Let’s Talk ‘Endo Belly’: How to manage flares with nutritional therapy

What nutritional tips could help with my ‘endo belly’?

woman showing flower on hands and bare belly

Last week, we talked about all things ‘endo belly’. The potential causes and effects it can have, and how this could inform our approach when managing this frustrating symptom. If you missed part 1, you can check it out here.

When looking at nutritional support for ‘endo belly’, there are a few things we must first consider.

  1. So far, our understanding is generally informed by studies exploring IBS as an endometriosis comorbidity (1,2). Studies of this nature commonly class ‘endo belly’ as a side effect of IBS rather than endo (1,2,3).
  2. This means recommendations may not support the non-IBS-related flares many people experience, often considered unexpected and random, making it difficult to trace the cause (4).
  3. Everybody is different, and everybody’s body is different – it’s one of the things that makes us so unique (and what makes nutritional therapy so interesting!). What causes one person’s flare might not cause another, and vice versa. The following suggestions are general, but if something does not work for you, it may just be because your body reacts differently or is triggered by something else – which is ok.

So, with that being said, the following tips focus on supporting the potential triggers we explored last week: stress, inflammation, and gut issues.

Here are five tips to help you prepare for and manage your next flare.

  1. Probiotics

The link between poor microbial health and endometriosis has been identified in recent years, acknowledging the importance of maintaining gut health (5). Our gut microbes help to regulate numerous processes (energy regulation, oestrogen metabolism, inflammation, and more), and dysregulation can cause a build-up of excess gas, causing bloating (6). That’s where probiotics come in. Probiotics are a type of live bacteria which help repopulate the microbiome with beneficial bacteria (6). This may help to manage not only the IBS-type symptoms that come with ‘endo belly’ but also improve our immune health, further supporting the gut and endometriosis (5,6,7). Numerous strains of probiotics have been identified, and evidence suggests the Lactobacillus strain may offer endo-protective effects by modulating inflammation (6,7).

Sources: kimchi, kombucha, kefir, yogurt, sauerkraut, supplements

2. Stress management

As we go through life, stress is inevitable. It can be sudden, ongoing, or intermittent, but; when it appears, it can wreak havoc on our bodies. When stressed, cortisol is secreted at a higher rate, which, over time, begins to induce an inflammatory response known to aggravate endometriosis development and symptoms (8). This is also considered a leading cause of IBS-type symptoms due to its impact on gut health (9). Introducing deep breathing techniques (4-7-8, for example) or meditation into your daily routine can help re-centre the mind and body (10). This activates the parasympathetic nervous system by reducing the stress response (10). Journaling also offers relief and can help to clear the mind for the day or night ahead.

3. Fibre, and 4. Liquids 

Fibre and liquids are like bread and butter – they just go together! Fibre is an indigestible carbohydrate which requires liquid, typically water, to help its movement through the body, bulking stools to allow them to pass through more easily (11). It supports a range of functions, from oestrogen metabolism to glucose regulation and feeding the gut microbes, as well as many more (11,12). If fibre is not efficiently moving through the body, excess gas can build up and cause bloating (11,12). Getting a range of soluble fibre sources into our diet alongside liquids can ensure we’re receiving its many benefits without enhancing digestive discomfort (11,12).

Sources: flax seeds, chickpeas, kiwi, oats, pears. 

       5. Antioxidants

Antioxidants help to reduce oxidative stress throughout the body by reducing free radicals produced in excess when inflammation is elevated (13). As it’s considered an inflammatory condition, endometriosis is associated with heightened free radicals, which can cause damage to cellular pathways (3,13). This has been found to induce symptoms of endometriosis such as pain, fatigue, and gut problems – as witnessed with ‘endo belly’ (3,13). Antioxidants may help reduce inflammation and microbial damage, increasing gut movement and the microbial population (3,13).

Sources: berries, green tea, peppers, dark chocolate, beetroot.

So, what does this mean for endo belly?

By regularly incorporating these suggestions into your daily routines, we can begin to ease some of the inflammatory and microbial damage endometriosis might have been causing on the body. Keeping note of your flares can also help you identify if there are any specific triggers or causes, helping us prepare for the next time.

It’s necessary to note that while these suggestions may provide benefits when used regularly, endometriosis is an unpredictable and still very-unexplored condition. This means that flare-ups might still occur, and if they do, it is important to remember that that is not your fault. Ensuring we remain kind to ourselves when trying to manage a chronic health condition is imperative to not only our mental health; but also our physical health.

In the words of Kris Jenner, you’re doing amazing, sweetie! I hope this post offers you some support, and if you have any questions, please feel free to drop me a message or get in touch below!

If you’re looking for further support, please feel free to get in touch via my contact page, or email me at jgreen.nutrition@gmail.com.

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  2. Mechsner S. Endometriosis, an Ongoing Pain—Step-by-Step Treatment. Journal of Clinical Medicine. 2022 Jan 17;11(2):467.
  3. Nap A, de Roos N. Endometriosis and the effects of dietary interventions: what are we looking for?. Reproduction and Fertility. 2022 Jun 1;3(2):C14-22.
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  8. Reis FM, Coutinho LM, Vannuccini S, Luisi S, Petraglia F. Is stress a cause or a consequence of endometriosis?. Reproductive Sciences. 2020 Jan;27:39-45.
  9. Ancona A, Petito C, Iavarone I, Petito V, Galasso L, Leonetti A, Turchini L, Belella D, Ferrarrese D, Addolorato G, Armuzzi A. The gut–brain axis in irritable bowel syndrome and inflammatory bowel disease. Digestive and Liver Disease. 2021 Mar 1;53(3):298-305.
  10. Drigas A, Mitsea E. Breathing: A powerfull tool for physical & neuropsychological regulation. The role of mobile apps. Technium Soc. Sci. J.. 2022;28:135.
  11. Patel S, Doerfler B, Boutros K, Ng S, Manuel M, DeSimone E. Review of treatment options for irritable bowel syndrome with constipation and chronic idiopathic constipation. International journal of general medicine. 2021 Apr 21:1457-68.
  12. Bruce E, Makaranka S, Urquhart G, Elsberger B. Does the gut microbiome environment influence response to systemic breast cancer treatment?. Exploration of Targeted Anti-tumor Therapy. 2021;2(4):374.
  13. Piecuch M, Garbicz J, Waliczek M, Malinowska-Borowska J, Rozentryt P. I Am the 1 in 10—What Should I Eat? A Research Review of Nutrition in Endometriosis. Nutrients. 2022 Dec 11;14(24):5283.

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