Periods and Poop

Why we need to listen to our bowel symptoms

So many young women have approached me about endometriosis – and its related symptoms – to help determine if they have the disease. Because of their age, the vast majority have been told by their doctors that it is likely they have endometriosis but it has not been confirmed through laparoscopy – the only way to confirm endometriosis today. In almost all cases, however, the number one symptom that is consistent with all these young women I have spoken to is increased diarrhea during menstruation.

Over 90% of women diagnosed with endometriosis actually present with GI symptoms as their initial symptoms. Bloating is the most common presenting symptom, and is typically reported by 83% of women with endometriosis” – Lagyndr.com

Not only is this so common, it is a leading factor in misdiagnosing these women with either IBS before the diagnosis of endometriosis has been made. But why is that? Why do we poop more during our periods? Why arent doctors being more diligent in finding the right cause?

OK lets start with ovulation…

Estrogen and progesterone – both naturally occurring hormones in the body – play a role in reproduction (aka sex hormones). Leading up to your period, during ovulation, estrogen is at its peak levels to stimulate the release of an egg. “From then on, oestrogen levels begin to fall. Meanwhile, after ovulation, progesterone does the opposite of oestrogen and continues to rise; this is in order to prepare your womb for the fertilisation of your egg.” – Emma Thornton.

Menstrualcyclegraph..fw

Progesterone can typically cause a bit of constipation but when levels of progesterone are depleted so quickly toward these last two weeks it can release its constipating effects and as result can stimulate some diarrhea (or rather, increased gut motility). While most women between the age of 18-40 are on birth control to help with the pain, the levels of these hormones are usually not as controlled in women with endometriosis and thus symptoms like cramping and diarrhea still break through.

Then you start bleeding…

It has been shown that cramping associated with menstruation is linked to prostaglandins – a hormone-like substance found in the tissue that are signaled to contract to facilitate the shedding of your lining (thus your period). Unfortunately, prostaglandins are found in basically any tissue that is able to contract (aka inflammation) and therefore when the body sends signals for them to contract, it most likely also results in contraction of your bowels. We all know cramping of your bowels is a sure way to stimulate some poop. Note that “Higher levels of prostaglandins are associated with more-severe menstrual cramps” and these higher levels are associated with a number of possible hormone-related issues such as Endometriosis. For those of us who have endometriosis on other parts of our bodies such as our thoracic cavity, we also notice cramping there too. Ouch!

Now lets talk about the gut…

In parallel we know that estrogen hormone receptors are found within the gut. There are several different interactions between estrogen and the gut that we are just beginning to understand, one of which may be the interaction of estrogen with estrogen-metabolizing bacteria residing in the gut which may promote certain side effects such as bloating. Gut microbiota shifts (lower lactobacilli concentrations and higher Gram negative
bacteria levels) have been demonstrated in a primate study of endometriosis, although the mechanisms linking these remain unclear.

We also know that medications such as the well known drug Lupron work by blocking Gonadotropin. “Gonadotropin releasing hormone agonist (GnRHa) stimulates the
production of follicle-stimulating hormone and luteinizing hormone thereby suppressing estrogen production making it a common treatment for the estrogen-driven disease, endometriosis.” If you are not familiar with Lupron and other drugs that work by this mechanism, they put you into chemical menopause which results in a laundry list of potential side effects. However we have seen that by this mechanism – by suppressing estrogen production – certain symptoms such as diarrhea may become tolerable.

Now you talk to your doctor and the conversation goes like this…

“I have painful periods and with it I get a lot of diarrhea” – the doctor glazes over the part about your painful periods and goes right to the diarrhea. First thing, lets get you a colonoscopy to see if there is any inflammation in your colon. Dr. Ken Sinervo from the Center for Endometriosis provides a wealth of knowledge about this very topic here. In a nutshell “As many as 8% of endometriosis patients with bowel symptoms may eventually be diagnosed with inflammatory bowel disease. IBD is usually characterized by abdominal pain, constipation, diarrhea, or alternating bouts of constipation and diarrhea as well as intestinal cramping.” You may be saying this sounds like you but your doctor said they didnt find anything. IBD is very distinct when looking through a camera. The gastroenterologist can see particular parts of your lining (Ulcerative Colitis) or throughout layers of your bowel (Crohn’s Disease) that are massively inflamed from physical ulcers formed therein. If the gastroenterologist doesnt see this they may order a fecal test called fecal calprotectin, which will test for inflammation specific to the gut through a biomarker that can be found in your stool. If both come back negative, and your doctor is thorough, they may choose to monitor any subsequent flare ups by ordering recurring calprotectin tests and measure the potential escalation in inflammation.

But my doctor gave me antidepressants and shooed me away…

If your doctor doesnt know how to look for the signs of endometriosis or doesnt feel the need to put you through a colonoscopy they may diagnose you with something called IBS. IBS is very similar to IBD but in lieu of physical lacerations in your colon you have a faulty gut-brain signal which means your brain is sending your gut these signals to poop. Accordingly to Dr. Sinervo:

Irritable Bowel Syndrome (IBS) is usually treated with dietary changes to avoid food triggers, and increasing dietary fiber. In some patients, stress can be a trigger. Avoiding stress or learning to deal more effectively with stress may help reduce the number of episodes. Exercise is beneficial for many patients. Medications are necessary for some patients. These may include anti-depressants, anti-spasmodics and other medications. In addition, medications that work better for patients with predominantly diarrhea or constipation are also available and have been shown to be beneficial for some, but not all patients.

Lets get technical for a second…

Both IBD and IBS, while they have different signature features, affect the gut. The goal then is to slow down the gut motility – the speed at which food moves through your gut – to try to reduce the number of bowel movements you have in a day. One hot topic at the moment is the gut microbiome. Many women with endometriosis experience something called ‘endobelly’. People with IBS or IBD have similar bloating without the catchy name. If a food diary is kept on hand most patients will identify certain trigger foods that will result in massive bloating. TMI Alert: this bloating is not something you can fart out, it needs to be dissipated over time. Why does this happen?

There is a community of bacteria that live in your gut – known as your gut microbiome. The bacteria have been around since birth, and each person has a unique microbiome based on their diet, their environment, their immune system and a wealth of other factors. The important thing is that you want to keep your gut microbiome healthy, meaning you want to keep particular strains of bacteria in higher quantity – the ones that have a protective nature – and you want to keep other bacteria like sugar-loving bacteria low in population. Antibiotics are a sure way of killing both the good and the bad bacteria, which is why so many of us in the medical community are really against shotgun approaches that render the host (thats you!) without any defense. Nonetheless, after your doctor has guided you on some diet changes such as low fiber and perhaps to stay away from dairy and red meat (other foods that cause bloating and inflammation) you might notice that your bloating is controlled and your diarrhea is not so bad. This is great! Lets not knock it, but it doesnt mean you dont have endometriosis. It just means you are killing off the bad bacteria in your gut – the ones that feed off dairy and sugar and in turn cause massive bloating. These bacteria – if fed properly – would emit gases that cause your bloating. Not convinced? Try taking some capsules of activated charcoal when you are really bloated. The charcoal absorbs any gaseous toxins and removes them through your poop (your poop will be black from the charcoal), and in turn will relieve the bloating caused by these gases.

But the pain is back (or never left)…

If the dietary changes are working for you, stay on them. Because even if you do have endometriosis you will eventually want to adhere to what’s known as the ‘endo diet’ or the ‘inflammatory diet’ which is similar to what you have been doing: no dairy, red meat, or gluten. For those of you with diagnosed IBD, you can follow along in my journey converting from a low residue diet (full of rice, bread and pasta) to one that is low in gluten. But what about the pain? All of a sudden you have to scream for someone to listen to you because, while it’s great that you are not pooping ten times a day anymore, the period pain is still unbearable!

Unfortunately at this time the only way to diagnose endometriosis is through a laparoscopic surgery where they will take a biopsy of the tissue and will remove any endometriosis that can be found while they are inside of you. In Canada and many other countries you need to have had 1 year of failed pregnancy to be referred to a fertility clinic where they then assess your eggs, fallopian tubes and other hormonal factors. Putting the pieces together they can make a case for surgery to make an official diagnosis. For women who are too young to be trying to have a baby, or choose not to have a baby, you will need to be referred to an endometriosis specialist who may or may not want to operate right away but instead help with pain management until it is too unbearable. I know I am painting a very sad picture right now but this is the reality. And to be honest I don’t know the process in other countries.

The first step in pain management is birth control. I know…, they suck! But the reality is that getting your hormones in check will certainly help with the pain. You may need to experiment with a few different types of birth control to see which one fits you best. If estradiol-progestin birth controls dont mitigate the pain, the next step might be to try medications that only contain progestin. Reducing the estrogen content in your body by removing the chemical mimic (estradiol) might help with the pain as well. In fact, along with the progestin-only birth control they may suggest getting rid of your cycle altogether by taking the pill continuously. The hope is that by eliminating any spikes in estrogen which would occur during your cycle this would completely stop menstruation and any side effects that come along with it.

Now it’s time for surgery… 

During the surgery you will be put under. The laparoscopic surgery makes three tiny holes in your abdomen and leaves very small scars. There is no telling where the doctors will find your endometriosis but the goal is to remove anything they can see. The point of me dragging this blog on for so long is because in a small percentage of women the endometriosis may be found on or around the bowel which may have contributed to the diarrhea in the first place. That contractile tissue we talked about earlier would have been contracting against your bowel which would have definitely produced some painful diarrhea.

When the endometrial tissue is gone all we can do is hope for the pain, cramping and pooping to be reduced and then we continue the journey from there. Part of the reality is having an official diagnosis which in some ways does bring a sigh of relief. Always looking at the positive 🙂

Please reach out if you have any questions!

Identity Crisis – redefining who I am after endo and UC

Feeling lost from auto-immune diseases

I know this sounds utterly drama-tastic but I literally feel like Im having an identity crisis. Over the last few years I had built myself up to be the strongest, most positive person there was. I was exercising every day, eating a whole food diet, and happy as a clam. I had found the love of my life, managing somehow to make long distance work. I found the most incredible job that allowed me to shine, and I moved back to Canada for it. Then shortly after my move, the endometriosis pain kicked in in places I had never felt it before. I was so fortunate to get a referral and acceptance into the BC Women’s Pain and Endo clinic but that was probably for me, the beginning of of the end. I was put on the wait list for the excision surgery and I was very diligent about an endo diet to control the inflammation and bowel movements until the surgery. I was asked to skip my periods, and therefore take Visanne which I was always reluctant to do. The hair loss started and the spot bleeding was equivalent to period pain at first. A few months later, the biggest bout of what seemed like a terrible flu accompanied by bloody, mucousy diarrhea with uncontrollable urgency sent me to the ER with a hospital stay of 10 days to confirm I had moderate to severe UC. I would have gone home earlier but the first round of mesalamine didnt work (I was pooping them out whole) and they had to try a different brand.

Since my UC diagnosis I have been on a low residue diet which – if any of you are on it still – is the OPPOSITE of an endo diet. Its literally high carb, high protein, NO FRUITS OR VEGGIES, no lentils, nothing with fiber. Do you know how utterly counter intuitive that is for endo????

4 months later, both doctors squabbled over whether I was in good enough shape to have the excision surgery. I was mad at my own body for putting me in the situation where the inflammation may prevent me from having the best surgery of my life. Needless to say I was able to go through with it, and it ended up being much more extensive than anticipated. The good news is, its mostly all out. The bad news is I feel like between the scar tissue on my colon and the UC itself, I actually dread having a bowel movement. AND I think the worst part about it is every morning I wake up with what I like to call a bolus of poop just hanging out in my lower colon waiting until IT is ready to come out. Nothing I can do about it and it looks and feels exactly like endo belly – so really I havent come that far yet.

Im trying to be patient. Im trying to be positive. But I am honestly no longer the person I was a year ago. I can barely walk for 20 minutes. I have to be so careful what I eat, not to mention alcohol is out of the picture (plus or minus a beer here and there). Im in pain constantly. Im tired constantly. And for the first time in 10 years I think I may have to up my anti-anxiety meds just because of how much is going on. I have missed so much work and I HATE missing work. Im a Director of Sales at a start up company in BC that is gaining tons of momentum and yet, I feel like Im the bottle neck. I do realize that “I am not what I eat”, and that this will take time, and hopefully once the inflammation has gone down I wont feel the endo pain again, and my UC will eventually go into remission. But for now… especially for RIGHT now… I feel like shit.

How to get your endo diet groove on

Recently I joined a ton of endo support groups on facebook. Within a few short weeks I noticed the same question being asked by new members: “what should I cut out of my diet?” The truth is, each person is unique and you need to do what is right for you. I dont like using the term endo diet because truthfully we dont know enough about the disease to know how certain foods affect the disease. What you DO know – better than your friends, family and doctor – is what works for you.

Typically if you are being seen by a doctor (an MD) who is assisting you with your pain, or infertility, it would be rare for them to go into nutrition, unfortunately. We seek assistance from each other – people on support groups who have done the nutrition piece of endometriosis. Take it from me, there are going to be a lot of mixed reviews and mine is just one of them. But I thought I would share with you my tips and tricks for converting over to a healthy personalized (plant based) diet.

Before I do, I have one disclaimer: endo vs ethics. If you are cutting out certain foods because of ethics (ie carbon footprints, animal rights, etc) then that is a much bigger discussion. I do agree with this perspective and I recommend you watch ‘Cowspiracy‘, the not yet released sequel ‘what the health‘, ‘hungry for change‘, and ‘before the flood‘ for an in depth understanding of how food production affects the globe. But if you are first and foremost interested in a lifestyle change to experiment with how foods will reduce pain and endo belly, then read on for some tips and tricks from my experience.

  1. Go slow! Dont assume you can cut everything out at one time. Your body, like any other machine, will break down if you put it under too much stress. “But I should be relieving stress by cutting out crap” you say. Yes well the reality is cutting out foods you have eaten for your whole life will scare the crap out of your body. It needs to know how to rewire.
  2. cutting back is a good half step to cutting out. If it is easier to cut out artificial sweeteners before you cut out whole sugar, do it. If it is easier to take one sugary food out of your diet at a time, do it. This is your body and you need to go at your own pace. I decided to cut out diet coke first. That was the only thing I was eating/drinking that contained artificial sweeteners so by taking that out I was now left with refined sugar. Slowly I reduced the amount of refined sugar until one day sugar was not what I desired anymore. That is a thing! 🙂
  3. negative side effects will go away. Its like building a new muscle. Okay maybe thats a bad analogy but after cutting certain things out you will experience a bit of body shock. For instance, coffee headaches and carb headaches are real things. Here are a few side effects to be prepared for:
    • cutting out coffee will give you headaches at first. I havent cut out coffee completely but at first when I reduced my intake I definitely had a headache in the morning.
    • cutting out wheat will give you pounding headaches. When I cut out wheat I had carb headaches for two weeks straight. I found a really good article that suggested putting salt in my food for those two weeks, or even adding a bit of salt to soda water. It helped a lot! But again, if you have a body that cant take salt, play it safe, please!
    • naturally adding more grains and lentils to your diet will cause flatulence. Yeah this is a new one for me. It sucks. It stinks. Like the rotten egg kinda stink. Your body needs to build stronger machinery to break down all the fiber you begin to feed it in replace of wheat. So beware. Mine took 2-3 WEEKS before I noticed a difference. Keep at it though because you need to continue to train your body. My saving grace was mint tea at night after dinner.
  4. carbs are fair game.“But you just said you took out wheat?!?”. I did. I took out wheat. period. the end. hard stop. Vegetables containing carbohydrates are still good for you. Rice, which has starch is still good for you. If you stick to the premise of the whole food plant based diet, these substances are found on earth with little to no refinement. They are good for you. Now… I am neither agreeing with nor diminishing the gluten argument. Because if you take out wheat, you pretty much cover your bases with gluten.
  5. foods with hormones should be avoided as they affect your hormones. Endometriosis is a hormone-based/affected disease where estrogen and progesterone are at war with one another. Foods you want to avoid are meat, dairy and soy. I have taken soy out this week and honestly it wasnt that big of a change. But meat and dairy will be a challenge and I will need your help when the time comes. A lot of us are an hormone drugs, so combining hormones from food sources is just bad overall.
  6. beans bean the wonderful fruit; the more you eat the more you___? Thats another one you need to remind yourself of. If you remove meat and start substituting with beans… be prepared.
  7. substitutes can be bad too. If you look for gluten free items you will find that a lot of pre-made food is built with corn which is really hard to digest, tapioca which causes extreme yeast infections in dogs but inconclusive in humans, potato which has the same effect as tapioca, or other things that I dont recognize. This can be just as bad as eating the real thing, so read those labels closely. If you have dairy like I do still, the higher the fat content (I believe to be) the better. If the fat ratio goes down they substitute with solid protein and sugar. Not cool.
  8. if it doesnt taste good dont eat it. There are too many tasty healthy things to eat. If you decide to make something that in theory should be good for you but it tastes like turd, dont eat it. Life is too short for that.
  9. (I almost made it to 10, but I will stop at 9) *****YOU ARE HUMAN. If you decide to have a slice of your best friend’s baby shower cake, dont beat yourself up about it. Most probably your body will beat you up later anyways.. but thats not the point. Take it in strides. You can do this, and you will do the best you can do.
  10. oh oh… I have a 10! People will convince you your diet doesnt have an impact. Let me be the first to tell you I am living with a substantially less degree of pain solely do to my diet, and many many many others have felt positive effects too. So tell those people where to go. A good diet helps prime your body to metabolize drugs and fight against ‘disease’ – so there!

Wow, I wrote that all in one breath. I will stop here but make sure you read my three part series on cutting foods out of my diet. Hopefully they help you break some ground.

Happy eating!

Rolled Eggplant with gluten-free Capellini

Ever feel like adding a little spin on a pasta dish? I did. And I found this recipe and loved it. I claim it as my own now simply because – as always – I made some modifications. Note that this recipe can be made with substitute cheeses if you find good ones. 

What you will need:

Filling

  • 1 cup sauce (meat sauce or not, your choice)
  • 4 fresh basil leaves, finely chopped
  • pinch of salt
  • pinch of ground black pepper
  • pinch of dried oregano (or some fresh oregano if you have some on hand)
  • 1/2 pound gluten free capellini or angel hair pasta.

Eggplant

  • 1 large elongated eggplant
  • 1 cup gluten free flour (to dust the eggplant)
  • 2 cups olive oil for frying
  • 1 cup tomato sauce
  • chili flakes
  • vegan sliced mozzarella (optional) 

To make the filling… if you choose to use meat in your sauce, cook the meat and mix with the cup of tomato sauce.

In a bowl combine the tomato/meat sauce (1 cup), basil, salt, pepper, and oregano. Stir to combine.

Meanwhile in a large crock pot cook the pasta (half the box roughly) until al dente. Remove from heat and drain.

Add the pasta to the mixture and mix until all the pasta is coated. With tongs and a knife, cut the pasta mixture in thirds so the strands of pasta are much shorter to work with. Mix again.

Preheat oven to 375F.

Thinly slice the eggplant lengthwise about 1/4 inch thick. dust each slice in flour and fry in a shallow frying pan until golden brown on each side. Remove finished slices and drain on paper towel. Continue process for all slices.

Line up slices and spoon about 1 tbsp (sloppily) of filling in the center of each slice. Roll each eggplant slice around the filling and place the roll into a baking dish. Once complete pour the tomato sauce (second cup) over the rolls. Top each roll with chili flakes and vegan sliced mozzarella (optional).

Bake for about 10 minutes (yup thats all!) or until cheese is golden brown. Remove from oven and serve.

As I have said before, I really dont like pasta that is made with corn because it isnt digested well so try to find something like chic pea or brown rice. 

This recipe is so delicious, and easy to make!

Cabbage Soup

I got on a cabbage kick when I first cut wheat out of my diet. I wanted to make sure that I wasnt replacing wheat with crap, so I looked for very healthy, very pure recipes. Like most soups you make at home, it will last for a long time (the amount, not the shelf life) so make sure to choose soups you like. And you can always freeze them.

For this soup, which I chose to keep vegetarian, is very endo-friendly.

What you will need:

  • 5 carrots, chopped (or halved if baby carrots)
  • 1 head cabbage, grated or cut into very thin slices
  • (2 medium white onions, or 1 of those ridiculously large ones, chopped)
  • 2 celery stocks, chopped
  • 1 leek, chopped
  • 2 lemons, squeezed
  • 4 tbsp extra virgin olive oil
  • 6-8 small garlic cloves
  • 1 tbsp turmeric powder
  • cayenne and/or black pepper to taste
  • chili flakes to taste
  • 2-3 liters of water

Pour olive oil in a large soup on high. Add garlic, onions, leek, salt and turmeric, and let cook until onions are soft.

Add carrots and celery, stirring occasionally. Add lemon juice.

When vegetables are getting soft add the cabbage.

After a few minutes add the water. Add seasoning to taste.

Bring to a boil and let simmer 1.5-2 hours.

Serve with a dollop of sour cream and grated cheddar cheese 🙂

One Part Plant – Jessica Murnane

I realize having a blog about my endo diet is kind of like reinventing the wheel. But I pride myself on following a natural diet as much as a can. If you have tried it, you know its a hard thing. And if you havent that speaks for itself. There are simple and delicious foods that cause us so much pain and yet its almost impossible to cut them out of our diets.

I have done a good job and Im here to help you. But while I am good, Jessica Murnane is great! She has certainly built an empire on truly endo-friendly foods and recipes.

I purchased her cook book recently that is full of information and guidance as well as meat free, sugar free, dairy free, gluten free recipes – yup, all of that! The book is fantastic. If you sign up on her website you also receive recipes every week that are in addition to the ones in the book.

http://www.jessicamurnane.com/

Endo sisters unite!

IMG_3943
She has endo too! (Thats a proud ‘!’ not a happy one)

Edamame and Mung Bean Fettuccine with Pesto Sauce

So I post this with caution. For those of you who are looking for wheat-free alternative pastas, this is certainly an endo-friendly pasta option and luckily does not contain corn. As I described before corn hurts my stomach terribly so I have to been mindful when I try gluten-free pastas. BUT I caution you that this flavor takes some getting used to.

Ingredients:

  • one box mung bean pasta
  • one jar pesto sauce
  • 1 tomato

This company as you can see has several different varieties but I have only tried to mung bean kind. I cooked the pasta as per the box directions, and added it to a pan of gently cooked tomatoes and pesto sauce. I am very curious whether you will let it. Message me and let me know.

Do you know of any other gluten-free corn free pastas?

It just makes sense – Endo and Nutrition

Hello there! thank you for stumbling upon my blog. As you will soon realize this is kind of a ‘dear diary’ of all things pertaining to endo – less so about the woes and more about the positive things. I may throw you a few questions about symptoms here and there, but for the most part I am trying to see (and share) what works for me in every aspect.

The biggest thing for me is my diet. I have developed a diet called it just makes sense. Basically I try to base my diet around natural foods (ie those that can be found in nature). If it has been in a lab, it is not good for me. Here goes:

  • Sugar: I have removed refined sugars and sweeteners – instead I use honey, agave or maple syrup to sweeten my coffee. I also juice with fruit from time to time.
  • Wheat: I have removed wheat, so no flour – but I have not cut out carbs or gluten. This lets me still eat potatoes, rice, and other fruits and vegetables. I dont have enough evidence that it is the gluten that makes me feel gross so for now it stays. This does mean no bread of any kind. For tacos I only use corn flour tortillas.
  • Corn: Corn flour is one thing, but corn starch is a detriment. Sadly this means I do not bother with gluten free pastas as they replace wheat/semolina/durum with corn flour and corn starch. At this cost I would rather eat whole wheat pasta hen I have a hankering.
  • Dairy: If I eat dairy it has to be high fat content. While this sounds counter intuitive to the endo diet, the lower the fat content the higher the sugar content. So if I have milk it is 2% and if I have cheese it is always full fat.
  • Meat: I tend to err on the side of caution when it comes to meat. With the combination of endo and the lack of gallbladder (unlike with dairy) I choose meats that are low in fat content. Raw meat does not sit well with me, so Im usually that person who orders her steak ‘overcooked’. At home I stick to chicken and pork.

Another major part of my routine is probiotics. One probiotic a day can do wonders for your insides, in conjunction with your diet. One should not substitute one for the other. If you are to take a probiotic, try choosing one with at least 10 strains of bacteria and as high a number of live strains per capsule as you can find. There is some correlation between high strain count and vaginal health, so if you choose the right probiotic it will help with both the gut microbiome and the vaginal microbiome.

probiotic