Endometriosis and IBS: Managing Holiday meals

For many, the holiday season is a time for festive foods and gatherings, but for those with both endometriosis and irritable bowel syndrome (IBS), it can also mean navigating dietary restrictions to avoid painful flare-ups. Interestingly, endometriosis and IBS can share symptoms, including abdominal pain, bloating, and bowel changes. Understanding this overlap and choosing foods that minimize symptoms for both conditions can make the holiday season more enjoyable. Let’s explore how these conditions connect and highlight some holiday food swaps that are can help you manage holiday meals.

Understanding the Overlap of Endometriosis and IBS

Endometriosis is a condition where tissue similar to the uterine lining grows outside the uterus, causing pain and inflammation, while IBS is a digestive disorder marked by bloating and abdominal discomfort. Women with endometriosis are three times more likely to have IBS¹, with 20% experiencing overlapping symptoms². Studies show that a Low FODMAP diet, often recommended for IBS, can reduce bloating and pain in women with both conditions by minimizing fermentable carbohydrates^3,4. Reducing inflammation through diet may also help ease symptoms during hormonal shifts, as both conditions are often affected by these changes.

What is a FODMAP?

FODMAPs are a group of carbohydrates (starches) that get broken down by bacteria in our digestive system. FODMAPS found in certain foods can trigger digestive symptoms like bloating, gas, and diarrhea in sensitive individuals, especially those with IBS. The term stands for Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols—sugars that are poorly absorbed in the gut. Common high-FODMAP foods include onions, garlic, apples, and dairy products. A low-FODMAP diet can help identify and manage trigger foods to improve gut health and comfort. Low FODMAP foods include most protein based foods (chicken, fish, meat) and carbohydrate foods such as rice, zucchini, spinach and berries.

Festive foods

During the holidays, traditional foods rich in fats, sugars, high FODMAP’s and trigger ingredients, combined with over eating and over indulging, can worsen both endometriosis and IBS symptoms, making it essential to choose alternatives that support gut health, reduce bloating and ensure good bowel movements.

Festive food alternatives for IBS and Endometriosis

To enjoy holiday meals without triggering symptoms, consider these swaps and meal ideas that are kind to both your gut and allow you to celebrate the festivities.

1. Low-FODMAP and anti-inflammatory dishes

Why: FODMAPs are types of carbohydrates that can ferment in the gut, causing bloating and discomfort in individuals with IBS. A low FODMAP diet has been shown to alleviate symptoms for many IBS sufferers^{3, 4}. Many low-FODMAP foods are also anti-inflammatory, making them super beneficial for endometriosis. Foods high in FODMAPs include garlic, onions, apples, pears, beans, cauliflower, mushrooms, wheat, and dairy products like milk and yogurt. These foods contain carbohydrates that can ferment in the gut and may cause digestive issues for those sensitive to FODMAPs.

Christmas stuffing for example combines high FODMAP foods – The combination of onions and garlic, breadcrumbs and fat can be dynamite for IBS symptoms and bloating.

In contrast low FODMAP foods include options like carrots, zucchini, spinach, strawberries, blueberries, rice, quinoa, lactose-free dairy, and proteins like chicken, eggs, and fish. These foods are easier on the digestive system and are less likely to trigger symptoms in people sensitive to FODMAPs.

TIP: If you really want stuffing, make one with lots of herbs and nuts but very little onions and garlic. Use the green part of spring onion and garlic infused oil*. Alternatively replace traditional stuffing with quinoa-based version, flavored with herbs like thyme and rosemary.

Opt for roasted vegetable like carrots, zucchini, and bell peppers rather than

cauliflower and broccoli.

2. Gluten-Free and Dairy-Free Options

Why: Gluten and dairy are common triggers for gut disturbances due to their potential to promote inflammation and digestive distress.

TIP: For holiday appetizers consider gluten-free crackers served with dairy-free cheese or mashed avocado. Replace dairy with lactose free dairy products. Replace mashed potato made with butter and cream with mashed sweet potato using olive oil or dairy free milk for creaminess.

3. Leaner, less fatty meals

Why: Holiday meals often include fatty, rich foods like creamy sauces, gravies, and fried dishes. While delicious, these can be particularly challenging for those with both endometriosis and IBS. High-fat foods can slow digestion, increase bloating, and even trigger gut spasms, all of which can intensify symptoms.

TIP: Opt for lighter versions of classic dishes. For example, choose baked or roasted vegetables instead of fried options, and use olive oil or avocado oil rather than butter for cooking. When it comes to sauces and gravies, try blending in vegetable or chicken broth to reduce richness while keeping the flavor. Also, watch your portions with rich foods—smaller amounts will reduce the likelihood of a flare-up.

4. Artificial sweeteners may not be best alternatives

Why: Artificial sweeteners, often found in sugar-free desserts and holiday treats, can be tough on the digestive system⁵. Sweeteners like sorbitol, xylitol, and aspartame are commonly used to replace sugar, but they can draw water into the intestines and cause bloating, gas, and cramping. This is especially problematic for people with IBS, who are more sensitive to gut irritants.

Tip: Look for treats made with natural sweeteners like small amounts of honey or pure maple syrup, which tend to be more tolerable in moderate amounts. If you’re unsure whether a food contains artificial sweeteners, check the label, or better yet, make your own holiday treats at home. Simple ingredient swaps can help you create gut-friendly desserts without sacrificing the festive sweetness.

5. Alcohol

Why? Alcohol can be a double-edged sword during the holidays. While it’s a popular part of celebrations, it’s also known to irritate the gut lining and disrupt digestion, which can lead to bloating, discomfort, and a flare-up of symptoms in both IBS⁵ and endometriosis. Additionally, alcohol can dehydrate the body, which may worsen cramping and constipation.

TIP: Limit alcohol intake to reduce gut discomfort. If you choose to indulge, alternate alcoholic drinks with a glass of water to stay hydrated, and consider lower-alcohol options like wine spritzers. Mocktails are a great alternative—try combining water with fresh fruit and herbs for a festive, gut-friendly drink. This way, you can enjoy a drink that feels celebratory without triggering symptoms.

FESTIVE SEASON MENU SWOP OUT IDEAS:

Appetizers:

Swap out: High-fat cheese platters and fried appetizers.
Try instead: A platter of gut friendly options like olives, roasted red pepper hummus, and veggie sticks. For more variety, include low-FODMAP* nuts like walnuts or macadamia nuts in small portions.

Main Dishes:

Swap out: Creamy casseroles or stuffing with garlic and onions.
Try instead: Oven-roasted turkey or chicken seasoned with fresh herbs (such as rosemary and thyme) and infused olive oil. Low-FODMAP vegetables like carrots, parsnips, and green beans are great roasted options that avoid potential IBS triggers.

Side Dishes:

Swap out: Mashed potatoes loaded with garlic and dairy-heavy cream.
Try instead: Use lactose-free milk or olive oil to make mashed potatoes creamy without the dairy. For extra flavor, infuse the potatoes with fresh chives and a hint of sea salt. Another great side is a quinoa salad with cranberries, pumpkin seeds, and fresh parsley for an anti-inflammatory twist.

Desserts:

Swap out: High-sugar pies and dairy-laden treats.
Try instead: A low-FODMAP fruit salad with strawberries, blueberries, and oranges or a dairy-free chocolate avocado mousse, which provides healthy fats and antioxidants while avoiding common endo and IBS triggers.

Navigating holiday meals with endometriosis and IBS may require some planning, but with these strategies, you can enjoy the festivities without sacrificing comfort. Remember, it’s all about making mindful choices that support your well-being, so you can make the most of the holiday season!

References:

Nabi MY, Nauhria S, Reel M et al. Endometriosis and irritable bowel syndrome: A systematic review and meta-analyses. Front Med (Lausanne). 2022 Jul 25;9:914356. DOI: 10.3389/fmed.2022.914356
Salmeri N, Sinagra E, Dolci C, et al. Microbiota in Irritable Bowel Syndrome and Endometriosis: Birds of a Feather Flock Together—A Review. Microorganisms. 2023 Aug 15;11(8):2089. DOI:10.3390/microorganisms11082089
van Haaps AP, Wijbers JV, Schreurs AMF, et al. The effect of dietary interventions on pain and quality of life in women diagnosed with endometriosis: a prospective study with control group. Hum Reprod. 2023 Dec 4;38(12):2433-2446. DOI: 10.1093/humrep/dead214.
Moore JS, Gibson PR, Perry RE & Burgell RE. Endometriosis in patients with irritable bowel syndrome: Specific symptomatic and demographic profile, and response to the low FODMAP diet. Aust N Z J Obstet Gynaecol. 2017 Apr;57(2):201-205. DOI: 10.1111/ajo.12594
Clevers E, Launders D, Helme D et al. Coffee, Alcohol, and Artificial Sweeteners Have Temporal Associations with Gastrointestinal Symptoms. Dig Dis Sci. 2024 Jul;69(7):2522-2529. DOI: 10.1007/s10620-024-08457-y

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