Before becoming an infertility counsellor, I knew almost nothing about endometriosis. I am now, unfortunately, all to aware of this horrible disease because so many of my clients suffer from it. And suffer they do.
Endo is typically characterized by unbearable pelvic pain from anywhere from several days to several weeks per month, and extremely heavy menstrual bleeding. Women with endo are often incapacitated for at least several days per month, often experiencing dizziness, depression and vomiting as accompanying side effects. When not caught early on, endo can do severe damage to a woman's reproductive organs and cause permanent infertility.
What upsets me so much about endo is that most of my clients with it spend years going from one doctor to another looking for help and are usually brushed off and told to suck it up, that their symptoms are just typical menstrual cycle symptoms. They are not! This is just pure sexism and misogyny.
The tragedy is that most of my clients don't discover they have endo (because doctors are constantly telling them nothing is wrong!), until they are having difficulty conceiving, and by then often the endo is severe enough to have damaged their egg quality, and/or damaged their uterus, so that they either have to do IVF, use an egg donor and/or use a gestational carrier (surrogate). Like WTF?
Hopefully the way women with endo are treated by the medical community will change. One doctor, Dr. Andrew S. Cook, a physician in the U.S. specializes in treating endo and pelvic pain and has just written a book entitled: The Endometriosis Health and Diet Program.
Since for most of my clients endo is usually treated with surgery, I was very interested to review this book which takes a lifestyle approach to it.
The book contains 4 parts:
Chapters 1 and 2 define the disease, examine different causes of pelvic pain (not just endo), and describe the symptoms. Chapter 3 outlines ways to diagnose it, and Chapter 4 summarizes the leading theories about the causes. Chapter 5 goes through the various conventional medical treatments for endo from hormones, to surgery.
This part of the book covers lifestyle/environmental factors that may be associated with endo: Chapter 6 covers toxins, 7 stress, 8 sleep, 9 exercise, 10 energy, 11 herbal treatments and supplements.
Dr. Cook's 3 phase diet plan
The chapters in Part 1 are clear and well organized and accessible even to those without much of a science or health background, though they are detailed and not dumbed down either. Cook does veer into territory that is a bit eyebrow raising for me, due to the relative lack of evidence. For example, there is a whole page about how wheat/gluten may cause health problems and there are no citations provided. It sounds like he just wrote out the Coles Notes version of Wheat Belly, a book which has been heavily criticized for its lack of credible evidence. Fortunately, in other areas of the book, footnotes show he is getting at least some info from peer-reviewed scientific journals.
I love that Part 2 addresses all key aspects of wellness, including stress, sleep, exercise, etc. The section on herbal treatments and supplements is where I might advise caution. There is little research on these products for treating endo. Don't run out and start taking a daily cocktail of them before consulting your doctor and/or naturopath who is aware of your entire health history and knows what other meds you are taking (herbs and supplements can cause interactions). This is particularly important if you are trying to conceive or undergoing fertility treatments.
The diet plan in Part 3 starts as an elimination diet to see if particular things may be triggering your pelvic pain and endo symptoms. Phase 1 of the plan is not at all appropriate if you are vegetarian or vegan as the only allowable protein sources are meat and seafood. Aside from ghee, dairy is also off the table as are all grains (kinda sounds like a lot of trendy low-carb diets!).
After 1-2 months on Phase 1, Phase 2 reintroduces eggs, nuts, seeds, gluten-free grains, and lentils along with cheese and yogurt.
Following 4 weeks on Phase 2, Phase 3 brings back most whole foods as long as you tolerate them without any flare up of symptoms.
The actual meal plan is a bit problematic for me. First, the breakfasts are tiny. I starve just reading them. Secondly, again, not possible for vegans or vegetarians. Third, your daily snack is bone marrow broth. I will be honest, I hate broth! I also hate this stupid, hipster term for what is essentially bubby's chicken (or beef) soup!
There is nothing wrong with the recipes, though they tend to be really heavy on the coconut oil, which is also a much over-hyped trendy food. I would say, if you try this meal plan and are hungry, lower the amount of coconut oil (and/or ghee or other 'magical' fat sources) and you can add in other foods in larger quantity for the same number of calories.
Though obviously some things about this book irk me, I do recommend it for individuals struggling with endo or pelvic pain, if only because it may help you navigate through a hostile health care system. By educating yourself about the disease you can press for the treatment you need when met with resistance and claims that you are fine and it is all in your head.
The lifestyle suggestions are, for the most part, what we should all be doing: managing stress, eating whole foods, exercising, and getting adequate sleep. Perhaps these factors are even more important for women with endometriosis.
Disclosure: I was sent this book to review, but all opinions on this blog are my own.