Endo Battery

Nutrition Strategies for Endometriosis: Insights from Registered Dietitian Sarah Rae

August 21, 2024 • Alanna • Episode 86

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What if the key to managing your endometriosis symptoms lies not in restrictive diets but in a compassionate, evidence-based approach to nutrition? Join us on Endo Battery as we welcome Sarah Rae, a registered dietitian with personal experience in endometriosis and adenomyosis, who navigated a challenging healthcare journey filled with painful periods, hormonal treatments, and a path to motherhood that led to a hysterectomy. Sarah's story highlights the importance of proper excision surgery and her passion for empowering others through personalized nutrition strategies, steering clear of the restrictive fads often found on social media.

Ever wondered about the difference between a nutritionist and a registered dietitian? We break down the rigorous training and accreditation required to become a registered dietitian, emphasizing the crucial role they play in providing evidence-based, personalized advice, especially for managing conditions like endometriosis. Sarah and I discuss the potential hazards of following unverified and restrictive diets, which can do more harm than good, and the importance of consulting with endo-informed professionals to maintain a balanced and healthy relationship with food.

From debunking myths about endometriosis nutrition to offering practical tips for balanced meals, this episode covers it all. We explore the misconceptions surrounding gluten and endometriosis, the importance of intuitive eating, and the role of genetics in managing symptoms. Tune in as we equip you with the knowledge and tools to improve your well-being, embrace your genetic makeup, and foster a positive relationship with food, all while navigating the complexities of endometriosis.

Links
sarahraerdn.com
intuitiveeating.org
icarebetter.com
Find Food Freedom Podcast
https://a.co/d/9TlWhSe
https://a.co/d/71lMskt

Articles
Barnard ND, Holtz DN, Schmidt N, Kolipaka S, Hata E, Sutton M, Znayenko-Miller T, Hazen ND, Cobb C, Kahleova H. Nutrition in the prevention and treatment of endometriosis: A review. Front Nutr. 2023 Feb 17;10:1089891. doi: 10.3389/fnut.2023.1089891. PMID: 36875844; PMCID: PMC9983692.

Influence of diet on the risk of developing endometriosis. Joanna Jurkiewicz-Przondziono, Magdalena Lemm, Anna Kwiatkowska-Pamuła, Ewa Ziółko, Mariusz K. Wójtowicz. DOI: 10.5603/GP.a2017.0017. Ginekol Pol 2017;88(2):96-102.

Marcinkowska, A.; Górnicka, M. The Role of Dietary Fats in the Development and Treatment of Endometriosis. Life 2023, 13, 654. https://doi.org/10.3390/ life13030654

Barnard, N.D., Holtz, D.N., Schmidt, N., Kolipaka, S., Hata, E., Sutton, M., Znayenko-Miller, T., Hazen, N.D., Cobb, C., & Kahleova, H. (2023). Diet associations in endometriosis: a critical narrative assessment with special reference to gluten. Frontiers in Nutrition, 10. https://doi.org/10.3389/fnut.2023.1166929

Social Media (Intuitive Eating)

@endonutrition.pnw

@find.food.freedom

@diet.culture.rebel

@ameeistalking

Website endobattery.com

Speaker 1:

Welcome to EndoBattery, where I share about my endometriosis and adenomyosis story and continue learning along the way. This podcast is not a substitute for professional medical advice or diagnosis, but a place to equip you with information and a sense of community, ensuring you never have to face this journey alone. Join me as I navigate the ups and downs and share stories of strength, resilience and hope. While navigating the world of endometriosis and adenomyosis, from personal experience to expert insights, I'm your host, alana, and this is EndoBattery charging our lives when endometriosis drains us. Welcome back to EndoBattery, grab your cup of coffee or your cup of tea and join me at the table.

Speaker 1:

I'm joined today by my guest, sarah Ray, who is a registered dietitian with a deep passion for helping individuals with endometriosis find freedom and joy through their personalized nutrition. Specializing in endometriosis symptom management and fertility nutrition, her mission is to empower people with endometriosis with the knowledge and tools to improve their symptoms and live their best life. As a woman with endometriosis and adenomyosis, she understands firsthand how overwhelming and restrictive endometriosis nutrition advice can be, and she advocates for a non-restrictive approach with intuitive eating strategies in her practice at Pacific Northwest Endometriosis Nutrition. Please help me in welcoming Sarah Ray. Thank you, sarah, so much for joining me today. I'm excited for our conversation, and to say that I wasn't a little hesitant would be misrepresented, because I was a little hesitant to talk to someone that's in the field of diet and because of all that's been spread. So I'm really excited about our conversation. I think you have a lot of value. So thank you for joining me today.

Speaker 2:

Yeah, Alana, thank you so much for having me on. I'm so excited that you are willing to consider talking with me today. I'm a big fan of the podcast and some of your episodes that have kind of stood out to me are episodes where you've talked about nutrition with providers and some of the lack of evidence for it, or you know, just some of that different information that's out there, and so I'm hoping that we can kind of dispel some myths today and make people feel a little bit more comfortable around nutrition as it relates to endo care.

Speaker 1:

Yeah, and I think this is personal for you. You can correct me if I'm wrong, but it's personal for you because you've kind of walked through this journey. What has your journey looked like, from you as a person to you as a dietitian. What has that been for you?

Speaker 2:

Yes, so I am a person who also has endometriosis and I think I had adenomyosis, although it wasn't completely diagnosed. I had symptoms starting from when I was 11 years old and I have a strong family history of endosymptoms, but no diagnosis until me for my whole life, and so I had really painful periods and things from the get go. But my mom did too, and so it was just something that I expected and I never really complained about her, about to her, because that's just like what our family was dealt. And so I started on birth control fairly young to manage my symptoms, and as I was a younger adult, as I was going to different exams and things, a lot of what was coming up was like pain with penetration and they kept sending me things on like how to be better at intimacy and making me feel like that was what was wrong with me. It was like you don't know how to do it right, and I wasn't really complaining about period pain because I just thought that that was normal. And then when I got off of birth control, I started bleeding so much and the same story as a lot of people just like the constant pain. I would be bleeding more days of the month than not, and I had countless ultrasounds, I went to so many different providers and it would be kind of the same story I just heard this with your interview with Jen out of the UK. It was like everything's normal, sorry, you know. And then I would wait until it was really impacting my life again, or I would get so fed up and then I would go find another doctor and try a new birth control and just like I guess I have to live with it because I knew I wanted to have children and things like that.

Speaker 2:

So fast forward a few years, I had a little bit of difficulty getting pregnant with my daughter and had a pretty traumatic birth experience which was not related to endometriosis. I just had a high-risk pregnancy. I had her right after the pandemic and she was in the NICU and so after that I just thought I was kind of done with my fertility journey and so I thought, well, I guess I'm done with my uterus because I cannot take a single like form of birth control. It was affecting my mental health. I wasn't sleeping, my anxiety was through the roof and I had been seeing a pelvic pain gynecologist at the time and she said that's kind of like your last option, especially if you're unwilling to try hormonal methods. And so I opted to have a hysterectomy.

Speaker 2:

I knew a little bit about endo at that point. I had had a friend who had it, I had done some research, and so when I was choosing my surgeon, I asked them will you take all the endo out if you see it? You know, I thought that I knew all of the questions to ask and she said, yes, absolutely I will. I'll look, you know, all over where I can. And after my surgery she told me she took all the endo out and she told my husband that.

Speaker 2:

But when the pathology came back, the only thing on the report was a uterus and fallopian tubes and a cervix. There was not a single sample taken out, and my sister was going through a tough fertility journey at that time, and so that was when we learned about excision surgery versus ablation. So it was like too late for me and I felt amazing. For like three months, you know, I was done bleeding, I wasn't having that cyclical pain and things like that, and then, bam, it just came right back. And so I was back at my provider's office saying like I still have a period, it just I don't bleed, like I can even smell the blood, something is not right and similar to the story on the podcast I heard this morning from Jen, like they just you shouldn't have these issues, you don't have a uterus anymore, you shouldn't be having cramping, you shouldn't be having leg pain. So then you know, I had to do a lot of self-advocacy and that's where I ended up with excision surgery and you know it's. It's a very long journey for all of us and something a journey I'm still on.

Speaker 2:

But kind of through all of that I also just was having some opportunities to go into private practice and things like that and I always really wanted to work in women's health, just because I connect well with women. I am so fascinated by fertility and, having struggled a bit with fertility and my sister struggling with it, I really wanted to kind of work in that realm. Struggled a bit with fertility and my sister struggling with it, I really wanted to kind of work in that realm and I had these people coming to me not for endo pain but having glaring endo signs. I have clients who have to wear diapers for their periods, which more adenomyosis, but pain with bowel movements, chronic constipation, fluctuations of diarrhea, nausea, vomiting all throughout the month and similar experiences to mine where they're not getting heard. You know they're.

Speaker 2:

They were coming to me because of the weight side effects that they're getting from their medications and not being able to exercise and things like that, and so I really felt like that was my sign to make this space to help people who have been through a similar journey, where I can help connect them with other providers, where I can dispel some of the myths and the restrictive diet advice that I found on my own journey, where you know I would read a book about endo and how we can improve it and just get raging anxiety about, like having to clean out my cabinets and what am I going to cook for the rest of my family when I can't eat and will life ever be enjoyable again?

Speaker 2:

And as I started digging into the research, it's like a lot of this is not really evidence-based and that's really frustrating to see as a dietician who really values, you know, health at every size and looking at people's individual backgrounds because, especially with this disease that mostly impacts women, we have other overlapping things that are coming with it, like disordered eating. We have teenagers suffering from it and we don't want to trigger that in them. People with endometriosis may also have diabetes or they may also have fertility issues, and so a lot of those books are just looking at this one thing, which there's not really a whole lot of evidence to support that nutrition helps on its own Right.

Speaker 1:

For those that maybe are questioning what the difference is between a dietitian versus a nutritionist, can you explain that a little bit, because I think that will help us, moving forward, understand exactly what you do and where you're coming from?

Speaker 2:

Yeah. So registered dietitians have to go through an accredited program. So people in my age group and older have to at least have a bachelor's degree in nutrition. People who have been credentialed more recently also have to have a master's degree to become a registered dietitian. And then you have to have an accredited, coordinated dietetic internship where we practice in several fields. So anything from long-term care to oncology, to eating disorders, to pediatric nutrition. We have at least a thousand hours of supervised practice and then we sit for a very rigorous exam and have continuing education requirements that we must fulfill to maintain our license. And then each state may have additional criteria that they require for a dietitian to be licensed there A nutritionist.

Speaker 2:

There are some programs for nutritionists but anybody can really call themselves a nutritionist, especially in certain states. Some people can see anybody without being a registered dietitian and there's really no laws around it. So if somebody is looking for that really evidence-based somebody who knows a bit more, who has been specifically trained in certain disease states and things like that, you would want to look for a registered dietitian.

Speaker 1:

And that's also helpful if you're wanting insurance to pay for visits with a nutrition type of program that can be a little confusing and a little gray and it's a little overwhelming for those of us who have struggled and I, you know. I have seen someone for my own health journey kind of understanding, especially after my hysterectomy, because I did not understand my body. It was completely new to me. I had no idea what, my next steps, what was working before now didn't work. Obviously, I didn't have ovaries anymore. The hormone changes and the shifts were different as well, and so seeing someone was beneficial for me to do that. But I do think that having someone as a dietician understanding the background of why we're in this place and from an educational standpoint, not a certification standpoint is really important and probably super helpful. Something that you had mentioned to me when we had talked previously is that with a dietician, you can often bill insurance for this. Can you explain that a little bit, because I think that a lot of people would benefit from knowing this?

Speaker 2:

Yes. So not all dieticians accept insurance, especially if they're in private practice, but many do. One of the wonderful things about most insurance plans, except for Medicare, is that oftentimes nutrition appointments are covered for free. I have had so many patients that have unlimited visits with a registered dietitian, and it doesn't matter what your size is, if you have diabetes. If you just want to talk to a dietitian, you could talk to them every single day and have that tool in your toolkit of providers. And the really nice thing is usually our limitations on appointments are like an hour, so we have a lot of time to address different things with you that you may not get when you go see, like an OBGYN or your surgeon or other providers, and that just depends on the person. Most insurance plans do not network with nutritionists, so oftentimes those would be an out-of-pocket either class or workshop or one-on-one coaching.

Speaker 1:

Given your background on being a dietitian, what are some of the things that you find harmful that we're seeing out in social media, things that endometriosis patients or just in general population have been exposed to that you find have been harmful, that you are now going back and working with your clients to help correct?

Speaker 2:

Yes. So I think the challenge is, if we're trying to just be helpful for the endo population, we have to kind of throw out all the ideas of what could be triggering their symptoms, such as maybe it's gluten, maybe it's dairy, maybe it's the hormones in red meat, maybe you need these supplements to help. It's really difficult because people with endo have different symptoms and different things that they're working on, and adding out or adding all of those things is not going to heal or cure or reverse your endo, even if you follow that diet really strictly. I've also seen, like the autoimmune protocol, which is a very restrictive diet and kind of you know, cutting out very similar things. So I think a lot of those providers are trying to give you as much information as they can to help kind of get you in the door and get you working with them.

Speaker 2:

But if that's not something that a patient is interested in and then maybe they're coming to this from a lens of like a long diet history or a poor relationship with food and body, it's like something that they can really cling on to and cut a lot of things and then end up with a worse relationship with food, maybe nutrient deficiencies, maybe they end up underweight.

Speaker 2:

I have had patients who already lost a lot of weight just from their symptoms, or maybe medications they're taking, or maybe they're binge eaters and so going so restrictive can actually make those binges worse later on, and so I think that if people are seeing that type of advice out there, they really need to make sure they're discussing it with either their provider or engage with a registered dietitian or a professional that can kind of help them weed out what is helpful for them. I would say, if there's anybody that's claiming that they're going to get to the root cause of your endo and they're not an excision surgeon, that that should be a red flag. Yeah, because the root cause of endo is endo. It's not like mold or lack of sleep or your hormone imbalance or your stress levels. Those things may be feeding into your endo flare, but that dietician, nutritionist, healthcare provider is not going to get to the root cause of your endo if you haven't actually had the endo taken out.

Speaker 1:

Right, I feel like that's probably been one of my hesitations in talking about diet and nutrition and I think why a lot of us have this like red flag right, Because we've heard this so many times and I can't tell you how many times I have seen this online where it's like I found this supplement to help you with your endo, or I have this program, or I have you know. There's all these promises, but with these promises is a big dip into your bank account.

Speaker 1:

Absolutely, and I do think like there's some people that legitimately think they're helping but, at the same time, that is a vulnerable population that feels like they're being preyed upon with misinformation, and I think that's why, for me, when approaching this episode specifically and when approaching our conversation, I was very hesitant at first until I understood the value and the benefit of talking to you and a registered dietitian who understands it, and I think we have to understand that again, root cause of endo is endo.

Speaker 2:

Like we were probably born with it. Yeah, you know it's still unknown, but it certainly wasn't what we ate or what we were fed when we were kids that caused the endo. At this point, there's no studies pointing to that being the case.

Speaker 1:

Yeah, and as someone who has struggled with eating and a poor relationship with food in my experience I've heard so much of the restrictive eating aspect of it that it has become harmful. And for someone who doesn't naturally love to eat all the time I'm a poor eater because of ADHD and stomach issues it can be really challenging to have to cut that out and then, all of a sudden, what are you left with? You know, and that's where I think it gets really tricky.

Speaker 2:

Yeah, I also think it can be, but harmful. On the other side, we live in a culture that really values thinness and I have struggled with disordered eating as well and that desire to be on a more restrictive diet. And so anytime you read these things, these diets that are meant to improve your symptoms and I've actually read a book that touted that it would also help you lose weight but if you're also thinking, oh, this is also going to help me get thinner, that is a harmful message that we're getting from those as well. That should not be. Your primary goal when working on improving endosymptoms is the weight loss, and any book that is recommending that without knowing your background is harmful in my opinion.

Speaker 2:

Yeah, other thing with nutrition is I was just talking to a client yesterday and she said she worked with a dietician in the past that didn't have endo and we can't all have endo and be dieticians for endo, necessarily but she was recommending like kale smoothies for the patient and she was saying that she's doubling over from the kale. So sometimes people's gut symptoms actually are that they can't tolerate veggies and they might do better with white toast, and so having somebody who really understands the whole thing going on with your system is also important.

Speaker 1:

And I think it's interesting you say that because we go back to like spending time with you and people that understand endo. As a dietician, spending time with you understanding symptoms, walking through okay, not only what you're eating, but what are your symptoms? How do you manage your pain at this point? What is going on around you that could potentially be causing a flare? How did this start? Just kind of understanding the roadmap to how they're feeling and why they're feeling it and how they manage it, I think is important too, because it's not the same for everyone.

Speaker 2:

Right and having somebody who understands that endo is a multi-system disease and that there's other providers that need to be involved with that. For example, I have a client who really, really struggles with constipation and she spends hundreds to thousands of dollars on supplements from a naturopath, colonics, all of these things and I was the first person to recommend to her that maybe you need to see PT to help relax your rectal muscles to let the stool out. And it's like how many providers has she been to? Similar to getting an endo diagnosis before somebody says, oh hey, maybe it's just like a muscular issue that you should see an endo-informed PT as well, and so I think seeing people who really understand the disease is important in all aspects.

Speaker 1:

What are some of the other challenges you have when people come in that have had a very restrictive eating background?

Speaker 2:

I think trying to get people out of diet culture is one of my main goals. So diet culture has found its way into endometriosis, even though it's not necessarily geared towards shrinking the body, shrinking the body. We now have all of these programs that are being sold to heal, cure, you know, reverse your endo and I think kind of getting people to reject that and just tune into their bodies so that they're not restricting anymore, so that they're not just looking for the next best quick fix. The next like prescriptive thing is something that I'm having to work with a lot.

Speaker 1:

Are you working a lot with people who have gone gluten-free? Because that's the big thing for endo patients is like you need to go dairy-free, gluten-free, you need low FODMAP, you need. You know there's like a lot of these different avenues that we've heard of, and for me personally, gluten does nothing, and I will probably say this on so many different podcasts that you guys are probably sick of it. But I'm just telling you, gluten has never affected me, but other things have that don't necessarily affect other people. I feel like that would be one of the biggest barriers for some of those endo patients to understand.

Speaker 2:

Yes, I have some people who are gluten-free and same. My mom has celiac and gluten does not affect me and my mindset is I'm not cutting it out in case I get celiac later in the night. I'm going to enjoy it while I can. That's right. It's so much easier. But I think one of the things is understanding people's history with it. So if they have been gluten-free for years and they've never really reintroduced it, I may not challenge them to do that in our first appointment.

Speaker 2:

So part of the dietitian client relationship is I'm their coach and their cheerleader. We can find a lot of good nutrition information online and kind of implement that themselves. But I may encourage them to reintroduce it if they haven't in a long time and just see if they have symptoms, especially if they've had excision surgery. I've seen clients who had excision surgery and just never really reintroduced and so it's kind of about like what those fears are, like what, what the reasons are like. If they have a strong family history of gluten intolerance, they may also have gluten intolerance or celiac disease as well. So it's kind of individualized, but it is something that I see being cut a lot and it's harmful if you don't need to cut it because you can see lower iron levels, lower B vitamin levels, lower fiber intake with a gluten-free diet, which increases your risk of colon cancers and things like that. So gluten is not bad unless you have a gluten allergy or celiac disease.

Speaker 1:

Is there any research to back that up? To like on either way, like either position for endometriosis or yes.

Speaker 2:

That's a great question. There's a study that I really like in the Frontiers in Nutrition that was released in September 2023 by Browns and others, looking specifically at gluten and endometriosis, and they're sort of breaking down different studies and what they found overall is there's not really enough evidence to support a gluten-free diet for endometriosis patients. Some of the studies that they have done, a lot of people just dropped out because of the adverse effects from being on a gluten-free diet, and so they didn't even end with the same pool that they started with and one that they talk about in there. That I think is really important to note is when you have celiac disease or irritable bowel syndrome and endometriosis, there can be a lot of overlapping symptoms with that, and so sometimes when people have excision surgery, those symptoms will go away.

Speaker 2:

So it would be important to actually be tested for celiac disease before cutting gluten or if you suspect that you may have it, and celiac disease is somewhat prevalent in the population. A lot of what they also found was the overlap of people who also were having celiac disease and endometriosis, and there's bound to be some crossover. When we're thinking about one in 10, or maybe more women having endometriosis, there's going to be some celiac disease or gluten intolerance, but they're not necessarily correlated or caused by each other. So it's just kind of a coincidence when people have gluten intolerance and endometriosis. And so that's where, kind of looking at your family history and individualized approach, and if you do decide to cut it, then make sure you reintroduce it to see if you actually are not tolerating it, so you're not missing out on vital nutrients.

Speaker 1:

I think that's important to understand because I certainly when I initially started I had cut out gluten for a while and I had I was one of those that had kind of that adverse effect and it played mental games with me. So I was like this probably isn't for me, I'll just suffer if that's gluten, like I'm good with it, you know. But I do think like it was good to understand for me what was setting my flares, what was causing this inflammatory response, what was affecting me negatively when it came to my bowel movements or the way that I felt in my stomach. And I think that we become a little more sensitive to this because some of us get endo belly really easy. But again, proper excision should help with that.

Speaker 1:

And in fact I was talking to Dr Mings about this not long ago on a podcast and he said the very same thing. I asked that very question when we're talking about bowel endometriosis, if it's properly excised, do some of these foods, can we eat them again? And he said yeah, usually you can. So I think that's like, as an excision specialist who works heavily in the bowel, it was good to kind of hear that as well. Like you don't have to stop it permanently for life. It's worth testing. It's worth investigating that a little bit closer.

Speaker 2:

Yeah, a lot of people really struggle with garlic and onions. So, looking at like some of the foods high in fermentable carbohydrates that can cause some gas and bloating, so known as FODMAPs, and in my own story, after I had my endometriosis excised, I could eat onions and salad without symptoms, and I do still get endo belly and onions can be triggering, but it's only when I'm ovulating, and so that's one of the things that I really work with people on understanding their symptoms. Even after excision surgery, you may have like five days that you need to be a little bit more careful, especially if endo belly is going to ruin your day or ruin your plans. Then maybe you don't have any milk at that triggering. You might be really careful about what raw veggies you eat on those days, but then the rest of the month go for it, eat as much as you want if it's not impacting you, and so sometimes we don't need to eliminate all foods all the time, but just at certain times of your cycle when maybe things are a little bit more inflamed.

Speaker 1:

So is this like part of what you do, too is like the cycle charting along with your food and keeping like a log of the things that you're eating so you can understand that better, and you're working with clients like all the time doing that. Is that kind of what's been the most beneficial for the people that you talk to?

Speaker 2:

Yes, as with everything, it's been the most beneficial for the people that you talk to. Yes, as with everything, it depends on the client, right. But if they are not really sure it just vaguely feels like they're bloating all the time or they're having gas all the time or they can't eat anything I will often start them with a cycle and symptom tracking so that we can see if it truly is all the time. I had one client who felt like it was, but she realized it was the first three days of her period only. And not to say that it's all in people's head, but it can just be really helpful for us to both kind of get in tune with what's going on in their cycle, and having that information can also be really helpful with bringing it in for evidence to talk with another provider about other symptoms that maybe we're not addressing with nutrition.

Speaker 2:

So we may start with cycle tracking and maybe some food journaling, depending on what we find about. Like hey, I noticed you're eating apples and every day you eat apples you get really gassy. So even though they're really healthy food, you might not be tolerating that really well. Like, let's try cutting the apples and see if that helps, rather than let's just cut red meat, even though you're bleeding all the time. Let's cut gluten, even though it's so hard to do so a lot of times, starting with tracking and getting people just to tune into their symptoms. A little bit is enough and we don't have to go the elimination diet route.

Speaker 1:

I think that's interesting. I guess the fact that you're mentioning this, because I had a friend the other day that was like you know, gluten really bothers me during my cycle and I was like, oh, she goes, but the rest of the month I've been okay. And when you mentioned that I'm like, okay, this makes more sense, like you don't have to be restrictive all the time, but it's good to understand that part of your body, and sometimes we aren't great at looking at those trends in our own diet or our own cycle or anything like that, because we're just trying to survive. So it's super helpful to have someone point that out. And I'm sure I don't know, but I'm sure you've seen people come to you and this is something they're finding out as well and they just thought of something that they've always had.

Speaker 2:

Yeah, it may not be bloating every day, and if it is, we may look at like are you pooping every day? Like, do we have some trapped gas and we need to address constipation, or you know what are these other things that go along with having endo. That we can adjust with maybe increasing fiber, maybe reducing fiber, maybe making sure you're eating frequently enough, because if you don't eat all day, you can get some gas built up that way. And so it's looking at that whole picture with what we're eating beyond, just like Eating too much sugar is super inflammatory. It doesn't matter what you have. If you eat too much sugar you're not going to feel great, but that doesn't mean that it should be demonized.

Speaker 1:

Yeah, absolutely. That's so true, Because I like my sugar, if we're being honest. Yes, me too. I think that we should have sugar occasionally.

Speaker 2:

I'm a dietician who eats dessert every day, and I do not have endosymptoms every day, and so it's really about also recognizing that you know, if we ate only broccoli all day, we're going to still feel crappy, like probably super gassy, and maybe have diarrhea, and so too much of anything is not good.

Speaker 1:

Yes, that's what I've always said Too much of anything. Too much red wine probably isn't too good. Too much chocolate really isn't too good, but it is helpful at times. Yes.

Speaker 2:

Yeah, exactly what are some ways that nutrition nutritionally to our bodies to help us feel full, to help us feel like we're getting enough rest to keep our hormones in balance and I'm not just talking about estrogen and progesterone. Insulin is really important as well. So one of the things that I talk a lot with my clients about is balancing your blood sugars. Just a general overview of what your blood sugars are is if we eat things containing carbohydrates, that's our body's preferred source of energy and so that causes a blood sugar rise and that helps feed our cells and our brain and things like that, so that we have energy to go throughout the day. But if we eat too many carbohydrates and not enough nutrients or we're cutting carbohydrates too low, we may not be feeling well and that can kind of mess with our insulin levels and that can impact estrogen and progesterone levels as well. And so working on just building a plate with all of the essential nutrients being carbohydrates, proteins and fats, and eating regularly, so trying not to go longer than about four to five hours between meals without something, can be really helpful and just feeling well in general. So helping prevent cravings for processed foods, for you know that brain fog If you're not feeding your brain, it's not going to feel great. Fueling your day with coffee and nothing you know nothing until two in the afternoon those are all kind of setting you up for just not feeling well in general, whether you have endo or not.

Speaker 2:

But when we're already fighting a lot of inflammation and things like that, we want to make sure we're building balanced meals throughout the day and then thinking about what nutrients that we can add in that support reducing inflammation, like omega-3 fats that we get from things like fatty fish and chia seeds and walnuts and flax seeds. How can we build meals with those things? Make sure we're getting enough vitamin D. Calcium intake is also really important. Has been shown in studies with endo as being helpful, as well as magnesium and phosphorus.

Speaker 2:

So if you're not having dairy symptoms, it's important to include those in, or if you're not having some sort of an alternative, so that you're really getting all the building blocks that you need for your bone and muscle health and heart health, especially if you have suppressed ovarian function and things like that. Making sure you're staying hydrated so important if you're having constipation or diarrhea. So it's really nothing too crazy in terms of nutrition in a way that you can best fuel your body for endo. It's really just like building an overall healthy and balanced diet, trying to fill your plate with proteins and fruits and vegetables so that you're feeling well. And when you're doing that, we tend to crave a lot less of those processed, quick, comforting foods, not to say they don't have a place in our lives for fun and comfort sometimes.

Speaker 1:

Yeah, I am in a season in my life where my kids are doing an activity all the time right now. My kids are doing an activity all the time right now, and we were just talking about this. And how do we create healthy food relationship while being busy? And I think for endo people specifically, I know for myself fatigue is really big sometimes where I really struggle with the motivation to cook these complete meals. It becomes a lot harder to understand my timing.

Speaker 1:

And how can I not fall into the trap of what I've been doing my whole life, which is having a bad relationship with food and feeling guilty for what I'm eating, when sometimes I just need a quick meal to feed my kids and I don't wanna pass on my trauma of food to my kids, but my fatigue is really bad and't want to pass on my trauma of food to my kids, but my fatigue is really bad and I need to foster that too. I need to fuel my body, I need to fuel my brain. I think it's a challenge to do this as Indo people in general, and especially when your life is so busy and you have disordered eating issues. So I think that's important. It doesn't even if you're going out to a restaurant.

Speaker 2:

Just having a colorful plate can be helpful and not beyond that, if your kids love boxed mac and cheese, how can you add some things to that meal to add some variety and color? Maybe you add some rotisserie chicken from the store for a protein source and some broccoli or some peas or like something green to the side. Bam, you have a protein, carbohydrate and fats all built into that meal. Maybe you have some tuna and crackers with some cucumbers on the side for a lunch or a snack on the go. It does not have to involve a lot of cooking. It's just thinking about do I have those three components? If you're from a culture that has a lot of mixed dishes, it doesn't have to be that my plate broccoli, rice and chicken kind of look where nothing is touching. Just does that meal have all of those components mixed in? Does not have to be a big side salad. It can be cooked vegetables, it can be pureed vegetables. All of those things count.

Speaker 1:

Yeah, and it's so funny that you mentioned salads. See, my girls love salads. But you can make a salad that is if you're like watching calories. It's so many more calories than like eating just something that is, you know, what people would normally turn their nose up at and it's actually really nutritious.

Speaker 2:

So salads can be good, but they can also you have to like, watch that too, like that diet mentality again. Yes, that's been hard for me. That would be. One of my quick and easy tips is try to include a source of protein, carbohydrates, some fiber and fat at all of your meals and eat regularly. If you take one thing away from that today, that will probably help you with your endo.

Speaker 1:

Yes, I wish I would have known that at, like you know, 20 in my early twenties.

Speaker 2:

I think the challenging thing is, you know, we have a bit more of the younger generation that are probably struggling with endosymptoms or maybe learning that they have endo now, but a lot of it is millennials and older and we we were raised in the culture of magazines, kind of touting like how to eat less or it being really normalized to maybe have a contest with your friend for how, you know, skipping a meal or one-upping somebody like, oh it's, I haven't eaten all day, and things like that, and that's still really normalized in our generation and something that I think a lot of people are trying to break away from, and that skipping of meals or not eating enough can really be harmful and it sometimes can make it difficult to lose weight. If that's what people are trying to do.

Speaker 1:

Right, yeah, it really messes with your metabolism. I know I had that very much. So for me, I you know I started and I'm going to be completely vulnerable on this podcast and this is not something I talk about often but because of trauma, because of pain at a very early age, I had some eating disorders and so I went from one disorder to the next because of what I was learning in my environment, and then, on top of that, I was creating an unhealthy version of who I was in my head and it played a part in my adulthood. Going into my adulthood, as my symptoms began becoming more severe, I would either not eat at all or I would binge eat because of that, and then my metabolism was messed up and I think because of that, my whole body felt terrible all the time, and it started at a really young age.

Speaker 1:

And so my husband and I have been very careful about even the way we talk about our bodies around our children, the way that we talk about food around our kids, like we don't restrict our kids from eating sugar, but we do it in moderation and for one kid that works great. The other kid wants sugar all the time as her, like she wants that to be her main course, you know, as a sugar. And so how do we balance talking healthy about food and healthy about our bodies, that ultimately supporting us all the way through our lives? Because I think it starts from a very early age in how we manage our life with food, moving forward and in trauma and in pain. It plays such an integral part of who we are. Like food does that to us?

Speaker 2:

Yes, one thing that's gaining a lot of traction that's actually not new, it started in around 1995 is intuitive eating and a lot of dietitians are moving towards this intuitive eating approach and it's something I'm working on with my clients as well. But the whole framework is about listening to your body and kind of tuning into your health and listening to those intuitive signals for what you're needing at the time and honoring that. So it's about honoring your hunger. Body acceptance kind of accepting your genetics is a big part of it. If every woman in your family has kind of a look and maybe they're like all around 185 pounds and they have this certain build, it's unlikely that you're going to be 120 pound person and not have to severely restrict and work for it for your entire life. And so kind of accepting those genetics and I think a part of that really is important for endo Even with excision surgery people still have symptoms and we have to kind of accept and honor our bodies for what they are and the part that we've been dealt.

Speaker 1:

Thank you for joining us this week, and if this episode gave you some great insights to how to manage your diet and your endometriosis symptoms, then join us again for part two, as we continue with this conversation. You won't want to miss it. Until next time, continue advocating for you and for those that you love.