Endometriosis and IBS: Key Differences, Overlaps, and Diagnosis Tips (with guest Rachelle LaCroix Mallik, MA, RDN)

Part 1 of the Women's Health Series

Endometriosis can show up like a gut disorder, and that confusion keeps many people stuck for years without answers. We map the overlap between endometriosis and IBS, explain what symptoms should raise suspicion, and share practical ways to build a care plan that supports both digestion and quality of life. 

• Endometriosis prevalence, symptoms and why it is often missed 
• IBS-like symptoms explained, including inflammation, adhesions, and visceral hypersensitivity 
• Hallmark signs beyond pelvic pain, including heavy periods, pain with sex, and pain with urination 
• Why diagnosis can be delayed and how updated guidance supports symptom-based evaluation plus imaging 
• Fertility considerations, diminished ovarian reserve risk, and why early treatment can matter 
• Low FODMAP as a short-term tool for GI symptoms, not a cure for endometriosis 
• Mediterranean-style and anti-inflammatory eating patterns as a less restrictive foundation 
• Stress, sleep, and gut-directed hypnotherapy as nervous-system support for pain and gut symptoms 
• Gluten-free and dairy-free myths, plus why celiac screening matters before cutting gluten 
• Supplement reality check, when to correct deficiencies, and why third-party testing matters 
• The “dream team” approach, including medical doctor, dietitian, pelvic floor physical therapy and mental health support 

This episode has been sponsored by Ardelyx.

References for this episode:

2023 narrative assessment on gluten and endometriosis

2025 meta-analysis on endometriosis and supplements

2023 UK survey dietitian support for endometriosis

Exploring the Nutrition‐Related Healthcare Experiences of Individuals With Endometriosis: Qualitative Interviews With Consumers and Dietitians

Rachelle’s delicious spaghetti & meatballs recipe 

Find Rachelle Mallik on Instagram

Consumer Lab

You can also follow us on social media at the Gut Health Podcast, where we'd love for you to share your thoughts, questions, and experiences.

Learn more about Kate and Dr. Riehl:

Website: www.katescarlata.com and www.drriehl.com
Instagram: @katescarlata @drriehl and @theguthealthpodcast

Order Kate and Dr. Riehl's book, Mind Your Gut: The Science-Based, Whole-body Guide to Living Well with IBS.  

The information included in this podcast is not a substitute for professional medical advice, examination, diagnosis or treatment.  Always seek the advice of your physician or other qualified health care provider before starting any new treatment or making changes to existing treatment.

Transcript

Sponsor And Show Welcome

Kate Scarlata, MPH, RDN 0:00

This podcast has been sponsored by Ardelyx. Maintaining a healthy gut is key for overall physical and mental well-being. Whether you're a health conscious advocate, an individual navigating the complexities of living with GI issues, or a healthcare provider, you are in the right place. The Gut Health Podcast will empower you with a fascinating scientific connection between your brain, food, and the gut. Come join us. We welcome you.

Dr. Megan Riehl 0:37

Hello, friends, and welcome to The Gut Health Podcast. We are your hosts. I'm Dr. Megan Riehl, a GI psychologist.

Women’s Health Series Kickoff

Kate Scarlata, MPH, RDN 0:44

And I'm Kate Scarlata, a GI dietitian. We are so excited to introduce a three-part series for May. We're going to be talking about women's health for Women's Health Month. And today's topic is endometriosis and gut symptoms and how IBS and endometriosis can sometimes overlap.

Endometriosis Facts And Symptoms

Dr. Megan Riehl 1:06

This is certainly a condition that is misunderstood, but so incredibly common in women, often associated with pelvic pain and gut symptoms. So we are very excited to bring on an expert today. And before we do that, we're going to tell you a couple quick facts about endometriosis. So our female listeners, endometriosis affects an estimated 10%. That's 190 million people around the world. These are women of reproductive age. And as we said, it's a chronic disease with symptoms that can include severe pain during menstruation, heavy menstrual bleeding, chronic pelvic pain, and the pain doesn't go away after you've had your period. It also can be associated with infertility affecting between 30 and 50% of women with this condition. And then some of those gut symptoms can be abdominal pain, bloating, and nausea.

Kate Scarlata, MPH, RDN 2:04

Absolutely. And it often gets missed. It's not always part of that differential diagnosis. So we want to bring some awareness to this condition so that you can advocate for yourself should you be experiencing pelvic pain. And as Dr. Riehl mentioned, most of the symptoms are in the pelvis, but sometimes they can be elsewhere in the body, including the abdomen and even the chest. So this endometrial tissue can grow outside the uterus and spread through various areas in the body, really complicating a symptom picture.

Meet Reproductive Dietitian Rachelle

Myth Weight Loss Equals Health

Dr. Megan Riehl 2:36

Yeah. And unfortunately, there's no definitive cure at this point. But we do know that early access to effective treatments, as well as even just getting a diagnosis. I know so many women that live with these symptoms for so long without knowing what it is, or maybe just associating it to potentially a GI symptom or a GI condition that they have, but it's it's a differential here. And so as a result, we want treatment that is focused on symptom management. A goal can be reducing pain, controlling the disease progression, and really the long-term effects of the endometriosis. So fortunately, there are multiple effective treatment options that can be available. And really the goal is to improve your quality of life because we know this can affect your mental health and your well-being overall, and certainly to reduce the risk of reoccurrence. And so with that, we are very excited to introduce our guest today, who is gonna answer a couple common questions. And I think really we'll have a nice conversation today on this important topic. Rachelle LaCroix Mallik is a reproductive dietitian and founder of The Food Therapist, a private practice specializing in fertility and women's health nutrition. With nearly 20 years of experience in reproductive health and almost a decade in private practice, she helps individuals navigate fertility, pregnancy, PCOS, endometriosis, and other women's health concerns with evidence-based weight-inclusive care. She regularly speaks at national conferences and serves as a reproductive health content expert for the Nutrition Care Manual's Board of Editors. In 2024, she received the Women's Health Dietetic Practice Group Excellence in Practice Award for her contributions to the field. Well, Rachel, we are so thrilled to have you today. And we are gonna kick off today's episode with a myth. So, what is one myth about women's health you wish you could instantly correct?

Rachelle LaCroix Mallik, MA, RDN 4:42

I love this question. I would say that weight loss leads to health improvement, that that is a myth. Yes. That just focusing solely on weight loss to improve health.

Kate Scarlata, MPH, RDN 4:52

That doesn't do it.

Rachelle LaCroix Mallik, MA, RDN 4:54

Do you want me to dive into that further?

Kate Scarlata, MPH, RDN 4:56

A little weight-inclusive dietitian. Yeah, why don't you just do a little elevated pitch of that?

Rachelle LaCroix Mallik, MA, RDN 5:01

Sure. Yeah. So as a weight-inclusive dietitian, what that means is like providing weight neutral nutrition counseling, right? So we're really focusing on those health promoting behaviors that may result in weight loss, but we're really focusing on the behaviors because weight is not a behavior and how your body responds to some health-promoting behaviors may not always look a certain way, right? And I just work with so many women, especially in reproductive health, whether they're trying to conceive PCOS, this comes up a lot more often, I'd say, than my endometriosis patients, but where, you know, I the doctor said I have to lose weight, or they feel the need to lose weight in order to improve their health. But when we dig a little deeper, there's things that they can work on that, again, may or may not result in weight loss, but we're focusing on adequate nourishment throughout the day, balanced meals, adequate fiber. We love to talk about fiber and good health. And, you know, enough fruits and vegetables and whole grains and lean proteins and heart-healthy fats and moving their body consistently in a way that they enjoy. That's not punishing, working on the relationship with food are all things that can help to promote health that again may not result in weight loss, but can still improve their health.

Dr. Megan Riehl 6:06

Well, yes. So it's that kind of idea that we can't tell health from our eyes in so many ways. And so I love that you brought that up. And you mentioned PCOS, and I also mentioned it in our introduction, and that's polycystic ovarian syndrome. And while we're not going to dive too much into that today, I did just want to say it's another common endocrine order, or it's another common endocrine disorder that can affect again a high percentage of women, 10 to 13% globally. So just another kind of concept or another term to be aware of when we're thinking about our health, our reproductive health, and one of those other diagnostic differentials to consider when it comes to our symptoms that we're going to talk about today.

Why Endometriosis Affects Digestion

Kate Scarlata, MPH, RDN 6:48

Absolutely. And I love the myth busting too, because I think women are so culturally have certain expectations to be a certain size, and there's a lot of gender pressure in this area. So it's a perfect, perfect myth to bust as we're going to be celebrating Women's Health Month. So I'm glad you picked that one. So I'd like to start with could you introduce what endometriosis is and then discuss a little bit why patients that have this disorder often experience digestive symptoms, whether that be bloating, constipation, sometimes diarrhea, and how endometriosis may really like play a part in exacerbating those symptoms.

Rachelle LaCroix Mallik, MA, RDN 7:32

Absolutely. So yeah, to start with, endometriosis is a chronic, estrogen-dependent inflammatory condition that is basically where endometrial-like tissue, so the tissue that grows on the inside of the uterus, right, that grows during the menstrual cycle and then is shed during the period, that is growing outside of the uterus. And it's hormonally driven. So as with the menstrual cycle, those symptoms can be exacerbated. And those lesions can be found in many places in the body. Typically outside, it'll be more in the uterus, on the outside of the uterus in the abdominal cavity, on the ovaries, perhaps sometimes in the bowel. And so when it comes to how there can be this overlap between endometriosis and digestive symptoms, there are symptoms that are concurrent with or compatible with the diagnosis for IBS, for irritable bowel syndrome. And there are proposed mechanisms. We don't know exactly why that may happen, but some proposed mechanisms are that inflammation. Sometimes it is related to those lesions, those endometrial-like tissue growing in other areas, infiltrating the bowels or causing adhesions, which can kind of kink up the intestines or bowels, and that can contribute to symptoms. But it's not just that. It's not that it doesn't always have to be in the bowels to be causing the symptoms of IBS like symptoms. Also, there can be, it can be hormonally driven, as I've already touched on. So it tends to be, symptoms tend to be worse in the latter half of the menstrual cycle. So post-ovulation leading up to the period. What's tricky though is that that can happen also with women with IBS. And I know from dealing with IBS myself that it tends to be worse leading up to in the first couple of days of the period. So that alone cannot differentiate IBS and endometriosis. And some other proposed mechanisms, we talk about this a lot in IBS, are the visceral hypersensitivity, right? That kind of overactive where a normal gut doesn't feel sensation from like normal gas production, someone with IBS feels it and is very uncomfortable and has abdominal pain. That can happen with endometriosis as well, that sensitization viscerally as well as in the central nervous system. So there's a lot of different ways that endometriosis can cause IBS-like symptoms.

Dr. Megan Riehl 9:40

And that visceral hypersensitivity is one of those tricky symptoms where sometimes, especially in IBS, there's no organic medical test that's gonna say it's visceral hypersensitivity, but it's again one of those classic drivers of your pain is real. Your pain is very real. However, your brain is involved in this pain. And, you know, some of our interventions to target that and calm that central nervous system down that we use in IBS, I imagine, would also be helpful as a strategy for somebody with endometriosis pain as well.

Rachelle LaCroix Mallik, MA, RDN 10:13

Absolutely.

Dr. Megan Riehl 10:14

Excellent. So, what are some of the hallmark signs and symptoms that we want to be aware of, specifically to endometriosis, that patients and I think also providers need to be aware of beyond pelvic pain?

Rachelle LaCroix Mallik, MA, RDN 10:29

Yeah, because you know, we're gonna talk a little bit later, I believe, around diagnosis of endometriosis. And one of the challenges is because there is these overlapping symptoms of IBS, it can sometimes be misdiagnosed as just IBS or only IBS. So some of the other symptoms that are typically more unique to endometriosis are very heavy periods or and/or painful periods. So typically with IBS, you might have a flare in some of your digestive symptoms, but the period itself or you know the pain you're experiencing isn't terrible. There can be pain with intercourse, there can be pain with urination, chronic fatigue. Those are some other symptoms that are more unique to endometriosis. Although people with IBS can also experience fatigue, but the pain with urination, the pain with intercourse, and the painful periods are some of the more hallmark signs. And is inflammation a key feature here? Absolutely. I mean, it's an inflammatory condition. So that's why, you know, oh, pain can also be like throughout the abdominal region or in the trunk. I was talking to a client just yesterday who was talking about how the pain like radiates to her back. And, you know, so yes, the inflammation is driving a lot of the symptoms.

Hallmark Signs Beyond Pelvic Pain

Dr. Megan Riehl 11:33

So, Rachel, you brought this up. I think diagnostic process is extremely important. And so walk us through what this typically looks like and also why is it so often delayed or missed in women?

Rachelle LaCroix Mallik, MA, RDN 11:47

Yeah, I mean, that's been one of the biggest challenges in endometriosis care, is how long it can take to get a diagnosis, anywhere from four to 11 or 12 years. It's a very long time to be experiencing so much pain and not have really many treatment options. So actually, we're recording this April 2026, and in February 2026, like the end of the month, just like five, six weeks ago, ACOG, the American College of Obstetricians and Gynecology, just updated their practice guideline on the diagnosis of endometriosis to not just be dependent on surgery, because historically it has been you need laparoscopic surgery to officially diagnose endometriosis. Now, I'm not a doctor, I'm not of primary care, OBGYN, REI, I'm not the one diagnosing this, but you know, the doctors who have been working with endometriosis patients for years have often been assuming endometriosis based on these symptoms that we were talking about, the pain with urination, the pain with sex, the heavy or painful periods, infertility. I didn't mention that earlier, but infertility is another sign of endometriosis. A common cause of infertility is endometriosis. So, anyway, the guidelines now include more of those clinical signs and symptoms. And they can also do other imaging like a transvaginal ultrasound or an MRI to try to see if they can visualize any of those lesions and from the endometriosis without doing surgery or doing surgery as needed, because sometimes that can be a treatment option depending on the patient's goals, but that they don't necessarily need to do that in order to get a definitive diagnosis.

Kate Scarlata, MPH, RDN 13:18

It just seems with me, you know, over the years, exploratory laps or laparoscopy. Mm-hmm. X lap. X lap. They just don't do them as frequently. I, you know, they were really doing that in patients, even with intestinal adhesions. And then they found they'd go in and they'd lysis some of the adhesions, whether they were endometriosis or otherwise. And then when there's regular scar tissue adhesions, they would come back in worse. So there was less and less of that. And I'm just not seeing that they're doing that anymore. So I'm glad to hear that there's some other metrics that they're using and other different imaging tools to really see what else is going on. And I think this is a nice advancement because certainly having surgery versus having an ultrasound is a little different.

Speaker 14:07

Absolutely. Surgery is a big procedure to undergo. And yeah, this can help people get care sooner as well, you know, in terms of other treatment options.

Diagnosis Updates And Delays

Dr. Megan Riehl 14:15

Well, maybe in the spirit of Women's Health Month, we're listening to women and observing what their bodies are doing. You know, I think we're hearing more and more how the onset of menstrual cycles is earlier in girls these days. And so it's kind of about tracking what is your experience with your menstrual cycle? Is something changing? And we see this a lot in gut health, where patients will say, I didn't know constipation wasn't normal. I, you know, I didn't know that it wasn't normal to go once a week. I didn't know I wasn't supposed to have pain with my bowel movements. And I hear this from women too. I didn't know that sex wasn't supposed to hurt. And so I think giving you the autonomy to be aware of changes in your body and then to report those is so incredibly important with our women's health. And then, of course, having providers that listen. And again, we say this a lot that if you do not feel heard by your providers, then it's time to move on. Go find somebody else. And particularly important in our gynecological health, too.

Rachelle LaCroix Mallik, MA, RDN 15:27

I think as therapists, you know, psychologists, dietitians, that even though we're not the ones diagnosing this, patients may tell us things that we're like, that's a little bit of a red flag. You know, you might want to consider seeing a reproductive endocrinologist, a gastroenterologist, whatever it may be, right? So we can be part of that, those identifiers, even if we're not the ones diagnosing. So it's helpful for us to be aware of what are signs and symptoms, even though we're not the ones diagnosing these conditions, because people may not have a diagnosis and be struggling or suffering.

Kate Scarlata, MPH, RDN 15:58

Exactly. And you know, patients, we need to, as providers, ask those questions. You know, are you experiencing pain with your periods? Do you have pain with sex? If you're starting to see this picture emerging, at least we can gather the information and refer out, like you mentioned. And I think, you know, even gastroenterologists, are some of these questions part of their intake when they're seeing a patient? Because we're so focused now in these specialized areas that I feel like everyone, oh, that's my wheelhouse, that's my wheelhouse. But and I think that's why multidisciplinary team approach works really well in IBS, because it's so complicated and we're each teasing out different parts of the story. So it doesn't matter whether you're a dietitian or a GI psychologist or a physician, all of these questions, you know, we need to keep asking so people get the help they need.

Dr. Megan Riehl 16:52

And you mentioned, so if you are having symptoms and you haven't talked about this with a physician, primary care may be a good place to start. And then a gynecologist, an endocrinologist could also be another expert in the field to kind of provide that diagnosis.

Rachelle LaCroix Mallik, MA, RDN 17:09

Yeah, specifically a reproductive endocrinologist.

Dr. Megan Riehl 17:11

There we go. Thank you for clarifying. Because again, you don't want to sit and an endocrinologist wait for them for six months only to be told, oh, wrong one. Gotta go to the thyroid disorder.

Rachelle LaCroix Mallik, MA, RDN 17:23

Do you have a diabetes? Diabetes. Yeah, no.

Dr. Megan Riehl 17:26

But that brings up another stat that I'm preparing for this. You know, the disease severity of endometriosis can have a profound impact on fertility, as we mentioned. And so without intervention, approximately 50% of women with mild endometriosis will still conceive. So half will, half won't, 25% with moderate disease, and then only a few with severe disease. And so that treatment is really important. And the untreated endometriosis can also cause higher risks of early pregnancy complications. So we want to be talking about this also early in our fertility journeys, too, because it's not impossible. This certainly does not mean that you need to be childless if that's something that you would like. We just want to have all the tools and resources in place to help you with that.

Fertility Impact And Early Action

Rachelle LaCroix Mallik, MA, RDN 18:13

I'd love to add to that too, that endometriosis can cause diminished ovarian reserve, meaning that it might be harder for you to get pregnant at a younger age than, you know, you're having less ovarian reserve or eggs ready to go than someone of the same age. So another reason that early diagnosis and treatment can be helpful preserving the fertility potentially.

Kate Scarlata, MPH, RDN 18:33

This is such a great episode. I feel like there's just so much awareness things I'm learning here, but I know our listeners are really gonna benefit from. So let's switch a little bit into lifestyle. Working in GI, of course, we often will consider the low FODMAP diet in someone with irritable bowel syndrome. And it's been studied a little bit in endometriosis as well from the Monash group. So that's something I'd like to talk about and maybe other dietary changes or lifestyle interventions that you find are helpful in your patients and when to select one thing over something else. Could you talk to that?

Rachelle LaCroix Mallik, MA, RDN 19:11

Absolutely. And it's one of those areas where, you know, more research is needed. As it's always kind of like the conclusion of every research study we look at. More research is needed. I feel like even compared to PCOS, like the role of nutrition and endometriosis is not as well studied. So low FODMAP diet, to your point, Kate, it can be a tool, a dietary intervention for people with endometriosis and those concurrent IBS symptoms. So it is not a treatment for endometriosis. It is a tool to help manage the digestive symptoms that someone with endometriosis may experience. So I was talking to another client about that this week as you know, something that we may be able to experiment. We talk through what it is based on her symptoms. Would this be something that could potentially be helpful? But as you all know here, the low FOMAP diet is not appropriate for everyone. There are many reasons why it would not be appropriate. So we just have to take the same lens if it's being used in endometriosis care of what are what would be any barriers to doing this? Is there an eating disorder history or disordered eating habits that we have to be cognizant of? Can they actually do this? Does it work with their goals? You know, if someone's about to undergo an IVF cycle, it's not an appropriate time to do a low FODMAP diet because they're going to be on these hormones. They're not, it's just not the right time to see if the diet's actually helpful for their symptoms. So, but that is being more researched and is kind of the best tool we have as a dietary intervention to help with bloating abdominal pain and diarrhea or, you know, other changes in stool form. So that can be used. So it is helpful that if dietitians, I feel, I mean, there must be other dietitians in a similar space, but I did the training through Monash University on the low FODMAP diet. So I feel like I am somewhat uniquely qualified, specializing in reproductive health and having that training to be able to help people in this way versus having to also refer out to a GI dietitian, right? Because then it might be having to work with a lot of different people versus having that multidisciplinary care team where it's your physician and a psychologist and a fellow public floor PT, right? If you have, it can just be a lot of cooks in the kitchen sometimes. So if you have multiple like dietitians or multiple medical providers. So anyway, I'm going off on a little bit of a tangent, but you would want to make sure that if you are working with someone for endometriosis and considering a low FODMAP diet, that they have some level of expertise with that as well to guide you. And that always, as with anybody undergoing a low FODMAP diet, that they are having a dietitian support them through it. As I, you know, many diet GI dietitians say this is not a handout diet. Right. Right. No, absolutely that this is not undertaken without some guidance and support because it's not intuitive.

Low FODMAP And Anti-Inflammatory Eating

Kate Scarlata, MPH, RDN 21:51

It isn't. That's right. That's right. And it's not long term, you know, it's really a dietary experiment, and we really want patients to go through all three phases. Phases and identify their particular triggers rather than doing this elimination diet forever and ever. Any other uh lifestyle interventions or supplements, vitamins, minerals, you know, anything else that would be more holistic or lifestyle oriented?

Rachelle LaCroix Mallik, MA, RDN 22:17

Well, I'd like to talk about some other dietary tools and then we can talk about supplements. So broadly, like in research that we have on fertility, for example, things that point to a more anti-inflammatory style diet, which can include like a Mediterranean style diet, which doesn't literally have to be Mediterranean cuisine. It's just focusing on more fruits, vegetables, whole grains, beans, lentils, fish and seafood, nuts and seeds, more of those unsaturated fats, less animal fat, is kind of broadly what a more anti-inflammatory diet looks like, you know, less added sugars, less low nutrient foods, that even though we don't have a ton of great data in their role in endometriosis for like pain management per se, we know that based on lots of other research, that this can help reduce inflammation, that this can help reduce, you know, improve cardiometabolic health. So a lot of times if low FODMAP is not appropriate because they don't also have those IBS-like symptoms, or it's not appropriate for another reason, then we might be looking at more of a an anti-inflammatory diet. And again, like I said before about not being a handout, anti-inflammatory people have many different interpretations of what that is. And when you look at the research, it's pretty, pretty straightforward of what food groups, nutrients, things that fall more into the anti-inflammatory than pro-inflammatory. So I tend to focus on that because that can overall help potentially with their fertility if they're working with me for that as well, and just their overall well-being without being too restrictive.

Kate Scarlata, MPH, RDN 23:39

I love that. And there's actually four, I think now, RCTs looking, maybe even five, but I think four, looking at the Mediterranean diet and IBS. And you know, they're all have signals. They're not strong signals like this is the one diet for everyone, but it has helped the vast majority of the individuals on the Mediterranean diet. Most of them have shown a positive response. Not all, not as effective as the low FODMAP diet, but close. And some quality of life enhancements too, which you know, Dr. Riehl can speak to, but you know, some quality of life benefits too, which is an added bonus when you were talking about a dietary intervention for sure.

Dr. Megan Riehl 24:20

Well, and Rachelle, when you were saying, you know, we want to be mindful of the individual and what's going on in their life. So if you're about to start an IVF cycle, that is not a low stress time of life, right? There's so many unknowns, uncontrollables. Your body is experiencing symptoms and pain. There can be, again, this anticipation of what's to come. And so throwing in some additional stress around your eating, the goal may just be let's get you eating regular, consistent meals, nourishing meals. Let's work on how are you managing your stress? Are you incorporating movement into your life and relaxation, stress management? I think that gut-directed hypnotherapy could be a tremendously beneficial strategy for patients that have endometriosis and IBS, because again, it's going to get right into that visceral hypersensitivity, helping with motility. It's also just a really peaceful intervention to give yourself about 15 to 20 minutes each day to kind of calm the mind, focus on some peaceful suggestions about the functioning of your body, especially when you're not maybe the happiest with your body. Those suggestions can be very helpful. So certainly before we dive into the supplements and minerals, I wanted to get my plug-in for the consideration of how much lifestyle I also just plug for sleep. You know, we might not be sleeping the best. And so creating a peaceful sleeping environment and, you know, working to prioritize that the best that you can, you know, we may have women out there that already have little ones. And so that's going to disrupt your sleep as well. And we want to be mindful of that. So even with sleep strategies, I always say, let's look at what's realistic for your life and how do we get you some adequate rest to the best of our ability?

Stress Sleep Hypnotherapy Support

Rachelle LaCroix Mallik, MA, RDN 26:16

I agree wholeheartedly. And I think, and Kate, I feel like you're the same as a dietitian. It's like nutrition is something, a tool that can support you in your overall health and well-being, right? We have to eat every day, multiple times a day. And at the same time, it's not meant to be another stressor, right? And like it's such a tricky balance of like trying to talk about nutrition and help people make health-promoting behaviors and not feel like it's uh just yeah, another thing on their to-do list, you know. And that's the approach I really take with the clients I work with is just like, how do we add nutrition in an easy way for you and not add more stress?

Kate Scarlata, MPH, RDN 26:52

A joyful way, right? I mean, food should bring joy and hopefully, you know, it can have that kind of feeling instead of feeling restrictive and stressful.

Dr. Megan Riehl 27:03

So obviously, the role of the dietitian is important. And also, if everything that we're saying, if you're listening and you're like, my gosh, I just don't even know where to start. And maybe you are experiencing some anxiety or low mood about all of this. Here we go. Here's my plug for mental health. You know, it doesn't have to be you lying on a couch for the rest of your life with no guidance. A therapist can be very direct and really give you a roadmap for things and done in a pretty short term, depending on, again, you as the individual. So if you're kind of feeling overwhelmed by all of this, think about maybe starting with the mental health side of things and then going from there.

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Gluten And Dairy Myths

Kate Scarlata, MPH, RDN 29:02

So any other supplements or diet or lifestyle components that you'd like to elaborate on?

Speaker 29:08

One thing I think we'd be remiss to not talk about today is gluten-free diets and endometriosis. Because, like speaking of those myths, right, that we we started this the episode with. One thing I hear all the time is I have endometriosis or or I have PCOS, both. And I shouldn't have gluten or dairy, like across the board. It is just a common misconception. There might be reasons why somebody has to avoid gluten or dairy, of course. And it is not required that everyone with both PCOS and/or endometriosis needs. And IBS. And IBS in there too. Yeah. I talk about all the time like the low FOMAP diet is low lactose, low fructan, but it is not gluten-free and it is not dairy-free. Right. Mm-hmm. Right. So there are a couple of studies. I can't recall if they were RCT. I don't think they were RCTs, but basically where they were looking at people on a gluten-free diet, you know, versus not, and that their symptoms were improved. But what do we know about gluten and wheat in the IBS world and low FODMAP world? Is that gluten or wheat products are also high in fructan, right? So even in the studies that, you know, when you look at them, it's like, okay, is it the gluten or is another compound of the wheat? And I'm such a fan of sourdough. I'm like, if we don't have to take out if we don't have to take out all gluten, can we get some traditional sourdough bread and see if that improves your symptoms at all, like your digestive symptoms? I always like to start there. Or make sure that they're getting appropriately screened for celiac disease before just, you know, avoiding gluten without really knowing if they need to.

Kate Scarlata, MPH, RDN 30:42

Absolutely. Absolutely. If you have those articles, I'd love to share them. But it's a very valid point because we see this, and I hear physicians talk about this actually when I'm like at a round table. Why don't we just do gluten-free? It seems easier. And it's like, it's not necessarily easier. And, you know, you can develop celiac disease at any point in time. That's why I think people think, like, oh, I had that ruled out. I'm all set. And unless you have gene testing done and you've ruled out that you don't have genes for celiac disease, that's a different story. But for people that have digestive symptoms like IBS and that often co-occur with endometriosis, you could get celiac 10 years from now. Like we don't know. You getting it tested again is a reasonable thing to do in a few years or if your symptoms are unresolved and you haven't figured out exactly what is causing them. So when you take gluten out or people go on these gluten-light diets, it's really hard to then get the gluten back into the diet to do these blood tests or, you know, endoscopies to check. And it's really important that we do that. And you can do a gluten-light diet and still have celiac disease, not have the symptoms that are very, or they are, and you're used to living with them. What people need to understand is that you in you have an increased risk for intestinal cancer if you're untreated celiac disease. So it's really important to work with a dietitian that understands the need to have gluten in the diet for the testing and to be careful not to self-diagnose yourself with gluten sensitivity and just go on a gluten-free or gluten-free life diet without some formal screening for celiac disease.

Speaker 32:23

Absolutely. I talk about that all the time because you know, if someone's gluten-free, but they're like, oh, but if it's the weekend, I'll have, I'll share a muffin or a cinnamon or they'll do soy sauce at a Japanese restaurant. I'm like, if you have celiac disease, you cannot do that, right? So I think getting properly diagnosed and/or screened, at least screened for that before avoiding gluten is important.

Supplements Evidence And Safety

Dr. Megan Riehl 32:42

Definitely. Okay, so with my two dietitians present, I always like to ask these questions because this is outside of my scope of expertise here. Any vitamins or supplements that you recommend off the shelf? You know, the women's health, reproductive health. I think I know the answer, but I always like to ask the experts. So give it to us straight. Can we pay $60 to $100 a month to help improve any of this?

Rachelle LaCroix Mallik, MA, RDN 33:09

Wouldn't that be nice? Well, I don't know if I'd want to spend $60 to $100 a month, but it would be nice to have alternatives, right? Or options. So there was a 2025 meta-analysis on supplements in their role in endometriosis pain. So happy to send that article along to y'all too. And basically, I wrote down their conclusion that given the absence of demonstrated benefits for endometriosis pain, along with the potential harms and costs, dietary supplements should not be recommended for managing endometriosis-related pain at this time. Yeah. And as, you know, working with individuals, there still may be opportunities where, okay, this person really, they're vitamin D deficient. Let's make sure they get supplementing for that. They're really not eating fish and seafood and not open to it. Let's get them some omega-3 supplements so that they can, you know, help get that anti-inflammatory benefit perhaps from the DHA and EPA. You know, so making sure if there are any nutrient or vitamin deficiencies that we're correcting those and supplementing where needed. And occasionally, like basically the wheat research is pretty low quality. Sometimes all clients will be open to trying ginger. I might suggest that. There's some very limited data that it may help with pain. It's usually like, I think 250 milligrams four times a day, something like that, as you could get as a capsule or as you know, teas, but you have to be pretty consistent with it. And again, I'm not gonna say like you could take this instead of ibuprofen. I'm not gonna be out there saying that, but that it might be an adjunct therapy that they can try. And if it seems to help them, great. It's pretty low cost and not a safety risk. That's the thing.

Kate Scarlata, MPH, RDN 34:44

Yeah. It's important to remember, and you did touch on this, is that, you know, supplements aren't really regulated. And so if there are gaps like a vitamin D deficiency, you know, you just want to make sure that you're selecting a supplement that has been third-party tested and has some kind of certification on its label, and maybe not buying it from Amazon where there's been, you know, some fraudulent release of look-alike vitamins, but they're not really the same brand. So just being careful of where you're getting your supplements as well and working with a health professional to help fill those gaps rather than just getting a bunch of supplements that you're basically putting down the toilet because it's just going right into your pee and into the bowl, right?

Dr. Megan Riehl 35:29

And look for the credentials of the person that's recommending them. I'm not saying that everyone selling something out there is a fraud, but credentials matter. And, you know, so if a life coach or a nutrition coach has a product out there on the market for $75 a month, and you know, they also happen to be an attorney on the side or they are owner of a retail store, be mindful. They can put whatever they want out there in terms of their results and somebody that will share a story. But we're looking for credentialed experts, Rachelle. We talked about what your expertise is. Kate, we know your expertise. So if you're thinking about taking something, putting something in your body, really talk to a specialist that can guide you as an individual before you end up putting out because some of these things, the supplements, can actually worsen your symptoms and they can cause worsened bloating, worsened abdominal pain, constipation. So again, we want to kind of personalize things to you.

Rachelle LaCroix Mallik, MA, RDN 36:38

It's so important. And, you know, I think there are times when it's like, well, it's natural, so it must be safe. And it's not, it's not always. And it's still made in a lab to make this supplemental form of something. And it is different than eating the food. But there are, again, are times that we can't get it all from our diets. And looking for that third party for potency purity is important. And that's why you can sometimes take me a while when someone's like, well, what do you recommend for X? And if it's not something I recommend often, I'm like, I gotta do some research for you on like some reputable product here.

Kate Scarlata, MPH, RDN 37:08

Absolutely. And I use Consumer Labs as sort of my benchmark. They do third-party testing. It is a subscription model, but for healthcare providers listening, it's a really great resource because you can look up specific supplements and they're screening them for lead and all sorts of contaminants and selecting, you know, best price point, a variety of different metrics to help you select the proper products for the patients that you're serving. So that's a good resource.

Rachelle LaCroix Mallik, MA, RDN 37:36

That's a good recommendation.

Building Your Long-Term Care Team

Dr. Megan Riehl 37:37

Well, Rachelle, what do you want patients to understand about living with both IBS and endometriosis in terms of their long-term symptom management? How are you setting them up for the expectations of what life can be like? What do you want them to know as we wrap up?

Rachelle LaCroix Mallik, MA, RDN 37:52

You know, the phrase like trial and error. I would think more of like the trial and learning, right? Of just it's not always gonna be this linear experience where, especially because the menstrual cycle, like things are changing, or where you are in your life cycle, depending on what your goals are, if you're building a family versus getting surgery or both. Sometimes people are getting surgery and then they're doing a fertility treatment, that it's just it's not always gonna, may not always be well controlled, even with the best efforts and the best care. But I would say that having a good care team, as we've alluded to or mentioned a couple of times already, about having your physician, whether it's an OBGYN, REI, or your primary care who can support you, having a psychologist who is well aware of endometriosis andor IBS, if that's what you're dealing with, who can support? Because this is mentally, psychologically super challenging, again, depending on what else you're dealing with, just but the pain alone itself can be really difficult to manage. And then dieticians to help with any dietary interventions, because here's the thing: even though the research isn't that great that a diet is going to significantly impact endometriosis pain, people want to do something. People are looking. People with endometriosis are looking for dietary support. So, regarding patient interest in nutrition support, a 2023 UK survey found that only about 13% of people with endometriosis had seen a dietitian for gut symptoms, while about 57.7% of those who had not said it would be helpful. So you can see there's a big disconnect from the people who have seen a dietitian for some of their gut symptoms with endometriosis versus people who actually want to. So again, you know, if someone might say, oh, well, diet's not going to make a big difference in your endometriosis pain, that doesn't mean there aren't things that we can help. And we know, depending if there are those concurrent GI symptoms, there are things we can do. Even just helping them feel like they're eating a well-balanced, nourishing diet, that they're doing something to improve their health and well-being and just have something to, for lack of a better word, be in control of, right? When things can feel out of control, as long as it's not becoming overly restrictive. Again, going back to we have to eat multiple times every single day. And if people are second-guessing those choices, or I shouldn't eat that, or I don't know if that's doing anything, a dietitian can be super helpful with that.

Kate Scarlata, MPH, RDN 40:05

Absolutely. I mean, nutrition matters, right?

Rachelle LaCroix Mallik, MA, RDN 40:08

Yes.

Kate Scarlata, MPH, RDN 40:09

Mental health.

Rachelle LaCroix Mallik, MA, RDN 40:10

Mental health matters, nutrition matters.

Kate Scarlata, MPH, RDN 40:12

You know, may not be a specific, you know, thing for endometriosis, but there's going to be some byproducts to eating a good diet.

Dr. Megan Riehl 40:19

Absolutely. Well, so the dream team, right? That's what people are.

Rachelle LaCroix Mallik, MA, RDN 40:23

I forgot one person on the dream team, the pelvic floor physical therapist. I was gonna say that. Yes, we have to have the pelvic thorough, psychologist, dietitian, pelvic floor PT.

Kate Scarlata, MPH, RDN 40:34

Yeah. I'm glad that the pelvic floor physical therapists are like getting a little more air time because it always has been such a huge component in my patient care.

Rachelle LaCroix Mallik, MA, RDN 40:46

Same. I mean, working in reproductive health, like, you know, pregnancy, postpartum. I talk about like, look, even if you had an easy labor, easy quote unquote labor and delivery, things shift. Uh, you know, getting just a checkup and evaluation can be helpful. Scar tissue mobilization with C-sections, you know, there's just things that pelvic four PT can help with with pain. And if you're experiencing pain with inner course, you know, that's things that the pelvic floor PT can help with as well.

Kate Scarlata, MPH, RDN 41:11

Exactly. Yep. We need the full enchilada for these patients, right? Not just a lot of people.

Rachelle LaCroix Mallik, MA, RDN 41:16

And I think that can just help because as I mentioned, you know, it's not a linear thing. People may still, you know, it may be ebb and flow in their symptoms, but getting making sure they're getting the support they need and tackling it from a couple of different angles is gonna give them the best outcomes.

Speed Round Food And Real Life

Kate Scarlata, MPH, RDN 41:29

That's awesome. Well, I think we're ready for speed round. Speed round. Very exciting. That's very exciting stuff. Okay. So we're gonna get to know you a little bit better and our audience will too, Rachelle. So, first question: what's one health habit you never skip, no matter how busy you are?

Rachelle LaCroix Mallik, MA, RDN 41:47

I never skip a meal. I really don't.

Kate Scarlata, MPH, RDN 41:51

Said by a good dietitian.

Rachelle LaCroix Mallik, MA, RDN 41:52

I love it. Unless, like, there's some crazy circumstances and then I'm hangry and it's not a good look. Like I don't let myself get hangry. I pack snacks if I know that I'm not gonna be able to get a meal. So eating generally three times a day and a snack or two, I eat consistently. That's always important to me.

Dr. Megan Riehl 42:09

Okay, question two then. What are those go-to meals or snacks that you love to come back to?

Rachelle LaCroix Mallik, MA, RDN 42:15

Oh gosh, there are so many. My tastes and food are quite varied. I would say sometimes when people talk about their desert island meal, I go to spaghetti meatballs. Low FODMAP, of course, or modified FODMAP, you know. I like to add some lentils to my meat, some canned lentils to my meatballs to boost the fiber, uh, good sensitive marinara that I tolerate, but I just love, I love spaghetti meatballs. Other than that, I don't know. I'm like breakfast, you know, yogurt, granola, berries kind of thing, super basic, but I love it. I look forward to it. There's just, I don't even know where to begin with.

Dr. Megan Riehl 42:47

It's hard to ask that question to a dietitian. I get it. Yeah, I get it.

Rachelle LaCroix Mallik, MA, RDN 42:51

I like so many different cuisines. I've had the you know privilege of traveling a bit. I've lived in Australia, where you know, Australian cuisine is such a mix of other cuisines of that region of the world, you know, where I ate a lot more like Malaysian and Thai food and Fijian things. And my husband's Indian, so I cook a lot of Indian foods as well. So yeah, I just I really it runs the gamut of foods that I'm gonna eat week to week.

Kate Scarlata, MPH, RDN 43:13

And I will say, following you on Instagram, I agree with that. It does run the gamut with you. I'm always like, what is that? You definitely have an expansive palette, and I've taken note. I love that. Rachelle, what's your Instagram?

Rachelle LaCroix Mallik, MA, RDN 43:26

At Rachelle Mallik. So R-A-C-H-E-L-L-E-M-A-L-L-I-K.

Dr. Megan Riehl 43:30

We'll put it on our show notes too, so that we can all drool over your food.

Rachelle LaCroix Mallik, MA, RDN 43:34

And okay, I gotta work on that. A friend was like, wait, you haven't posted recently for me to screenshot and write down dinner ideas. So I gotta get back to that. We're in the middle of a home reno that's taken up a little bit of my side time. But you know, I'm eating. I'm just not always taking pictures and posting about it.

Kate Scarlata, MPH, RDN 43:51

That's right. Okay. So, what's a woman's health trend that makes you roll your eyes?

Rachelle LaCroix Mallik, MA, RDN 43:57

I would say the term like harmless. Balancing or balancing hormones.

Kate Scarlata, MPH, RDN 44:02

Through diet? It's or just yeah.

Rachelle LaCroix Mallik, MA, RDN 44:05

Through diet. Yeah. It's usually like eat this to balance your hormones. Yeah. And I'm like, that is such a vague term. I mean, endocrinologists kind of lose their, you know, minds over like, what hormones are we talking about? We're talking about thyroid hormones, reproductive hormones, hunger hormones. So it's not to say that diet has no impact on any of those hormones. Like we need enough iodine to make thyroid hormone, right? Right. It's not that nutrition, again, we know nutrition matters, but saying like eat this to balance hormones, I think is just way overpromising.

Dr. Megan Riehl 44:39

Okay. What's one question you wish more patients would ask you about?

Rachelle LaCroix Mallik, MA, RDN 44:44

If there's a food that they're open to trying, like something they don't eat very often, but are like, I want to try this or I'm open to it, asking me for some suggestions. Okay. Great. Because like I'm thinking the other day somebody was mentioning like radishes. And she's like, I don't know if I just didn't do it right or it was too thick. And I was like, have you ever tried like a matchstick radish on top of a taco? And she's like, Oh, that sounds good. So, like a really either mandolin, super thin sliced, or just like really finely chopped, like, or just, you know, we have expertise in cooking and culinary skills that help us apply the nutrition interventions, right? And so I think if people are just like, the only reason they're not eating is because they don't know what to do with it. Right. Then that's I love having those conversations. Yes, ask your dietitian. You know, yeah, or they, I don't like beans and lentils, right? Because we'll talk about getting some more plant-based proteins in. Broadly, they just hear beans and lentils. I don't like that. Oh, but I would eat eat refried beans. Oh, I like lentil soup. Like we start talking about different iterations, different ways you can put things into a meal where it's like, okay, you prefer meat, but you could also add lentils or beans to this. It doesn't have to be either or. So I love having those conversations that helping people expand their palates a little bit to add nutrition to their plates.

Kate Scarlata, MPH, RDN 45:56

That's perfect. Loving it. All right. So, what is something people would be surprised to learn about you?

Rachelle LaCroix Mallik, MA, RDN 46:03

I love to sing. I have sung in choirs a lot of my life, not my entire life, not since kids, but before that, I was in musical theater growing up. I'm up for karaoke if if anyone invites me, I'm I'm there. That is good to know.

Dr. Megan Riehl 46:17

Okay, so what's your karaoke song?

Rachelle LaCroix Mallik, MA, RDN 46:19

Where's my mic? Oh, I have a list. I keep a running list. And then you read the room of like, are we going, you know? There's again, speaking of my food preferences, my musical preferences are really all over the place too. And then I have to be able to sing in my range. So I'm an outdoor. Okay. So that's going to limit certain choices for very high-pitched female soprano singers. So I don't have one go-to, but I've got many. I can understand that.

Kate Scarlata, MPH, RDN 46:42

I'm seeing a karaoke party.

Rachelle LaCroix Mallik, MA, RDN 46:44

I think we need to have a karaoke party. If you host one, I will be there. Okay. Good to know.

Final Takeaways And Subscribe

Dr. Megan Riehl 46:50

Okay, The Gut Health Podcast karaoke experience. That's right. That's right. Rachelle, this has been an incredible way to kick off our three-part series for Women's Health Month. So many incredible tips and tricks. So thank you very, very much for joining us this episode. It's a privilege to be here. Thank you so much.

Kate Scarlata, MPH, RDN 47:13

All right, friends. Like, subscribe, share The Gut Health Podcast.

Dr. Megan Riehl 47:18

Thank you for joining us as we grow this gut health community. We hope you enjoyed this episode and don't forget to subscribe, rate, and leave us a comment. You can also follow us on social media at The Gut Health Podcast, where we'd love for you to share your thoughts, questions, and experiences. Thanks for tuning in, friends.