Dr. Laura Ricci is one of the country's foremost experts in nutrition for pelvic health. She also has an incredibly inspiring personal story, and understands better than anyone the importance that nutrition can play in dealing with serious health issues. She is based in Amarillo, Texas, but advises patients around the country and across the globe. We often talk about the importance of a holistic approach to healing - Laura has personified that in her own healing journey, and now helps patients add the nutritional component to their own journey. We're excited to have her for this three-part interview; for more information, you can visit Laura's website at lauraricci.vpweb.com.
If you missed Part 1 of our interview with Dr. Laura, make sure to check out her background and inspiring personal story of healing.
Nicole: What are some of the first things someone experiencing pelvic pain should think about with regards to their diet?
Dr. Laura: I think it is important to understand that the foods we eat can contribute to inflammation, and therefore pain in the body (including in the pelvis and hips). Eating foods that you have sensitivity to can cause the immune system to overreact, resulting in inflammation. Also, with pelvic pain, there are often other issues going on besides just the pelvic pain itself. Several of my clients are also struggling with constipation, diarrhea, bloating, IBS, GERD, or other digestive issues in addition to their pelvic pain. It is so important for anyone struggling with pelvic pain to work on normalizing bowel movements. Ideally, we should have 2-3 well-formed bowel movements a day; if not, we have some things that need to be addressed. Constipation is a very common issue, which can have an effect on the pelvic floor muscles. Ongoing constipation can stretch the pudendal nerve, due to frequent straining. It can also create more pressure on the bladder and urethra, which could contribute to increased urinary frequency or retention, and also contribute to pelvic floor dysfunction. It’s all related. We often don’t think that what we eat could affect what’s going on in our pelvis, but I’m here to tell you it can.
Nicole: That's so true! Researchers have found a close relationship between IC and IBS, for example, and constipation is extremely common for patients with pelvic dysfunction. Are there general principles for anyone with pelvic pain? Or does it vary from person to person, or diagnosis to diagnosis?
Dr. Laura: There are some general principles that would be helpful to be aware of; but, I also believe in bioindividuality, and my job as a health and functional nutrition coach is to help my client find the right diet that fits her specific needs. The top seven food sensitivities that can contribute to inflammation in the body are:
I like to refer to these as the “big guns.” People can do a 30-day elimination diet of these foods, in which they remove one or all of them completely for 30 days and then reintroduce them, one at a time, to see if any reactions take place. The trick with the elimination diet is that it has to be done completely. The client needs to be diligent and make sure that she is not having even small amounts of the food she is avoiding, and these ingredients are often hiding in packaged foods. I tell clients it’s like being pregnant; you either are pregnant or you’re not pregnant. You can’t be a little bit pregnant. The same goes for an elimination diet. You can’t have a little gluten during an elimination diet. You will not get accurate results. The reason we have to be so diligent is that the inflammatory response from food can last up to 3 months. I’ve seen some research showing the inflammatory response from gluten can last up to 6 months!
An elimination diet can provide you with helpful information and give you some guidance as to which foods might be causing you problems. It is important to note that you should not just be looking at digestive symptoms during the reintroduction phase. Changes in mood, acne, rashes, sleep, energy, pain, brain fog, etc. can all be signs that you are having a reaction and should stay away from that food. In fact, the number one symptom of celiac disease is depression! You have to be a bit of a detective and look at your body and your symptoms as a whole. It also might not be a bad idea to keep a symptom journal to help you keep track of how you are feeling and what you are experiencing while doing an elimination diet and reintroduction. After all, you know your body better than anyone else.
For some people, following a general elimination diet can prove to be extremely helpful; for others, we may have to dig deeper. Some people can be sensitive to grains, legumes, nightshade vegetables, FODMAPs, oxalates, histamines, etc. Some people could also have underlying blood sugar issues and need to address any insulin resistance that may be going on. Again, this is all about finding the right diet for you, the one that you feel best on. It can be a bit of a trial and error process, but it is worth it, and you will know when you have found what works best for you because you will see improvement in your symptoms and feel better.
Some other general guidelines for pelvic pain, besides reducing inflammation through diet and improving bowel movements, include: staying hydrated with clean filtered water, eating enough healthy fats (like coconut or coconut oil, avocado, chia seeds, hemp seeds, flax seeds, olive oil, etc.) and gradually increasing fiber in the form or organic vegetables, especially dark leafy greens, and lower glycemic organic fruits (like berries, green apples, and pears). I also recommend that if you eat animal protein, you make sure that it is organic and from clean sources like grass-fed beef, organic chicken without antibiotics, and wild caught fish, rather than factory-farmed fish. Quality definitely matters.
Nicole; What kind of impact can changing your diet have on symptoms?
Dr. Laura: Changing your diet can have a profound effect on your symptoms. For me personally, when I went gluten, dairy, sugar, soy, corn, and peanut-free for 3 months, I noticed my chronic constipation completely vanished. My PMS symptoms went away as well, and my periods, for the first time in my life, completely regulated! Before, I had extremely irregular periods, anywhere from a 13-day to 65-day cycle. I never knew when my period was coming and felt like I lived in a constant state of PMS. I would struggle with frequent uterine cramps and swollen bleeding gums. When my period would finally come, it was very painful with heavy bleeding and clotting, and would last an entire week. It was awful. Now I can actually predict within a three-day range when my cycle will start, I typically have a 26-28 day cycle, which is a huge improvement. I hardly notice any PMS at all, and I have normal bleeding, without the heavy clotting, which only lasts 5 days. It changed my quality of life for the better! Also, I had some ongoing pain in my left knee that, as a physical therapist, I was not able to improve with traditional treatments (stretching, strengthening, manual therapy, ultrasound, iontophoresis, etc.). Three months into changing my diet, this pain went completely away and never came back. It was amazing! What you eat really can have a profound impact on how you feel and the quality of your life.
What is Pelvic Physical Therapy?
Dr. Nicole Cozean is the founder of PelvicSanity physical therapy, Orange County's premier pelvic floor physical therapy clinic. One of only 270 PTs to be board-certified in the pelvic floor, and the first PT to serve on the ICA Board of Directors, Nicole is the author of the acclaimed and best-selling book The Interstitial Cystitis Solution (2016). She is an adjunct professor at her alma mater, Chapman University. The PelvicSanity blog focuses on presenting practical, positive information to help patients beyond the walls of Nicole's clinic.