There are a handful of things I do believe all endo patients deal with across the board. But one is rarely linked to endo when it comes to the dietary recommendations: Blood-Sugar Dysregulation. That’s right, it’s the endo girls’ enemy #1 on many levels, but it’s rarely focused on

More often, we hear remove allergens, remove meat, remove dairy, remove eggs, lower fat, remove remove remove. Then, by removing all these incredibly nourishing foods that balance blood sugar, we end up eating a lot of fruit, a lot of starches, a lot of grains or gluten free things, and our blood sugar rollercoaster gets supercharged, and the symptoms get worse, so we remove even more, and suddenly we’re only eating fruits, starches, and grains, and the blood sugar rollercoaster is now going lightspeed, and…. OUCH. Insert big fat endo flair, insert energy-draining, insert fingernails chipping and hair turning brittle, insert endo-belly, a whole lot of un-health. Bummer.

Wait, what is blood sugar again? And how is it associated with endometriosis?

I’m glad you asked! If you want the deep dive, please read this awesome blog on endometriosis and blood sugar here!

Quick recap? When carbohydrate consumption dominates over quality protein, fat, and fiber, your blood sugar will start to rollercoaster—where your glucose, insulin, hunger levels, and energy levels spike and plummet all day long. Blood sugar rollercoasters like this affect the vast majority of Americans, starting with low blood sugar dips (shaking or feeling faint when hungry), becoming hungry so fast you feel “hangry” (hungry + angry), or hypoglycemia.

A blood sugar rollercoaster means two things that are important to endo: 1) sometimes you will have excess glucose and insulin in your system, and 2) other times you’ll have too little glucose. Unfortunately, both may influence the way our endo behaves, from creation of inflammation to directly provoking the immune dysfunction witnessed around lesions.

Symptoms of Blood Sugar Dysregulation

Most of us actually have no' clue we have blood sugar dysregulation as we've so normalized the symptoms associated with it. Since most of us have been dealing with it since childhood, we honestly don’t even know there’s another way. I myself had no idea I was in so deep until the wild ride was over (hindsight is 20/20 it turns out). If you're like me, here are a few clues you’re in deep:

Hangry: Hunger + angry. Before meals you feel shaky, irritable, or weak. If meals are delayed you’re a demon  - or maybe you’re faint. When hunger strikes, you find it hard to go another second without eating. You may even define yourself by this as a hypoglycemic. This is probably most people you know.

Can’t not-snack: If you ate breakfast and then told you “no food or drinks besides water for 4 hours” you’d be terrified, angry, and claw at me. In fact, you may not be able to go more than 2 hours without snacking or drinking anything besides water.

You’re addicted to “sweet”: I work with a lot of girls that say they never eat sugar, but oh-my-lawdy do they eat sweet! Cold pressed juices, paleo things smothered in maple syrup or honey,  6-10 servings of fruit per day, “healthy” treats/snacks such as breakfast bars, snack bars, chia puddings, sorbets, pancakes … all with just as much glucose as a whoopee pie. Could you easily not eat "sweet" for a week?

Your emotions and energy levels are wild: maybe your temper flares, your emotions fluctuate, you're energized then crash. Fatigue is very present in your life. Maybe you think you’re hard-wired for chronic stress and anxiety. You also think this is pretty normal since everyone has this problem, right?? Ahem.... 

You can’t seem to lose weight, no matter how many low-calorie or low-fat diets you do: And you especially gain weight around your middle. You may even be in a calorie deficit and still be gaining weight, this is very possible for someone who's insulin resistant (have blood sugar chaos)

Endo-Belly: Constant bloating can be a big sign that there are too many carbohydrates being consumed.

You have diabetes, pre-diabetes, reactive hypoglycemia, or PCOS: Obviously at this point, you have clinical levels of blood sugar dysregulation and insulin resistance. I just have to say it in case there's any question at all :)

Ok, how’d you do reading those, any one of them resonate? I'm guessing at least a handful did, because I know very few people who aren’t on the blood sugar rollercoaster. Except for some of my kick-butt clients who conquered that issue and are living the dream! You know who you are.

The Endometriosis Diet Elephant in the Room: Blood Sugar

If you’re confused about how you got here, please know it’s not your fault!! It’s not. The world is so confusing when it comes to health.

I even just, this very second, looked around some trendy sites for endometriosis and food and, well, most of it makes me sad. Everything is sweet: vegan sweet French toast or pancakes, “natural" sugary beverages, juices and smoothies, “healthy” cookies, cakes, bars, granolas, oats covered in fruit and honey. Things that aren't sweet are still 100% glucose driven: There are gluten-free bread, toasts, pastries, pasta, pizzas, bowls and bowls of grains, beans, starches, sugars in hiding. These recipes are meat-free, egg-free, dairy-free, mostly low-fat, and thus NUTRIENT-FREE and INSULIN-SPIKING and therefore inflammatory because of both.

But wow, they sure do look delicious … for dessert ;)

8 Tips to Get off the Blood Sugar (Endometriosis-Provoking) Rollercoaster

For some of you, this won’t be easy - because being on the blood sugar rollercoaster is a little bit like being on crack - but here are a few pointers to start easing you out of glucose purgatory and starting to heal anew.

1) First, just replace processed foods with whole foods

This is the most straightforward step needed for those of you eating a lot of processed foods, be they gluten-free or not. If it's in a box or a bag, swap it out with whole foods fare. This is the best switch to do today on so many levels, and I know you can do this! Fill your carb coffers with carbohydrates that offer nutrients, like sweet potatoes and squash, instead of processed, refined fare that offers you nothing. If you're already doing this, read on.

2) Limit fruit to 1-2 servings (not pieces) per day

I sometimes have to work hard to convince my clients why this is appropriate since we’ve been told for so long that fruit is healthy. And it is! In…moderation. Think of fruit as a vegetable with more sugar in it. Eat fruit, enjoy it in moderation, eat it with fat to prevent sugar spikes (like apples + almond butter, strawberries + cream), but be aware if your cravings for it are much higher than you realized - Some of you may literally be eating 8-10 servings of fruit per day. Also, be aware of serving size - some jumbo fruits are actually 2-3 servings, while some smoothies,  juices, and bowls become a whopping 4-5 servings worth of fruit!

3) Don’t cut out carbs completely

This goes out to you fad dieters already googling keto on a separate page. Ketogenic diets are extremely low carb, with less than 50g of carbohydrates per day. Where there is a time and place for such a therapeutic diet, I don’t believe it’s for most people, and even more so if you’re of childbearing age with hormonal imbalances. If you want to be able to stick with this food shift long-term, such a restrictive diet won't help you make this a lifestyle change - which is what you want this to be. So

General rule of thumb? Eat less carbs overall, with a focus on whole foods carbs (also known as low + slow carb). Axe simple sugars and processed refined foods, then allow a moderate amount of starches and fruits. This is like prioritizing fats, proteins, and non-starchy carbs as the staple of your meal, rather than prioritizing starches (like the USDA tells you to do). Make this fun, enjoyable, and delicious - not your next fad diet.

4) cut the excess sugar

This might hurt! Go through your pantry and fridge and work diligently to remove all the hidden sugars. Yup, sugar is sneaky added to ketchup, mustard, mayo, tomato sauce, salad dressings, condiments, etc. Look for honey, molasses, maple syrup, fructose, and all the other natural sweeteners too. Why is it in everything? Because we, as a nation and world, are addicted. Food manufactures are simply supplying us our drugs. Read labels and swap out for the many options now available that are free from sugar.

5) Unsubscribe from sites and Social accounts that tempt you.

OMG the photos are so pretty!!!! But looking at some of these sugar-laden recipes all I can see (as a nutritional therapist dedicated to helping women from endometriosis heal into remission) is that these women bloggers, authors, and cooks are soooooo addicted to sugar. I know they’re very well-meaning, but don’t let them tempt you because they can’t break up with “sweet” themselves. Thank them, and break up with them before they send you another recipe for “healthy” vegan breakfast cookies or “high protein” chocolate cups. Focus on healing.

6) Eat protein and fat with every meal, and make your BREAKFAST count!

Yup, I’m that woman with endometriosis who advocates for meat, eggs, and even raw dairy if you can tolerate it. Only 100% grass-fed or pastured, of course, duh. And lucky for us, proteins and fats are the only two macronutrients that don’t spike blood sugar. That's why this is the only way you’re going to be able to survive when you replace that rich carbohydrate food source with something that won't cause the insulin-spiking systemic inflammation. So don't just cut out more, replace that glucose hit with delicious, satiating fats and proteins.

The best place to start? Breakfast!! Breakfast sets your whole day for success, so make it your goal to eat as much fat + protein (filled out with veggies of course) as you can at this morning meal so that you can attempt to make it to lunch without needing food. When you achieve this goal, I give you permission to dance embarrassingly wherever you are.

**If you can't digest protein or fat I have another blog coming for you, hang in there :) 

7) Eventually make your meals bigger so you can wean off of snacks

You rarely hear this piece of advice because so many dietitians are telling you to snack all the time to "keep blood sugar stable". They're telling this, of course, to a land of blood-sugar zombies. Truth is, if you want to really step off the rollercoaster for good, aim to slowly wean yourself off snacks while you make your meals much much bigger (per above). Big enough and nutritious enough to hold you over 4-5 hours between meals to keep you from snacking. This won't be easy - or even possible right now - for most of you, but keep it in the back of your mind as you get stronger and less addicted to quick-energy fixes. This will help re-sensitize your cells to insulin again, as long as your meals are serious.

Rule of thumb to start moving this direction: If you find yourself crashing or craving anything within 2-3 hours of eating, immediately up the amount of fat, protein, and the size of your meals. I don't care about the calories - if you're not making it a few simple hours then you’re simply not eating enough, and by not eating enough you're forcing yourself back on the rollercoaster.

8) Pretty please don’t calorie restrict.

This is the hardest thing for some women to conquer, and may be why your paleo (or even keto) diet is leaving you with as much fatigue and blood sugar issues as before. When women adopt these diets, they may do so with a goal of being thin in the back of their minds. Again, not your fault, we were trained this way. So, now’s the time to UN-train this practice. Calorie restriction and/or skipping meals affects our rollercoaster the same as too much sugar.

The cool thing is that by eliminating sugars and refined foods, and limiting starches and fruits, your body will naturally crave what it needs. This is called intuitive eating, following your body’s cues to eat what it wants, when it wants. You may even find that your body wants to gorge on certain foods while you give her the green light to eat what she’s been starving for, maybe for decades. So let her eat, and watch as she climbs off the blood-sugar rollercoaster all by herself :)

Endometriosis Diet Takeaway: Eat real food in its whole food form that's not a desert in disguise.

If you do so, many of you should start to see "miraculous" results of pain, bloat, skin issues, fatigue issues and more start to minimizing within a few weeks. Who needs those chocolate breakfast bars anyways ;)

In Aloha

Katie

I am a Nutritional Therapist, certified through the Nutritional Therapy Association, but I am not a dietitian, doctor, or medical professional, and this site is solely for guidance and information to give people more information to make an informed decision about their own bodies best treatment plan. Please check with your doctor or care provider before making changes in your life