis is based on a physical test called Beighton score, which looks at the range of mobility in your joints, as well as issues like teeth overcrowding. Family and patient history should also be taken into account, and signs of co-conditions, like allergies and dizziness. It’s worth noting here that you can still have hEDS if you don’t score highly on the Beighton score. There is a link to it in the slides, but it does have some confusing terminology and is not to be used as a tool for diagnosis without a doctor.

Genetic testing will also be carried out to rule out the rarer forms of EDS.

PoTs is tested for by testing heart rate and blood pressure when going from sitting to standing and lying down (on a tilted table) to upright. You’ll need to speak to your GP to get a referral. If you test positive for EDS and you have signs of dysautonmia, even if it’s just fatigue, it’s worth looking into this. 

Other tests may be run to look for other types of dysautonomia

Listen and subscribe on your favourite player or listen directly/download MP3 here or just listen below!

Let's get social! Come say hello on Instagram or sign up to my newsletter.

Sign up to the wait list for my course, Live and Thrive with Endo here.

My cookbook This EndoLife, It Starts with Breakfast is out now! Get 28 anti-inflammatory, hormone friendly recipes for living and thriving with endometriosis. Order your copy here.

If you feel like you need more support with managing endometriosis, you can join Your EndoLife Coaching Programme. A 1-to-1 three month health and life coaching programme to help you thrive with endometriosis. To find out more about the programme and to discuss whether it could be right for you, email me at [email protected] or visit my website.

This episode is sponsored by The Pod Farm. Learn all about how to start your own podcast with the complete course from The Pod Farm. Aimed at beginners, this course takes a simple and straightforward approach to planning, equipment buying, setting up, recording, editing and hosting your own podcast. With hours of audio and video materials, and downloadable guides and useful links, this multimedia approach aims to have something for every kind of learner. From now until April 15, newsletter subscribers get 20% off the course price. Visit www.thepodfarm.com to enroll or find out more

This episode is sponsored by BeYou. Soothe period cramps the natural way with these 100% natural and discreet menthol and eucalyptus oil stick on patches and CBD range. Click here to find out more and to shop: https://beyouonline.co.uk

Show Notes

Stats references

https://www.rcgp.org.uk/clinical-and-research/resources/toolkits/ehlers-danlos-syndromes-toolkit.aspx

https://www.siboinfo.com/associated-diseases.html

https://pubmed.ncbi.nlm.nih.gov/29687534/

https://www.ehlers-danlos.com/pdf/2018-annual-conference/N-Blagowidow-2018Baltimore-OB-GYN-and-EDS-HSD-S.pdf

Symptoms

https://www.nhs.uk/conditions/ehlers-danlos-syndromes/

https://www.rcgp.org.uk/clinical-and-research/resources/toolkits/ehlers-danlos-syndromes-toolkit.aspx

https://ehlers-danlos.com/wp-content/uploads/hEDS-Dx-Criteria-checklist-1.pdf

https://www.rcgp.org.uk/clinical-and-research/resources/toolkits/ehlers-danlos-syndromes-toolkit.aspx

Dysautonomia

https://pubmed.ncbi.nlm.nih.gov/31267471/

https://drbeckycampbell.com/mast-cell-activation-syndrome-postural-orthostatic-tachycardia-syndrome-and-ehlers-danlos-syndrome-what-is-the-connection/

https://www.nhs.uk/conditions/postural-tachycardia-syndrome/

https://my.clevelandclinic.org/health/diseases/6004-dysautonomia

https://join.sibosos.com/page/94124

Testing references

https://www.nhs.uk/conditions/ehlers-danlos-syndromes/

https://ehlers-danlos.com/wp-content/uploads/hEDS-Dx-Criteria-checklist-1.pdf

https://www.rcgp.org.uk/clinical-and-research/resources/toolkits/ehlers-danlos-syndromes-toolkit.aspx

https://www.nhs.uk/conditions/postural-tachycardia-syndrome/

This episode is from a mini IG Live answering your questions about painful sex with endo (which turned out not to be mini, more like 40 mins).

Here’s the three most common questions I answered:

Is there anything that will make sex with endo eventually not painful/how do I fix it?
I’ve tried everything but still get pain, is surgery the next option?
How to navigate painful sex without killing the mood?

In this IG Live I talk about inflammation, adhesions, having a hypertonic pelvic floor, pain science and share lots of tools, resources and books to help you on your way to having less pain (hopefully pain free) sex.

I really hope you find this useful!

Let's get social! Come say hello on Instagram or sign up to my newsletter.

Sign up to the wait list for my course, Live and Thrive with Endo here.

My cookbook This EndoLife, It Starts with Breakfast is out now! Get 28 anti-inflammatory, hormone friendly recipes for living and thriving with endometriosis. Order your copy here.

If you feel like you need more support with managing endometriosis, you can join Your EndoLife Coaching Programme. A 1-to-1 three month health and life coaching programme to help you thrive with endometriosis. To find out more about the programme and to discuss whether it could be right for you, email me at [email protected] or visit my website.

This episode is sponsored by The Pod Farm. Learn all about how to start your own podcast with the complete course from The Pod Farm. Aimed at beginners, this course takes a simple and straightforward approach to planning, equipment buying, setting up, recording, editing and hosting your own podcast. With hours of audio and video materials, and downloadable guides and useful links, this multimedia approach aims to have something for every kind of learner. From now until April 15, newsletter subscribers get 20% off the course price. Visit www.thepodfarm.com to enroll or find out more

This episode is sponsored by BeYou. Soothe period cramps the natural way with these 100% natural and discreet menthol and eucalyptus oil stick on patches and CBD range. Click here to find out more and to shop: https://beyouonline.co.uk

This week’s episode is a snippet from my upcoming course, The Endo Belly Course. I realised when creating this lesson, that this information is info everyone should know, not just my students! So today’s episode is all about what’s a ‘normal’ and healthy gut vs. what is the endo belly?

So first up, I wanted to actually talk about what the endo belly is.

The ‘endo belly’ is not actually a medical term, but instead is a name the community has coined in reference to the severe bloating we often experience. So, there isn’t technically a set definition, but it is generally thought to be severe bloating/swelling that tends to be attributed to endometriosis and is sometimes accompanied by pain. Some experts, articles and endo patients also include gut problems within this term too, but not always.

My definition, from my training and from seeing so many clients with these symptoms is that the endo belly is exaggerated/severe bloating, often accompanied by gut symptoms, pain or discomfort - but it is not always caused by endometriosis directly.

So here are some of the common symptoms I see in my clients and that I tend to think of as fitting under the term ‘the endo belly’:

• Flares up with stress/food/pain/cycle - but not always, this might just be a daily thing for you.

• Normally comes with IBS issues like diarrhea, constipation, abdominal pain, gas. These might not be flares, but more so just your daily bowel habits and gut issues. So, for example, you may tend to always lean towards constipation or loose stools, or you may have a lot of gas on a daily basis.

• It’s often debilitating -  so it may disturb social life, diet, work, or confidence. You might worry about eating out because you’re scared of a flare up, you might have to eat a restricted diet to control symptoms, you might have to sometimes take sick days, or you just struggle at work with your symptoms. It’s not as simple as just feeling a bit bloated after lunch.

• Normally a dramatic increase in abdominal size - endo patients often report looking pregnant, requiring different sized clothing, having swelling that’s so bad they’re in pain. 

 And finally, I just want to note - some sources discuss the endo belly swelling being lower down in the abdomen and that IBS issues are higher up, but I think the problem with this is that it’s not true for everyone and it might mean you dismiss any other possible causes because you think “Oh it’s low down, it’s just my endo”. I’ve seen lots of people with SIBO and endo, whose bloating is from their diaphragm all the way down or starts from their belly button and goes down to their pubic bone, so I really wouldn’t pay a huge amount of attention to where the bloating is, unless of course you’re just getting a tiny bit of bloat or a bump on say one side near your ovaries, which might indicate a cyst, for example.

So, something I really think is important to discuss is what is normal vs. what is endo belly, because I don’t want us to be trying to reach for an unattainable vision of a healthy gut.

So here are some signs of the endo belly/something more is going on with your gut…

• Bloating and gut problems get worse and worse as day goes on. You get more uncomfortable, maybe your pain increases and by your last meal your stomach has swollen to triple its normal size.

• Symptoms can only be controlled through restriction - a ‘normal’ diet can’t be achieved, and you find yourself skipping meals or having to restrict to avoid flare ups.

• Often can no longer fit into clothes or need to change to be comfortable when your belly swells up because it’s become so distended. In short, the bloating is severe and significant.

• May be accompanied by other health problems and nutrient deficiencies like achy joints, fatigue, low B12 or low iron. These are signs of inflammation and malabsorption of nutrients.

• You might get constipated before period. From a functional medicine point of view, which is what my training is based on, you should have at least one daily bowel movement, and this is actually really important for hormonal health, because old oestrogen is excreted through waste and that needs to occur daily. However, in contrast, dieticians and conventional doctors tend to take a different stance and say whatever is normal for you, is normal or at least three times a week. In terms of my training with Dr Allison Siebecker, Dr Jessica Drummond, etc. we would consider that as constipation, basically anything that is not once a day, is leaning towards a form of constipation. It might be considered normal, but we wouldn’t class it as optimal for health.

• Diarrhea on period which causes abdominal discomfort, eating problems (maybe you have to avoid food or eat a restricted diet), affects daily life (you might not be able to have a normal workday because you’re stuck in the toilet), sicks days, etc.

• Often affects daily life/confidence because you’ve been asked so many times whether you’re pregnant, you get comments or you just feel fed up with not being able to wear the clothes you’d like. Additionally, your gut symptoms are affecting your daily life, so for example, I had a client who would get several bouts of loose stools every morning, to the point where she would sometimes be late for dropping her child off to nursery. Another client wouldn’t be able to finish meals without needing to dash to the toilet.

• Wake up bloated already or with gut problems/sleep is disturbed due to discomfort. So, I had one client who had a distended belly all the time, and it was so bad she actually got to the point where it was too painful to sit or stand up, she had to lay down all the time. Another client wouldn’t be able to sleep because by the evening, her belly was so bloated she couldn’t get comfortable, and she’d be in agony from all the gas inside her.

So, in contrast, I wanted to talk about what is normal for a healthy gut, and some of this might surprise you -

•  Feel satisfied after eating, not overly full or like food isn’t going down. Of course, if it’s Christmas or Ramadan you might be feasting on more food than you normally would, so of course sometimes you’re going to feel full to bursting, but generally, you should feel like you’re able to digest your food and like it’s going down. It’s not just sitting there for hours afterwards.

• May be a bit bloated or gassy after meals (esp. high fibre. or large meals), but the bloating should subside a few hours later and it’s not accompanied by GI distress. This is because our good gut bugs actually eat our food and ferment it, as part of the digestion process. We actually need this to happen to get all of our nutrients. But a result of this process is the creation of gas from the bacteria, and so naturally we will get a bit of expansion after a meal and of course, we’re putting food into our stomach, you wouldn’t expect to fill an empty bag with food shopping and for it not to expand or look bigger. So, there will be some extension of your abdomen after meals, but it shouldn’t be painful, be accompanied by GI distress, be severe or worsen as the day goes on. It should naturally go down and not affect your life or comfort. Additionally, so you know, according to the NHS, a normal amount of passing gas is about 5 to 15 times a day.

• You should wake up with a relatively flatter stomach in contrast to after meals. This is because your digestion has been working overnight. Now note I don’t say your stomach should be flat in the morning, it will be flatter in contrast to after meals, because you haven’t eaten in something like 10 or 12 hours.

• And to follow on from that, a normal healthy gut doesn’t mean your stomach is flat all the time. Your stomach shouldn’t be flat all the time, it should naturally expand a bit with food!

• Bloating tends to increase towards period and in luteal phase, but it shouldn’t be severe/painful/debilitating. This is because progesterone and oestrogen affect water retention, and so bloating and swelling can increase towards your period when progesterone is at its highest. Now if your hormones are imbalanced, this will be worse, so supporting your hormones (which this course will help with) should minimise the effects, but they won’t eradicate them entirely. Additionally, those inflammatory chemicals, prostaglandins, naturally begin building in the uterus from ovulation to your period, and as we know, inflammation creates swelling, so there may be some level of normal swelling during this time, but again, it shouldn’t be severe. If it is, this may be an indicator that your inflammation levels are too high, which is likely to be the case anyway, given that the endometriosis lesions release prostaglandins. Lastly, progesterone relaxes muscles, including the muscles of the intestines, so as a result, digestion slows down, meaning things become a bit sluggish and we get a bit more of a build-up of gas and waste, leading to a bit of bloating - again, it shouldn’t be severe.

• Bowels might feel a bit sluggish towards period but shouldn’t have full-blown constipation or if you do have any, it should at least short lived, so a day or so, for example. Or maybe your stools are a little harder or more cracked than normal.

• In contrast, it’s normal to have bowel movements that are looser during your period. This is because those prostaglandin E2 causes the muscles to contract, and as your uterus is right next to your colon, this can create contractions in the colon, resulting in a bowel movement and looser stools. If your inflammation levels are high, you may get full blown diarrhea, and that’s when we’ll want to reduce those levels. Ideally, a normal scenario is maybe more bowel movements which are a bit looser on your period, but they shouldn’t be causing you pain or affecting your day-to-day life during this time.

• Bloating after meals doesn’t require a new dress size!

Image from Integrative Women’s Health Institute

To show you what a healthy stool looks like, here is the Bristol Stool Chart. This is a diagnostic tool used to determine the health of stools, especially in IBS populations. In terms of functional medicine training, at IWHI we aim for a 4, so your stools should be snake like, smooth, easy to pass with a banana-like consistency. You should be having one to three bowel movements a day, one is the minimum because for optimal health and hormonal health, we want to removing waste on a daily basis, including old oestrogen, to prevent hormonal imbalances. 

Now, dieticians and conventional medicine will likely say to aim for somewhere between a 3-5. In terms of my training, we see 3 as beginning to lean towards constipation and 5 beginning to lean towards diarrhea. This is something that we focus on heavily with SIBO, a lot of people think that they don’t have constipation, or they don’t have diarrhea - but these bowel movements actually exist on a spectrum. Stools that are like pellets, hard and round, or difficult to pass, is a form of constipation. In my training, anything before 4 is a form of constipation and above 4 is a form of diarrhea or loose stools. They don’t show pudding like stools here, but I would consider that as form of diarrhea. However, opinions will vary as I have mentioned, so be guided by what feels best for you.

The caveat here is that if you are vegan and eat a lot of plants (not processed vegan food), you may have softer stools, nearer to a 5, so I wouldn’t worry too much about that. The other thing I would say is don’t chase perfection, which I’ve been guilty of. When my IBS was the most managed it’s ever been (at the time of recording it’s not, because I’ve had a SIBO relapse), my stools were about a 5 but I was very caught up on getting them to a 4! So, if your endo belly dramatically improves, if you get an all clear for gut conditions, etc. but sometimes your stools are a little either side of type 4, this is probably not something to worry about. It might just be that you ate a little more or a little less fibre that week, or maybe that’s just your normal. If you’re concerned about it, certainly see a gut health practitioner, but I just wouldn’t obsess about it that’s the only issue left and there are no other signs that something is up with your gut. 

Just to finish off this section, I want to hammer this home. A super flat stomach does not equal a happy gut - in fact, it sort of suggests that the gut microbiome is under fed or non-existent, because for them to thrive, they need to eat food and as a result, that creates gas.

So, we’re not aiming for washboard abs all the time, we’re aiming for gut health that doesn’t affect your daily life, cause you pain or physical/mental/emotional distress.

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