Gut Loving and Motility Boosting Dark Chocolate Covered Fruity Oat Bars
Constipation is a common GI complaint many people with endometriosis experience, and it can be for a number of reasons, from Intestinal Methanogen Overgrowth to pelvic floor dysfunction and adhesions.
However, nutrition can make a bigger difference than we can imagine, from speeding up motility time (like kiwis) to softening bowel movements, and whilst sometimes more deeper investigations and more treatment might be required, for some, dietary tweaks can really help.
I recently designed this fruity oat bar for my client who struggles with constipation. She’s been eating it in the mornings and it’s really helped get things moving again!
Oh - and P.S. eating prunes daily has been shown to help bone density!
Every ingredient in this recipe is designed to help with constipation.
Prunes are evidenced based for improving constipation, and are even more effective than psyllium husk. The presence of sorbitol (a type of carbohydrate) draws water into the colon which has laxative effects, and soluble fibre soften stools, whilst the insoluble fibre also found in prunes adds bulk and helps increase transit time.
Now, most of the studies used large amounts of prunes per day, such as 100g, but that for many, would cause quite a lot of blood sugar dysregulation, so we’re not using that many prunes, which is why I’ve combined prunes with other constipation treatments.
Oats also contain soluble fibre which soften bowel movements, making them easier to pass, and have been shown to aid with constipation and increasing stool weight (meaning they bulk up stools).
Flax is also a great evidenced-based treatment for constipation, and is a recommendation on the NHS. You can learn all about using flax for constipation here.
Oils such as olive oil and flaxseed oil can trigger large intestine motility helping to initiate a bowel movement, and they can also coat the stools to help the transition. One study found that 4ml of olive oil or flaxseed oil a day over 4 weeks was effective for treating constipation.
Finally, dark chocolate contains natural stimulants like caffeine and theobromine, which can stimulate contractions in the intestine, encouraging bowel movements. In fact, one recent study showed an increase in frequency and stool amount after ingestion of dark chocolate.
Now - a word of caution, for some people with IBS, certain fibres and sugars (like sorbitol), fats and caffeine can trigger gut discomfort, like cramping. Additionally, going from a low fibre diet to a high fibre diet can also trigger some discomfort. If you’re not sure how you’ll respond to this, start with a smaller serving size per day, and give your gut time to adjust and for you to work out what your tolerance threshold is.
Additionally - give these ingredients time! Most constipation aids come from regular, daily ingestion over a period of time, so it may take a few days or even weeks for bowel movements to regulate.
Rich in prebiotics and polyphenols to help heal the endo belly and reduce systemic inflammation.
The latest data shows that 96% of UK adults are getting less than the recommended 30g fibre a day. That’s not great for our guts, which rely on fibre to thrive, and people with endo need extra gut support already (as you’ll come to learn shortly) so a lack of fibre isn’t going to help the situation (though you may find you need to tailor your fibre sources if you have IBS or SIBO).
These fruity oat squares offer 6g of your recommended 30g!
Additionally, a major study of 10,000 people found that eating 30 or more plant foods a week helps to create a healthier and more diverse microbiome. This recipe offers you 5 of your 30 already, and with herbs, spices, olive oil, fruits, veggies, beans/legumes, teas and coffee and whole grains all counting, you can easily top up your levels further. For extra guidance on how to reach your 30 a week, check out this article by The Gut Health Doctor or this one by Zoe.
And thanks to our specific ingredients of dark chocolate, prunes and olive oil this recipe is also high in polyphenols. Polyphenols are types of antioxidants found in certain plant foods that not only reduce inflammation levels and improve overall health, but they are also an absolute favourite food (prebiotic) for our gut microbiome, which means they can support our good gut bugs to thrive.
But why does this matter for us endo folk?
Research is finding a strong correlation between microbiome disturbances and endometriosis development, such as reduced levels and variety of good gut bugs and higher levels of pathogenic (bad, infectious), opportunistic (in high numbers, can cause problems like inflammation) gut bugs, as well as gut bugs linked to elevated oestrogen levels. These microbiome differences have also been associated with higher IL-8 levels, a type of inflammatory cytokine shown to be involved in the development of endometriosis.
Polyphenols and prebiotic fibre are like gut bug boosters - the more we provide to our good gut bugs, the more they grow and outnumber the bad guys. This helps to bring the gut back into harmony, which can improve gut symptoms and intestinal inflammation and whilst we need to do more research, could even help us fight endo.
These prebiotic fibres help us to increase our production of gut friendly fats, called short chain fatty acids, which are made when good bacteria consume fibre. Research shows that people with endo may be low in short chain fatty acids, especially one called butyrate. Butyrate is a short-chain fatty acid produced by our gut microbiome, and has been found to be low in people with endo. Butyrate has a range of benefits for endometriosis and gut health (so therefore, can help us tackle endo belly) such as reducing intestinal inflammation, improving insulin sensitivity, preventing leaky gut, promoting the growth of beneficial bacteria and inhibiting the growth of harmful bacteria. Butyrate inhibits our inflammatory immune response to lipopolysaccharides (LPS), LPS are toxins that come from certain bacteria, and have been shown to be heavily involved in endo pathogenesis, so by improving our fibre levels, we may actually be improving some of our defences against endo.
Better for blood sugar to stabilise hormones, reduce PMS, reduce period pain and lower oxidative stress.
Unfortunately, a lot of store bought “healthy” oat and fruit bars are actually laden with added sugar like rice syrup and glucose syrup, and contain additives - making these foods actually highly processed.
Blood sugar spiking foods such as high sugar foods and processed foods can potentially contribute to morePMS, menstrual pain and endo pain. Blood sugar spikes increase oxidative stress, which leads to more inflammation in the body and that may trigger further pain and symptoms. In fact, oxidative stress is higher in people with endo, and it’s a key driver of endo growth.
To avoid these issues, I have focused on the presence of healthy fats (from the olive oil) and fibre (flax, oats, and prunes), which have both been shown to help stabilise blood sugar levels and slow down the uptake of glucose/starch from our food (from the prunes and chocolate, in this case) to our blood stream, preventing blood sugar spikes.
In fact, just one square offers around 6g fibre!
One of the easiest ways for us to support our blood sugar is to opt for whole food carbohydrates, such as fruit, instead of sugar or maple syrup, as I have done here. Whole foods still contain their fibre, which helps slow down digestion and the resulting absorption of glucose to the blood stream, creating a steady drip rather than a flood.
Another great way to support blood sugar is with lower glycemic index foods, and every ingredient in this recipe, even the dark chocolate (because we are opting for a high percentage and low sugar version) is low to moderate on the glycemic index scale. The glycemic index is a tool that looks at foods and the impact they can have on your blood sugar, on a scale of 0-100. A high GI index would be 70 and above, a medium GI is 56-69 and a low GI index is 55 or less. High GI foods are very likely to spike your blood sugar levels and do so quickly, foods with a medium GI rating tend to cause a moderate rise and low GI foods tend to keep blood sugar levels stable and steady over time with a gentle rise. This is because low GI foods break down slowly in the gut because they are rich in fibre and slow release carbohydrates, this means that the release of glucose to the blood stream is slow and gradual.
I’ve also intentionally used olive oil, flax and oats in this recipe to further support blood sugar.
Rolled oats contain beta-glucan, a special type of fibre found in oats that offers a wide range of health benefits, including stabilising blood sugar post-meals, and as a result, makes oat-based foods more effective than wheat based foods (like using regular flour) for blood sugar stability.
Research has also shown that adding olive oil to meals reduces the post-prandial blood sugar levels (meaning it helps prevent blood sugar spikes from foods/meals), even in high glycemic meals (meaning meals/foods high in sugar or starch that can cause rapid blood sugar spikes).
Oats also contain something called resistant starch. Resistant starch is a type of starch that resists digestion in the small intestine. Typically, starch is broken down and absorbed very quickly by the small intestine, which is why you may hear me or other health practitioners discuss moderation or being mindful with starchy foods, because it can spike blood sugar.
But resistant starch resists digestion. It makes its way to the large intestine, where good bacteria eat it and this has some incredible benefits for the gut and endo due (more on that below).
Because this type of starch resists digestion and breaks down slower, resistant starch is better for blood sugar vs. regular starch. In fact, resistant starch has been shown to be improve insulin sensitivity and blood sugar levels in multiple studies, and has even been shown to improve postprandial glucose levels when paired with a high sugar meal (in this study, it was 500g of syrup) in contrast to regular starch.
Uncooked oats, as we’re using here, are rich in resistant starch - when they’re cooked, that resistant starch turns into regular starch, which has the potential to affect blood sugar levels, which is why I always recommend pairing cooked oats with plenty of fat, fibre and healthy fats.
Flax seeds contain something called viscose fibre. Viscose fibre forms a gel-like texture when added to water, and when combined with liquids and food in the gut. This slows down digestion (so great for us when we’re drinking coffee) and also the release of glucose (even better when we’re drinking coffee with a pastry or cake!). In fact, research showed that 30g of flaxseed helped reduce the glucose spike with a sugary or starchy meal, whilst 20g flax per day improved overall glucose levels and responses over 12 weeks.
Constant blood sugar swings can take their toll on hormones, leading to issues like elevated androgens (think testosterone), which can affect ovulation and cycle length. Blood sugar swings may also cause oestrogen excess or dominance and low progesterone if ovulation is interrupted or stopped entirely. Both of these imbalances can cause more PMS, heavier periods, and may also exacerbate endometriosis symptoms.
Additionally, these fruity oat squares can help us out with luteal phase or period cravings. When we’re in our luteal phase, we often experience more blood sugar swings because oestrogen, which dominates in our follicular phase, helps us to regulate our blood sugar response, but is lower in the luteal phase. As a result, we tend to get cravings for sweet foods or foods high in starch. The problem is, these foods keep us on a blood sugar rollercoaster, and raise inflammation levels, resulting in more of those inflammatory symptoms and pain that we’re trying to avoid. These fruity oat bars, being lower in sugar and rich in fibre, can help us get our fix without the pain and PMS triggering spikes.
Finally, blood sugar swings are linked heavily with mood disorders such as depression and anxiety, so if you struggle with low moods in your luteal phase, supporting blood sugar can actually support your mental health.
Now, let’s be clear before we wrap up this section. I am not saying you have to avoid sugar or refined carbs for the rest of your life, but if like me, you enjoy a sweet treat as a snack or after dinner, it can help to make these regular goodies a bit more blood sugar balancing, so that we’re looking after ourselves on a day to day basis.
A good source of hormone and endo beneficial nutrients, including magnesium, iron, folate and zinc.
Oats, olive oil, prunes and dark chocolate contain some key nutrients for hormone health…
Magnesium
Research has shown magnesium to be an effective treatment in preventing dysmenorrhea (period pain) because it reduces inflammatory prostaglandins that are the drivers of both endo and period pain. One study showed that six months of magnesium treatment reduced prostaglandin F2a by over half! In fact, in recent research, magnesium is being explored as a dietary treatment for endo and a higher intake of magnesium rich foods was associated with a lower risk of endo. Additionally, magnesium helps to regulate our sex hormones, and as result, is a recognised treatment for preventing PMS.
Iron
A recent major study of over 43,000 endo patients found that we have a six-fold increased risk of iron deficiency. SIBO could be a player here, as it inhibits iron absorption but it could also be from heavy menstrual bleeding, restricting red meat and other factors.
Iron plays a major role in preventing fatigue, and yet many of the clients who I work with, come to me with significantly low levels. Supporting healthy iron absorption and intake is a key part of beating endo fatigue and recovering from heavy blood loss and low levels can cause brain fog, extreme tiredness, heart palpitations, dizziness, muscle weakness and depression to name a few.
Healthy iron levels are also essential for ovarian function, which is key to producing healthy amounts of sex hormones and low levels are associated with menstrual irregularities and fertility problems.
Additionally, low iron levels are linked to ADHD development and can worsen ADHD symptoms, and ADHD is a condition which many people with endo struggle with.
Folate
Folate is crucial to ovarian function and ovulation, and low folate levels can cause irritability, mood swings and fatigue, and fertility problems.
Zinc
Low levels of zinc have been linked to endo, and research has shown it can significantly reduce period pain thanks to its anti-inflammatory benefits. It additionally supports follicle development and ovulation, while deficiency has been linked to infertility.
IMPORTANT NOTES TO HELP YOU TAILOR THIS RECIPE TO YOUR OWN BODY AND NEEDS (AND TASTEBUDS!)
Everything you’ve said about blood sugar and processed foods, does that mean I can never have my favourite treats again?
Absolutely not. I am all for ‘worth it moments’. Enjoy our fav foods, whatever they are, in moments when we really desire them. But I am a health coach, and my goal is to minimise your symptoms and lower things like oxidative stress and inflammation that could contribute them, so I am going to encourage snacking smarter and leaning on healthier treats on a day to day basis, and that’s way these recipes are for. So you can have your cake, and eat it!
Are oats gluten free?
Oats are naturally gluten free, but are often processed in a factory that handles gluten, so if you’re coeliac, then go for gluten-free oats which have been processed in a factory without gluten.
Are these fruity oat squares low FODMAP?
Normally I make as many of my recipes low FODMAP, but this one absolutely isn’t - because the core ingredient, prunes, are high FODMAP. Whilst prunes are great for constipation, if you don’t tolerate sorbitol or fructans very well, these may not be for you.
Why do you make so many recipes low FODMAP?
The low FODMAP diet is being shown in the research to be one of the most effective dietary interventions we have for symptom relief in endo (esp. for those with IBS issues). That doesn’t mean you have to do it, and if you do, it should be done under supervision of a doctor or low FODMAP trained professional, but some people may be on the diet already, so I like to tailor to as many people as possible. It also means this recipe is less likely to trigger bloating (though that’s not guaranteed, because everyone is different).
Is this recipe suitable for SIBO?
Everyone’s triggers vary with SIBO, but this recipe may not be, as the prunes are high FODMAP, but see what works best for you.
Further resources
If you’re struggling with your endo symptoms or gut health, you might find my courses and one to one coaching helpful. You can find out more here. I’ve also got endless podcast episodes on endometriosis and SIBO.
Gut Loving and Motility Boosting Dark Chocolate Covered Fruity Oat Bars
Ingredients:
200g prunes
200g rolled oats
50g flax seed, ground
50ml olive oil
100g 90% dark chocolate (the darker, the better for getting things moving, but if you need more sweetness, go for 85%)
Makes: 10 squares
prep time: 15 minutes + 15 minute coating time
chill time: 1-3 hours or overnight
Method:
In a food processor, pulse the prunes, half the oats, ground flax seed and olive oil until well combined and the prunes have become a paste. I do this altogether for time and ease, but if you prefer, you can process the prunes and oil first until a prune paste forms, and then add the oats and flax and pulse a few more times to combine.
Then, stir through the remaining oats.
Line a loaf tin with baking paper, and press the dough down into the tin, using the back of a spoon. Make sure you put pressure on it, as this will help it to stick together.
Refrigerate for 2 hours, then cut into 10 squares and return to the fridge and either refrigerate for several hours/overnight until firm or freeze for 1-2 hours.
Once firm and very cold, melt the chocolate over a double boiler or gently, in 10 second increments, in the microwave. Once melted, remove from the heat, and using a fork, cover each square in the chocolate (you can also dip half in or drizzle with chocolate, so you have different patterns) and then place onto a chopping board covered with baking paper, and return to the fridge or freezer to set for an hour.
Sprinkle with flaky sea salt before serving. If keeping frozen, remove from the freezer 10-15 minutes before eating.
June and July special offer - if you’ve got half way through the year and endo has taken much of that time from you, for June and July only, I’m offering £500 off my 12 session 1:1 coaching or £250 off the six session coaching. Learn more about coaching here.
Looking for tools to help you manage endo and your hormones?
These are some of my favourite brands…
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Need more help or want to learn how to work with me?
Ways to work with me:
One to one coaching info and application
Live and Thrive with Endo 2.0 DIY online course
Endo Sessions: Single and mini-package one to one endo coaching
SIBO Sessions: Single and mini-package one to one SIBO coaching
Masterclasses in endo nutrition, surgery prep and recovery and pain relief
This EndoLife, It Starts with Breakfast digital cookbook
Free resources:
This podcast!