Ever heard words like "we don't know the reason for your pain" or "it must be in your head"? You're not alone!
It's a bit "taboo" so if you embarrass easily, don't watch 👀 😳
Food Sensitivities Explained Part III: Optimizing Digestive Function
Here’s a list-style overview of what we’ll be talking about relating to Optimizing Digestive FUNCTION:
Intestinal Lining Health & Gut Microbiome
Note on SIBO
We’ve previously visited the topic of RESTING the Digestive SYSTEM. Both resting of the system (via an elimination diet) AND optimizing digestive function must be happening at the same time if we’re going to heal the entire compromised digestive system and get back to eating most foods.
So when we talk about optimizing digestive function we’re mainly talking about nutrient absorption. Because you’re following an elimination diet followed by the re-intro phase your body is getting lots of good macro and micro nutrients.
But what good do all those nourishing nutrients do for you if your digestive system can’t absorb them so that other body systems can use them? What other body systems? Literally everything that your body does. Nutrition is the foundation for maintaining health.
It’s sort of like a car. You can put gasoline in it (the fuel that it needs to run) but if the fuel can’t be used to create mechanical energy then the car aint moving. Maybe the fuel pump isn’t functioning so the gas can’t get from the engine to the tank. It can’t “absorb” the fuel it’s been given.
Let’s start with environment. How true are these statements of you:
If any of these are true for you then you’re at least sometimes eating food under stress, whether you realize it or not. Remember when we’re talking about stress response we’re talking about physical processes in the body by way of the HPA Axis and the release of cortisol; essentially your body in “fight or flight” mode. And operating in fight or flight mode turns the body’s attention away from digestion. And instead concentrates on increasing your heart rate and your blood pressure.
Resolve right now to come up with ways, maybe with the help of a friend or a health coach, that you can create relaxing, calm, stress free environments while you eat.
WATCH THE VIDEO:
Research has found the evidence-based amount of times to chew hard foods (like nuts) is 40 times. Participants who chewed 40 times, their smaller particles of food were absorbed faster than those participants who chewed 10 or 25 times. Participants who chewed only 10-25 times, their larger particles weren’t absorbed at all, the body just eliminated them!
So, chew your food. 25-40 times. More like 40 for hard to chew foods like nuts.
While the vast majority of nutrient absorption is in the small intestines, the stomach does play a role. And the stomach must be acidic enough for proper nutrient absorption during that stage of digestion. Low stomach acidity is called “hypochlorhydria”.
It can be caused by long term use of PPIs, genetic predispositions, stress, chronic pain, aging, drinking too much liquid with meals, and often it’s found in people with blood type A.
If you have weak or peeling nails, iron deficiency, or undigested food in your poop you may want to consider this issue. Natural sources to encourage appropriate stomach acid levels are:
A more aggressive approach involves taking Bentaine HCL capsules with Pepsin to test your body’s response to this supplemental source of hydrochloric acid. Do NOT use this method with PPIs or antacids or if you have ulcers or ulcerative colitis.
When food transitions from the stomach to the small intestines, the pancreas releases digestive enzymes to break down nutrients in this stage of digestion. To determine if you need supplemental digestive enzymes you can just try plant-based digestive enzymes and see how you feel. Here’s a link to a good one:
Or your functional medicine practitioner can order testing.
Naturally stimulate digestive enzymes with:
Intestinal Lining Health & Gut Microbiome:
We could talk about the gut and gut microbiota for days and days. For our purposes today let’s just highlight a few things:
To re-cap, to Optimize Digestive Function:
Eat in Stress-Free Environments
Chew Your Food
Maintain Adequate Stomach Acids
Maintain Adequate Digestive Enzymes
Support Intestinal Lining Health & the Gut Microbiome
Until next time!
Food Sensitivities Explained: Part II
7. Whip up 11 eggs in a large bowl and add some spices. I used a spice mix I had: garlic, onion, celery, rosemary, basil, oregano. I used a pretty healthy helping, like 2 TBPS. It's a lot of eggs!
8. Pour the eggs over the top of everything in the pan. Mine eggs didn't quite cover the spinach so I might add more eggs in the future but it was still good this way!
Whole 30 Taco Soup: https://themovementmenu.com/recipes/easy-whole30-taco-soup/
Baked Turkey Cutlets: I'll try to post this one too, when I make it!
Spiralized Sweet Potato Fries: themovementmenu.com/recipes/spiralized-sweet-potato-fries/
Roasted Chicken: Again, I'll try to post about it when I make it!
Hubs?: This means you let your husband cook dinner ;)
Curried Shepherd's Pie: www.copymethat.com/r/OoozhDS/curried-shepherds-pie-with-sweet-potato-/
Tilapia: You'll quickly notice spelling is NOT one of my strengths. Couldn't find it at the store so I bought some wild caught flounder instead. Will let you know how that goes! #NutritionalYeast!
"Can Your Vagina Actually Be Depressed? The Answer Is Yes"
Read the responses from two women's health professionals below:
Response From Two Women's Health Professionals:
Women's Health Physical Therapist, Stephanie Pendergast, MPT
The answer is actually no. I am not sure which news outlet started this incorrect and damaging trend of reporting that Vulvodynia is synonymous with a depressed vagina but it has to stop. Last week Rachel Gelman and I contacted Reader’s Digest because they suggested Vulvodynia came from a lack of sex. Rightfully they recognized their mistakes and they are printing a retraction. I am hoping those at Popsugar will consider doing the same, my reasons are listed below. We need to set the record straight on what Vulvodynia is and is not, this type of misinformation in the media is devastating to those suffering from this disorder and it needs to stop.
First, please use the correct anatomy. A recent article came out stating 50% of men cannot correctly identify a vagina (http://nypost.com/2017/08/31/50-of-men-cant-correctly-identify-a-vagina/). Perhaps this is because the terms ‘vulva’ and ‘vagina’ are incorrectly being used interchangeably in multiple places, including this article. Two structures most commonly affected in women with vulvodynia are the vulva and teh vestibule. These two structures are not synonymous with the ‘vagina’. It is incorrect to say the vagina is depressed and it is incorrect to say the vulvodynia is vaginal pain. However, it is important to note that vaginal pain can exist with vulvodynia.
Vulvodynia is NOT caused by a depressed vagina.
There are 7 known causes of vulvodynia and 8 associated causes and depression is NOT one of them. I know because I was part of the task force that reviewed the literature and published a consensus paper in 2015. Ref: Bornstein J, Goldstein AT, Stockdale CK et al. 2015 ISSVD, ISSWSH, and IPPS consensus terminology and classification of persistent vulvar pain vulvodynia. J Sex Med 2016; 13(4):6-7 -12. The first paragraph of the Popsugar article quotes a sexologist, Kristie Overstreet. She is using the ISSVD definition of Vulvodynia from 2003. This information has been updated but even so, I can assure your the 2003 terminology does NOT list depression as a cause of Vulvodynia.
The term ‘depressed vagina’ is not synonymous with vulvodynia.
In all fairness to the writers calling vulvodynia a depressed vagina, I can see how they arrived at this conclusion. This topic is can be complicated. Tricyclic antidepressants (TCAs) are FDA-approved and effective for reducing neuropathic pain. Certain subtypes of vulvodynia have a neuropathic pain component and therefore TCAs are used as treatment. This is not because the woman, or her vagina, are depressed. TCAs reduce pain because they regulate the central nervous system, the dosage used for pain is lower than the dosage used for anti-depressive effects. Sex in the City misconstrued the disorder before we could tweet about our outrage. It wasn’t ok then and it isn’t ok now.
3. Experts DO know what causes Vulvodynia.
4. “ There is no treatment specifically for vulvodynia, and anything that is used is still pretty experimental. But due to the highly intrinsic connection between the vagina and brain, vulvodynia is often treated with antidepressants and other forms of therapy to adjust the serotonin levels in the brain rather than to address the painful symptoms themselves. Any course of treatment is individualised based on the person's experience with the condition.”
This is completely false. There are a number of treatments for vulvodynia and each treatment plan will vary based on the cause of a person’s vulvodynia. Effective treatments include pelvic floor physical therapy, topical medications, oral medications, medical interventions such as botox injections and nerve blocks and in some cases, surgery. Tricyclic antidepressants are used to treat Vulvodynia because of their neuromodulating effects and are used at a dosage lower than that used for depression. It is incorrect to say its mechanism of action is to influence serotonin levels and therefore ‘undepress a vagina”. Furthermore, the vagina is not the problem, the vulva and the vestibule are the problematic anatomic structures. The anatomy in this article needs to be corrected.
Reference: Vulvodynia: Assessment and Treatment. Goldstein AT, Pukall CF, Brown C, Bergeron S, Stein A, Kellogg-Spadt S.
J Sex Med. 2016 Apr;13(4):572-90. doi: 10.1016/j.jsxm.2016.01.020. Epub 2016 Mar 25. Review.
Gigi and editor, I speak on behalf of a large group of medical professionals who have dedicated their careers to helping men and women recover from debilitating pelvic pain syndromes, including vulvodynia. While this disorder may seem sensational to you it is most certainly not for those fighting to get better. I am strongly urging you to speak with some of the leading experts on this condition and publish an article that accurately depicts this syndrome and helps women get the help they need. It is possible for Vulvodynia to be successfully treated and they need to know that. I am more than happy to help and I look forward to hearing from you.
Stephanie A. Prendergast
CEO and Co-founder
Pelvic Health and Rehabilitation Center
Los Angeles Branch
I have read Stephanie Prendergast's excellent and accurate responses to these distorted, exaggerated, sensationalized and blatantly false articles that have been part of the media's misunderstanding of the disorders that affect approximately 30 million American women. As she correctly states, there is already plenty of misinformation or lack of information about these complex debilitating physical illnesses that affect women and men alike with chronic pelvic, genital and sexual pain. Basic anatomy and physiology about the pelvic and genital area is sorely lacking even among many of my colleagues in gynecology, urology, gastroenterology.
I am a Board Certified Ob/Gyn MD who spent 30 years caring for women with their pregnancies and surgical repairs of their reproductive organs. I have now spent 16 further years specializing in all of the illnesses that together form the overall category of chronic pelvic pain (CPP). These disorders include vulvodynia, vestibular non-infectious inflammatory pain, bladder pain syndromes, pain of irritable bowel, multiple neuropathies of the pelvic region, muscular spasming disorders between the mid-abdomen and mid thigh regions, and a host of other assorted associated "triggers" of pain in the pelvic and genital region in women and also in men. These patients are socially stigmatized and often become more and more isolated in their lives because they are commonly told these complaints are "made up" and are "in their heads" or are "drug seekers".
In my experience of seeing over 1400 patients with these complex problems from all over the country and many from outside the US, it is obvious that these patients are desperate for help. Their relationships are in jeopardy, they often cannot work, continue school and have already had multiple surgeries, invasive diagnostic procedures, and every type of blood test, CT scan, MRI, Ultrasound and even young teens are getting many of these tests in the prime of their lives. There is no such thing as a "depressed vagina" or a "tiny bladder" or "sexual deviations" causing these highly disturbing illnesses. I have been interviewed countless times for various media and it is almost universal that what I say and try to get across as factual medical science about these issues is routinely edited down to a few "sound bites" of information out of context.
As Stephainie Prendergast said about being interviewed to do an accurate story about these disorders, I too would be more than happy to do so. A few years ago, I wrote to the NY Times and suggested that they do a series of investigative reports on these issues but only got a reply that indicated they would pass it on to their medical feature writers and I never heard anything further. If nothing more, it seems to be really important at this point in our debates over the skyrocketing costs of our health care system in this country, that some attention be paid to a very large patient population that is costing the system hundreds of billions of dollars utilizing many wasted procedures and other resources that don't seem to be working well for all chronic pain disorders, not just the ones in the pelvic and genital area. The study of pain itself is "exploding" but this neuro-science and many of its advancements are not yet "trickling down" to the average clinician, especially those working in the pelvic area of the body.
Proper acknowledgement and education about diagnosis and treatment that is now a reality in the relatively small medical community of pelvic pain could serve the whole medical care system well - since chronic pain costs our system more than diabetes, stroke, heart disease and cancer combined. I am attaching that letter I wrote in 2009 to the NY Times.
Robert J. Echenberg, MD, FACOG
Member: International Pelvic Pain Society and International Association for the Study of Pain
Co-Author: "Secret Suffering: How Women's Sexual and Pelvic Pain Affects Their Relationships"
Co-Producer: "Healing the Pain Down There: A Guide for Females with Persistent Genital & Sexual Pain"
It is estimated that 30 million reproductive aged women in the US alone (20% worldwide) suffer from persistent genital and sexual pain.
My name is Stephanie Yeager and I'm one of these women. After my own journey of misdiagnosis and multiple practitioners I created an educational and instructional video series with a team of pelvic health professionals for other women like me to heal the pain 'down there'.
It's taken 7 years and over $20,000 for this project to get to where it is today. Plus countless personal hours and volunteer hours from our OBGYN Specialist, Dr. Robert Echenberg; our Physical Therapist, Karen Liberi; and Human Sexuality Therapist, Alex Milspaw. Read their Bios here. Watch the preview of the DVD we created by clicking on the second video in the gallery.
Back in 2010, packaging the material as a DVD was the obvious choice. (It is still for sale) How the world has changed even in 7 short years! Would you be a part of bringing the project up to date?
What It Will Take To Launch Forward
$10,000 will pay for the costs of turning the educational and instructional material into an online program. The online program will look like this:
- 6 Month Program
- 10-15 women participants all start together
- All women will meet one on one with the doctor and physical therapist over video conferencing
- New material (video content already created) will be sent to participants every two weeks by an online platform
- Every two weeks all participants will meet as a group over video conferencing with the health coach and aromatherapist (me!)
- The doctor and PT will also join the group video calls once during the 6 months.
- Ongoing support even after 6 months via a closed Facebook group
- All participants will receive a care-package of therapeutic aids: Mindfullness Based Stress Reduction Meditation CD; Secret Sufferings: How Women's Sexual and Pelvic Pain Affects Their Relationships (Book); 4" air-filled ball; Squeeze bottle; and Sample Essential Oils Kit
Our goal is to keep the price for the Pain Down There Online Program very reasonable. The money also allows us to give substantial discounts to the first two groups of women as we're building momentum and gathering testimonies.
Partner With Us
I will be so, unspeakably, thankful for your contribution. Paindownthere.com and the website of Dr. Echenberg get many inquiries from women who are desperate for help and don't have anywhere else to turn. Unfortunately, women's health physicians just aren't equipped or trained in the complexities of pelvic, genital, and sexual pain. (Check out this blog for more info and our call-out for OBGYN education reform)
All Donors will be listed on paindownthere.com as a special thank you (unless you prefer to remain anonymous). Any funding above and beyond the $10,000 will go towards a scholarship fund for women needing financial assistance to participate in the program.
$2000: Aromatherapy Certification for Stephanie Yeager - Essential Oils effect on the central nervous system and our body's tissues support the healing and wellness process in unique ways. We'd be remiss to leave this type of education out of any program that addresses chronic pain.
$5000: Women's Health Coach Certification for Stephanie Yeager - I can't help women in this program as a patient - advocate only. I need to be certified as a health coach to take them through the material, answer questions, and brainstorm solutions to challenges.
$3000: Overhead for 1 year - the online content delivery system, the video conferencing platform and other costs
Looking to have the funds by June 30th.
1. CHANGE YOUR PAD OFTEN
2. USE UNSCENTED LAUNDRY PRODUCTS
3. WASH YOUR VAGINAL AREA WITH WATER ONLY
4. BEND OVER TO RINSE OUT SHAMPOO
5. WIPE THE RECTAL AREA PROPERLY
It is also really important to realize that the most common reason for entrance pain with intercourse, tampon use, vaginal speculum or just light touch from clothing is the common condition known as vulvar vestibulitis or better called vulvar vestibulodynia. (“itis” means inflammation and “dynia” means pain).
So back to looking in the mirror. You’ve probably never whispered “you’re special” to your vulvar vestibule. But it is. Not just for its role in the reproduction of life, but because the external tissues in that area are actually very different from other mucosal surfaces in the body. Mucosal surfaces are those bodily tissues that excrete mucus like the inside of your mouth and the inside of your nose. The difference is in the “profile” of the immune cells in that area, meaning the type and the amount of the cells of the immune system. Given how important the external genitalia is to the reproduction of life, we would suspect that it would indeed be a place that needs some extra immune system defense. This same observation holds true for other species as well, not just humans.
We also know that one of the methods the immune system uses to attack what it identifies as a threat to the system is inflammation. And as a result of inflammation we often feel pain. It makes sense then that pain brought on by inflammation at the vulvar vestibule would be different than the pain brought on by inflammation at other mucosal sites. Recent research seems to indicate that pain felt in this area is determined by 1) the amount (not simply the presence alone) of low grade inflammation, 2) altered vulvar nerve innervations, meaning an abnormality in the distribution of impulses of the nerves in that area, and 3) genetic susceptibilities that contribute to abnormal inflammatory cascades (chemical messengers that ramp up the immune system and cause a domino effect).
Vagina! (You are definitely more complicated than we thought!!!)
Just making sure you’re still with me here, this information is dense but it’s how we know persistent genital, sexual, and pelvic pain has a MEDICAL and SCIENTIFIC explanation.
Ok, back to the mirror. We know that the vulvar vestibule is derived (or made from) the endoderm. When we were just embryos in the womb, the inner-most layer of that embryo is called the endoderm. Do you know what else was derived from the endoderm? The bladder and urethra and also the gastrointestinal tract. It is possible that these other structures also have unique immune profiles, similar to that of the vulvar vestibule.
Let’s briefly recap: The vulvar vestibule has a unique immune profile compared with that of other mucosal sites. An immune/inflammation response at the vulvar vestibule isn’t enough to cause pain. Pain is determined by the magnitude of the immune response/inflammation. The vulvar vestibule, the bladder, and urethral linings are all derived from the endoderm and could share immune profiles.
One last piece of information that’s critical to note: the most recent research is finding that in the clinical setting, self-reported pain levels at the vulvar vestibule are closely connected with the release of an immune system messenger known as cytokine. That means when research study participants reported increased pain, the presence of cytokines in the examined vulvar tissue also increased.
What does all of this really mean? It means that we know that chronic genital, sexual, and pelvic pain is real in a clinical and biological sense. We of course recommend treatment modalities that work from the top-down to address the mind-body connection and help turn the central nervous system pain ‘volume dial’ down. But we also want to highlight the science behind the pain and the need for bottom-up approaches in line with current research and the desperate need for earlier diagnosis and appropriate treatment modalities and medications to counter these inflammatory and painful processes.
2. Interstitial Cystitis (IC)
3. Irritable Bowel (IBS)
4. Lichen Sclerosis
5. Myofascial Pain Syndrome
6. Pelvic Endometriosis
This misplaced tissue forms growths that look like dark spots. These growths respond to the menstrual cycle and break down and bleed each month, the same way the lining of the uterus does. This causes cyclical pain and inflammation - called dysmenorrhea. Additionally, the body’s immune response to this internal bleeding and breakdown of blood and tissues begins to cause scar tissue and adhesions (affected pelvic organs or structures adhering to one another) which can also cause ongoing pain.
Endometriosis affects millions of women but is often over diagnosed as the primary cause of pelvic and sexual pain. If the pain or deep sexual discomfort is intermittent and all month long, even though it may become worse leading up to the menstrual period, endometriosis may not be the primary reason for the pain. If you have been diagnosed and treated for endometriosis and you don't begin to get signifiant improvement either after medication or surgical treatment, insist on further evaluation for bladder, bowel, musculoskeletal, or nerve related causes of your pain.
7. Pelvic Floor Dysfunction
8. Previous life-long Pelvic Trauma
9. Generalized Vulvodynia
10. Vulvar Vestibulodynia (Vestibulitis)
An Update from The Journal for Nurse Practitioners
Volume 12, Issue 8, September 2016
This article by the Journal for Nurse Practitioners focused on the holistic treatment approach to provoked vulvodynia, highlighting several recent research findings that we’d like to share. According to the International Society for the Study of Vulvovaginal Disease, provoked vulvodynia is pain localized to the vaginal vestibule when provoked (touched) that has been present for at least 3 months and does not have a clear identifiable cause. Provoked vulvodynia (PVD) you may have heard also referred to as vestibulitis or vestibulodynia.
How PVD begins isn’t known, but likely it is a complex combination of factors involving genetics, musculoskeletal and neurologic mechanisms, and psychological factors, including the interplay between chronic stress and pain, leading to a sustained pain response. Research has also shown that low confidence about how to manage and cope with the pain is related to higher pain intensity. Depression and anxiety further complicate PVD. As we are already aware, providers are generally unfamiliar with this disorder. Women see up to 6 providers before being accurately diagnosed and treated.
Current recommendations call for the least invasive treatment options available. This article focused on two treatment options which are noninvasive and comprehensive, yet often only recommended as alternative options: Cognitive Behavioral Therapy (CBT) and Mindfulness. CBT is a multi-session practice that includes relaxation, self-management techniques, and restructuring thoughts and emotions that are maladaptive. While CBT is a change-oriented strategy, mindfulness seeks to create awareness of the body, thoughts, and emotions by simply noticing them rather than judging them.
In one study, CBT was found to be superior to surgical procedures in pain relief with intercourse at a 2 ½ year follow up. And CBT has been shown to be more effective in reducing pain and improving sexual function than topical steroids. CBT was also found to improve patient confidence in being able to manage and cope with the pain, along with significantly reducing depression and pain anxiety. At the 1 year follow up these findings had either been maintained or improved.
Current studies also suggest that women with PVD benefit from the practice of mindfulness. Women were found to have significant improvements in their own confidence to manage and cope with their pain, along with decreases in pain hypersensitivity and feelings of hopelessness. Women who participated in a mindfulness-based CBT program experienced decreased depression, anxiety, and fear. These findings were maintained at the 6 month follow up.
CBT and mindfulness are noninvasive, effective long term, and provide an approach that factors in both mind and body, not just physical pain. Current research would suggest these options be recommended as a first-line treatment instead of an alternative therapy. More evidence-based guidelines are needed for PVD in tandem with increased provider awareness.
In addition, we at paindownthere.com would add that further research is needed in the multidisciplinary approach to treating PVD. We believe highly in “top-down” approaches such as mindfulness but also recognize the need for simultaneous “bottom-up” approaches that take into consideration biological/medical factors that may call for medication, physical therapy, and nutrition intervention as well.
Guest Blog: 6 Steps to Take If You Have Vulvodynia
Founder and CEO of the
Integrative Women's Health Institute
Vulvodynia affects over 14 million women in the US alone.
What is vulvodynia? Vulvodynia is the fancy medical term for vulvar pain, or pain specifically in the vulvar vestibule (a small bit of tissue at the back of the vaginal opening) that can be provoked or generalized.
If your vulvodynia is provoked, then it only bothers you when the tissue is irritated, during sex, when wiping after using the bathroom, when wearing tight pants, sitting, etc. If it's generalized, the pain can surface at any time.
As with any chronic pain condition, your body has the wisdom that it needs to heal. It is your job, together with your healthcare team, to set the stage to make it easier for your body to heal. All chronic pain conditions have body, mind, and spirit components. My clients usually find it easier to start with creating optimal conditions in the body.
Here are the 6 steps that we work through to resolve vulvodynia from the root cause for each unique client.
1. Structural - There are muscles just inside of your vulva that support your vagina, bladder, rectum and are an integral part of your pelvic structure. Just like any other muscles in your body, these can be tight, weak, and/ or in spasm. Working with a highly skilled pelvic floor physical therapist can help you to find any issue with your muscles or other soft tissues and using self-massage or other manual therapy techniques - sometimes combined with energy work, visualizations, affirmations, breath work, and/or exercises to relax and strengthen those tissues.
2. Nervous System Quieting - Many people with chronic pain live in a state of "fight or flight." If your nervous system is more sensitive to pain or discomfort due to lack of sleep, excessive intake of inflammatory foods, emotional stressors (often related to job, relationship or caregiving stress), chronic infections, excessive environmental toxin exposure, or pain "cross talk" from your reproductive organs, bladder or colon strategies that help to calm the nervous system allow your body to become less sensitive to stimulation that is currently causing you pain.
We work with each client to develop a unique nervous system quieting program that is tailored to her needs. For most of my clients sleep strategies are essential, mindfulness, yoga, and/ or breathing exercises can be helpful, and eliminating inflammatory foods is key. Individualized testing for yeast infections or bacterial vaginosis can be essential if we suspect underlying chronic infections.
3. Digestion - In every case, finding each woman's optimal, individualized food plan is essential. A personalized elimination diet that is guided by one of our expert clinicians helps each woman to determine the foods that her body is uniquely sensitive to. Unfortunately, there is no "Vulvodynia Diet" because not only are each woman's food sensitivities unique, but her digestive function challenges are also unique.
You can be eating the best diet in the world, but if your stomach acid is low, your digestive enzymes are sluggish, your small intestines or bowel are inflamed, or you're constipated you can't appropriately absorb the foods you need to heal and your irritated digestive system may be irritating your vulva because it's irritated and they simply happen to live in the same neighborhood - your pelvis (there's that pesky organ cross talk!)
Individualized stool testing and other empiric testing can help us to find your best combination of foods and supplements to reduce chronic inflammation and support optimal nutrient absorption so that your body will have all of the vitamins, minerals, proteins, and fats that it needs to heal.
4. Nutrient Deficiencies - Many women with vulvodynia lack essential nutrients for the vulvar, vaginal, and pelvic tissues to function optimally. Vitamin D, omega-3 fatty acid, other antioxidant, B vitamin, and magnesium deficiencies commonly show up on nutrient deficiency and organic acids testing in my clients with vulvodynia. Restoring each woman's unique nutrient deficiencies with targeted supplementation (from companies that have high quality products) helps to maintain optimal vulvovaginal heath and general health for the long term.
5. Endocrine System - Optimal hormone balance is essential lubrication of your vulvovaginal tissues and strength of your pelvic floor muscles. Plus, having optimal stress hormone balance helps to keep the nervous system calm. Many women with vulvodynia have low estrogen, progesterone, and/or testosterone. Many struggle with high cortisol and/or low melatonin. Some women with vulvar pain also have thyroid issues and/or chronic fatigue that may be hormonally related. Again, testing to see where your hormone levels may be out of balance, helps us to figure out why they are out of balance and how to balance them from the root. Just putting topical estrogen cream on the vulva without understanding why the estrogen levels are low (and how estrogen is breaking down in the body) - and addressing that cause, is really just a band-aid fix that is unlikely to be effective in the long term.
6. Narrative Medicine - At the risk of sounding a bit "woo woo" here, once the structural, nervous system, digestive, nutrition, and hormonal factors have been addressed, it's important to tune into what your pain is trying to tell you. In fact, we usually address all 6 of these factors concurrently with each of our clients.
Many women with vulvodynia have experienced trauma - abuse, sexual trauma, birth trauma, etc. - and addressing that trauma with the help of a skilled psychotherapist who specializes in pelvic pain is key.
In addition, our skilled coaching approach helps you to work through practical stressors (whether you have had trauma or not) that are worsening your pain - anything from work, relationship or parenting challenges, to lack of feeling safe in your body or in your life. Our clients often feel a lack of safety in their bodies, lack of financial safety, or have deeply ingrained societal messages of sexuality being shameful. And, many of our clients are over giving to the point of exhaustion. Addressing these common emotional, spiritual, and practical challenges that so many women face is our specialty using coaching tools and strategies.
In narrative medicine, your stories, beliefs, support networks, perspective, unique gifts, and goals are all a part of the root cause healing process.
Using these 6 steps, you will learn so much about what your body needs to most easily tap into it's own healing ability. Your mind, body, and spirit do the healing, we just support you to create the environment in your body and life to make your healing easier, more rapid, and more complete.
In the words of one of my former patients, “In order to really receive the benefits..., you definitely need to be committed to the plan, which can be hard (especially for very active, busy women). But it is really all possible with the help of a knowledgeable and patient nutritionist, advice from a team of other medical professionals who care about you, and support from your friends and family. And finally, the most important part of successfully completing the (program), is giving yourself permission to focus on yourself, because you deserve to live a happy, healthy, and pain-free life”
Click here to read our recently published research on vulvodynia in the journal, Integrative Medicine.
In the past 17 years, my team and I have helped thousands of women with vulvodynia all over the world heal. You have the capacity to heal, we would be honored to support you along the way.
To learn more about our virtual clinic, click here. We are currently accepting new clients and referrals.
At that time there was much less access to information on complementary therapies for pelvic pain, but I learned as much as I could about a holistic approach for treating endometriosis and other pelvic pain issues that I developed. I followed specific dietary recommendations along with addressing other lifestyle factors like exercise, sleep, and mind-body practices and had regular treatment with pelvic floor physical therapy, acupuncture and massage therapy. It took trial and error to learn what worked best for my body, but I had great results in managing my health outcome.
Most of the time there’s not a magic bullet cure for pelvic pain - it takes an integrated and multi-disciplinary approach to support sustained healing. Whether you suffer with painful bladder syndrome, pelvic floor dysfunction, endometriosis, irritable bowel syndrome (IBS), vulvodynia, or other sources of chronic pelvic pain, nutrition can be used as an additional therapeutic tool to improve these conditions, and to heal co-existing health issues that can increase pelvic pain.
NUTRITION AND ROOT CAUSES OF PELVIC PAIN
When working with nutritional therapy for pelvic pain we want to consider what some of the root causes and triggers might be. It’s estimated that the breakdown of sources of chronic pelvic pain are approximately 37% gastro-intestinal, 31% from urologic causes, 20% reproductive system, and 12% musculoskeletal.
Studies have shown that chronic pelvic pain is frequently associated with systemic inflammation, including autoimmune diseases. (2)
A 2002 study reported in the Sept. 27th issue of Human Reproduction (3) concluded that hypothyroidism, fibromyalgia, chronic fatigue syndrome, autoimmune diseases, allergies and asthma are all significantly more common in women with endometriosis than in women in the general USA population.
Vulvodynia is associated with other chronic comorbid pain conditions such as fibromyalgia, interstitial cystitis and irritable bowel syndrome, individually and in combination, and the presence of vulvodynia or any of the other comorbid pain conditions increases the likelihood that a woman will have one or more of the other chronic pain conditions. (4)
If you suffer with multiple health issues, nutritional therapy can not only address the pain symptoms, but can also support healing in other inter-related body systems that can be impacting your pelvic pain. The right nutritional shifts can correct digestive disorders, improve the healthy balance of gut microbiota and ability to absorb healing nutrients, bring hormones and blood sugar levels into better balance – all of which can impact pain levels, support your recovery from surgery and medical procedures, and help to down-regulate the nervous system so pain response is not as intense.
ELIMINATION DIETS TO DECREASE INFLAMMATION AND PAIN
To begin to address pelvic pain symptoms, a personalized elimination diet is an important tool. What exactly is an elimination diet and why do we use it?
Most people are familiar with food allergies and how potentially deadly they can be. A food allergy reaction occurs when your body recognizes a certain food as harmful and produces an immune response to that food, which can result in severe symptoms. Antibodies produced in the allergic response (most commonly IgE antibodies) will show up on a food allergy test. 8 food groups have been identified as causing 90% of all IgE food allergies in the U.S.: Milk, eggs, fish, shellfish, wheat, soy, peanuts, and tree nuts.
But many of these same foods also cause reactions that may not produce IgE antibodies, but do cause other immune responses, and these reactions are referred to as food sensitivities or intolerances. A common example of this would be having “lactose intolerance” where you’re lacking the enzyme needed to properly digest this milk sugar. These kind of responses are often delayed and not always as obvious to detect. Symptoms of food intolerances can include digestive problems like bloating, cramping, constipation, diarrhea; headaches; sinus problems; unexplained weight gain; fatigue; skin conditions; and increased pain anywhere in your body.
You can imagine if you’re eating poorly tolerated foods over and over again, and each time your body is having a reaction, that this can lead over time to a chronic state of low-grade inflammation, as the immune system is always being activated. And once inflammation is ongoing, it can also lead to developing even more food intolerances, so a very negative cycle of inflammation is set up, and symptoms increase.
Testing for allergies and food intolerances can be extremely helpful, but tests are not always completely accurate, and can be expensive, so using an elimination diet can be another effective method to help identify these possible food sensitivities. One of the main goals of using an elimination diet with pelvic pain conditions is to calm down and reduce the inflammation cycle and resulting pain and symptoms, and allow the body to rest and heal.
ELIMINATION DIET BASICS
The nutritional advice I followed over 20 years ago for my pain was to stop eating dairy, wheat and sugar (and processed foods in general) and focus on whole foods. I’ll admit it wasn’t a total breeze at first! Those three food groups are still considered top of the list to avoid to reduce many disease or pain states, including pelvic pain conditions. But in a full elimination diet protocol we include all of the main “allergenic” foods: dairy, gluten, corn, shellfish, soy, eggs, peanuts, tree nuts as well as alcohol and caffeine. Some people may also need to remove nightshades, citrus fruits and sometimes even non-gluten grains and/or legumes.
These foods are removed for 3 to 4 weeks, and at the end of that time you add back only one of the eliminated food groups at a time, eating 2-3 servings per day for 3 to 4 days, making note of any symptoms that arise and then breaking from that food to let the symptoms resolve. The following week you try reintroducing the next food. For those foods you identify as having a reaction to, it’s a good idea to then stay off of them for at least 3 to 6 months, if not longer, to allow for full healing before trying to introduce them again. Many people choose to permanently remove certain foods because they experience such improvements in their health.
When people first think about removing these foods from their diet, especially dairy, gluten and sugar, it can be overwhelming to say the least, because these foods have become such a huge part of the standard North American diet. It helped me stay motivated when I understood a little more of the “why” -
Dairy: Lactose is a sugar in cow’s milk, and casein is the protein found in cow’s milk. People can be sensitive to either or both. Many people who are gluten intolerant are also casein or lactose intolerant. Gluten can damage the part of the intestine that is responsible for producing the enzyme lactase, which is necessary for breaking down lactose. About 75% of adults worldwide are lactose intolerant, and don’t have the digestive enzymes needed to digest this milk sugar, and that means digestive distress. Dairy products are also a dietary source of arachidonic acid, the fat used by the body to produce “bad” prostaglandins, localized hormones which can increase pelvic pain, cramps, and inflammation.
Gluten: Gluten includes several related proteins found in wheat and other grains including spelt, kamut, triticale, barley and rye. It’s estimated that approximately 30 to 40% of the U.S. population has some sensitivity to gluten, in addition to those diagnosed with full blown autoimmune celiac disease. Non celiac gluten sensitivity can over time result in damage to the intestinal lining or mucosa, that then allows undigested food proteins to “leak” through the gut wall into the bloodstream, which can trigger pain, inflammation and autoimmune responses. Even among people who are not sensitive to gluten, eating it triggers the release of a protein produced in the small intestine called zonulin, which again can lead to damaged intestinal lining. Gluten expert Dr. Alessio Fasano has stated that nobody digests these proteins well, and because of this it tends to trigger an inflammatory response.
Gluten intolerance has also been linked to altered estrogen levels. In a 2012 study on women with severe painful endometriosis-related symptoms over 12 months, 75% of the over 200 participants reported statistically significant improvements in painful symptoms when eating gluten-free. (5)
Sugar: Sugar depletes the body’s B complex vitamins and minerals which can worsen muscle tension as well as nervous tension and anxiety. Lack of B vitamins can make it harder for the liver to handle estrogen (important with a number of pelvic pain conditions), and B6 in particular is required for production of good prostaglandins that have relaxant and anti-inflammatory effects. Too many simple carbohydrates and sugar can contribute to indigestion, leaky gut (damage to the lining of the gut), a suppressed immune system, and candida overgrowth. These all mean more inflammation, which can trigger increased pain or symptoms.
FOCUS ON ANTI-INFLAMMATORY FOODS
The good news is there are still lots of delicious, satisfying and nourishing foods left to eat – really! With the right guidance, you will find an elimination diet isn’t the imagined journey of utter deprivation, but leads to discovering and enjoying new foods, losing old cravings, and learning to easily make healthy substitutions. Foods that are well tolerated can be eaten again after only a few weeks.
A focus on choosing mostly whole, nutrient dense, organic foods when possible reduces exposure to toxic chemicals, pesticides and added hormones, so the best choices are:
- free range, grass fed meats, wild game, and wild-caught salmon
- a wide variety and rainbow colors of veggies
- gluten free grains - quinoa, millet, amaranth, tapioca, rice, sorghum
- nuts and seeds - coconut, pine nuts, chia seeds, almonds, brazil nuts, walnuts, pecans, nut flours, and meals
- whole fruits, especially berries
- healthy fats from olive oil, coconut oil, avocados, ghee, and nut oils
- fermented foods like water kefir, sauerkraut, kim chee, other fermented vegetables
- herbs and spices
- beverages - water, broths, un-caffeinated herbal teas, mineral water, diluted juices, vegetable juices, coconut and other non-dairy milks
- sweeteners (to be used sparingly!) - brown rice syrup, raw honey, stevia, fruit sweetener, blackstrap molasses
A basic elimination diet is a great start to tackling your pelvic pain. There are growing resources available via books, group programs, and personal nutrition coaching to lead you through the process, but it’s always best to work with someone who understands pelvic pain conditions and can develop your personalized nutrition plan based on your particular genetic makeup, pelvic pain symptoms, and other health conditions and treatments you’re undergoing, especially in working to identify any personal food sensitivities and recommendations that are outside of a basic elimination diet.
A few examples of how we would tailor a pelvic pain nutritional program would be to also test removing additional foods that are known to increase symptoms for specific conditions:
- for women with vulvodynia, avoiding foods that are high in oxalates may reduce symptoms. Some higher oxalate containing foods include spinach, soybeans, grains, legumes, potatoes, almonds, cashews, rhubarb, raspberries, chocolate
- for sufferers of interstitial cystitis/painful bladder syndrome avoiding foods like citrus juices, coffee, alcohol, and spicy foods that can cause bladder irritation may be very helpful
- in treating endometriosis, we emphasize the balancing of excess estrogen which can fuel the growth of the disease, by removing inflammatory foods and products that tend to imbalance estrogen levels, and emphasizing detoxifying veggies, fruits, fiber and supplements as part of a comprehensive approach to pain reduction and hormone balancing
- Lark, Susan M., M.D., Fibroid Tumors and Endometriosis Self Help Book. 1995
- J Reprod Med. 2005 Oct;50(10):745-758
- Human Reprod. 2002;17(10):2715-2724
- Reed BD, Harlow SD, Sen A, Edwards RM, Chen D, Haefner HK. Relationship Between Vulvodynia and Chronic Comorbid Pain Conditions. Obstetrics and gynecology. 2012;120(1):145-151. doi:10.1097/AOG.0b013e31825957cf.
- Marziali M, Venza M, Lazzaro S, et al. “Gluten- Free Diet: a new strategy for management of painful endometriosis related symptoms?” Minerva Chirurgica. Dec; 67(6) (2012): 499-504
Cohan, Wendy, RN, The Better Bladder Book. 2011
Morrison, JA, Sullivan, J. A novel approach to treating endometriosis. Alternative & Complimentary Therapies, August 1999, p 225-229.
Petrelluzzi KF, Garcia MC, Petta CA, et al. “Salivary cortisol concentrations, stress and quality of life in women with endometriosis and chronic pelvic pain.” Sep;11(5) (2008): 390-7. doi: 10.1080/10253890701840610.
Segersten, Alissa and Malterre, Tom, MS, CN, The Elimination Diet. 2015
Susan Tessman is a Certified Nutrition Coach, and Certified by the Integrative Women’s Health Institute as a Women’s Health and Nutrition Coach, with specialized training in chronic pelvic pain, hormone health and pre-conception health. She is dedicated to supporting women suffering with pelvic pain conditions, using a whole person approach that includes nutrition and lifestyle solutions. For more resources on endometriosis and pelvic pain please visit www.susantessman.com
Stephanie Yeager: Passionate about spreading the word of hope and healing for those like her, influencing a paradigm shift in the medical community toward greater understanding of chronic pelvic pain disorders, and prevention initiatives that may protect young women before onset can occur.
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