Endo Belly Series Part 2: Digestion
A few weeks ago we covered how endo belly bloating can be exacerbated by the core musculature’s inability to properly hold your organs in. This resembles bloating, as your internal organs get pushed forward. Real bloating is different, when the inside of the body is filling up with something (usually gas and water), which pushes the contents of the abdomen out.
And to be clear, if you have core dysfunction PLUS bloating, you may have a really, really huge endo belly! It’s why I started this series talking about the core musculature because, for many of us, it sets the foundation for one ENORMOUSNESS endo belly (see image below). If you didn’t read that post, check it out here.
Back to bloating, there are really many reasons your internal ecosystem is filling up with gas and water. And the problem could be anywhere, from the stomach to somewhere in the 17 ft of the small intestine or perhaps the winding large intestine. So many things to talk about! Yet, for today’s sake, we’re going to talk about the most “low-hanging fruit” (i.e. easiest to correct) problem I see with endo-belly clients, and luckily something that may start to deflate your bloat asap.
Endo Belly Trigger du Jour: Poor Digestion
After you eat do you feel like a lump of coal has hit your insides and won’t move? Do you often feel uncomfortably full? Do you have heartburn, gastritis, or acid reflux? Does your stool have partially digested food in it? Do you have a hard time salivating? And, yes, do you bloat big after meals? Meet some classic symptoms of poor digestion, and boy can this make you bloat like a balloon.
Digestion is the very first thing that happens after you eat. It’s an essential step, since digestion is what breaks down those proteins, fats, and carbohydrates into teeny tiny particles that can be absorbed in your intestinal tract. So digestion happens first, then absorption next — two totally different processes in totally different places.
These particles also need to be teeny tiny so they don’t putrefy or ferment in your small intestine … or feed the wrong types of bacteria (which produce gases that bloat you). So, if your digestion is NOT working, and large (undigested) pieces of fats, carbs, and proteins are making it to your small intestine, get ready for some bloat-a-licious issues. Not to mention some right quadrant pain as your IVC becomes super inflamed (read all about that specific endo belly issue here).
How does digestion even happen? It’s so much more than the stomach!
The magic of turning food into microscopic bits before it gets to the small intestine is a four-step process we take for granted. Let’s learn about the four steps that are needed (so we can see if all of yours are working).
1) Digestion starts in the mouth! First there’s grinding to a pulp, which takes the heavy lifting off your other organs. If you see big pieces of food in your stool, blame a lazy mouth before anything else. Second, saliva has a digestive enzyme called salivary amylase, which is crucial for breaking down carbohydrates. If you’re not salivating, your carbs will become a bloating feast for wanton bacteria below. Last, chewing/salivating is essential for mental signaling. When you tune in to your meal with taste, relaxation, and saliva, you signal to the digestive organs below to “start their engines.” That’s why the simple act of chewing well is so crucial (and why when you eat a meal fast and without tasting it, you feel like a brick has landed in your tummy and zero digestion is occurring).
2) Next comes the stomach, whose primary role is breaking down animal proteins, cleaving minerals, and disinfecting pathogens with all that acid. Your stomach is an acidic organ, and it’s supposed to be! Think of that cyborg in Terminator melting into molten metal. This is what your stomach does to your food.
3) On entrance to your small intestine, this food-goo is hit by a wave of pancreatic digestive enzymes to break everything down even more! You know those expensive digestive enzymes you buy at the store? Yah, your pancreas makes those. It also releases sodium bicarbonate (like baking soda) to neutralize all that acid from your stomach so it doesn’t burn your other parts.
4) Up next, the gallbladder releases bile, your fat emulsifier. Without proper bile levels, you won’t be digesting or absorbing your fats very well.
There you have it! Your protein, fats, and carbs are now broken down into teeny tiny pieces, ready to be absorbed for the remainder of the small intestine.
**For the whiz kids out there, yes, there is even more digestion that happens in the intestinal tract thanks to the brush border enzymes. So if you have a damaged intestinal lining, this is even one more digestive step that will be missing.
Why Bonkers Digestion Causes Endo Belly Bloat
If something along this digestive chain is NOT working (or perhaps everything along this line), that food you eat will not be microscopic nutrient packets. It will instead be gross chunks of protein, fats, and carbohydrates just waiting to blow your stomach up like a balloon and make you feel oh-my-gawd uncomfortable. There are two main reasons why:
In-tact (i.e. whole) carbohydrates, fats, and proteins left in a moist, 98 degree environment will ferment or putrefy, growing in size. If you want an example go to a hot, wet tropical climate (like the Amazon) and leave your smoothie there, in a closed container, for the day. When you come back and open it, you will BAM be hit in the face by exploding smoothie as the contents ballooned in size! This is what happens inside your tummy too. Eww, gross.
Poorly digested carbohydrates, fats, and proteins feed certain types of bacteria in the intestinal tract that can a) overgrow and b) produce gases as they eat. If you have a large overgrowth, you can even lie down after you eat and watch it happen before your eyes: the steady inflation of your stomach as if someone was inflating a balloon in your middle.
Here’s an image of what I’m talking about. Notice the picture on the left, how one big meal is broken down into tiny particles and doesn’t make a bloating impact. On the right, that meal is barely broken down, leaving a festering pile of mush for your intestines to handle on their own. Poor intestines! Let the bloat begin. So let’s help our body out by repairing our sad, broken digestive “machine”.
Let’s Start Fixing Endometriosis Bloating!
Ready to turn those disgustingly enormous chunks of food into teeny tiny particles that feed your body while starving yucky bacteria and yeasts? Great! It’s something I dive into in-depth in my best-selling book, Heal Endo. If you want 3 free tips in the meantime, read on.
1) Endometriosis bloating starts in … your brain?
The number one tip I have for everyone, whether you have a terrible case of SIBO or a minor case of acid indigestion, is this: CHEW and salivate. It’s such a boring recommendation that most people cry when I reiterate it over and over and over. They’re like “No way! I just know I have parasites with bloating like this! Give me a parasite cleanse!”
But the reality is, without chewing, nothing will work below. Nada. What you’ll get instead is stagnation and, yes, in some case an environment so sad and sick it could indeed become a place where grossies set up … like SIBO, candida, giardia or even some trendy new parasite to worry about.
This is why focusing on Meal Hygiene — chewing, salivating, and enjoying meals in a stress-free environment (which allows you to chew and salivate) — is your big-ticket lifestyle swap that will help pop endo belly AND keep it at bay for the rest of your life.
“Seriously, I have to chew and salivate my whole life?” you ask. “Yes” I reply, “forever. So, best start now.” Especially since it can take a while to realllllly incorporate this boring ‘ol tip. But it can be done (said one who personally didn’t know how to salivate and who’s jaw was tired and needed a nap after actually chewing a salad).
POP QUIZ: Am I stressed when I eat? There is a great way to check-in. Quite simply, see if you can salivate. Can you? While you’re eating? If yes, then your body is doing well! You’re not stressed (at this one meal), and your digestive juices are firing. No saliva at all?? Don’t worry, you are not broken, just really stressed and quite disconnected from your food. Make this the first focus of your endo belly journey before anything else
Tips for best Meal Hygiene Ever:
Make your food flavorful with herbs and spices, not simply salty. Flavorful food will help connect your mind-mouth wire and get you salivating and tasting. Think of ethnic cuisine that uses a lot more spices than bland old American fare, like South American, Thai, Indian, Spanish, etc. I LOVE Sababa, an Israeli cookbook!
If you really have difficulty salivating and need to wake these glands up, bring a 4oz glass of water to the table filled with 2tsp apple cider vinegar or lemon juice, or 1 tsp bitters. In between swallows sip on a bit of the concoction to help *bing* force some saliva to secrete.
Chew your food to a pulp. This will take a while, and even longer if your jaw and tongue are atrophied from not chewing in, like, your whole life. The more atrophied your face, the bigger break it may need. While you’re strengthening this essential musclature, try soft cooked veggies and meats like stews and soups instead of large kale salads for coleslaw (leave those for when your tongue and jaw are stellar chewers!).
Eat with a friend, not your phone. This is what’s so fun about Heal Endo, you can actually have fun with people and live a better life with these tips! No one really likes being addicted to phones and mindlessly scrolling, but sometimes we need help making new friends to eat lunch with. If this is you, here are some fun conversation starters :)
2) To heal endometriosis bloating, take a digestive enzyme
This is not to take the place of chewing and salivating, but rather a crutch to lean on in addition. If you have endo-belly, I can almost guarentee with certainty you haven’t been digesting your food for ages. Maybe eons. So popping a helpful digestive support have be sink or swim for many of us as we learn to rehab the whole process.
There are many quality brands on the market, such as Biotics, Seeking Health, Pure Encapsulations, Thorne, and more. I personally like Digest Gold by Enzymedica and/or SIBB-Zymes by Klaire Labs (which are brush border enzymes). You may also need consider something like oxbile if you need extra support digesting fats. If you’ve tried one digestive enzyme and it didn’t do much, you may consider another brand, or a double dose. Maybe even a triple dose if you’re really, really in need. Play around with it. Rule of thumb is that if it gives you symptoms (like bloating, diarrhea, etc) rather than relieving symptoms, then you’re taking too many.
The one thing in the endo world to be watchful for is an ingredient in many digestive enzymes called Betaine HCL, which is stomach acid replacer. Many of us desperately need more stomach acid, but if you’ve been on birth control, painkillers, and other pharmaceuticals for a while (not to mention dealing with intestinal inflammation and stress), your stomach may not yet be ready for this addition — i.e. it can burn you. Or, it may be totally fine for you. If you’re interested in understanding supplemental stomach acid (it’s importance! and it’s caution!) check out my Endo Belly ebook for detailed instructions on finding your dose).
3) To heal endometriosis bloating, do not graze between meals.
This is a tip of nearly biblical proportions here at Heal Endo. I want you to avoid sipping or nibbling anything (besides water) in between meals. If this is hard for you, start by avoiding all food/beverage consumption for 3 hours and, as your blood sugar balances, work to elongate meal spacing to 4 or 5 hours. Without grazing, snacking, nada. [Did you watch Ted Lasso? If not you should! When you do, notice how he opens a jar of peanut butter, leaves it on the counter, and eats a bite every time he walks by. I used to do something similar. DO NOT DO THIS. But still, watch the show, it’s a fav]
Watch Ted Lasso (great show), but don’t be like Ted and eat a bite of peanut butter every time you walk by the, kitchen. No more grazing, this is a firm rule.
Why the dogma? Because digestion is a task your body must prioritize. So, anytime you eat, the body focuses on digesting for an hour or so. Then, when finished, it focuses on nutrient absorption and small intestinal mobility (basically, moving that food along the 17 feet of small intestine). If you graze all day long, your body will never ever, never ever, get out of the digestion phase … which is exhausting. Literally, you will feel exhausted and bloated by the end of the day. This was so me, and I bet it’s so you too.
In addition, your digestive organs can become fatigued themselves, in a way. Digestive juices take a lot of work/ingredients to make, so if you’re mindlessly grazing all day, shoving little bits of food into your stomach every hour or less, your digestive organs may start to protest with a whole lot of “I’m over this”. This may be why your stomach feels heavy and awful, like you can no longer digests protein (why that burger felt like it sat in your stomach for hoursssss), or why you balloon out when you eat carbs (and were forced into a carnivore diet). So let’s give the whole body a break :)
Your goal is to come to your meal hungry and ready to eat, which will help re-establish that digestive connection rather than stagnation. Aim for three solid meals per day, so your body will only need to digest 3x a day instead of 30x.
If your body needs lots of extra help digesting and three full meals feels like way too much food at once, consider starting with 4-5 smaller meals per day and slowly decrease to 3 as you’re able. Remember chewing, salivating, and eating in a lovely stress-free environment.