Advice for dietary choices

2017, Responses from: Clarice Hebblethwaite and Courtney Hibberd

It can be hard to balance diet between multiple health conditions. Any advice on how to balance healthy food choices so that the food intake doesn’t seem really restricted? I’d love some advice on how to eat with IC (interstitial cystitis), as I and others I know do struggle with it.

Clarice Hebblethwaite: Ideally when planning a diet all health issues are taken into account. There may well be food intolerances and in the case of Endometriosis this may be to some of the FODMAP group of foods. Alternatively in the case of Endometriosis and Interstitial cystitis there could be intolerances to Histamine rich foods.

The key is to only eliminate suspects for a trial period and then re test them to ensure as much variety of foods stays in the diet. There must be improvements in symptoms to warrant staying on any restriction and over time foods may be introduced again. We now believe that it is best to keep small amounts of poorly tolerated foods in the diet as a way of building tolerance. The exception to this is food allergies resulting in severe symptoms including anaphylaxis.

Ultimately I believe the burden of a severely restricted diet must not outweigh the benefits on symptoms. All too often people are on an ever reducing number of foods and the stress of this and depletions of nutrients can undermine the benefits on health.

Whenever we look at eliminating foods we must equally look at all the foods that can be eaten and the financial, social and emotional impact of having more flexibility on eating. We should also be addressing ways to overcome food intolerance.

For both conditions of Endometriosis and Interstitial cystitis I do recommend dietary changes are done with the guidance of a dietitian specialised in intolerances and allergies.

Courtney Hibberd: Managing multiple medical conditions can be tricky especially if there are concerns that diet may be contributing towards the symptoms.

But eating a wide and varied diet is one of the best ways to keep yourself (mentally) and your body (physically) in tip top condition.

Undertaking an elimination diet to try and identify foods that may trigger a symptom is best done under the guidance of an experienced allergy and food intolerance dietitian. They will provide you with the tools to identify whether food is contributing towards a flare of your interstitial cystitis and or endometriosis symptoms; and at the same time, ensure your diet remains nutritionally adequate and as varied as possible. Keeping to fresh foods and decreasing pre-packaged or processed foods can help manage your symptoms as well as make it easier to identify what might be triggering a flare.

As with a lot of food intolerances, they are often dose dependent – i.e. the more you eat of a particular food the worse the symptoms are likely to be. However, small amounts spread out over the day or week are likely to be well tolerated. This also helps to prevent over restricting the diet.

I struggle with the concept of everyone panicking that they have to completely cut out lots of food groups (as is advertised in the so-called Endo diet), so I would like some more info on what is important with Endo and what we should be focusing on dietary wise. Does everyone with Endometriosis need to eliminate things from their diet, or do some people not have symptom improvement through diet?

Clarice Hebblethwaite: It’s true there are so many dietary approaches and many contradict each other. It can seem more confusing than ever. So, what may work for one person does not always fit another and may change at different stages of life.

More than ever the diet needs to be tailored to the person individually. One person may have the most vitality and be in optimal health being Vegan and another person feel the same way on a Paleo inspired diet.

Regarding the Endo diet, this is picking up on the themes of other ‘anti- inflammatory’ diets in which certain foods are seen as anti -inflammatory or pro- inflammatory. When the body has higher levels of inflammation typically this can lead to higher levels of pain in conditions including Endometriosis.

Here I’ll address some of the key points of the ‘anti- inflammatory’ diets:

  • It is certainly true that having a diet rich in many colourful vegetables and fruits containing phytonutrients help minimise oxidation in the body so lessen the levels of inflammation. So many advocate eating 5-8 serves a day of colourful fibrous vegetables and fruits, especially berries.
  • There is good agreement for health that reducing added sugars is a good idea for supporting good immune health and that added sugar can be associated with higher levels of inflammation.
  • It is also widely agreed that eating more omega 3 oily rich foods versus omega 6 oils can help reduce inflammation. So, incorporating omega 3 rich oils such as linseed, flax oil, oily fish and walnuts in place of the vegetable oils in our diet helps this ratio change in our body.
  • There is some research for reducing saturated fat from red meats and dairy foods in inflammatory conditions. Generally, we in New Zealand are eating much more red meat than is recommended given the sizes of our portions so reducing to smaller portions (i.e. 90 g) and replacing some red meat meals with vegetarian or fish meals is usually beneficial.
    In the case of reducing dairy, there are different reasons why this may be done. Some people are allergic or intolerant to dairy foods either because of the protein called casein or the sugar called lactose or histamine in fermented or aged dairy foods. There is also some research to show that cows’ milk has insulin growth like factors stimulating oestrogen effects in the body including that of Endometriosis.

In the first question I explain about whether there is a need to eliminate foods from the diet.

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