Cutting back on foods that cause gut grief also appears to help women with the inflammatory condition.
The research brings hope to the estimated 120,000 New Zealand women with endometriosis. But it also raises questions about how many other chronic health conditions could be improved with tailored diets.
Endometriosis, which affects up to a tenth of women, is an inflammatory disease. It occurs when tissue similar to the uterus lining (endometrium) is found outside the uterus, typically on the peritoneum, pelvic ligaments, ovaries and bowel in the pelvic region, but occasionally as far away as the lungs.
It is associated with severe period pain, abnormally heavy or prolonged bleeding and chronic abdominal pain. Bowel symptoms similar to those of IBS – abdominal bloating, diarrhoea and/or constipation – are also common. Dyspareunia (painful sexual intercourse) and dyschezia (excessive straining with stools) are two other classic endometriosis symptoms reported by IBS patients.
The symptoms common to both conditions make it difficult for clinicians to tell them apart. As a result, some patients with endometriosis are initially told their bowel is the problem. Still, despite the apparent overlap between the conditions, little research has investigated the topic until now.
The low-Fodmap diet, which has been developed in the past decade, has been a big help for people with IBS. Fodmaps – an acronym of fermentable oligo-, di- and mono-saccharides and polyols – are short-chain carbohydrates with similar properties: first, they draw water from the body into the gut and, second, they’re rapidly fermented by the bacteria in the colon, which produce gases. IBS patients tend to be sensitive to Fodmap-rich foods.
The low-Fodmap diet involves a highly restricted initial phase that is often confusing: while certain fruits and vegetables are recommended, such as oranges and broccoli, other fruits and vegetables must be totally avoided, such as stone fruit and cauliflower. Wheat, onions, garlic and wheat-containing foods are major contributors of fructans that must be avoided in the initial stages.
But there are other problematic Fodmaps, too, such as the sugar polyols in artificially sweetened chewing gums, lactose for people who are lactose-intolerant, the galacto-oligosaccharides found in legumes such as chickpeas, and fructose when consumed in excessive amounts, as is found in honey and certain fruits. After the highly restricted initial phase, different Fodmap-containing foods are then trialled to see if they can be tolerated by each individual.
Given that women with endometriosis experience similar pain to people with IBS, researchers from Melbourne’s Monash University speculated that a low-Fodmap diet might relieve their symptoms.
One hundred and sixty patients of Intus, a private IBS clinic in Christchurch, were recruited for the study, the results of which were published in the Australian and New Zealand Journal of Obstetrics and Gynaecology. All the women had a confirmed IBS diagnosis and 59 (37%) also had endometriosis.
The participants were initially taught how to follow the low-Fodmap diet. After four weeks, 49% of the IBS patients, who did not have endometriosis, reported a significant improvement in their bowel symptoms. And 72% of the women with both the bowel condition and endometriosis reported their symptoms had eased on the diet.
This study is the first to show the benefits of a low-Fodmap diet in patients with endometriosis and raises an important question. IBS is common among women with endometriosis, with up to 90% of endometriosis patients experiencing gastrointestinal symptoms, leading to the suggestion: could IBS in many cases be a symptom of endometriosis? Although a low-Fodmap diet may be beneficial for both conditions, undiagnosed endometriosis can affect fertility, so early diagnosis is vital.
Given dyspareunia, bowel-affected menstruation and pelvic pain were more frequently reported in those with endometriosis than IBS, the researchers recommended that serious consideration of an endometriosis diagnosis be given to patients with these symptoms and a family history of endometriosis.
So, for those with diagnosed endometriosis, trying a low-Fodmap diet under a trained dietitian’s supervision is worth considering.
- Period pain – discomfort is normal but distress is not
- Bowel problems such as bloating, diarrhoea, constipation, painful wind and bowel movements (sometimes diagnosed as irritable bowel syndrome)
- Painful intercourse
- Sub-fertility or infertility
- Tiredness and low energy
- Pain in the lower back
- Pain at ovulation or intermittently
- Premenstrual syndrome (PMS), making you feel moody, emotional or irritable
- Abnormal menstrual bleeding
- Bladder troubles such as interstitial cystitis (IC)
This article was first published in the April 15, 2017 issue of the New Zealand Listener.