Welcome to the new age of diets!! In my mom’s day, there was a low-fat diet… yup, that’s about it. Today, there is seriously a “diet” for every issue under the sun, and some dietary approaches for the same issue (like endo) are about as different as water and oil, which makes it all even more confusing.

Us endo gals could consider “The Endo Diet”, vegan, keto, vegetarian, paleo, carnivore, the candida diet, alkaline diet, Walhs Protocol, lowFODMAP, Paleo AIP, the list goes on and on. And when we don’t feel well and scroll through Instagram, we can feel sick with worry trying to “choose” the best diet for us.

NEWSFLASH: YOUR ENDOMETRIOSIS LIFE SHOULD NOT BE A CRASH DIET

You shouldn’t have to choose a super strict diet mantra to live by. The goal is to eat as diverse as possible from every food group under the sun - focusing on the color of the rainbow, from plant, animal, ocean, earth, and nutrient density - and feel well. I truly believe that just as your ancestors did, and your microbiome agrees.

However, if you’re reading this blog post I’m guessing that you

a) have endo, and

b) are still suffering.

If you had it all figured out, you probably wouldn’t be googling to find your food-based solution to this chronic illness that has become the bane of your existence. Am I right?

And, I understand! Boy do I ever. I myself have my own issues with specific foods (like oranges and egg white, weird). And my clients have totally unique issues as well. Some of them react to eggs, other to dairy, some to FODMAPs, the list goes on. But you don’t just wake up one day knowing what you’re reacting to, you usually have to investigate. How? With therapeutic diets.

What is a therapeutic diet and how does is relate to my endometriosis?

A therapeutic diet is a strict, targeted, and short-term dietary approach to achieve a desired goal, such as digestive, blood sugar, or food intolerance management. And while a medically prescribed diet may be something you’d have to stay on long-term due to a missing organ or serious medical condition, therapeutic diets are meant to be short-term to alleviate symptoms, heal a targeted issue, or gain insight into what foods are flaring you. In my mind, the focus should be on investigation with a Sherlock Holmes-style candor, with the goal to reintroduce as many foods as possible while keeping symptoms at bay.

How it relates to your endo shouldn’t be surprising. Endometriosis symptoms and severity are directly related to issues like blood sugar dysregulation, gut dysbiosis, hormonal imbalances, inflammation, malnutrition, and food intolerances - all issues you can only address through diet and lifestyle. Thus, if you’ve met the health basics and are still battling with some of endo’s worst symptoms, a therapeutic diet may help shift your life from unbearable to manageable. (Although please note, a therapeutic diet is no stand-in for surgery when you need one. Got it? Okay read on).

The Therapeutic Diets I Use Most Often for Endometriosis

The 4 I use in my own practice are the lowFODMAP, low Carb, Specific Carbohydrate Diet, and Paleo AIP. These are all super strict diets that cut out swaths of totally healthy foods to achieve a goal, before reintroducing back all the healthy goodies that were missing for nutrient sufficiency, microbiome diversity, and sanity.

In fact, the MOST important aspect of these therapeutic diets is the reintroduction strategy! This way you can uncover what amazing foods you can tolerate, and which you can’t. You may tolerate grass-fed butter and egg yolks beautifully, although you have to avoid egg whites and cheddar cheese. You may be able to eat unlimited amounts of grass-fed beef, but you actually have to stay away from onions and garlic for a while! #weird. The only way to know is by removing the potential triggers and then reintroducing them one by one while you look for reactions..

**What a therapeutic is NOT is just as important to note. These diets are not crash diets, nor should they be used in a yo-yo diet like fashion.

But how do therapeutic diets work if they’re not supposed to be long-term??

Don’t fret if a short-term therapeutic approach sounds weird. I was there with you 10 years ago when I complained of digestive issues to my doc and he recommended a 2-week elimination diet. Because my food choices hadn’t changed in a decade (I thought it was my digestion that had changed) I couldn’t fathom how my “brand new issues” were related to a decade-long vegetarian diet that didn’t seem to affect me just a few years ago.

Why eliminate foods I’ve eaten for years without problem… until now?

What I didn’t understand was that my new issues were more of the tipping point of my bodily systems. When I thought back, there had been so many symptoms in the years leading up to all this that my body signaled to me something wasn’t right at all. Fatigue, terrible hormonal imbalance, acne, bloating. Oh, I mean BLOATING. Maybe that long-time diet was affecting me more than I realized. Oops.

Thus, to find out what’s triggering you now (not 10 years ago), a therapeutic diet removes the triggers you may be reacting to. Once those issues balance out and you feel quasi-normal again, you start to slowly reintroduce all the foods you had removed to see which/if any bring back the symptoms.

Let’s take chronic bloating/diarrhea for a very simple example. Imagine this symptom is your least favorite, so you do a 2-4 week lowFODMAP and low and behold the symptoms are gone! Now you meticulously reintroduce all the FODMAP groups one by one, even though you’re scared, and find that the only types of FODMAPs you react to are a small handful, so now you just avoid those. Wow, all in 2 months, you fixed that issue you’ve had for 10 years! (again, just an example)

To think about your own worst symptoms, take a sec to jot down how you feel you’re faring with digestion, your moods, your hormones, and your endo. Doing this, you may realize there are quite a few symptoms showing something isn’t going right. You may have some serious gut issues like chronic constipation, diarrhea, or both. You may have migraines, eczema, ovulation pain, and terrible allergies. Depression and anxiety, anyone? Yeah, so in order to find out what’s triggering these symptoms,  we need to find out which foods your body is reacting to, and often the clearest way is to find out through investigation a la therapeutic diet.

The ENORMOUS Problem with therapeutic diets + chronic illness: don’t fall into the trap

If you just celebrated the New Year 2020 with some huge resolution involving following a strict diet this year, you may have fallen into problem numero uno: diets marketed as the dietary solution.

Carnivore seems to be a prime up’n’coming example, competing with ketogenic and vegan. All diets are extremely limited, in all 3 diets it’s impossible to meet your long-term nutrient needs without supplementation, yet all 3 diets have been pushed as a cure-all for everything under the sun, including endo. Each of these diets is also totally different and with enormous following of die-hard converts, which is truly confusing when all you want is to feel better. [And although I don’t use any of these three diets in my own practice, each diet could still offer insight to particular health issues if done in a controlled, short-term fashion, with reintroductions being a key focus.]

However, if we’re talking about a correctly done therapeutic approach - using food as therapy rather than drastic lifestyle swap- the biggest problem I see here is that women can get stuck on these therapies by not understanding how to reintroduce foods, or not understanding lack of progress doesn’t mean failure (not at all!). And sticking on the diet long term can be detrimental to your health, nutrient sufficiency status, and microbiome

So if you feel like you’re stuck and can’t get off without feeling your symptoms race back, get thee to a health professional for further testing. There are often deep gut issues that can be holding you back that need addressing. Some people can eat their way out of dysbiosis, and some people need actual medical and/or naturopathic treatment.

Conversely, although therapeutic diets aim to calm the system, these diets are strict. So if you battle with orthorexia, anorexia, bulimia, or other mental-food-relationship issues proceed with dire caution, if. at. all. It’s also better to avoid a therapeutic diet if it’s stressful in any way, since trading chronic, debilitating stress for some better food options is not the fix you’re after. If this is you, again, work with a professional!

Am I a candidate for a therapeutic diet?

Let me first ask you this: are you a die-hard dieter who is always looking for the next intense diet to “cure” you? If so, I’d say hold the door. Take 10 steps back and make it your goal to simply have a beautiful baseline diet + lifestyle of organic whole foods, sleep 8-9 hours per night, drink 10 cups of water per day (between meals), reduce your stress, and get outdoors and into the sun. For many of my clients I don’t recommend a therapeutic diet at all! Not ever, they just don’t need them after employing these very common-sense health habits.

However, if you have terrible IBS, are married to the toilet, have chronic migraines or allergies, autoimmune issues, painful joints, rashes, acne, or other unbearable symptoms, and have employed common sense health to no avail, a therapeutic diet may be just what you need. But which one is for you?

Which therapeutic diets to consider for endometriosis?

As a certified Nutritional Therapist, Paleo AIP Certified Coach, with continuing education certificates in lowFODMAP diets, the 4 main therapeutic diets I use are:

1) low Carb: usually an excellent starting point for most everyone, also known as a blood-sugar control diet. Just about every client who walks through my doors could use a bit of this one… probably you too, reader ;)

2) lowFODMAP: if you’re an IBS-Endo gal, a lowFODMAP approach may change your life when you realize your garlic obsession (for example) is not only causing you gastric distress but also causing those radical endo-belly flares you thought would never go away.

3) Paleo Autoimmune Protocol (AIP): If you have autoimmune issues, joint pain, brain fog, chronic fatigue or more, an AIP diet may slowly and steadily lower the enormous amount of inflammation in your life so that you can go back to work, or even get pregnant.

4) Specific Carbohydrate Diet: This is a diet used for people with have inflammatory bowel disease or celiac to heal the villi, but it can also be good for any villi that is damaged. SIBO is a form of dysbiosis that damages the villi, and many of us with endo have it.

Curious about when to use these diet? Curious about what you may be able to find, or terrible symptom you may finally be able to overcome? Awesome! Over the next few weeks I’ll be writing about each one individually, when to consider if it’s appropriate for you, and why they’re so darned helpful for certain endo issues. Stay tuned, and happy 2020!