Nutritional practices and dietetic provision in the endometriosis population, with a focus on functional gut symptoms

Abstract

Background Endometriosis is a common condition causing chronic pain, fatigue and gut symptoms. Research suggests that dietary changes may improve symptoms; however, evidence is lacking. The present study aimed to investigate the nutritional practices and needs of individuals with endometriosis (IWE) and the management of endometriosis by dietitians in the UK, focusing on gut symptoms. Methods Two online questionnaires were distributed via social media: a survey of dietitians working with IWE and functional gut symptoms and a survey of IWE. Results All respondents to the dietitian survey (n = 21) used the low fermentable oligosaccharides disaccharides monosaccharides and polyols (FODMAP) diet in IWE, with the majority 69.3% (n = 14), reporting positive adherence and patient benefit. Dietitians recommended more training (85.7%, n = 18) and resources (81%, n = 17) for IWE. Of those who completed the IWE questionnaire (n = 1385), 38.5% (n = 533) had coexisting irritable bowel syndrome. Only 24.1% (n = 330) had satisfactory relief of gut symptoms. The most common symptoms were tiredness, bloating and abdominal pain, experienced by 85.5% (n = 1163), 75.3% (n = 1025) and 67.3% (n = 917), respectively. Some 52.2% (n = 723) had tried dietary modifications to relieve their gut symptoms; 36.7% (n = 500) ate a restricted diet at present; 13.5% (n = 184) experienced recent unintentional weight loss and 29.8% (n = 407) a decreased appetite Some 13.2% (n = 183) had seen a dietitian regarding their gut symptoms. Of those who had not seen a dietitian, 57.7% (n = 693) would find it useful to. Conclusions Gut symptoms and dietary restriction are very common in IWE; however, dietetic input is not. More research on the role of nutrition and dietetics in the management of endometriosis is recommended.

Evolution, adaptation, and new applications of the FODMAP diet

“…Among patients, over 75% reported inadequately controlled GI symptoms, and the majority had tried dietary restrictions to manage these. 90 Despite this uptake of diet therapies for endometriosis, limited data support the efficacy of any given dietary approach. This lack of evidence is reflected in clinical guidelines.…”

“…Similarly, a U.K. survey of dietitians working with endometriosis patients ( n = 21) and women with endometriosis ( n = 1385) showed that all dietitians used the low‐FODMAP diet, and with modest success. Among patients, over 75% reported inadequately controlled GI symptoms, and the majority had tried dietary restrictions to manage these 90 …”

“…Among patients, over 75% reported inadequately controlled GI symptoms, and the majority had tried dietary restrictions to manage these. 90 …”

Self-managed dietary changes and functional gut symptoms in endometriosis: A qualitative interview study

“…The symptoms of endometriosis include chronic pelvic pain arising from painful ovulation, painful periods, and pain during or after sexual intercourse. Gastrointestinal symptoms, including bloating, abdominal pain and change in bowel movement, are also a common feature of endometriosis, affecting up to 36–38.5 % [5] , [6] . In a recent survey, 84 % of UK respondents reported bowel symptoms related to endometriosis [4] .…”

“…Registered dietitians are the only nutrition professionals to be regulated by law in the UK, however dietetic interventions in endometriosis are currently minimal [6] , [20] , [21] . A recent survey undertaken by our group revealed a lack of training, resources and investment in staff, alongside a need for nutritional information from endometriosis patients [6] .…”