Endo Series Part 4: The GUT & Endometriosis - Why The Low FODMAP Diet Often Doesn’t Cut It 🧄
Things people with endometriosis are sick of hearing about their gut symptoms:
Have you tried the low FODMAP diet?
Have you tried cutting out gluten and dairy?
Maybe you should just reduce your stress?
🙄😡🙄😡🙄😡
So helpful isn’t it!
Often people have tried all of these things to no avail. Or maybe they don’t want to – and that’s absolutely fine!
There’s a reason why the low FODMAP diet might not sufficiently help symptoms
OR it might help short term but you find your symptoms returning long term
OR it might be terrible for your relationship with food!
Either way – I want you to know that it’s not your fault.
Gut symptoms in endometriosis are complex. And I wish more people knew why! So that’s what we’re going to chat about today.
Firstly, a couple of facts that might blow your mind:
85-90% of people with endometriosis report digestive symptoms (Ek et al. 2015).
People with endo have 3 x the risk of having IBS (Nabi et al., 2022).
“...researchers discovered that the microbiome and endometriosis development are bidirectional related, implying that any change in the host’s microbiome can have a significant impact on the development and progression of endometriosis” (Ser et al., 2023).
Aka gut symptoms in endo are SUPER common – you’re not alone.
Secondly, the gut symptoms may not only be an uncomfortable symptom in endo but the health of the gut may even contribute to the disease! AND therefore be a key avenue for healing. 🤯
With that being said, most people wonder WHY they have gut symptoms with endo.
Let’s go through the three key ways endo can cause gut symptoms:
1. Altered gut motility
Motility is essentially the movement of food from the top of the tube (mouth) to the bottom of the tube (anus). Peristalsis of our muscles is one way that this happens.
In endometriosis motility can be altered – being either sped up or slowed down. This can be caused by a number of things such as having a tight pelvic floor, endometriosis tissue or adhesions, stress and certain medications just to name a few!
2. Altered gut sensitivity
Everyone on the planet has a connection between our gut and our brain. Many people don’t realise that we have an entire nervous system in out gut. It’s called the enteric nervous system (aka the GUT brain).
The gut brain is connected to the head brain (central nervous system) via the vagus nerve. It’s like we have a little phone in our gut and a little phone in our brain connected by a wire and they’re chatting constantly.
For some people, the chatting feels a lot more like yelling. We call this visceral hypersensitivity.
There’s research that shows that people with endometriosis might have more sensitivity in their bowel and pelvic organs. This heightened sensitivity might explain the increase in pain in people with endo.
Having a highly sensitive gut is not fun and is exactly why we need to not just “cut out foods” but also work alongside our nervous system!
3. Gut microbiota out of balance
We also all have a little ecosystem of microbes in our gut and vulvovaginal area.
Fascinatingly we have research that shows that people with endo might have an increase in the less favourable microbes and a decrease in the more favourable ones.
Because our microbiota play a key role in our health (such as supporting our immune system, producing neurotransmitters and micronutrients) - this is a VERY important finding and hopefully an avenue for future treatment.
I know I just got all science-y on you but hopefully it helps you to understand WHY improving gut symptoms in pelvic pain isn’t quite as simple as “do the low FODMAP diet” or “are you drinking enough water”.
Check out for my next blog post in the series when I give you my top FOUR tips for improving gut symptoms.
Nadia xx
REFERENCES
Ek, M., Roth, B., Ekström, P., Valentin, L., Bengtsson, M., & Ohlsson, B. (2015). Gastrointestinal symptoms among endometriosis patients--A case-cohort study. BMC women's health, 15, 59. https://doi.org/10.1186/s12905-015-0213-2
Nabi, M. Y., Nauhria, S., Reel, M., Londono, S., Vasireddi, A., Elmiry, M., & Ramdass, P. V. A. K. (2022). Endometriosis and irritable bowel syndrome: A systematic review and meta-analyses. Frontiers in medicine, 9, 914356. https://doi.org/10.3389/fmed.2022.914356
Ser, H. L., Au Yong, S. J., Shafiee, M. N., Mokhtar, N. M., & Ali, R. A. R. (2023). Current Updates on the Role of Microbiome in Endometriosis: A Narrative Review. Microorganisms, 11(2), 360. https://doi.org/10.3390/microorganisms11020360