Bloating, Acid Reflux & Loose Stools with endometriosis? Your pancreas may be the culprit.
Many women living with endometriosis are quick to assume that stomach pain, bloating and other gastrointestinal upsets, are just par for the course with endo. Let me tell you something...it’s not!
When it comes to gut health, virtually ALL endobabes at some point or another experience issues and imbalances with their gut resulting in bloating, pain, diarrhea, nausea, acid reflux, loose stools — the list goes on and on. The relationship between endometriosis and gut health, however, is complicated simply because there are a multitude of factors that can influence the health of your gut. On the one hand, systemic inflammation and stress caused by endometriosis can lead to gut issues, but on the other hand, a sub-optimal gut can cause a number of unpleasant symptoms.
What does this all mean? It means that when our body signals that something might not be right in the gut, it’s important to get to the root of the issue and address what’s going on. If you have any persistent symptom that suggests your gut isn’t functioning optimally, then it’s time to dig deeper.
Remember, 70-80% of our immune system lives in the gut. And, when our gut isn’t functioning right, it can have a huge impact on how nutrients are digested and absorbed by the body. And, most endobabes have a dysfunctional immune system, thus underscoring just how important it is to have your gut health intact and working optimally.
“I SEE FIRSTHAND JUST HOW COMMON LOW PANCREATIC ELASTASE ACTUALLY IS AMONG ENDOWARRIORS, YET IT’S SOMETHING MOST WOMEN KNOW VERY LITTLE ABOUT.”
A lesser known cause of endobelly: Low pancreatic elastase
Because gut health is so comprehensive, there truly are dozens of factors that may impact your gut health. Common risk factors might include a simple lack of fiber in the diet or dehydration, but then of course there are other more unconventional factors that can contribute to unpleasant symptoms, like gut pathogens and parasites, small intestine bacterial overgrowth (SIBO), and something called low pancreatic elastase, which is an indirect marker, measured in stool, of pancreatic function.
As a registered dietitian working to support women with endometriosis, I see firsthand just how common low pancreatic elastase actually is among endowarriors, yet it’s something most women know very little about. Elastase, an enzyme made by tissue in the pancreas, is a helpful marker of pancreatic function. What does this mean? It means that when it shows up low in the stools, it may indicate a problem with the break down of fats, proteins and carbohydrates after you eat. When the pancreas does not secrete enough elastase, not only is this a possible indicator that your body is not sufficiently digesting and absorbing nutrients from the foods you eat, but it may also explain why you experience bloating, acid reflux, loose stools and/or diarrhea, abdominal pain, loss of appetite or feeling full quickly, as well as weight loss.
3 COMMON SYMPTOMS INDICATIVE OF A LOW FECAL ELASTASE WITH ENDOMETRIOSIS
1. Acid Reflux/Low Stomach Acid
Reflux is most often a symptom of low stomach acid. Stomach acid is a signal to the rest of the digestive tract for a number of important things like opening the sphincter between the stomach and the small intestine. When that stomach acid signal is insufficient, it may result in slow motility, causing food to move slower through the digestive tract. Adequate stomach acid also stimulates the production of bile and signals the pancreas to secrete digestive enzymes including amylase, lipase and protease to help the body digest carbohydrates, fats and proteins.
2. Persistent Bloating
Similar to the above, if the body is not producing stomach acid sufficiently and isn’t properly signalling the body to produce key fluids necessary for digestion like bile and said enzymes, then part of those macronutrients in the foods you’re eating may make their way through the digestive tract undigested into the gut where fermentation by gut bacteria begins, resulting in persistent bloating.
3. Diarrhea & Loose Stools
When food makes its way through the digestive tract undigested, it can impact the health of your stools. When the pancreas isn’t producing digestive enzymes adequately, it’s not uncommon to experience diarrhea, or stools that are loose, fatty or mucousy looking, or that contain undigested foods and roughage from fibres like lentils or legumes. Sometimes endobabes may also experience weightloss as a result of foods passing through the stool undigested and not adequately being absorbed by the body.
CAUSES & DIAGNOSIS OF LOW FECAL ELASTASE IN ENDOWARRIORS
As mentioned, gut issues with endobabes tend to be complex and sort of like a double-edged sword because they can manifest as a result of inflammation from endometriosis, or from other causes thus contributing to an increase in inflammation. With low pancreatic elastase in particular, there are a handful of risk factors to consider such as inflammation, vegan and/or vegetarian diets, low stomach acid, and any sort of damage to the pancreas or trauma as a result of surgery.
The silver lining, however, is that endowarriors can work with a healthcare professional to get to the root of their gut issues and determine the underlying cause for their unpleasant symptoms and ultimately develop a protocol to address the issue and relieve the symptoms.
If you experience frequent acid reflux, bloating and/or loose stools, I’d encourage you to check in with your healthcare practitioner and request some further testing to help you better understand what’s happening with your gut health. There are a few very effective tests that can be done under the supervision of a medical professional, including:
Betaine hydrochloride (HCL) titration test: Looks at your overall stomach acid production and determines the adequate amount of stomach acid needed to replace the amount your stomach is not producing on its own.
GI stool map test: A functional medicine test that examines an individual’s stool for parasites, pathogens, viruses, worms, commensal and opportunistic bacteria, antibiotic resistance, and markers of intestinal health including elastase (a marker of pancreatic output), immune response to gluten, calprotectin (the most accurate marker of intestinal inflammation), and steatocrit (amount of fat in the stool), secretory IGA (marker of gut integratory), and zonulin, which can determine if leaky gut is present.
The simple at-home stomach acid test
For a quick and easy at-home stomach acid test, mix ¼ teaspoon of natural baking soda in about four ounces of water. Drink this mixture on an empty stomach before any other food or water. Because the stomach is meant to be acidic, if you add something alkaline, like baking soda, and don’t experience a burping reaction within a couple of minutes, this indicates you may have low stomach acid. I encourage my clients to do this test a few times to get a good average.
TREATMENT PROTOCOLS FOR LOW FECAL ELASTASE
As mentioned, I highly encourage all testing and treatment protocols to be advised by and under the supervision of a healthcare professional. Should your healthcare professional determine that your pancreas isn’t functioning optimally, there are a number of treatment options that can help address the issue at hand. These may include:
Replacing your digestive enzymes with supplemental digestive enzymes (these should not be self-prescribed but recommended by a healthcare practitioner).
If you have low stomach acid or low pancreatic enzymes, you may look for a specific type of digestive enzyme, like one with a combination of amylase, lipase and protease as well as betaine hydrochloride (if your stomach acid needs some support), pepsin (for support with breaking down proteins) and ox bile (for fat absorption).
With endometriosis specifically, an overall reduction in inflammation can help rebound pancreatic elastase as it will help support digestion further down the digestive tract.
Supporting changes in your gut flora, which goes hand in hand with supporting stomach acid production.
THE IMPORTANCE OF TAKING CARE OF YOUR GUT WITH ENDOMETRIOSIS
Overall, there is no shortage of reasons why supporting your gut health with endometriosis is absolutely integral. Having optimal gut health is important for so many reasons, such as:
Weight maintenance. Firmicuates, a classification of bacteria, are able to extract more calories from food, meaning if you have an overabundance, you may be storing fat, even if you’re not overeating. Fat tissue can be a source of inflammation with endo, as it can produce estrogen. This in turn can contribute to more severe symptoms of endometriosis.
Mental health. Beneficial gut bacteria produce butyrate, which reduces anxiety and depression. Fermentation of some foods (high sugar diet or high refined carb diet) result in the release of toxins and chemicals that make you feel foggy, groggy, drugged and fatigued — symptoms we don’t want to be intensifying with endo.
Healthy pH balance. A healthy gut maintains a healthy pH. A healthy pH prevents an overgrowth of toxin-producing bacteria that can be a source of inflammation (and pain) in endo.
Balanced hormones. An imbalance in the gut (common with low fiber diets and constipation), favours the reactivation of beta-glucuronidase. This is an enzyme that reactivates estrogen otherwise destined for removal through the stools. Since estrogen is a source of inflammation and can contribute to proliferation of endometriosis, we want to be eliminating estrogen as much as possible through daily stools.
Immunity. If the GALT — a communication system between the gut, nervous system, and immune system — is impacted by things like inflammation, this too impacts immunity. A dysfunctional immune system can result in severe and unpredictable symptoms of endometriosis.
Barrier maintenance. A healthy gut prevents a leaky gut. When leaky gut occurs due to dysbiosis, gut inflammation, or stress, large molecules can enter general circulation and promote an immune reaction. This in turn may contribute further to the immune system dysfunction we already experience with endo, and intensify symptoms of autoimmunity, or result in the development of an auto-immune condition.
Want to learn more about the easy ways you can eat to support your endometriosis?
Download my free resource, Eating for Endo Basics, a guide that outlines the foundations of how to eat to manage your endo symptoms.