5 Digestive Reasons You May Have Endo-Belly


Endo belly {noun}: the painfully distended and embarrassingly large bloated belly that accompanies endometriosis.

Okay, maybe that's not the official definition (is there one?), but if you have endo you’ll relate. Some women get it more often than others, some get it larger than others, but most endo-sisters will agree that appearing 6 months pregnant is a reality that accompanies them throughout their endo-lives, and no one gives us much help as to WHY?? I mean seriously, why did I look 6 months pregnant on the reg????

Perhaps because endometriosis is so often touted as a “hormonal” problem, many people lump it together with the PMS bloat that happens to many women at some time during their cycle, and just assume ours is bigger and bolder since everything involved with our hormones is bigger and bolder. Rarely will a gynecologist emphasize the crucial role that digestive health has in contributing to this horrible symptom, forcing us women to accept limited treatment options when something is seriously wrong. I know I personally assumed for a long time that it was something related the hormone rollercoaster that has no end....

So, what happens if we start extricating "endo belly" from endometriosis and start treating it as a separate symptom on its own, one that is actually contributing to our chronic sickness, colds, flus, and sinus infections all on its own? One that is creating our allergies and is the reason behind our chronic fatigue? What if, by turning our attention for a moment away from the endo and instead focus diligently on our “endo bellies” we could make large gains towards healing?

Endo Belly and AutoImmune

What all auto-immune diseases have in common is a severely impacted digestive system (and remember, endo is auto-immune related). Moreover, what nearly all endometriosis patients have in common is digestive distress of some sort, which is another reason endo is often overlooked during diagnosis which instead says something like IBS. Even more, since changing of diets is the most touted way to help relieve endo symptoms, we can understand that, overall, there’s a gut-endo connection.

Plus, one of the most obvious signs of a digestive system in distress is: severe abdominal bloating.

Here’s a question for you: did you actually have “endo belly” long before your diagnosis? Ok, I know diagnosis can take a ridiculously long time, so how about: did you find yourself with obnoxious abdominal bloating before your onslaught of other endo symptoms? I ask this just to check in with your own story and see if your endo belly was caused by endo, or perhaps helped cause the endo…

For me I was diagnosed very young with my first autoimmune disorder: ITP. This is where your body attacks your platelets (the little guys that coagulate your blood when you’re cut) so I could potentially bleed to death if I was hit too hard. That’s another story on its own, but looking back at pictures I had "endo belly" all the way back then, long before I even had my period. I looked like little miss sunshine, glasses and all!

 Me next to all my friends, took the glasses off for this pic ;)

Me next to all my friends, took the glasses off for this pic ;)

I only was able to put the story together as I started to heal my gut and saw my endo-belly deflating. I wasn’t treating the endo, rather I was treating my entire digestive tract, and as my enormous endo bloat faded, so too were many of my endo-related symptoms. The digestive distress was, unknowingly to me, directly impacting the severity of the endometriosis. 

Ok ok ok, enough about me, this is about all of us! Which is why I want to introduce 5 reasons you might have endo belly, and a few solutions (including baby steps). To get in touch with your digestive system I’m going to go through each step of the process, and explain why, if it’s not working properly, you might have endo belly.

** The below issues are VERY simplified. If any of you endo ladies want me to go deeper into each one, please send me a note :)

Endo Belly Reason #1: You’re running from lions

Potential symptoms: overall digestive distress, can lead to any/all digestive issues

You probably wanted me to start with something else, but don’t skip ahead! This is where digestion starts, as you get excited about food your body turns on your digestive juices. If you’re on the run, doing a thousand things while eating or stressed out, your body won’t produce these juices. Why? It’s that simple fight or flight mechanism … if you’re body is worried about survival, it’s putting its energy where it counts: towards surviving in the moment. It doesn’t care about slowing down to produce digestive juices! Plain and simple it would rather you make it through the day alive.

Solution: Take time to eat, to appreciate and respect your food and where it came from, to smell it and salivate, and be mellow while you eat. B R E A T H E. If you can eat with a friend or family that’s best. Take time to talk and enjoy each other. Eating alone and get bored? Read something that relaxes you, or listen to a positive podcast or book on tape. Seriously, you could even buy a cute picture book of puppies and kittens (or whatever cuteness overload gets you) and stick it on your dining table to remind you to slow down and put your body in a parasympathetic - opposite of stress - state.

Another reminder if you’re afraid of gaining weight or deal with body image doubts, try to work on changing the way you see food, moving it from the enemy to the savior. The power of the mind is strong, and if you’re subconsciously cursing food, or afraid of it, or have an unhealthy relationship around it, your body will follow in your thought-shadow. Send your food L-O-V-E :)

Reason #2: You don’t chew enough

Potential symptoms: overall digestive distress, can lead to any/all digestive issues

I’m sure you’ve heard a thousand times how we need to chew our food. You might want to yell at me “DUH! I get it!”. Slowwww down here though because I have a very important question: do you really chew? Before you answer, go grab something actually chewy. Could be an firm apple, a steak, or kale salad, whatever you like best. Now chew this food, each bite, until it’s pulp. This will probably take about 30 or so chews, no joke. Now  swallow. Ok that was one bite. If you haven’t been chewing, you may have just realized chewing an apple fully, bite for bite, takes quite a long time, and your jaw will literally be sore after this one little meal. One meal! That means your jaw, my sister, is atrophied from not chewing.

Why is chewing important? You mean, Why is it perhaps the most important and absolutely free thing you can do? Good question :) Because it sets your entire digestive system up for success, and if your digestive system is already incredibly distressed, which it is, than this is the most beneficial thing you can before anything else. And it's free!

Chewing does three things, the most obvious #1: masticating your food to bits. If you think your stomach will take care of the rest that’s NOT TRUE because of #2: salivary amylase. This enzyme is produced in your saliva and is the first (and only) thing that breaks down starches until they reach your small intestine — so if they haven’t been broken down through saliva first, the army of tiny enzymes down south doesn’t stand a chance against these enormous bits. Neither do fats and proteins because of #3: chewing signals your stomach to release HCL (hydrochloric acid). This is why it’s wrong to think your stomach will do the rest of the work your teeth don’t, because if you’re not chewing + salivating + slowly swallowing, your body doesn’t see a need to produce enough HCL.

Solution: Take a clue from step 1, and  allow yourself a nice, relaxing environment in which to eat. Bad habits are hard to break though, so while you're chil-axing with your food, remember to either put down your fork in between bites (and not add more food into your mouth until you’ve swallowed fully), or eat with chopsticks. Ask your friends and family to remind you or make it a goal to support each other so everyone benefits from the magic of chewing. As you get better at chewing your jaw will also get stronger, making it easier to dismantle chewy object.

Reason 3: Not enough stomach acid (HCL)

Potential Symptoms: endo belly appears within an hour of eating, feeling uncomfortably full after eating, acid reflux, GERD, H. Pylori, chronic nausea, food feels “stuck” in stomach.

Your stomach depends on the above two protocols to perform optimally, so if you are stressed, distracted, rushing, and not chewing, your stomach will get hit hard. 

A stomach in distress can have many symptoms, including acid reflux, GERD, a “way too full” feeling after eating, ulcers, or an H. Pylori overgrowth. All of these symptoms are most of the time linked to too low HCL levels, rather than too much acid as we hear about, and why all naturopaths have their clients introduce HCL pills to their meals rather than ant-acids. Here’s why:

When you fill your stomach up with everything you chewed it’s like a fat, protein, and starch smoothie. If you have plenty of stomach acid these foods will start breaking down quickly and be moved forward into the small intestine. If it’s not acidic enough, the food will do what food does in a moist, warm, alkaline environment: rot. Imagine if you blended up you meal and stuck it in a jar, on a shelf, in humid 98 degree weather. You’d quickly watch those fats go rancid, the proteins putrefy, the starches ferment, and the entire jar contents would expand and expand. If you sealed the jar tight it would explode (I'm not kidding, I've had this happen to one of my ferments!) 

This is what happens in your stomach when there’s not enough HCL, it becomes a warm, moist cave. As the expanding food mass rises, it hits your esophagus and burns it - which is why taking an antacid helps. The antacid neutralizes the acid right there at your esophagus where the rising food mass hit as it grew so large. That’s why the antacid is often a band-aid for a much larger problem of not enough HCL in the first place.

Solution: If your endo belly appears within an hour of eating, you could well pinpoint your stomach as one of the main issues in your digestive chain. Same with being overfull or having chronic nausea - a big endo symptom. As you’ll start to see, the solution often lies in treating the issues north of the problem, so in this case focusing on creating a non-stressful environment while eating as well as Chewing. Chewing. Chewing. This will help remind your body to make HCL :)

However, if you’re quite nutritionally depleted (like most of us with endo) even the simple act of making HCL can be very difficult to do. That’s because it takes a lot of nutrients to make HCL, and vise versa it takes lots of HCL to absorb these nutrients (for example you need zinc to make HCL, but you need HCL to absorb zinc). So if your stomach has been working overtime for a long time, you might have lost your HCL ingredient reserves.

In this case, you might consider supplementing with HCL Pepsin pills. This sounds scary (omg taking stomach acid pills??!!) but for many of us can get to the crux of the issue while our body builds back up enough reserves to make stomach acid. If this is the case for you, once you start introducing HCL into your system, your body will your body will finally be able to correctly start the process of digestion.

I’ll remind everyone it’s always best to do this under the supervision of a nutritional practitioner who can help guide you through the process. If you want to read about the HCL Challenge here’s a link to Wellness Mama where she describes it at the bottom. In my personal journey this what an enormous key in finally allowing my body to properly digest and absorb nutrients.

Another thing to consider are your meds. A lot of pain medications can seriously impact your stomach lining and gut mucosa. Only you and your doctor know which meds you need and which ones you can minimize or stop taking, but it’s worth thinking about if you’re serious about starting to heal your gut.

**Food for thought (no pun intended), HCL breaks down proteins, so if you don’t produce enough HCL you can’t effectively break down tryptophan, an important amino acid necessary to make serotonin. If you don’t have any, you literally won’t be able to make serotonin, and you will have issues feeling, well, good. See how it’s all connected?

Reason 4: Small intestine dysfunction

Potential symptoms: Endo belly flairs 2-4 hours after eating, allergies, chronic sickness, malnutrition, have other autoimmune disorders

Now if you're stuck in hyper-drive, haven’t chewed, and don’t have enough HCL, not only will you be utterly uncomfortable, but food from your stomach will pass into your small intestine only partially broken down. Not to mention any pathogens will still be alive and well as they hit your sensitive intestinal tract. 

The middle and lower part of the small intestine is where the bulk of absorption happens. Here the villi and microvilli act like grasses, sweeping up the now itty-bitty nutrients. If your food is half digested, the villi won’t stand a chance at nutrient catching. Imagine having a butterfly net in a field of monarchs. Now imagine having a butterfly net in a field of tetradactyls (yes I had to spell check that one). If your villi aren’t getting nutrients it doesn’t matter how much organic, healthy food you eat, you won’t absorb it. You know what this also means? Yup, chronic, debilitating fatigue.

 On left, villi is short, damaged, and fragile. Nutrients pass on by.

Moreover, now your villi are going to be barely surviving in this unhealthy toxic environment of all those gross, unbroken down food particles and pathogens. I don't want to talk too much about other issues here since there's simply not enough space, but stress, drugs, excess alcohol and sugar, and antibiotics are also big time compounding factors. All this stress leads to issues like gut permeability, or leaky gut.

click image to make bigger - this is your gut when leaky

Leaky gut occurs as the villi environment breakdown, teeny tiny gaps in the intestinal lining are created from which proteins leak out. Because your body is programmed to attack proteins (like viruses and bacteria) they stage an immune response here in your gut against things like … gluten, or casein. Eventually maybe your gut is so deteriorated your body goes into an immune response with nearly everything you eat: eggplant, tomatoes, eggs, grains, etc, and you fall into a cycle of chronic sickness.

Solution: If your endo belly really flares 2-4 hours after eating, or you struggle with allergies, skin issues, or chronic fatigue, you’re probably going to want to spend a good long time healing your sensitive, inflamed, and damaged small intestine.

First steps? Start at the top: Relax while you eat, chew-chew-chew, breathe, and make sure you have enough HCL and Pepsin. This will start to ensure food passing through your system from here on out is more properly digested.

Next, you’re going to have to really delve in to your diet. The diet most associated with healing leaky gut is called the GAPS diet, and is used to heal autoimmune issues as well as issues like autism. Again, it’s really important to work with a naturopathic diet specialist if you want to really see a thorough impact in this area. Every person is unique, so if you try the same elimination diet as your friend Betty, you might not get the same positive results and feel like giving up. When you work with a specialist (I highly recommend working with a Nutritional Therapist, find one here) you’ll be able to start your healing journey with a map, sword, and steed. Without one you may start your journey with some tattered boots and a bucket full of hope … needless to say it could take years. 

Not to say it can’t be done though, you just have to be vigilant :) For more info you can check out my Heal The Gut link all about intestinal permeability and how to approach it. Healing the small intestine means eliminating all inflammatories while the gut heals, including all sugar and starches to kill off pathogens, and calm that inflammation. Depending on your situation (if you deal with candida or SIBO) you may have to do extra re-building and eliminating protocol. Bone broth here will be your best friend (or collagen or gelatin powder) as L-glutamine helps seal and rebuild the intestinal wall.

Reason #5: Large Intestine Dysfunction

Potential Symptoms: foul gas, white coated tongue, diarrhea or constipation, Crones, IBS, Colitis, parasites, dysbiosis

Your large intestine is quite different from your small. It’s where the “leftovers” of water, fiber, and waste move through a larger tube filled with gut-friendly bacteria (over 3 pounds in a healthy person!!) where there leftovers are sucked dry of water and any last-standing nutrients before they exit your body as waste. 

There’s not much blood supply to the large intestine. Instead it relies on its enormous colonies of beneficial bacteria to nourish it. Indeed the bacteria thrive under the right conditions and even create nutrients - including vitamin K, B1, B2, B12, and butyric acid (which is needed to heal and strengthen the intestinal lining)

When there’s dysfunction, though, the large intestine often bears the brunt of everything going on above it. When there’s mal-digested foods arriving from the small intestine, the ileocecal valve (where the two meet, you’d find this halfway between your belly button and right hip bone) can get clogged or even stuck open, allowing “sewage” more-or-less to seep back up into the small intestine where it’s not supposed to be. My celiac friend told me she calls this spot her “gluten spot”, since it always hurt when she accidentally ate gluten, which is a sure sign the valve is inflamed and unhappy.

As these toxic food particles make their way through the large intestines — it’s been maybe 20 hours of warm incubation now, so imagine teeny tiny particles of rancid fats, putrefying proteins, fermenting sugars, and living pathogens — the system is, needless to say, unhappy. And if it’s bombarded like this for years and years, the unhappy ecosystem goes completely haywire. Out go the good bacteria, who can’t thrive in that environment, and in come the guys who can: parasites, dysbiosis, and lots of inflammation. This is where you’d experience anything from chronically bad gas to life altering problems of crones, colitis, or IBS.

A quick note on constipation -- which many endo girls have -- this may not be a symptom of too little fiber. Yes of course it can be that too, but if you've added fiber and still deal with this issue hear ye' hear ye': constipation can just as easily be a symptom of malnutrition. It happens when your body is dry of nutrients and doing everything in its power to absorb them, so if you're small intestine is dysfunctioning and you're not getting what you need, your large intestine is going to try to make up for it by absorbing as much as it can. Since this isn't the main function of the colon, you're going to find yourself chronically clogged (or also going between constipation and diarrhea) and your body strains to get something out of your meals.

Solution: You should be able to repeat this by now :) Start at the top! Relax while you eat, chew-chew-chew, breathe, and make sure you have plenty HCL and Pepsin in your stomach. This will start to ensure food passing through your system from here on out is more properly digested.

I also sense big diet changes in your future, although what they are will depend on your unique circumstance. To address issues like SIBO, crones, colitis, or IBS, I can’t say enough how working with a skilled provider would benefit you. Many of these large intestinal issues are very, very deep, and some people find themselves managing them for years, even decades, without improvement. By addressing diet, adding specially targeted supplements, and taking a Sherlock style approach to discovering which foods trigger you and which pathogens have their hold, you will slowly be able to calm the inflammation, heal the gut, and eventually resume a normal, healthy life without digestive fear.

Lastly, it’s a really good practice to start abdominal massage. Your large intestine skirts your abdomen, and massaging it with little circles as you pass over your abdomen from right hip up to rib cage, across, and back down to left hip will help you colon start functioning better. If you have pain at your ileocecal valve a daily massage will help slowly ease the discomfort.

Endo Belly Popped

I hope this lay-mans description of the digestive tract has helped you better understand what’s going on inside your body and a few of the reasons you may experience such extreme endo belly. Yes you may experience bloating because of hormones, but daily endo-belly distress is most often the symptom of digestive dysfunction rather than a side effect of hormone imbalance.

This might also drive home for some of you the reasons behind your chronic allergies, chronic fatigue, chronic sicknesses, why you have a nice collection of auto-immune diseases, or even why your extreme endo diet didn’t work for you. If your digestive tract is in terrible shape it doesn’t really matter how many nutrients you put inside if they can’t be properly absorbed.

It's also a good reminder why the common endo suggestion of making sure you have a high fiber diet won't do any healing ... the deterioration of our guts is wayyyyy beyond a simple fiber solution.

Healing the gut is really a fascinating process though. I'm sure you'll first be amazed at how much better you feel by simply CHEWING your food, and maybe adding a few HCL pills at each meal. This alone might take your endo belly down a few big belt notches. As for diet, unlike a strict “endo diet” of limiting everything you eat for, like, ever, your strict gut-healing diet will eventually end. As you heal your intestinal lining with a diet like the GAPS diet, you will be able to add back in foods you once would have fallen over in pain as you ate, and foods you probably really miss.

Depending on the level of destruction within (you might be able to guess by the severity of chronic fatigue, digestive issues, and amount of autoimmune disorders you have) the diet could, potentially, take a year or so for you to really recover. For others, a 1-2 month strict protocol might be all you need to start immediately feeling better. Try not to think about the time, though, focus on where you are now in your healing journey. The time will pass no matter what, so always better to feel better as it passes than feel worse. Be patient and lean in to it, remembering to always chew of course :)

Hey, no one said healing was easy, but that’s why they call us endo-warriors.

 Endo warrior, off to kill pathogens in her gut

Endo warrior, off to kill pathogens in her gut

The joys are in what you find as you heal the gut! You wouldn’t even believe that your sugar cravings will disappear (this from a girl who, 5 years ago, screamed at the thought of not having ketchup on her eggs) and you will find yourself with energy without an all-day stimulant stream. Dealing with chronic fatigue is one of the worst things I personally experienced with endo (aside from the pain), and healing my gut allowed me to reclaim my life. You will find your skin returns to normal, your nails and hair begin to regrow, and your moods lifted. Oh yah, and you’ll fix your endo belly too :)))

DISCLAIMER:  I am not a dietitian, doctor, or medical professional, this site is solely for guidance and information to give people more information to make an informed decision about their own bodies best treatment plan. It’s a source of information that helped me put my own endometriosis in remission, and information I wanted to share for anyone else it might help on their journey.