13: Digestive Distress & Period Pain? The IBS and Endometriosis Link Explained

Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:00):
It's so much more powerful if you can go to your healthcare
provider and say, look, I have 3-4, six months of data here.
I've missed work X number of times.
I haven't been able to attend lectures X number of times.
I've vomited 6 times this month because of pain.
I took X amount of ibuprofen andit maybe reduce my pain from

(00:21):
5:50 or 7:50 or maybe not at all, right?
That's so much more powerful than just going into the
appointment and saying I have really painful periods.
Welcome to the Gut Fit Nutritionpodcast, the show where we dive
deep into the world of gut health, nutrition and fitness to
help you unlock your best self from the inside out.
I'm your host, Lee Morado, a registered dietitian, gut health

(00:42):
expert, long distance. Runner and movement enthusiast
on a mission to. Empower you with science backed
whole body strategies to fuel your body, heal your gut, and
thrive in your active life. Whether you're here to finally
break free from IBS and digestive symptoms, optimize
your fitness performance, or learn how to support your gut
health natural strategies, you're in the right place.

(01:02):
Each week we'll explore topics like conquering digestive
symptoms, building a gut friendly lifestyle, enhancing
endurance and strength performance and.
More. So grab a cup of your favorite
gut friendly tea and settle in because we're about to get gut
fit together. Today's episode is all about the
connection between endometriosisand IBS.

(01:23):
Endometriosis effects one in 10 women, yet many still go years
without answers. Symptoms can range from intense
pelvic pain and painful periods to bloating, bowel and bladder
issues, fatigue, infertility andmore.
And for those with IBS, it can be very confusing to tease apart
what's gut related and what might be something more.

(01:43):
Research shows that people with endometriosis have a three times
greater risk of developing IBS, according to a 2022 systematic
review and meta analysis. To help me.
Break This All Down is Sidney Dabrowska, Registered Dietitian
who specializes in endometriosisand fertility nutrition.
As an endo warrior herself, she made it her mission to support

(02:03):
others walking the same path. Her approach is grounded in
evidence, compassion, and an integrated view of healing that
considers the gut, immune system, hormones, lifestyle, and
mental health. Whether you're newly diagnosed
with endometriosis, still searching for answers, or
supporting a loved one with Endo, this episode will help you
better understand your body, advocate for yourself, and

(02:24):
explore new options for managingsymptoms and feeling more like
yourself again. Let's get into it.
Hello, Cindy, and welcome to theshow.
Haley, thanks for having me. Yeah, I've been really excited
to have this conversation. I think we've been talking about
doing something for probably like a couple years now.
And I know I've, I've had a lot of clients with IBS who have

(02:45):
been actually later diagnosed ashaving endometriosis.
So I think it's a very, very important conversation to have.
And we'll, I'm excited to, to dive deeper and really hear your
side of the side of the picture and get your expertise on
endometriosis. Yeah.
There's certainly a a big overlap for sure between IBS and
Endo, so it's a great topic to cover.

(03:07):
Yeah. So just to start off, I'll let
you tell us more about yourself really who you help, where
you're located and yeah, and sort of share more about about
Cindy behind endometriosis dietitian.
Sure. So my name is Cindy Dabrowska.
I'm a registered dietitian specializing in endometriosis

(03:28):
and fertility. I have endometriosis myself.
So that's kind of the, the bridge there between why I got
into this space and a lot of my personal experience is what led
me to work with, with women who have endometriosis and
infertility or some fertility asa result of endometriosis.
You know, I've, I've been through the wringer as somebody

(03:49):
with endometriosis, all those like typical treatments that are
thrown your way, you know, hormonal birth control, hormonal
suppressants, surgery. And I unfortunately didn't have
the best of luck with these options.
And so, you know, I thought to myself, there has to be another
way. And we have nutrition guidelines
for so many other chronic inflammatory conditions.

(04:10):
So I just thought to myself, youknow, maybe maybe I can apply
some nutrition lifestyle, maybe supplement strategies to help
with the pain. And that's been a really
effective strategy for me. And that took me a really long
time to discover, you know, over2, two years of researching and,
and trial and error. And so I really wanted to bring

(04:30):
that to the endometriosis population so people can start
to kind of tease apart what may help and what may not help from
the sort of holistic natural functional medicine space I do.
So like I said, I, I work exclusively with people who have
endometriosis and infertility asa result of that, of that
endometriosis. And I'm in Ontario, Canada.

(04:51):
And yeah, it's, it's just a big passion of mine, obviously
because of the the overlap with my personal experience.
And yeah, it's definitely like avery common condition too.
I know you, yeah. You've had your practice now for
about 6 years. Yeah, 2019 I was was launched
the the online platform. It's crazy how fast.

(05:13):
It lies and I think it like exploded pretty quickly, right,
in terms of your online audienceand following.
And yeah, I know you've had a pretty busy private practice.
So obviously speaks to the the need and the demand for more, I
guess call it like holistic or integrative strategies for
endometriosis and people seekingthat, you know, high touch

(05:37):
evidence based support that theycan't get from maybe the, you
know, conventional medical healthcare.
Yeah, yeah, I do agree. And I think, you know what I
always say, like it's great for me in terms of my practice for
sure, but it's also heartbreaking to see how big the
need is in this space. And I think that largely stems

(05:58):
from, OK, your options are, and they're not even good options in
my opinion. I mean, they can be helpful,
don't get me wrong. I mean, I don't want to, I don't
want to go down a rabbit hole with this, but you know, you're
presented with hormone therapies.
Maybe you're somebody with Endo who has tried these and didn't
have a good reaction. Your other option is surgery,
but maybe you're waiting a year for that or 18 months for that.

(06:18):
Sometimes it's a ridiculous recommendation, but sometimes
pregnancy, you know, is, is suggested as a, as an
intervention. And you might not be somebody
who's in that stage of life where this is something that's
top of mind for you. And so I think it's, I think
it's a, a natural, you know, segue into, into wanting to
explore the natural side, right.And we do have a lot of

(06:40):
literature, we have a lot of research that shows various
vitamins, minerals, various types of diets and the
foundations, as I like to call them, like a good sleep and
exercise and and how they have avery positive profound effect on
symptoms of endometriosis. So yes, I would agree that there
is a big need and I think it kind of stems from the lack of
options offered right through traditional sort of Western

(07:03):
medicine. Definitely and I know here in in
Canada, it's even just getting harder and harder to you know,
get testing done blood work, getreferred to specialist.
The wait times are becoming longer and that just means more
people are sort of suffering with their symptoms and, you
know, not really able to even maybe even get that

(07:23):
endometriosis diagnosis for a long time too, which we'll go
into more. I guess it's just for you
personally. I mean, you can share as much as
you feel comfortable, but did ittake you a long time to sort of
discover that endometriosis was at the heart of the symptoms you
were experiencing? Did that happen like from a
young age or what sort of your your timeline look like personal

(07:45):
story? Yeah.
So Andrew was so interesting, you know, because like you could
be somebody like me who is symptomatic from your very first
period ever. And I can definitely give you a
little bit more context and detail there.
Or you can be somebody who, you know, didn't start becoming
symptomatic until after like fertility treatments or in your
older years or after surgery or something like that, right.

(08:08):
Like it, it's so different for every single person.
There's also the silent endometriosis where you're not
presenting with those characteristic pain symptoms.
But usually the first symptom there is is infertility, right?
You haven't been able to become pregnant and you're looking for,
for an answer as to why that is.But yeah, for me, 12 years of
age, first period ever, extremely debilitating.

(08:31):
Like not a, not a good way to, you know, to be introduced to
womanhood and menstruation. And yeah, so, so I, I remember
actually vividly, like I was in,I guess I would have been in
elementary school at the time. And I was in the office, they
were calling my mom to come pickme up because I was in pain.

(08:55):
And, and yeah, it was just, yeah.
So from 12 years of age, it was just debilitating, you know,
unpredictable symptoms. I don't, I don't know exactly
Lee, but I want to say like I probably didn't hear about the
word endometriosis until I was maybe like 1819 years old.
That's probably when I kind of first was introduced to it.

(09:18):
And then I was diagnosed in 2018.
So 15 years of of living with those symptoms, not knowing, you
know, what was going on at that point, I had suspected
endometriosis because I knew what it was.
I had started dabbling in those natural lifestyle strategies

(09:39):
before then. So I had already found a way to
manage my symptoms. But I was formally diagnosed
through the surgery in 2018. I was newly married.
My husband was there with me when I had my surgery.
He record, he actually recorded a video of the surgeon
explaining where they found the endo.
And although I didn't get a lot of symptom relief from the
surgery, unfortunately, it was just really satisfying to know

(10:02):
that there was something causingthese symptoms all these years.
So yeah, that's my story. I'm somebody like very early on,
I was symptomatic and sorry, my husband was leaving.
Yeah, very symptomatic. But it's, it's, I think it's
important to note that it's different.
It's different for so many women, right?
You could be like me and you could be symptomatic very, very

(10:23):
early on. And those symptoms could become
extremely more painful, more debilitating, more
uncomfortable. Or you could be somebody who
doesn't have pain for a big chunk of your early teenage or
young adult years, and then you suddenly do become symptomatic.
Maybe it's stress induced. Maybe it's some kind of nervous
system dysfunction component. Maybe it's abdominal injury.
Maybe it's childbirth. And so yeah, and do is

(10:44):
definitely not something I wish on anybody.
It's extremely complex and confusing.
But yeah, that's that's my introduction to endometriosis in
my personal life. Wow, wow.
And I guess along that like that15 years, were you told it was
anything else like did you receive any sort of inaccurate

(11:05):
diagnosis or the given a reason for your symptoms or?
Yeah, a lot of just like it's normal.
You're a woman. So not necessarily a diagnosis,
but just kind of brushing, brushing off the symptoms.
Ibsi have had a lot of like various testing done.
Like I had colonoscopies done ata very young age.

(11:26):
I've had more ultrasounds that Ican count.
But I am somebody actually like you.
You see a lot of content online where people are saying, you
know, I was diagnosed with this long list of things, IBS,
Crohn's, some kind of autoimmunecondition in my case, maybe IBS
and just kind of brushing it, brushing it off and not really

(11:48):
not really giving me much of A diagnosis.
That's my personal experience. And just sort of telling you to
take pain medication, rest and yeah, I don't know if you were
told to go on birth control. I did, yeah, I was.
I'm very transparent about this.I did take birth control for a
big part of my teenage years andyoung adult life up until about,

(12:10):
you know, 2122 or so, that's a whole other story.
But basically it just kind of stopped working for me.
Like I started getting strange symptoms in response to the
birth control and my doctor's response was to put me on a
stronger one. And something about that didn't
really feel right to me. And that's when I started to
explore the sort of natural holistic side.
But yes, I was and I, and I'm super transparent about this.

(12:32):
Like, it definitely did give me a huge amount of my quality of
life back. Like it definitely allowed me to
be more flexible. I mean, I was a student at the
time I went into university. And so it definitely gave me a
lot of that that quality of lifeback for sure.
For for a certain amount of timeand then yeah came back just.

(12:54):
Curious. And there's a whole story also
with when I transitioned off. And that was that was probably
when my symptoms were the worst,actually, when I came off the
pill. And I spent two years trying to
rebound from that. Yeah.
It was like mental health side effects.
It was physical side effects, like spotting extreme pain, like

(13:14):
to the point where I would vomitand faint from pain.
I would lose control of my body.I would turn white as a ghost.
But then seconds later I would burn up.
So yeah, really scary when that happens.
Really scary. Yeah, yeah, With birth control
pill it can be. So yeah, it can be interesting
just in terms of the symptoms that it can help, but then also
the symptoms that you can end upwith.

(13:35):
But yeah, that is a whole notherconversation for maybe in your
yeah, in your experience, like what's what led you to getting
that diagnosis? Like did you advocate for a
referral to a specialist or a certain test or how did that,
how did you finally get that diagnosis?
Yeah. So when I heard that term

(13:58):
endometriosis, and I was convinced I had it, it was
literally I looked up endometriosis specialists near
me. I essentially demanded a
referral to one that I found online that I knew was taking
new patients. I saw the surgeon within like a
few weeks and then within three months of our initial meeting, I
was scheduled for surgery. So I recognize that I'm very

(14:20):
fortunate because a lot of people connect with the surgeon
and then they have to wait six months, 12 months, 18 months.
Some people have to travel to different countries to get the
surgery. They have to travel across, you
know, this like the States and it's very expensive in different
parts of the world. So I, I recognize that I'm very
fortunate that three months for meeting with the surgeon, I was
able to have the surgery. And yeah, it was basically just

(14:42):
advocacy. I told the doctor what I wanted.
I definitely got pushed back. But I mean, at the end of the
day, this is my healthcare. And it's funny because when I
told her that, you know, it turned out that I had
endometriosis and this is what was causing my symptoms all
these years, she basically responded by saying, oh, well,
we knew that something was wrong.
OK, Well, then why didn't you push?
Why didn't you suggest a referral years ago?

(15:03):
You know what I mean? And now especially, you know,
like, sorry to go off on a little bit of a tangent here,
but now that we know that it's really important to catch
endometriosis in your earlier years if you're symptomatic
because it has such profound effects on fertility.
And so you, it can make a huge difference to a young person's
life to be able to diagnose thisearly and support them in like

(15:24):
fertility preservation or, you know, get them on the right
types of interventions. And so, you know, it's, it's not
something to just like brush under the table and and not give
much attention to. Like it is important that young
people, if they're symptomatic, if if they're suspicious that
they may have endometriosis, geta diagnosis.
And I know that one of your questions, Lee was around

(15:45):
diagnosis. So like, I don't know if if
that's something you want to bring back up after or talk
about it now, but you know, we, we do have advancements in how
to diagnose endometriosis. So it's not as complicated as it
as it once was. So we don't really have excuses
for waiting 15 years or 20 or 25years in in the case of some
people to get a diagnosis. But that's my that's how I went

(16:08):
about getting the diagnosis. Yeah, Yeah, that makes sense.
I guess you are also fortunate in the, in the sense that you,
yeah, you're a healthcare practitioner yourself and
because of your education, you obviously have a higher health
and nutrition literacy. So you're able to sort of look
into the information and the evidence on it and then be able
to, you know, clearly advocate for yourself.

(16:30):
Whereas people who maybe don't have that background, it can be
even more challenging just not knowing what to ask for.
And then sometimes we, you know,people can sort of fall into
forget like what the term is, but sort of just seeing their
their doctor as having like, youknow, the most most important or
the most valid sort of reasoningor opinion, just sort of giving

(16:51):
in to to whatever their their doctor says and not really
feeling comfortable or feeling like they're able to push back
or advocate. Yeah.
So, yeah, I can see how, you know, will go on for a long time
that maybe people don't don't get the answers that they they
need to I think just to lay. Yeah.
Lay the foundation for some listening.

(17:11):
They may, you know, have endometriosis and probably
familiar with what it actually is.
Although I'm sure you get peoplewho are diagnosed with it and
don't even know how to explain it or what's going on.
But can you just sort of in in simple terms explain exactly
what endometriosis it actually is?
Yeah, for sure. So endo is a chronic

(17:32):
inflammatory condition, primarily of immune dysfunction,
and I can explain what that means in a moment.
But this is when tissue that's similar but not identical to the
endometrium. So the tissue that lines the the
uterus grows basically we found it on every organ of the body at
this point. It does respond to the cyclical,
you know, hormonal shifts throughout the cycle.
And so these lesions do bleed orthis tissue, however you want to

(17:54):
refer to it, it does bleed. But because it's not within the
uterus, it's not like exiting the body as menstrual blood,
right? And so it bleeds into the
abdomen or the thoracic cavity or wherever it's located on the
bladder, etcetera. And then that can, you know,
bind organs together that can cause extreme debilitating pain.

(18:14):
You know it, it definitely contributes to infertility or
sub fertility. It could affect organ function,
right? If you have it on the ureters or
if it punctures your bowel deep enough.
And so that that is endometriosis.
So it affects a lot of differentsystems in the body then not
just sort of central to the female reproductive system, like

(18:36):
it affects other organs and right symptoms in all different
areas, which sort of I guess then makes sense as to why it
maybe would not be diagnosed as early.
But can you explain sort of how how someone would get to a
endometriosis diagnosis? Yeah.
So you're, you're not wrong whenyou say that.

(18:58):
Yep. It it impacts multiple different
systems throughout the body and therefore it could be mistaken
for other conditions. Absolutely.
I mean, it could be a mistaken for IBS.
It often is mistaken for IBS because upwards of 90% of people
with endometriosis have like some kind of digestive symptoms,
bloating, Constipation, diarrhea.

(19:21):
I think for so long it's been kind of normal, unfortunately.
I mean, it shouldn't be normal, but I think it's been kind of
normal to just brush off pain related to menstruation.
And so you know that that's another kind of overlap as to
why the diagnosis is, is often delayed.
So OK, let me take it back to the initial question.

(19:42):
What is it? What does it take to get a
diagnosis? So, so there are a few ways that
you can get diagnosed with endometriosis.
I do think that it's important that you have sort of the right
team to get you there. And so if you are suspicious
that you have endometriosis and we can talk about the symptoms
in a moment to maybe make that alittle bit clearer.

(20:05):
But it is important that you have like the right team, people
who can recognize that this may be endometriosis or request the
right referrals. Because if you're talking or
connecting with somebody who's not well versed in endometriosis
or kind of. Gaslights you or, you know,
belittles your pain or I don't know, something extreme like
doesn't think endometriosis is athing or something like that.

(20:25):
Obviously, you need to kind of be in the right the right hands
to get that diagnosis. But it could be as simple as
just, you know, looking for an endometriosis specialist near
you, like wherever you are located geographically and you
know, assessing to see do they take patients right now and just
requesting A referral to that professional.
That's like the best way to start the process.

(20:49):
I think this is like more of a, an appropriate answer to some of
your other questions. But I would definitely suggest
that if you are suspicious that you may have endometriosis,
definitely start tracking, right?
Track the cyclical nature of your symptoms when they're
getting bad. Are you experiencing some of the
other symptoms of endometriosis like pain with intercourse, pain
with passing stools, or urination?

(21:11):
Are your symptoms around menstruation or these high pain
phases of your cycle like maybe ovulation so debilitating that
that it's affecting your abilityto do activities of daily
living? Are you vomiting, fainting.
Are you losing control of your body?
Is your pain untouched by over the counter pain relieving
medications? You know, are you passing a lot
of blood clots? Do you have extremely low

(21:33):
energy? Is there, you know, digestive
symptoms, Constipation, diarrhea?
Are your bowels bouncing around right?
Like are you going from 1 extreme to the next?
These are just some symptoms, right?
Of course, it extends into infertility.
It extends into like the mental health side, bladder pain and
pressure pain with urination, things like this.

(21:54):
Also, you know, if you've got like a very hard distended
abdomen, right, that like not not necessarily bloating.
And I know a lot of people have a hard time kind of
differentiating bloating betweenabdominal swelling or
inflammation. But if it's just like always
very swollen, always very inflamed, you know that that
could be also an indicator. But yeah, back to charting the

(22:15):
symptoms. So chart, right, Because it's so
much more powerful if you can goto your healthcare provider and
say, look, I have 3-4, six months of data here.
I've missed work X number of times.
I haven't been able to attend lectures X number of times.
I've vomited 6 times this month because of pain.
I took X amount of ibuprofen andit maybe reduce my pain from

(22:38):
5:50 or 7:50 or maybe not at all, right?
That's so much more powerful than just going into the
appointment and saying I have really painful periods.
It's unfortunate that we have totry so hard, but it's going to
be much, much harder for the healthcare provider to dismiss.
And it is their obligation if you are presenting with these,
you know, quite debilitating symptoms to offer you something

(23:01):
or offer you a referral or medication or something.
So up until recently, the the gold standard for diagnosis is
laparoscopy with excision. So this is a a type of surgery
where small incisions are made and then the endometriosis
lesions are cut out essentially from the root and then they're

(23:23):
biopsied to confirm, you know, if it is in fact endometriosis
lesions or if it's something like scar tissue or something
like that. And so it's been the gold
standard for a really long time because of that biopsy portion.
Like in my case, for example, when I had excision done, they
biopsied all like all the lesions, small parts of the
lesions that they excise. And on my left abdominal wall,

(23:45):
it was actually scar tissue, notendometriosis, right?
Whereas endometriosis is found on my bladder and on my bowels
and on my cervix. And so those places were
endometriosis, but then there was that one spot of scar
tissue, right? So they want to be able to
differentiate that. But now there's these newer
technologies, right? Like if you have deep

(24:06):
infiltrating endometriosis whereit's penetrating the the surface
quite a bit deeper than superficial, which is just kind
of right on the surface. This can often be seen in
through through using advanced ultrasound.
So I do want to be very aware that like a like a regular

(24:27):
ultrasound and somebody who's not trained in reading these
ultrasounds to identify endometriosis might not be able
to, to communicate that diagnosis to you.
But if this is somebody who's well versed in advanced
ultrasound, they know what to look for.
They know the way that the tissue behaves when fluid is
added. You can absolutely receive a
diagnosis and it's very accuratefor deep infiltrating

(24:48):
endometriosis. You can also see deep
infiltrating endometriosis. On scans like MRI, you can see
large endometriomas, which are cystic lesions.
It's a more advanced form of thedisease, so you can see those
through ultrasound and MRI. I guess the last thing I'll say
too is like, if it's not showingup on ultrasound or MRI, it
doesn't mean it's not there. It might mean that you have a

(25:10):
superficial form of endometriosis and that doesn't
mean that it's less severe. It doesn't mean that it's less
likely to cause you less pain. Like you can have a very early
stage of endometriosis and stillbe experiencing extremely
debilitating symptoms. So the, the, you know, how
aggressive it is or whether it'ssuperficial doesn't necessarily

(25:30):
dictate how much pain or the severity of your symptoms that
you're experiencing. But yeah, if it doesn't present
an ultrasound or MRI, it doesn'tmean that it's ruling it out,
right? It doesn't mean that, oh, it's
not showing up. So you don't have it.
You would then still need to pursue a surgery to get that
formal confirmation, right? Because surgery really would be
like the best way to rule out superficial.

(25:51):
Have I answered your question, Lee, or did I just go off and
and answer some other questions?I think that was really helpful.
And I guess if someone has the MRI or the ultrasound and it
doesn't show that they have endometriosis, but they have
that data from symptom tracking,yeah, sort of, you know,
highlights that in terms of endometriosis, Then would you

(26:13):
suggest someone still sort of pushes or advocates for
themselves to do the surgery that way they can fully rule it
out even in the first Test that,you know, they may not have it?
Yeah, definitely. And it's also a treatment
option, right. So a lot of people do experience
symptom improvements with excision like it's, it's very
heteromanous. You might have symptom

(26:34):
improvement, you might not like in my case, but it is also a a
treatment, right. It does restore fertility in
many cases that does help with pain.
It can change the hormonal profile.
So it is still a treatment, right?
So just getting a diagnosis through ultrasound or MRI,
that's just like 1, you know, one part of the battle, right?
You still need to then actually pursue some kind of treatment.

(26:56):
Yeah. And when you say endometriosis
specialist, is that like a specific designation like a
gynecologist or you're referringto like a nurse practitioner or?
Yeah. What would that look like?
That's a good question. I mean, I think from like the
traditional sense of like a likean endo specialized Dr., it

(27:18):
would be an OBGYN who specializes in endometriosis or
a gynecologist that specializes in endometriosis.
Yeah. Is that common or is that is
that hard to find? It's very hard to find.
Very hard. To find, yeah, yeah, I guess
even where we are like, well, I know you're not quite in
Toronto, but are there many hereor like a select few?

(27:44):
There are a few. There are a few.
I mean, there's not as many as we would like to have, of
course, right? There's like Doctor Leonardi out
of McMaster. I think there is one doctor
working out of Humber River, butI'm not 100% positive if he's
endo specialized. I know that there's somebody in

(28:04):
Ottawa as well. Don't quote me on the name.
I think it's doctors thing. I could be wrong, but there are
a handful. I mean like, like think about
the population of Ontario, Toronto, like just these big,
like Toronto, Ottawa, like threenames, like that's, that's not,
that's not enough, right? That's not enough.
But I'm sure there's more, but there's there's not enough I

(28:25):
guess is my answer to my question.
And I guess with all that in mind, like do do they know what
what causes IBS or, or I'm sorry, not IBS for endometriosis
or is it just sort of theories for now where sort of thoughts
as to what, what can contribute to developing?

(28:45):
Yeah, right now, I mean, the short answer is we don't know.
It's a lot of theories, right? So some theories have to do with
retrograde menstruation. So the the back flow of the
menstrual blood through the fallopian tubes back into the
pelvis. There are theories around
genetics and how genetics play arole.
I would say that the genetic theory is, is very alive and

(29:06):
well. Like you're 6 times more likely
to have endometriosis if some immediate family member has it,
like your mom or your sister or your aunt.
And so I think that that's, that's pretty solid.
But I mean, that still doesn't explain the 'cause there's, you
know, theories around environmental toxins and dioxins
and their role to play in, you know, endometriosis establishing

(29:31):
and starting and then growing inthe body.
There's various theories around,I don't even know what to call
it, but it's like a, it's like acertain type of, I want to call
it a stem cell that they theorize is traveling through

(29:52):
the lymph even pre birth. And that's, you know, explaining
why endometriosis can be found in any part of the body.
So there are a couple of theories, but yeah, we don't, we
don't really know for sure the cause, but maybe some
combination of those things. Yeah, a large genetic
contribution. Yeah, there's also the, yeah,

(30:15):
there's the bacterial one, whichrecently got a lot of attention
on social media and in the mediabecause there was this study
which really wasn't even that strong around a certain type of
bacteria, Fuso bacteria being connected to endometriosis.
But that that has been long has been a theory as to, you know,
why endometriosis may, may establish.
But yeah, there's just theories right now, unfortunately.

(30:38):
Yeah. What's the idea with that the
the bacteria? Just that it's more common in
people with endometriosis and that it can be part of the
reason why it establishes and grows.
We, we tend to have more of it, right?
We tend to have more of it in the various microbiomes
throughout the body. It's basically it.
And then they this, in the study, they treated mice with

(31:00):
antibiotics to get rid of it. And then they noticed that the
endometriosis lesions kind of almost started to like
disappear. They started to get better.
But this is very controlled too,right?
It's very controlled. So we don't know.
We don't know what the application of that study would
be in real human women who have endometriosis.
You know what I mean? It was an animal study.

(31:21):
It was a it was in mice. Yeah, it.
Was poor mice. I know.
And what's what's conditions do you often see overlapping?
Oh my gosh, a lot, a lot. Because endo is so multifaceted,
right? There's like the the chronic

(31:42):
inflammation component, which could predispose you to other
chronic inflammatory conditions,like even things like elevated
cholesterol, high blood pressure, diabetes, these types
of things. There's the mental health
component. We know that people with endo
tend to produce less serotonin and then that can lead to more

(32:04):
anxiety, depression, those typesof diagnosis.
Lots of other chronic pain conditions overlap as well.
So I think I mentioned like the chronic inflammation, but
migraines, interstitial cystitis, painful bladder
syndrome. There's the GI side too, right?
A lot of IBS, a lot of this kindof overlaps with like the

(32:26):
autoimmune realm, right? Because it, there is also this
immune dysfunction component in endometriosis for the immune
cells don't function as well as they should.
And so we know that there is a huge increased likelihood that
you'll develop some kind of autoimmune condition if you're
somebody with endometriosis. So it could be celiac, it could
be inflammatory bowel disease, it could be Hashimoto's, but

(32:47):
there is an overlap there as well, and a genetic overlap as
well. There's a fertility related
condition, so PCOS, adenomyosis,which is the sister condition of
endometriosis. So lots, lots from the side of
like inflammation, immune dysfunction, chronic pain
conditions, the autoimmune piece.

(33:08):
And yeah, and I mentioned the mental health component as well.
So yeah, unfortunately a lot. Yeah, wow.
I guess in the case of IDs, so Iknow there was, there's been
several studies on it by the 2022 systematic review meta
analysis that looked at the overlap between endometriosis
and IBS. And I think they found that

(33:29):
people with endo have about a like a three fold risk of also
having or developing IBSI think with the way that like IBS is
diagnosed, like the Rome 4 criteria should be used.
It's not always used, but that'ssort of been evolving.
So you know, in terms of that being like a set diagnosis and
that patients we're not entirelysure, but the idea there is that

(33:51):
like IBS is common alongside endometriosis, which I'll just
explain. I know many listening know what
IBS is, but it's considered likechronic functional gut disorder
and typically with persistent abdominal pain, gas, bloating
and then sort of diarrhea, Constipation or like alternating

(34:12):
episodes of both typically considered like a gut brain
disorder. But I think based on more recent
research, I see it more as like a microbiome disorder because of
the role of the gut microbiome. And then even there's like an
autoimmune component that we're learning more about with IBS.
So I guess why do you, why do you think that maybe those
conditions are? Yeah.

(34:35):
Well, I mean, you alluded to oneof those causes or reasons,
which is the the microbiome, thedysbiosis there.
There's also other studies just in the endometriosis population
showing that women with endometriosis, you know, tend to
have more dysbiosis in the gut microbiome with a predisposition
towards more pro inflammatory species, E coli, Prevotella,

(34:57):
there's some other ones as well.So there's that, right.
There's the visceral hypersensitivity component as
well. All of that inflammation, just
making those internal organs significantly more sensitive and
that, you know, includes the thedigestive, the organs
responsible for digestion. There's also a lot of you know,

(35:20):
with, with endometriosis, it's this chronic inflammatory
condition, right? Like often what I'm doing like
testing with patients or we're trying to tease apart like what
hallmarks apply to you? There's a big like mental health
component, the gut brain axis component, right?
Because I mean, you're living with a chronic inflammatory

(35:41):
condition that's, that's just going to be a stressor in and of
itself, right? And then most people, you know,
the average person will have a ton of other stress, right?
Like I always tell people, I don't think that it's normal to
be completely small. Maybe I shouldn't use the word
normal, but I think it's common for everybody to have some
degree of stress, right? We live in a stressful world.
There's a lot going on going on in the world, but it's important

(36:02):
that we know how to manage it, right?
And when one of the things that's contributing to that
stress is this chronic illness that's so unpredictable and it's
like manifesting in symptoms that you can't make sense of.
And they're so unpredictable andthey're changing from year to
year. I mean, that's going to be a
huge stressor, not just mentally, but even physically.
And so I think that that has a big role to play too, in terms

(36:22):
of that gut brain access, right?Because we know stress is a huge
driver of digestive symptoms of IBS type symptoms.
And so I think that that's probably the reason, right?
That the gut brain axis, the inflammation component.
One thing I didn't mention is the the hormonal component too,
right? We know that endo is estrogen.
It's an estrogen dependent condition.

(36:44):
Now, not everybody will present with elevated estrogen and blood
work or like urine tests or however you're testing the
hormones. But you know, we know that
estrogen can thicken bile, it can affect digestion as well.
And so it can it can be a sourceof inflammation.
And so you know, again, there's that spillover of inflammation

(37:06):
into the digestive symptoms and the effects on visceral
hypersensitivity. And so I think that there's a
few reasons to a few, a few reasons that's another one of
the reasons to right. And so yeah, I would say
visceral hypersensitivity, the inflammation, the gut dysbiosis
that we know is very common in the endopopulation, the
inflammation component. I think those are all reasons

(37:27):
why these two diagnosis overlap so much.
Yeah, I wanted to because I do have, I do have clients with IBS
that don't have the visceral hypersensitivity symptoms,
although it is really calm like I think up to like 70%.
So and just to explain it, that visceral hypersensitivity is
like an altered sensation to pain or sort of a abnormal pain

(37:50):
response specifically in IBS. Like the nerve receptors in the
gut may detect pain or send a message of pain to the brain to
things that may not normally cause pain, like a little bit of
normal stretching or gas production, the bowels or maybe
sort of respond a lot more more strongly so to things like
Vodmaps or fiber or versions. But I guess with yeah, with with

(38:14):
sort of like looking at what maycontribute to visceral
hypersensitivity, I think a lot of the common reasons are
potentially the like the gut microbiome imbalance sort of
causing low grade inflammation in the gut.
I think even like adverse early childhood events and trauma like
lifestyle changes, maybe mental health, sleep issues, even

(38:37):
different nutrient deficiencies,even thoughts around like iron
and copper and blood flow and all that.
And I think you sort of mentioned as some of those being
maybe you know, connected to contributors of, of, of
endometriosis development too. So you can kind of see.
You know one way. Contribute to the other.
And then also, yeah, sort of possible with with Endo 2 like

(39:01):
you mentioned, like you have sort of tissue growing on other
parts of the the body and you mentioned like potentially on
the bowels as well. So if someone has that excess
tissue like growing and pressingon the bowels is that would
someone get it an IBS diagnosis because of that or is that just
considered maybe they'll have GIsymptoms as a result of the endo

(39:21):
but it not technically being IBS?
Yeah, I mean, if it's somebody who's not really investigating
the root of the root of those symptoms, they might just end up
with an IBS diagnosis, right? Which I would argue is very
dangerous because if this is endo that's rapidly progressing,
it's deep infiltrating, you can literally have endometriosis
puncture the bowel, right? And that becomes a lot more

(39:44):
dangerous. So, yeah, it's possible that if
you have symptoms, IBS, like symptoms because of
endometriosis on the bowel, it'spossible that you might just get
an IBS diagnosis. But if it's somebody who's
Deeping, Deeping, digging a little bit deeper, you know,
they might dig to see, you know,is there what it, what is the
root of these symptoms? And if they find that

(40:05):
endometriosis on the bowel. Then.
Yeah, I don't know. I don't know if that would still
be IBS or if it I would imagine that that would probably be an
endometriosis diagnosis. And I would be really curious to
know if that individual notices improvements in their digestive
symptoms when they have it excised.

(40:27):
Yeah. And anecdotally, in my practice,
I've had people report that those symptoms do improve with
excision surgery. I don't know if I answered your
question. Yeah, no, I think it's, it's
hard to tease out I guess, but the idea is like technically the
thought is that you're you're having those symptoms and
there's no sort of like abnormalities in the, you know,

(40:50):
digestive tractor, the large or small bowel.
But if someone did have those like lesions or, you know,
excess tissue pushing on the bowel, then you could sort of
say that the it's the endo causing the symptoms and they
may not have IBS. But I guess if you were to have
it removed and then they still have, you know, the typical IBS
symptoms that they may still have both.
But yeah, definitely important to get get a proper diagnosis so

(41:13):
that you can actually treat what's going on and not just
assume. Yeah.
I was going to add too, like, you know, anecdotally, like this
is not typically the way you would see digestive symptoms
present, but I've had people who've had like cyclical
digestive symptoms, right. And so that's kind of something
that you might want to dig a little bit deeper into, right?

(41:35):
Like like I wouldn't expect somebody to test positive for
something like small intestinal bacterial overgrowth if their
symptoms are not consistent all the time, right?
Like if you're experiencing painful, persistent bloating, if
you're chronically constipated, have diarrhea, if there's some
kind of triggering event that kind of snowballed into these

(41:55):
symptoms, then yeah, that would that would line up a little bit
more to me. I mean, obviously I would still
want to investigate that, but I wouldn't think twice about
having somebody do. And I don't know what your
position Lee is on like CEBO testing and that sort of thing.
But like, I would, I would probably not, you know, jump to
testing if the symptoms are are not consistent.

(42:16):
But I have seen in practice people have cyclical symptoms
and, and test positive. So yeah, and it was very tricky.
I think you can complicate a lotof these symptoms and in and in
this particular person's case, she did actually get a lot of
relief from her symptoms with treatment.
So it's just, it's very fascinating.
Definitely. There's a lot of levels and

(42:38):
layers to it. Definitely.
And physically and yeah, metaphorically, yeah, sure.
Oh, I had a point about, I guesswith, I don't know, I lost my
train of thought. But yeah, in terms of the
connection between like gut microbiome, gut health and endo,

(42:59):
I guess how do you, how do you work with that in your practice
whether someone does have IDs oror does not have it overlapping
with endo? I, I always like to like if
somebody presents with digestivesymptoms, I always like to
investigate that. I don't like to just kind of
chalk it up to, I mean, for the longest time people were saying,

(43:19):
you know, IBS is sort of like a blanket term.
If somebody's actively having symptoms like they're having
diarrhea every day or they're chronically constipated.
These are things that have massive implications for the way
that you live with endo, right? If you're having diarrhea every
day, you're losing a lot of beneficial nutrition that your
body can be using to fight inflammation in your body or

(43:41):
support hormone production or whatever it might be, right?
So I don't really want to just chalk that up to IBS and, and
not make an effort to try and improve that if we can.
Same thing with Constipation, right?
Constipation, we, at least this is my understanding, it will
create more of a kind of pro inflammatory state in the gut,

(44:04):
right? And so not only does the gut
become an additional source of inflammation for you as somebody
with endometriosis, but there are other implications of that,
right? We know that gut is a, a major
site of serotonin synthesis. We were already depleted in
serotonin as people living with chronic inflammation.
And so, you know, that can have effects on mental health, on
energy, on mood, on sleep quality, and all those things

(44:27):
matter. You know, I would argue a little
bit more than the average personbecause you're already dealing
with chronic inflammation, you're already dealing with this
immune dysfunction component. So we want to be extra on top of
these foundational pieces like good sleep and your ability to
move your body and eliminate. We also get estrogen cycling
back into the body from the gut,right?
So if you're not able to, you know, have that estrogen exit

(44:50):
through your stools, then that's, you know, there's the
potential that it will cycle back.
And we know that endo is estrogen dependent.
We don't really want a lot of that excess estrogen floating
around in the body. This is a big part of my
personal journey with endometriosis.
My symptoms were terrible when Iwas constipated and eating
McDonald's three times a day when I was at USP in like, I

(45:11):
don't know when was that 2015 orwhatever.
Terrible, like, terrible, terrible, terrible Constipation,
like must be resolved. Like must be resolved.
If you have endometriosis, sometimes it's a little bit
trickier to resolve, but it's important for those reasons.
And was the last thing I was going to say.
I mean, we synthesize some vitamins in the gut and these

(45:32):
are vitamins that are especiallyimportant for the nervous
system. They're very important for
estrogen elimination for supporting the liver.
So I have no idea if I'm answering your question, but I
guess the answer is like, I do want to address it.
So how I go about addressing it,It depends on what the symptoms
are. You know, sometimes it's not
like sometimes the first step isnot OK, let's you know, go plan

(45:56):
of attack. Let's get you on like 16
different types of fiber in this50 billion probiotic.
Sometimes it's just OK, let's assess the diet and lifestyle.
Let's see if we can boost up thefiber content.
You know, let's complement, let's complement, implement the
nutrition in your diet with maybe a supplement like a multi
year prenatal because you're losing a lot of nutrition in the

(46:16):
case of of diarrhea. For Constipation, again, like
foundations, hydration, movementand fiber.
Can we improve these things? First, if that's not working, if
I'm assessing your charting, you're getting that 30 grams of
fiber and that 3235 grams of fiber because I do like to see
it a little bit higher in the endometriosis population and the
hydration is, you know, consistent with that amount of
fiber. Let's move into, you know, maybe

(46:39):
trying some ginger or a science backed probiotic strain for
Constipation, right? Like let's kind of try these
things in sequence. But yeah, I definitely don't
want to leave them, you know, just not not addressing that
like I want to, I want to try and intervene on that.
And that's actually typically myfirst, first place that I start,
right? Because the guy is so sad, all

(47:00):
these other things. So yeah, that's the first place
I start. Yeah, and it also effects how
you feel. Like, like you said, losing a
lot of stool, then you're losingnutrients, you could become
dehydrated, losing electrolytes.And on the other hand, being
constipated is. It's not fun.
Yeah, when things are going to clear out of you and having that

(47:23):
hard belly, it could be so. Sure, feel.
Uncomfortable. Yeah.
Yeah, And like, I can't even tell you how many people report
to me and say, like, I am scaredto go anywhere because I don't
know when I'm going to have to have a bowel movement.
And like with Endo, passing a bowel movement can be so much
scarier than for the average person, right?
Like some people block out from pain.

(47:46):
They get such sharp stabbing pains in the rectum.
It can be scary. Like if you have to travel and
these things are happening, it'sit's uncomfortable.
But I know that that's very common with IBS patients as
well. Take away from what you said
about the like the gut connection is that Endo is so
like unique to each person and Ithink sort of understanding like

(48:08):
what what are the drivers of their symptoms and they're sort
of unique profile in that and then using that to address the
treatment and the management strategies, which I guess looks
different probably from person to person.
Yeah, yeah, yeah. And it's similar, similar in IBS
too. Like part of it is understanding
what they're subtype is and thensort of getting to the root of

(48:30):
what's driving their symptoms too.
Is it, you know, that dysbiosis is it more around the gut, brain
connection, motility issues? And you know, treatment may not
look the same from person to person.
And not everyone just needs to do the low FODMAP diet.
Take your probiotics. What are the what are the
subtypes? Are those the one that the

(48:51):
things you were just listing offthere like the motility issues,
the so yeah, technically IBS is considered you have 4 different
subtypes. So there's IBS D diarrhea,
Dominic. Oh, those ones, OK.
Yeah, yeah, IBS, Constipation, IBS mix, you get alternating
both and then there's also IBS EU, where they actually may have

(49:12):
normal bowel movements, but thenthey get the symptoms like pain
and bloating and gas. How is that last one treated or
managed? I find that that one actually,
they tend to have, you know, another part of the picture
going on sometimes mental healthor IMO, Yeah, that's yeah, I see

(49:32):
basically another condition, butI see, OK, yeah, I usually see
with IBS that it's, they have that they have IBS, but they
usually have something else going on too.
So yeah, I see a lot of that. But I did know that there was
like a formal. IBS designation for that, it's
good. Yeah, yeah, yeah.
So they still like have daily type 3-4 bowel movements on the

(49:55):
Bristol chart, but then they getthe symptoms of IBS and they've
had testing done, nothing else going on, no sort of, you know,
abnormalities in the gut and yeah, IBSUI know.
Interesting. One last thing around the gut.
Gut health I guess. How does Gulch or GAGALT play a

(50:17):
role? Yeah, yeah, the immune
connection. So I mean the, the gut is our
largest immune organ. It houses like, what is it,
7080% of our immune system? And so yeah, if the gut is
dysbiotic, if it's inflamed, if it's unhappy, if we're lacking a
lot of anti-inflammatory bacteria, that's going to have a

(50:40):
spillover effect into your immune system, right?
The way your immune system functions.
I actually posted something on socials that got a lot of, got a
lot of hate in the last couple about this connection.
But you know, when you really dig into it and you understand
that having a healthy anti-inflammatory environment in

(51:03):
the gut equates to better functioning T cells, B cells
like, and then, and then if you dig deeper, you, you go one step
deeper in the research and go, and you learn how these various
immune cells are dysfunctional with endometriosis and how
having a healthy gut directly corresponds with better
functioning of these immune cells.

(51:25):
And then if you add into that, you know, complicated, you know,
collection of, of information that I, just, that I just said,
if you add in that component, that understanding that endo is
a condition of immune dysfunction, it's that the fact
that these cells do not functionoptimally is the reason why
these endometriosis lesions are able to establish and develop a

(51:45):
blood supply and grow. I, I, I would, I would
absolutely go so far as to say that that has a profound effect
on you being able to control howendometriosis behaves in your
body. And that is something that I
will, I will continue to, you know, to, to say because I, I
think it's true. And I think you have a good

(52:06):
understanding of the research and understanding of, of the
human body and then how these things are connected.
I think, I think it's, it's not difficult to acknowledge that
there is that, that connection there, but that's what it is.
It's the the, you know, connection that overlap between
the gut and the immune system. Yeah, for sure.
I guess we're learning that, youknow, the gut micro mile and

(52:26):
plays a role in so many conditions, diabetes, disease,
food allergies, yeah, so many things.
So how can we dismiss it as not having it?
Yeah, this is completely anecdotal, but you know when I
do some some functional testing,I do see that and and I do want

(52:46):
to like acknowledge that the tests we have available are not
perfect, you know, they are flawed.
The microbiome changes with every meal that we consume.
But when I see really important species under detectable limits
like Echomanzia, this is very often will correspond with the
most severe symptoms that I see in practice, right.

(53:08):
So that's anecdotal. I'm sure there is research to
that. I'll I'll find.
It but it just goes to show right just how profound that
overlap is. Yeah, definitely.
I guess for the for the clients that you work with, how long do
you find it typically takes for them to see like improvements in
their symptoms? What's the average or?

(53:30):
Yeah, yeah. I wish I could be like, yeah,
it's three months for every single person.
It's such a mixed bag. I mean, some people, it could be
within a few weeks, right, that they can start to, to see their
bloat come down, their followingperiod, be better in terms of
pain symptoms, their bleeding patterns change, you know,
whatever their objective is, it could be a few weeks, it could

(53:52):
be 3 months. For some people, they don't,
they don't see improvements withnatural or holistic strategies.
And that's just the reality of endometriosis, right?
Some people, you know, really need the surgery.
Some people do really well with hormone therapies and some
people do really well with the, the holistic side.
So I wish I could say, you know,as a little plug to my services

(54:15):
that it works for everybody, butit doesn't.
It's just the reality, right? It just doesn't.
And I, I always say like, you know, if, if you have the
resources, if you have the capacity, if you have access to
support in every single one of these realms, like if you can
get surgery, if you can, you know, work with a pelvic floor
physio, if you can work with a dietitian, I think you're going
to have the best luck with that sort of comprehensive approach.

(54:38):
But it depends. I mean, just like surgery didn't
work for me and doesn't work formany others, you know, that
might be the only thing that works for other people in the
endometriosis space. It's very complicated and
confusing. Yeah.
I guess can you just highlight what are the like sort of the
typical like medical treatment routes for any yeah, that look

(55:02):
like, what would a doctor suggest?
Yeah. So it would be like pain
medication, so ibuprofen or it could be like a more intense
pain relieving medication. It could be like morphine, it
could be opioids, that type of thing.
Hormonal birth control. So like combo hormonal birth
controls like synthetic progesterone and synthetic

(55:25):
estrogen. The progestin only pill has
become very, very popular just because it's one that I mean,
all of these have side effects, but this is one that seems to do
quite a bit better there. There is quite a bit of positive
research coming out about it. So progestin only, and that's
things like Byzan, Dynajest, Mirena, IUD.

(55:47):
So Mirena is like a whole kind of other because it's an IUD.
So it's a different type of hormone therapy, but it is a
progestin only as well. They're not being used as much
anymore, but aromatase inhibitors like letrozole,
clomid. And then there's like the
gonadotropin releasing hormone agonist and antagonist, which

(56:07):
are like Oralissa Lupron actually in the research and in
the guidelines like the the clinical practice guidelines for
doctors working in the space or medical professionals working in
the space. A lot of these big institutions
that I guess publish the guidelines, like I know the one

(56:29):
in the UK has changed recently. They're actually moving away
from recommending the gonadotropin releasing hormone
agonists and antagonists becausethe side effects are just crazy,
right? They basically you go from
having healthy levels of estrogen to postmenopausal like
within a few days or within a week.
And so you get a lot of the likehot flashes, the bone pain, the

(56:51):
mood shifts, like really low thoughts and so and they're not
really even finding them to be super effective.
So yeah, lots changing in that space too.
But those are sort of the traditional like medical
management options. And then of course there's
surgery. And I mean, I wouldn't even go

(57:12):
so far as to say it's a treatment for endometriosis
because it's absolutely not. But hysterectomy, right, Having
the, the uterus removed, It's, it's a, it's a mixed bag.
Some people report, you know, it's absolutely given them their
life back and their quality of life.
Some people continue to have symptoms after a hysterectomy,
but it is not, it's not really atreatment for endometriosis.

(57:34):
Like you don't need your uterus in order for endometriosis to,
to grow, right? You don't.
But in the research, when the ovaries were preserved, they did
see what I think it was like a 60% likelihood of recurrence.
It is less with ovary with when the ovaries are removed.

(57:56):
But then you have to think aboutthe symptoms and the side
effects of that right when you're having your ovaries
removed. This is a major site of the,
the, the largest site of estrogen production
progesterone. Well, technically the
progesterones produced through the corpus luteum, but yeah,
that that drastically changes the hormonal profile.
And you have to think about whatare the implications of no
longer making those hormones. So, yeah, wouldn't go so far as

(58:18):
to say that that's a treatment option, but some people do
pursue hysterectomy. Yeah.
Yeah. And then I guess what advice
would you have for someone with the IBS diagnosis that maybe has
suspected endometriosis? I think you, yeah, maybe alluded
to it before, but for those listening, what would be your

(58:38):
advice to them? So somebody has IBS symptoms but
also suspects endo, right? That's the question.
Yeah, maybe their IBS isn't getting better, sort of the the
typical IBS. Strategy, it's tricky.

(59:05):
Yeah, it it's tricky. I would say like endo,
absolutely endo could be a part of that symptom picture for
sure. So if you're suspecting endo, if
you have other symptoms of endometriosis, I would
definitely kind of get the ball rolling on maybe getting a
diagnosis, getting scanned for that.

(59:25):
But yeah, I mean, yeah, sorry, Lee, I'm doing a terrible job
answering this question. Like if if endo is part of that
symptom picture, then certainly,you know, you're going to want
to explore like some kind of management of the endo.
And that might help for sure. That can help depending on where

(59:46):
the endo is, how deep infiltrating it is, you know,
having surgery, having excision surgery, you know, can help.
Sometimes when I have patients who have a lot of uncomfortable
digestive symptoms with endo, I like to recommend things like
frequency specific microcurrent or visceral manipulation or like

(01:00:06):
like a self massage or like justbeing extra on top of those like
manual therapies. We can try and get the the
tissue to kind of be a little bit more mobile.
But yeah, if Endo is involved, Imean, you're definitely going to
want to seek out support for that, but I think.
Whether it's IBS, whether it's Endo, whether it's both, I think

(01:00:26):
the foundations are always really, really, really important
here. If you're somebody who's kind of
gone through the wringer, maybe the foundations are not new to
you. And, and this is not information
that's new to you, but protecting the sleep.
You're eating the well structured meals spaced, you
know, a decent, decent amount apart, like not grazing, right?
One hour or two hours. This is the recommendations I

(01:00:46):
make the 3 1/2 to 4 hours in between meals, you know,
hydrating really well, moving your body.
These are, oh, sorry, that was really loud.
You know, the foundations of of like good health, right?
Sleep well, manage stress as best as you can because this
will help both of these two conditions, right?
Whichever one it is that's that's affecting the symptoms or

(01:01:07):
contributing to the symptoms. But yeah, ultimately if Endo is
at the heart of that, then maybesome of those manual therapies,
definitely seeking out a referral for a diagnosis would
be step one. Yeah, OK.
And like you said, tracking, tracking symptoms to get those,
those data points and then looking for an endo specialist

(01:01:28):
and advocate. Yeah.
Yeah, I think tracking the symptoms is extremely powerful
because, you know, maybe you're somebody who just has the
digestive symptoms, but you don't have a lot of the
characteristic pain symptoms of endometriosis.
When you're getting those symptoms and how they're
presenting and, you know, whether they're directly tied to
your cycle like that, that's, that's very helpful information

(01:01:50):
to have. Right.
Like if these things are only happening cyclically around this
time, that's obviously indicating that there's hormonal
involvement, maybe there's inflammation stemming from the
hormonal shifts in that time of your cycle.
And that can really help, you know, navigate who you get
referred to, the timeliness of that referral and and these

(01:02:10):
types of things. So yeah, I think especially
important when IBS and endosymptoms overlap.
Yeah, actually that going a little, little off track from
that, but that made me think of something that I, I sometimes
get stuck with is when someone is has an IUD and they only
bleed every three months and they're not tracking.

(01:02:31):
How do we know if their symptomsare cyclical?
They don't get that traditional bleed.
That's where it gets a little a little tricky.
What are your thoughts? Yeah.
So not so, no, no two people arethe same when they are taking
hormone therapies. I have clients who take hormone
therapies and they still get cyclical symptoms, like
literally cyclical symptoms to the point where I think we can

(01:02:52):
probably even see this reflectedin blood work 'cause they're so
obvious the symptoms that, that I think that we can, we might be
able to like track some data there.
So if, but if you're somebody who you know, they're, they're
not cyclical in nature at all, Iguess like, so I guess I would

(01:03:15):
look at other biomarkers. I'd look to see like are you
getting any kind of discharge? Are you getting any other kind
of symptoms that are consistent with endo that are not maybe
cyclical in nature? Like are you inflamed?
I'd also maybe look to see if like we know that these hormone
therapies will affect different parts of the body differently.

(01:03:36):
Like they can't affect the liver, they can make you mildly
insulin resistant, they can't contribute to a bit of blood
sugar dysregulation, they can't affect the thyroid depending on
the medication. So I might do a deep dive there
to see if there's any patterns consistent with that.
And if we intervene on those areas, like maybe if we're
seeing mild insulin resistance or something like that and we
work on the diet, maybe we add in magnesium or something to

(01:03:59):
help with insulin resistance. And if the symptoms improve,
that might be kind of 1 indirectway of gauging whether it could
be something like like endo. I mean, I'm coming up with ideas
here that ultimately, like, it could be so much more simple if
you're just scanned or if you seek up surgery for

(01:04:19):
endometriosis, right? Like, I also don't want to
encourage people to wait if they're suspicious of endo
because the faster you can get that diagnosis, the faster you
can kind of start to work on your health and and get answers.
But it is a good question. Yeah.
Sometimes people present with the symptoms, even if they're on
hormone therapies. Sometimes you can rely on other
biomarkers. Not everybody with endo skips

(01:04:41):
ovulation on these hormone therapies.
Some people will continue to ovulate.
And so you can lean into like cervical mucus or temperature
shifts. There are temperature shifts and
cervical mucus patterns that youcan look for to determine
whether there's cervical inflammation, whether you may be
producing high levels of estrogen, which might be
consistent with endo, whether your temperatures are low, which
rate might indicate progesteroneresistance in the luteal phase.

(01:05:04):
So it's all very complicated stuff, but I guess it's it
depends on the individual. But yeah, I don't want to
discourage people from waiting to get a scan or to get assessed
for endometriosis. So that would be the the first
step. I would still suggest doing
that. Yeah, for sure.
I think that's, yeah, probably really helpful for people
listening. Covered a lot today, a lot of

(01:05:24):
great details and I'm sure a lotlistening had some some light
bulb moments. I guess any, any final thoughts
or anything that we didn't touchon that you want to want to add
for our discussion today? So I mean, I guess one thing
would be some hormone therapies,if you are somebody with

(01:05:46):
endometriosis have interesting ingredients that can exacerbate
digestive symptoms. A lot of birth control pills
contain sugar alcohols can can contain lactose.
So especially if you're noticingthe symptoms kind of change
around the start of a certain hormone therapy or medication,

(01:06:06):
maybe just look at the ingredient list and make sure
there's nothing in there that you know you're reactive to.
I have literally had so many clients who were like, OK, I'm
having these digestive issues and I'm like, OK, how long have
you been on the birth control? I've been on the birth control
for six years. OK, It has Manatol.
It has lactose. Can we switch it?
Can we try and switch it for a different one that maybe doesn't

(01:06:27):
have these? Or would you be willing to come
off of it temporarily? Symptoms completely go away.
Or sometimes the birth control is a barrier to them being able
to clear something like intestinal methanogen
overgrowth. So that's one thing just because
there's a big overlap there, right?
Like if you have endo, the firstthing you're likely going to be
suggested is some kind of normaltherapy.
The big thing, which we talked about at length is the tracking,

(01:06:48):
right? Track as much as you can.
I know it's annoying and as people with endo, we don't want
to be super hyper aware of our symptoms because we're already
super hyper aware. But this is really important
data for you to have. It's going to be so much harder
for you to be dismissed. If you can say, look, look how
sick I was. Look how many pain medications I
took, you know, look how how many days off work or school I

(01:07:09):
had to take off to track the symptoms.
And then, you know, if you're suspicious of endometriosis,
just seek out an endo specialistas soon as you can so you can
get confirmation and you can intervene and get some direction
on, on your plan of attack basically as soon as possible.
So those would be my, my final thoughts there.
And follow my Instagram and sendme any DMS if you have

(01:07:31):
questions. Yeah.
That that's my final question. So where can those listening or
watching on YouTube get in touchwith you?
Do you have any free resources, anything, anything that you want
to share? And I'll I'll include the links
below on the episode. Sure.
Yeah. So I'm probably most active on
Instagram and my handle there isendo dot fertility dot dietitian

(01:07:51):
with two TS, no CI. Don't know who spells dietitian
with CS. Is it like an American?
Anyway. Anyone who's not a dietitian,
typically. OK, there you go.
There you go. So yeah, that's my handle there.
I'm also on Tiktok, same handle,endo dot fertility dot
dietitian. I have a Pinterest, I have a
YouTube, the YouTube channels, the Endo fertility space channel

(01:08:13):
and yeah, my website, I've got blogs on there and I'm and I'm
quite responsive. I mean, I may or may not respond
to you right away if you send meAdm on like a random weekday in
the middle of the day, but I am usually quite responsive in DMS
if you send me a question. So that's where you can find me
and I look forward to connectingwith you.

(01:08:36):
Yeah, awesome. Well, thank you so much, Cindy.
It's been a really great conversation.
And yeah, we look forward to hearing some comments.
Maybe you need some questions about what we chatted about.
And I'm sure, I'm sure there'll be a few people listening that
this definitely relates to theirexperience.
So. Well, yeah, thanks for having
me, Lee. That's a wrap for today's

(01:08:56):
episode. Thank you so much for listening
and being a part of our community here.
If the Gut Fit Nutrition podcastis giving you value, helped your
digestion and fitness, made you rethink how you approach your
gut health, consider leaving a review on Apple, Spotify, or
wherever you're getting your podcasts.
If you have. Questions for my listener Q&A
episodes. You can submit them as a comment

(01:09:18):
on this episode or send me an e-mail at lee@leemorado.com.
For more digestible IBS gut health and fitness tips, be sure
to follow me on Instagram at LeeMorado under score Rd. and to
apply for coaching, shop the resource suite or grab a
freebie, visit gutfitnutrition.com.
Thanks for tuning in. We'll be in touch.
Soon.

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