Food Sensitivities Explained Part III: Optimizing Digestive FunctionHere’s a list-style overview of what we’ll be talking about relating to Optimizing Digestive FUNCTION: Environment Chewing Stomach Acids Digestive Enzymes Intestinal Lining Health & Gut Microbiome Hydration 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. YAY! 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. Think … Organ Detox Hormonal Balance Cellular Function Metabolism Energy 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. Environment: 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:Chewing: 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. Stomach Acids: 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. Digestive Enzymes: 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: https://www.amazon.com/Designs-Health-Digestive-Vegetarian-Protease/dp/B000FGXL50 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 Hydration!! Until next time!
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Food Sensitivities Explained: Part II |
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First, let’s have ultimate clarity on what we’re talking about. Food ALLERGIES and Food SENSITIVITIES are different. Allergic reactions to food are modulated by Immunoglobulin E (or IgE) which are antibodies produced by the immune system. Symptoms of allergic reaction are typically seen very quickly after exposure to what the immune system has determined to be an allergen, say peanuts for instance. So rather immediately you notice itching, rashes, hives, and in extreme cases even swelling of the throat & tongue which can restrict your breathing and is life threatening, requiring emergency room care.
Food sensitivities or intolerances on the other hand are a whole other discussion. It’s a controversial topic among the medical community in general because we don’t yet understand the mechanisms behind it. Several theories have been researched, including the possibility of a different class of Immunoglobulin, IgG, that may modulate food intolerance responses. But evidence for this theory is still lacking in the literature. So, as of this moment in history, we don’t really know. But I’m sure science will eventually answer that question for us.
In the meantime, we do know by why of observation that food sensitivities and intolerances exist. They can be tricky to track down because unlike allergies, symptoms often appear much later, typically 48-72 hours after exposure. So pinpointing what exactly you’re reacting to can be difficult.
Food sensitivities or intolerances on the other hand are a whole other discussion. It’s a controversial topic among the medical community in general because we don’t yet understand the mechanisms behind it. Several theories have been researched, including the possibility of a different class of Immunoglobulin, IgG, that may modulate food intolerance responses. But evidence for this theory is still lacking in the literature. So, as of this moment in history, we don’t really know. But I’m sure science will eventually answer that question for us.
In the meantime, we do know by why of observation that food sensitivities and intolerances exist. They can be tricky to track down because unlike allergies, symptoms often appear much later, typically 48-72 hours after exposure. So pinpointing what exactly you’re reacting to can be difficult.
WATCH THE VIDEO:
Let me just take a time-out real quick and touch on lactose. Lactose is the sugar molecule in milk. And in order for the body to break it down and absorb it, the enzyme lactase is required. Some people don’t make enough lactase to fully digest lactose in the small intestines. Therefore, undigested lactose passes into the large intestine where it is fermented. Fermentation = gas. So you end up with the typical signs of lactose intolerance: bloating, cramping, etc.
Dear Lactose & Lactase, Thank you for being so straightforward. Sincerely, Everyone
However, maybe we can learn something about other sensitivities from lactose/lactase? After all, the lactase enzyme is produced by the cells that line the wall of the small intestine. And we know that when the tight junctions between the cells of the lining or “wall” of the small intestine becomes compromised that the intestines “leak”. In other words, particles that aren’t supposed to pass back and forth through the wall now do. And as a result, some of these particles are recognized by the immune system as antigens or invaders and an attack against them is mounted. And this is the basis for at least some autoimmune related reactions in the body.
Anyway, all of this to say: maybe the question for the moment isn’t: HOW do we explain food sensitivities? But instead: WHY is your body’s digestive SYSTEM compromised?
So if you’re having symptoms of food sensitivities which could include:
Then consider taking a systems approach to RESTING the digestive system because clearly the whole system is under stress and needs rested. The question is: Why? Why is this happening? The answer is in both your physical and your emotional stressors. For instance, did you know that blood sugar imbalance is stressful on your systems? If you eat the standard American diet it is quite likely that your blood sugar is often dysregulated and that is stress on your body. Poor and inadequate sleep is a physical stressor. If you’re emotionally stressed out and constantly rushing, constantly “doing”, you’re up-regulating your central nervous system and spending life in “fight or flight” mode. All of this stress is contributing to the dysregulation of your Stress Response System (the HPA Axis), which increases cortisol. And we know that cortisol breaks down the lining of the small intestines! Other things that damage or break down the lining of the small intestines:
So the goal is: take the stressors off the digestive system while optimizing digestive function. Then, get back to eating most foods. (Break out in Dance or the Hallelujah Chorus). That’s right! The goal is to go back to eating most foods. Take for instance, lectins. Lectins are antinutrients found in a number of foods: grains, beans, nuts, and nightshade vegetables (like tomatoes and peppers and eggplant). And our bodies should have the capacity to break them down. But in a compromised digestive system, we maybe can’t. So after resting the system AND optimizing digestive function, you can reintroduce or “challenge” lectins. And it’s possible that you can then tolerate all or least some lectin-containing foods.
How does one rest the digestive system while optimizing digestive function? Join me next time and we’ll dive into it!
Dear Lactose & Lactase, Thank you for being so straightforward. Sincerely, Everyone
However, maybe we can learn something about other sensitivities from lactose/lactase? After all, the lactase enzyme is produced by the cells that line the wall of the small intestine. And we know that when the tight junctions between the cells of the lining or “wall” of the small intestine becomes compromised that the intestines “leak”. In other words, particles that aren’t supposed to pass back and forth through the wall now do. And as a result, some of these particles are recognized by the immune system as antigens or invaders and an attack against them is mounted. And this is the basis for at least some autoimmune related reactions in the body.
Anyway, all of this to say: maybe the question for the moment isn’t: HOW do we explain food sensitivities? But instead: WHY is your body’s digestive SYSTEM compromised?
So if you’re having symptoms of food sensitivities which could include:
- Runny nose / Sinus congestion
- Stomach aches
- Headaches / Migraines
- “Brain fog” or inability to concentrate
- Joint pain and inflammation
- Skin issues like acne and dermatitis
Then consider taking a systems approach to RESTING the digestive system because clearly the whole system is under stress and needs rested. The question is: Why? Why is this happening? The answer is in both your physical and your emotional stressors. For instance, did you know that blood sugar imbalance is stressful on your systems? If you eat the standard American diet it is quite likely that your blood sugar is often dysregulated and that is stress on your body. Poor and inadequate sleep is a physical stressor. If you’re emotionally stressed out and constantly rushing, constantly “doing”, you’re up-regulating your central nervous system and spending life in “fight or flight” mode. All of this stress is contributing to the dysregulation of your Stress Response System (the HPA Axis), which increases cortisol. And we know that cortisol breaks down the lining of the small intestines! Other things that damage or break down the lining of the small intestines:
- Dehydration
- Over exercising
- Proteins in gluten
- Genetic Modification of food
- Pesticides
So the goal is: take the stressors off the digestive system while optimizing digestive function. Then, get back to eating most foods. (Break out in Dance or the Hallelujah Chorus). That’s right! The goal is to go back to eating most foods. Take for instance, lectins. Lectins are antinutrients found in a number of foods: grains, beans, nuts, and nightshade vegetables (like tomatoes and peppers and eggplant). And our bodies should have the capacity to break them down. But in a compromised digestive system, we maybe can’t. So after resting the system AND optimizing digestive function, you can reintroduce or “challenge” lectins. And it’s possible that you can then tolerate all or least some lectin-containing foods.
How does one rest the digestive system while optimizing digestive function? Join me next time and we’ll dive into it!
The road to optimizing the health of our body's systems is rarely a straight line. Case in point: this is how my meal plan I posted a few weeks ago played out in real life.
While I don't make a habit of analyzing my meal plans after the fact I thought it would be helpful for you (and for me) to see that it's messy. Only a few times did things actually play out as I planned them. Everything else got moved around, adjusted, and rearranged!
It was still totally worth it to make the plan and grocery shop accordingly because it's important to have those meals ready to slot in as life ebbs and flows and changes. But my point for all of us is: let go of it having to be perfect or "as planned" and let's give ourselves plenty of space and grace for flexibility and mistakes and messes.
Paleo Ground Turkey Cutlets with Roasted Veg
(& Turmeric Rice)
Ingredients:
1 pound ground turkey
1/4 cup chopped green onions
3 large garlic cloves, diced fine
1/2 bunch of parsley (can sub other herb like cilantro)
S&P
Sauce:
Balsamic vinegar
Maple syrup
Dejon mustard
1 pound ground turkey
1/4 cup chopped green onions
3 large garlic cloves, diced fine
1/2 bunch of parsley (can sub other herb like cilantro)
S&P
Sauce:
Balsamic vinegar
Maple syrup
Dejon mustard
1. Preheat the oven to 400 degrees and line a baking sheet with foil
2. Chop up the garlic, green onion, and parsley. Combine in a large bowl with the ground turkey.
3. Add desired amount of salt and pepper
4. Using your hands (take rings off for this one ladies!) toss and smoosh it all together real good until it looks like this:
2. Chop up the garlic, green onion, and parsley. Combine in a large bowl with the ground turkey.
3. Add desired amount of salt and pepper
4. Using your hands (take rings off for this one ladies!) toss and smoosh it all together real good until it looks like this:
Ground turkey is so sticky so it's perfect for cutlets and meatballs!
| 5. Grab a handful at a time and shape them into cutlets. Is a cutlet really just a fancy name for a patty without a bun? 6. Bake in the oven for about 25-30 minutes. Make sure a food thermometer reads at least 160 or if you don't have a thermometer, cut in them to check for doneness. |  |
7. I stuck mine in the broiler for just about 2 minutes to brown up the tops
8. In a small/medium bowl combine equal parts balsamic vinegar and maple syrup (the pure stuff!). I think I did about 1/4 cup of each.
9. Whisk in some dejon mustard until it tastes good to you! (2-3 Tbsp)
10. Drizzle the sauce over the cutlets or use it for dipping
8. In a small/medium bowl combine equal parts balsamic vinegar and maple syrup (the pure stuff!). I think I did about 1/4 cup of each.
9. Whisk in some dejon mustard until it tastes good to you! (2-3 Tbsp)
10. Drizzle the sauce over the cutlets or use it for dipping
Additional info on the meal:
I also cut up one bunch of broccoli and cauliflower. And a couple of jalapeños I had left over from making Whole 30 Taco Soup :)
- Line another baking sheet with foil and drizzle some olive oil over the veggies
- Add some S&P
- I like to also grate some lemon rind on top of it all (I always have 3-4 whole lemons in the freezer for just this purpose!)
You can do all of this once the cutlets are in the oven because the veggies won't take as long. Maybe 15 minutes? Just keep checking them until they're as done as you like them. I tend to like them with just the edges starting to brown.
I also cut up one bunch of broccoli and cauliflower. And a couple of jalapeños I had left over from making Whole 30 Taco Soup :)
- Line another baking sheet with foil and drizzle some olive oil over the veggies
- Add some S&P
- I like to also grate some lemon rind on top of it all (I always have 3-4 whole lemons in the freezer for just this purpose!)
You can do all of this once the cutlets are in the oven because the veggies won't take as long. Maybe 15 minutes? Just keep checking them until they're as done as you like them. I tend to like them with just the edges starting to brown.
A Note about Rice:
White Rice isn't Paleo and it wouldn't appear much in Mediterranean or Ketogenic Diets either. But if you aren't sensitive to grains and if it's a gluten free "starch" your husband (or other dinner companions) will eat, it can be an "ok" addition to the meal. Most of the time I will have a little but sometimes I opt out of it all together.
I like to use a few 'tricks' to make it a little more worth its space on our plates:
- rinse the white rice a few times in cold water before cooking it to remove the surface starches
- add 2 capsules of Turmeric to the rice before it cooks. It doesn't really change the flavor at all but it makes it a fun color and we might as well get some more turmeric in our diet where we can.
Beware: it WILL stain your rice cooker orange. But I don't really care because it still works just fine. ;)
White Rice isn't Paleo and it wouldn't appear much in Mediterranean or Ketogenic Diets either. But if you aren't sensitive to grains and if it's a gluten free "starch" your husband (or other dinner companions) will eat, it can be an "ok" addition to the meal. Most of the time I will have a little but sometimes I opt out of it all together.
I like to use a few 'tricks' to make it a little more worth its space on our plates:
- rinse the white rice a few times in cold water before cooking it to remove the surface starches
- add 2 capsules of Turmeric to the rice before it cooks. It doesn't really change the flavor at all but it makes it a fun color and we might as well get some more turmeric in our diet where we can.
Beware: it WILL stain your rice cooker orange. But I don't really care because it still works just fine. ;)
This recipe is compliments of my good friend who sent me the basics of the idea!
PS: I don't currently follow the Whole 30 Diet. But it's a GREAT resource for recipe and meal planning because you know it will be based in clean animal proteins, veggies, and healthy fats while leaving out dairy, grains, and sugar. #winning
* If you're sensitive to eggs, though, this one's not for you.
PS: I don't currently follow the Whole 30 Diet. But it's a GREAT resource for recipe and meal planning because you know it will be based in clean animal proteins, veggies, and healthy fats while leaving out dairy, grains, and sugar. #winning
* If you're sensitive to eggs, though, this one's not for you.
Ingredients:
1 lb breakfast sausage
1 zucchini
1 sweet bell pepper
2 cups spinach
11 eggs
Spices
1 lb breakfast sausage
1 zucchini
1 sweet bell pepper
2 cups spinach
11 eggs
Spices
1. Cook a pound of breakfast sausage.
2. Shred, spiralize, or just julienne a green or yellow zucchini
3. Chop up a sweet bell pepper, I used an orange one
 | 4. Put the cooked sausage on the bottom of a 9X13 pan (I sprayed some coconut oil in the pan first) 5. Then layer on the zucchini and the peppers 6. Layer on some shredded spinach. Or I just used an organic combo of baby spinach and arugula. I added some salt and pepper at this point. |
My pan looked like this at this point
 | 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! |
9. Bake in the oven at 350. Mine took 25 minutes. But my oven was on its deathbed when we bought the condo 7 years ago so you can imagine the accuracy. Start at 18 minutes and check it every few minutes after that for the eggs at the consistency you like them.
Besides a fabulous Sunday brunch meal, I can eat on this for a few mornings this week!
Egg/Sausage Casserole: Check out the next blog post!
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!
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!
NUTRITIONAL THERAPY FOR PELVIC PAIN GUEST POST BY CERTIFIED WOMEN'S HEALTH AND NUTRITION COACH, SUSAN TESSMAN
“After years of working with thousands of women patients, I have found that no therapy can be fully effective without including beneficial dietary changes as part of the treatment plan." (1) Over 20 years ago those words in a book on endometriosis were my first introduction to the connection between food and pelvic pain. I had been diagnosed with uterine fibroids, ovarian cysts and advanced endometriosis earlier that year and was determined to try anything I could that might help to reduce the pain, and avoid having to undergo further surgery or deal with the emotional and physical side effects of hormonal treatments.
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:
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:
Resources
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
BIO
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
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
- legumes
- 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
Resources
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
BIO
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
Author
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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