Endometriosis Foundation of America
Virtual Patient Conference, October 16-18, 2020
Follow Your Gut: Endometriosis & Nutrition - Lilia Bolgov, MS, RD
Diana Falzone:
Up next, we have Lilia Bolgov. She is a registered dietician. She's passionate about helping women with endo and providing evidence-based nutrition, counseling for managing pain and symptoms. Welcome, Lilia.
Lilia Bolgov:
Hi, thank you.
Diana Falzone:
Hi. What a cute little puppy there.
Lilia Bolgov:
Hello, everybody. My name is Lilia, and I'm a registered dietician, and I also have endometriosis. I am honored to be here today to advocate for us, advocate for nutrition, and just to raise awareness to something that's so, so important. I really wanted to talk about quite a bit of things today. We have a lot, but I'm going to try to go through it pretty quickly. Just want to start out by telling that, nutrition is so important in the disease process. What we put in our bodies can have such an effect on our hormones, our inflammation level, and our symptoms, and even fertility. There's so many things that tie into it, and also what I want to really discuss today are the foods that could potentially really aggravate your digestive system, because on top of dealing with endometriosis and pain and everything else, we don't need to deal with the GI distress, because we all have to work and live our lives. There's just so much more that is going on. I think it's so important to discuss what are some things we can avoid and what are some things we can do? I'm also going to give you some tips just to, how to go about it and how to make these changes sustainable.
I'm going to share a quick PowerPoint. Okay, so again, it's Follow Your Gut: Endometriosis and Nutrition. One of the first things I wanted to talk about, I do want to talk about mostly the anti-inflammatory diet, how to include more anti-inflammatory foods and avoid what are the pro-inflammatory foods. Again, these are the foods that can potentially cause, the more stress you put on your body, if you have intolerances or allergies, those are just things that can lead to more inflammation and your body having to react to it as a foreign substance. That's what we want to avoid.
Gluten, I want to talk about separately because it's such a huge topic. Of course, gluten, it's a protein that's found in a lot of wheat, rye, barley, grains, flour, pasta, a lot of the foods that are made with those flours, so those types of grains can all contain gluten. Gluten can be an allergy, a severe allergy, which is manifested as celiac disease. That has to be diagnosed by a physician. However, most people will have some form of gluten intolerance or just not digesting it properly.
Those are foods that you need to avoid. If you're going to do gluten free, you really do have to commit to gluten-free if that's something that you feel like it's really tolerating. When a patient's with endometriosis, just looking at research have shown that up to 50 to 75% of the patients can have some form of gluten intolerance. The reason I also want to talk about it separately is because not everybody does. I don't think it's necessarily ... I don't want to associate these negative ... I guess I don't want to make these negative associations with certain foods and just to say, everybody should just avoid these because it might not be something that necessarily is bad for you, is bad for everybody. It's very individualized. I think those are things that are very important to note.
The other thing is sugar, again, high consumption of sugar, especially simple sugar. Desserts, processed foods, even savory foods that are processed contain a lot of sugar too. Those are things again, that can lead to inflammation in the body and it's just one of those things that I ... that's just overall I would recommend to be definitely in moderation.
Soy. Soy's also a very controversial food. There's a lot of conflicting studies and research showing that certain types of soy are more negatively impact the endometriosis. Some studies shown that soy does not negatively impact endometriosis. It's just really, really, I think, important to kind of separate some of the different research and kind of understand that maybe too much of course, can be ... Too much of anything can negatively impact anyone, but for those who do want to follow a plant-based diet for example, soy can be a really good source of complete protein.
I think if I had to make recommendations, I would definitely say I would be moderate on the soy consumption and I would definitely avoid any processed soy, nonorganic soy, genetically modified soy. Anything like a soy protein isolate that's processed or soy milks, foods like that and more sticking to the more natural forms of soy tempeh, miso. Those can actually ... They're fermented soy and can actually have some positive effects as well.
The last one is dairy. Dairy is again, it's one of those things that some patients, some people can intolerant to and it's not everybody. However, those are the things you kind of have to pay attention to your body and understand that dairy can be, not everybody can digest lactose very well, which is what irritates the digestive system and the GI tract. I think identifying the foods, not everybody's necessarily intolerant to all dairy, a lot of times is just the milk itself or ice creams, things like that, but they can tolerate yogurt or some forms of cheeses like dry cheese. Those are okay. Again, it's kind of important to listen to your body and understand what dairy is to you.
Then next I do want to talk about, so kind of getting to the anti-inflammatory diet. I want to start with the negatives. The foods that we should avoid and then go to the positive. Bad news first, then good news. Some of the foods ... I'm sorry, I can't see my own slide here. Here we go. Anything processed foods, again, I kind of mentioned upon that. That's like fast foods, anything that's cured, anything that's highly processed, anything that's ready to eat. Anything that if you look at the ingredients label and there's just like a whole paragraph of things, likely there's a lot of additives and it's been processed highly. Definitely kind of looking more in food in its natural form, cooking from scratch, trying to buy ... Avoiding non-organic food and then refined grains.
Again, I kind of discussed that with not just gluten content, but as well as just, it doesn't really provide a ton of nutrients because it's been refined, it's been processed, bleached. Really just a lot of it is just a source of sugars and carbohydrates. That's why on the other side is more just including foods that are whole grain. Smoked meats, I jumped a little bit, there we go. Smoked meats again, just high nitrate content. Smoked meats are not necessarily very good, especially if they're red meats, which is the next one. Red meat has been shown to high consumption, especially one or two times a day has shown to almost one and a half times increased the risk of endometriosis, which in red meats also can have hormone disruptors, and there's also red meat is very difficult to digest.
I think red meat is one of the ones that I would definitely recommend to really be wary of, and really if you are going to consume red meat, make sure that it's hormone-free, organic and just know where it's coming from sustainable, but definitely I would stick to not very often.
Then sugary foods kind of what we touched upon before. FODMAPs, I know that's kind of a big one, but it's generally just really short chain carbohydrates. It's found in a lot of foods and they're just very difficult to digest. A lot of GI distress, a lot of times is actually attributed to high FODMAP content foods. Those are foods that have a lot of fructose, a lot of like just very high amounts of fruit, lactose in dairy. Fructans, which is found in grains and rye and barley, which kind of goes back to the gluten. Galactans, which are just large amounts of ... Like if you eat large amount of legumes, we all know we can get a little bit bloated and sugar alcohols, which are found in a lot of like sugar substitutes, those can make you very bloated too.
Those are just the high FODMAP foods. Again, it's one of those things that you can definitely look up and there's a long list and kind of seeing if those foods are something that you want to avoid. Of course, alcohol, caffeine, all those can be taxing on ... Alcohol can be taxing on the liver, which in turn is just it can create more inflammation. Not [inaudible 00:10:07] ... Let me go through these, [inaudible 00:10:09] coffee, not entirely, you don't have to entirely cut it out, but I think important to know that caffeine can definitely irritate your GI system. However, up to a cup of coffee a day, 12 ounces, or 200 milligrams of caffeine is okay. Then we kind of already touched upon gluten and dairy.
Oh, there we go. Let me talk about some of the foods that are on the anti-inflammatory list and it's foods rich in Omega-3 fatty acids, iron, magnesium, such as salmon, mono unsaturated fats that are found in salmon, avocado, sardines, nuts, and seeds really important to, like I said, to kind of just avoid the trans fatty acids and include more of the Omega-3s and dark leafy greens. Just in general, legumes, fresh berries, which fruit and berries, berries have a lot of antioxidants, which can help with that oxidative stress that some of the foods that's already in our bodies, and then also a lot of research has shown that vegetables, just higher consumption of vegetables, decreased symptoms of endometriosis. I think it's important to kind of go, if you can, most days of the week go with a more plant-based approach to the diets.
Then my last slide, I want to just talk about as a dietician, we're not just trained to tell people what to eat. We're also trained in motivational interviewing and also helping people to kind of get to these goals because it's not that easy to just wake up one morning and say, "I'm going to overhaul my entire diet." One of the things I want to talk about is, there I have a clock as one of my pictures and for two reasons, and I wanted to talk about just giving yourself time. It's okay to give yourself time to make these changes, not everything can happen at once. It's not that easy. Giving yourself that space and being kind to yourself and just giving yourself time by setting smaller goals towards ... Smaller changes towards bigger goals.
It can be something very simple. I'm going to cut back to one cup of coffee instead of three cups of coffee, and I'm going to have decaf the rest of the day, just to kind of satisfy those. If that's something that has been a part of my day and that's okay, we all have that. Just being a dietician over a decade, I can go back and forth all the time with experimenting with things and trying things. Some days are better than others, definitely.
The second reason I have the clock is I think it's important to understand that most people want to see changes right away. I want to really stress this, that if you do make a difference in your diet, if you do decide to eliminate something that you think has caused you inflammation or irritation for so long, it takes just as long sometimes to feel better. Even with, for example, when people cut out gluten from their diet, it can take up to six months to a year to really feel the effects of it and actually feel better. I know it's so tempting to just want to cut something out and tomorrow and be like, "Do I feel better?" Really like I said, give it time. Some of the dietary changes that you make might not necessarily manifest themselves until a few months down the road where you actually start feeling better every day and you kind of forget what happened.
My other suggestion is really just sharing with friends and family and building a team around you because that's so important to your mental health and also sustaining these changes. If you're not honest with everybody else about what you're doing, and you don't have that support around you, it's very hard to sustain some of the dietary habits that you were trying to make. Listening to your body, understanding what irritates you, what doesn't, and what works for one person might not work for another person. It's very important to just understand and listen to your body and being intuitive. Then I did put in physical activity in here, I'm a dietician. Exercise is important, but also I do want to talk ... it's important to know that it's not ... Yeah, I'll stop sharing so you can ... Not just physical activity necessarily in the form of vigorous exercise, it can be something very low impact.
It can be something that you just do on a daily basis or maybe five minutes, an hour, whatever is ... Everything's cumulative. There's always ways we can kind of find something to get moving a little bit as much as we can. I know some days are just not made for those. There's some days I wake up and I'm like, "Not today, not running, not doing that," but totally understandable. I think just finding ways to have some physical activity in your life is so important, not just for your weight management, but also for your mental health. It staves off so many different diseases, diabetes, Alzheimer's, heart health. All these changes have so many positive effects in the future and not just for endometriosis, but just in general for your health, so that's it. If you have any questions, I'm so happy to answer. Hopefully, we caught up on time a little bit.
Diana Falzone:
Thank you, and we have a lot of questions, a lot of questions, and people are equally concerned about the coffee part. My buddy here, Sophia wrote, "How about coffee? Can we get a little bit more into that?" Do we have to cut it completely out? How can we at least have one?" Okay.
Lilia Bolgov:
Yes. Absolutely. I'd say up to a cup a day, which is usually it's like a serving of coffee. About two to 250 milligrams of caffeine is okay. I drink coffee too. I try to cut back a little bit to a point where I got to about three quarters of a cup and that's what I need just to kind of start my day because it's hard to make those changes and I need it. It's usually equivalent to like a tall Starbucks coffee or a shot of espresso or just a cup of coffee. Yeah, that's okay.
Diana Falzone:
From Jessica we have, "Would you mind chatting about red meat and alcohol please?"
Lilia Bolgov:
Okay. Red meat, so it's just a lot of the research, if you ... As I was reading through is just that, like I said, red meat has potentially hormone disrupting compounds that can mimic estrogen, sometimes some of the additives, antibiotics, the hormones, the processing that goes on with red meat. It has shown a strong link, specifically red meat and endometriosis, and has shown a strong correlation between people that have a high consumption of red meat, not only to colon cancers and other things like down the road, but also specifically endometriosis because of that gut barrier, gut brain barrier. Then it just kind of has shown to cause a lot of inflammation. Again, I don't think you need to entirely cut it out if you are vegetarian, vegan. Great.
I understand that it's so hard to make these big changes, but as I mentioned, cutting it down to at least maybe one or two times a week from instead of daily, if that's what you do now and also just kind of emphasizing more of it's organic with no additives if you can.
Diana Falzone:
Alcohol.
Lilia Bolgov:
Yes. Alcohol is very taxing on the liver. It turns into simple sugars once it's digested and processed. I think it's just an irritant in general to our bodies and in general to our digestive system and alcohol in regular consumption can cause inflammation in the body, which again, we're trying to avoid since we're already, some of us are already in a pro-inflammatory state just due to the disease process of endometriosis.
Diana Falzone:
Right. We have a good question here from Amanda. She said, "I'm not a huge fish person. Would it be okay to substitute for fish oil or use fish oil supplements instead of eating fish?"
Lilia Bolgov:
Absolutely, yeah. Omega-3 fatty acids, fish oil supplements. Absolutely. Yeah.
Diana Falzone:
Alison, this will be our final question. She says, "By making these changes to our diets, such as cutting out red meat, dairy, et cetera, should we be supplementing with specific nutrients, vitamins and/or minerals that we would otherwise won't be getting any more?"
Lilia Bolgov:
Yeah. If you are following a vegetarian or vegan diet, depending on the source of protein that you are including, because there's a lot of complete protein you can include. As I mentioned, I know tempeh, but also, pea protein. There's different things, but yes, I would definitely recommend for everybody in general, just a general multivitamin or prenatal vitamin. Some of the things we can definitely miss out on are the B vitamins and iron as we cut out a lot of different meats. I would definitely recommend something with iron and B vitamins and just the multivitamin for everybody in general.
Diana Falzone:
We have a little bit more time for about one more question. Leisha asks, "I've heard that some women have cured themselves with nutrition. Is that true? Even possible?"
Lilia Bolgov:
I mean, I can't speak to the medical side of endometriosis, but I think it's, you can make a big difference in the severity of your symptoms and just again, kind of it can be preventative for how bad or how much more worse the endometriosis can progress in the future. I don't think it can be cured. However, I know that certain medications, certain treatments can definitely help with alleviating symptoms. That's a part of what nutrition does too, is it can help with that oxidative stress, that inflammation, that hormone disruption to kind of help your body normalize itself.
I do think it's still important to talk to a medical professional as far as the progression of the disease, because I know everybody experiences symptoms very differently and just because you have a pain-free month doesn't mean that it's necessarily gone, but I do think just important to work with your physician. If you really, again, just everybody, since I'm wrapping up, I think if you guys do have a dietician anywhere that you can speak to, I think it's very important because what we do is very individualized and it's so hard to kind of generalize what is going on with you over this presentation. I do think it's very important to work with somebody because that's part of the recovery process and part of that process of healing.
Diana Falzone:
Thank you. That was very eloquently put because like you said, everyone experiences endometriosis in a different way and everyone also has different food sensitivities. I for one can have dairy, but I sure love my coffee and I'm not sure if it's an issue, but each to their own. Like you said, talk to your doctor, talk to a nutritionist, try to work together and see what works for you. Wonderful, wonderful panel. Thank you so much for that. That was so great.
Lilia Bolgov:
Thank you so much for having me. Again, I'm honored to be here today, so just thank you.
Diana Falzone:
Thank you
