Speaker 1 (00:00:00):
Make sure we have this.
(00:00:04):
Hello. Today we have Cindy joining us. We're so excited to hear from Cindy to tap into her wisdom around endometriosis. Can I introduce Cindy here? Let's see, where did this go? So Cindy is a registered dietician, a master of applied nutrition, an endo warrior, and the founder of the Supportive rd. Her passion comes from supporting women who, like herself have said enough is enough to debilitating life altering symptoms of endometriosis. Cindy supports Endo warriors who are looking for improvements in pain, fertility, fatigue, constipation, diarrhea, bloat, PCOS, hormonal imbalances and indigestion as a consequence of endometriosis as a registered dietician and warrior herself is, Cindy is proud to be an ally and a resource for the Endo Warriors on their symptom improvement journey. So inspiring Cindy, and we're so excited to have you here and share your wisdom with us. Thank you for being here.
Speaker 2 (00:01:09):
Yeah, my pleasure. I'm curious, does anybody in the group have endometriosis or is this more of just a personal interest topic?
Speaker 3 (00:01:19):
I very likely have it, but it's undiagnosed at this point. I've got a pre-op appointment with an excision specialist in a couple of days. Okay.
Speaker 2 (00:01:31):
Alright. So hopefully if you have some questions brewing about endo, I'm happy to answer whatever's within my scope to address. Yeah, I think the statistic is one in nine now, but I would argue that it's significantly more than that. I think if we look at our group of friends, it's probably, I think it's probably so much more than that. If I think of a close group of my friends, I think maybe out of five of us, maybe one hasn't had a diagnosis of endometriosis. I would argue it's significantly more common than one in nine. But sorry, I just kind hijacked that.
Speaker 1 (00:02:12):
No, it's wild to hear the prevalence and I think starting out because not everyone is familiar and I think that's why some of the under-diagnosis is happening. We write this off and we think, oh, it's normal to be curled over in so much pain or to have all of these other symptoms, which I'm really excited to get into some of the other symptoms and just draw awareness around, Hey, how many of us could be dealing with this and we don't even know. And then there's the silent endo reality. So can you just first introduce endometriosis for anyone here who is unaware of what it is?
Speaker 2 (00:02:47):
Of course. Yeah. So endometriosis a chronic condition, and I can kind of get into the details of exactly what type of condition it is, but it's where tissue that is similar but also has quite a few significant differences to the endometrium. So the lining of the uterus is not identical to the lining of the uterus, but it does behave similarly in some ways. And so these lesions grow, I mean at this point they've been found everywhere in the body, even in very rare spots like the brain or in the thoracic cavity or the gallbladder, like in every organ of the body. It's been found at this point and those lesions respond to the cyclical hormonal shifts throughout the cycle. So you've probably done a lot of education around this, Jess, in your program around the hormonal shifts in the cycle. But when our hormones drop leading into menstruation, we get the shedding of the uterine lining.
(00:03:43):
These lesions, they kind of respond similarly. And so you get this sort of bleeding of these lesions if you can visualize it, but because it's not the endometrium, they don't have anywhere to go. So these lesions essentially form, they can bind organs together, they can block fallopian tubes, they can affect ureters, the flow of urine into the bladder. And so it's a chronic condition, like I mentioned, it's an inflammatory condition, but primarily it is a condition of immune dysfunction. So when we think about why do these lesions even establish in the first place, it's this dysfunction within the immune system. So these immune cells that are meant to rush to these sites of this attempting to establish endometriosis lesion, they're not fully functioning. So don't take the numbers that I'm throwing at you literally, but just to paint a picture, let's say 90% of that attempting to establish endometriosis lesion is cleared by your immune system. As somebody with endometriosis, that defect, that 10% that isn't covered by that dysfunction in the immune response ends up allowing endometriosis lesion to establish, develop a blood supply and then grow and spread throughout the body. So that is endometriosis. Hopefully that was a relatively simple definition and explanation in terms of the symptoms. Did you want me to go into the symptoms?
Speaker 1 (00:05:09):
Yes, please.
Speaker 2 (00:05:13):
Okay. So symptoms, it's nothing about endometriosis is simple unfortunately, but some of the classic symptoms of endometriosis would be debilitating pain, pain that is untouched by over the counter pain relieving medications, pain that makes you vomit or faint that makes you burn up or results in these drastic temperature shifts. Probably I would say the statistic is somewhere like 90 to 98% of people with endometriosis have some kind of digestive symptoms, whether that's bloating, whether that's constipation, whether that's diarrhea, whether that's symptoms, characteristic of inflammation along the bowel, like sticky stools or hard to wipe clean stools or pain, abdominal pain. We see a lot of estrogen access symptoms with endometriosis. So heavy bleeding clotting, breast tenderness, mood shifts leading into the period spotting before the period or tail end brown bleeding at the end of the period. We see a lot of low mood sleep disruption with endometriosis and we see a lot of back pain, leg pain.
(00:06:21):
Sometimes it's specific around menstruation or the high estrogen phases of the cycle in the luteal phase. So that phase between ovulation and the start of your period or around ovulation as well. Sorry, I keep saying these questions pop up here or these comments pop up. So those symptoms, and then I always make a point of mentioning the mental health side, right? Endometriosis can be very isolating, especially what you alluded to just around in the beginning around it being kind of brushed off, being kind of normalized if you're every month vomiting from pain or passing out from pain or having to cancel plans or not able to get into work or school, and this is like your life every couple of weeks. And for some people it's more often than that. It's not just the pain and the symptoms are not just specific around those times of the cycle and you're being told, oh yeah, this is normal.
(00:07:18):
Just take pain medications or take birth control. This could feel very isolating. You could feel very gaslit, nobody understands you. And what's really frustrating about endometriosis, you don't always look the way that you're feeling, right? You don't always look in pain. Not everybody who has endometriosis will look swollen or inflamed. So I probably didn't even cover 25% of the symptoms. There are so many, but I like to mention that there's the GI side, the pain side, infertility is a huge symptom. I think the statistic is like 50% of all infertility cases are due to endometriosis. You had mentioned invisible or silent endometriosis in the beginning. So this is when you have endometriosis, but you don't have those characteristic pain or digestive symptoms. And it's typically only discovered when you've been trying to conceive or grow your family and you don't have success there. And so if you're working with a well-versed knowledgeable fertility team or gynecologist, then you might eventually get to the point where you have excision surgery or some kind of diagnostic lap and then it's found.
(00:08:38):
Right. Sorry, I'm going off on a bit of a tangent. I should avoid you, Jess. I go off on tangents. But yeah, I would say those are kind of the main symptoms. There's the hormonally driven symptoms, there's the pain symptoms, infertility is huge. There's a lot of digestive symptoms. One that I actually really like to mention is what appears like UTI iLike symptoms. And this is one that I make a point of mentioning too, because it's insane how many people I've connected with who have these symptoms of recurring UTIs. It seems like they're getting these UTIs on repeat, but when they actually culture, when they actually test the urine, there's no bacteria. And now what we understand is that endometriosis on the bladder or on the ureters can actually present is these UT iLike symptoms. And what's troublesome about this is there's no bacteria in the urine.
(00:09:37):
And so doctors are kind of left wondering, okay, what's causing this? Let's give you antibiotics anyway, right? Let's treat you for something that isn't there anyway. And then a year or two or three down the line, after you've had six or seven or more rounds of antibiotics, you've completely wiped away the bacteria that colonize your large bowel, which we now understand is huge for symptom management with endometriosis. And now you're way worse off. You haven't treated anything because there wasn't any infection to begin with. And now because of the effects on the gut microbiome, the symptoms have gotten so much worse. Your ability to eliminate hormones and toxin and waste in your ability to have complete normal bowels has been affected negatively. And all of these things matter for symptoms with endo. So yeah, that was a really long answer. I'm sorry.
Speaker 1 (00:10:33):
It was amazing. We're learning so much, and I mean, it's such a testament to just inflammation in the body. I mean, this is, when we're talking about PMDD, it's very different. Again, it's systemic. We have to look at the whole body, but it's the way that endo pervades into all of these areas. And I think it's really cool that you're bringing up the reoccurring kind of bladder pain that's setting off some red flags in my mind for myself there. And just the infertility, how it bleeds into all of these different areas and into the mood too. That's one of the reasons why I wanted to bring you into our community because so many of us are dealing with mood problems and also very severe period pain. And I think a lot of people when they think of endo, it's just like, oh, I'm in all this pain, and they don't really understand the far reaching symptoms where we're moving into all of the different body systems and experiencing so much. I mean, pain with sex, pain with urination, so many symptoms like you said, that we haven't even listed yet, because there are so many. And it really is interesting, the digestive connection where people are dealing with these digestive symptoms for so long, and it's never even brought up in the conversation of, oh, could this have something to do with endometriosis?
Speaker 2 (00:11:56):
Yeah. And I think that's a big part of the reason why it takes so long to get a diagnosis. I mean, I don't know how many of your, this is a community you have, right? Or a program. Yeah. I dunno how many of the participants are on top of new literature research around diagnostic methods for endometriosis. But there's been so much lately in the media about diagnostic, new diagnostic innovations for endometriosis. But anyway, I was saying about the delayed diagnosis. I mean, for me personally took 15 years. It's rare to encounter somebody who was maybe diagnosed in two years or three years from onset of symptoms. I mean, it's certainly possible if you have a receptive healthcare team, but the average to diagnosis is somewhere between eight to 15 years. The average is about seven to eight years, but it could be 15 years plus. And I think what you mentioned in the beginning around it being normalized and brushed off and then coupled on top of that is, well, these symptoms don't present as something like endometriosis. They present as like IBS or they present as these recurring UTI symptoms that have nothing to do with endometriosis. And lo and behold, it has everything to do with endometriosis. Endometriosis is actually at the heart of why you're getting those symptoms. So yeah, I don't wish it on anybody.
(00:13:20):
It's not pleasant having endometriosis, but I don't want to be super doom and gloom. There are things within your control to improve symptoms and live a good quality of life. But yeah. Yeah, you're right. I'll leave it at that.
Speaker 1 (00:13:36):
There's so much to say. It seems like there's such a lack of education, even from providers and how things have changed over the years where incision is now seen as the way to go where a lot of providers, one of our students here today went to seeking help, and they're still referring to methods that are not seen as the most, the first line of exploration. Yeah,
Speaker 2 (00:14:09):
I don't know if this is what you're alluding to, but I have a very, I think, controversial opinion on hormone therapies for endometriosis, and I don't know if that's something that you want to talk about today. I try and remain very neutral, so there's no judgment for me, for anybody who's ever taken birth control or alysa or Lupron or any of these hormone therapies that are available for endometriosis. I've taken birth control for many years as somebody with endometriosis. I think that that's probably the only reason I was able to make it through university, right? Because I was managing with some kind of hormone therapy. So there's absolutely never any judgment for me. What's frustrating though is that providers do not educate people on the whole body effects of these therapies and how they're connected and how their effects overlap and have relevance for how your endometriosis behaves in future. I don't know if that's something that you wanted to get into, but I'm definitely happy to talk about that. But yeah, again, I've hijacked conversation.
Speaker 1 (00:15:13):
Well, no, it's so important because people, if you're taking a treatment recommendation like that with the understanding that this is going to help me in the wider scale versus this is just treating a symptom in the end, I mean, you're left very disappointed because you had a misunderstanding of what was really being offered and what was really being provided, and in that amount of time, how much worse have things gotten? And you're really not addressing any of that, the root of the inflammation, the root of what's really going on. So I'm down to here. You're controversial viewpoint on it for sure.
Speaker 2 (00:15:50):
Yeah, I 100% agree with what you just said, how it's more of like a bandaid. But even beyond that, I mean, we know that a lot of these hormone therapies, when they did studies before these medications were launched, when you look at whether it's in the endometriosis population specifically or not, they found that almost all of them will elevate liver enzymes. And I don't know if this is something that you educate on in your programs, but when your liver enzymes elevate, this is a sign of some more often than not, if you're a healthy young person, non-permanent liver damage or that something is some damage to the liver cells, right? Because your liver is your major detox organ, it stores several minerals. It stores many fat soluble vitamins. It's responsible for processing and eliminating estrogen in the first two steps of how estrogen is eliminated.
(00:16:44):
And there's so many more things that the liver does for us. So when you really think about this, and this is just one example, if you're taking this medication for the purpose of helping to improve symptoms of endometriosis, but then at the same time it's causing these elevations in liver enzymes, which then have implications for the way that your liver functions, is it like, do you know what I mean? Is this a non-direct? Is it doing more harm than good? Right. That's one question for me. We know that a lot of hormone therapies affect blood sugars and cause mild elevations and insulin and blood sugar dysregulation. We know that insulin is growth promoting. We know that it's part of why fibroids and cysts and endometriomas grow. We know that it's growth promoting. So if we're causing this little shift in blood sugars and insulin, again, is it having that desired effect?
(00:17:42):
We also know that birth control affects nutrient absorption, right? This is plastered all over social media, magnesium deficiency, and B, vitamin deficiencies and zinc deficiencies. These are some of the most important vitamins and minerals as somebody with endometriosis. Zinc is extremely important for supporting your immune response. Magnesium, really important for muscle contraction, relaxation, and for how estrogen is eliminated through the liver. If you're magnesium deficient, you're going to have more severe symptoms. B vitamins, extremely important for converting food to energy for the body and implicated in the way that we eliminate estrogen. And because endo is an estrogen dependent condition, I think that the spillover effects of that are pretty obvious. That being said though, because I know I'm maybe making this sound so much worse than it is, these are things that you can support yourself with. If birth control feels good to you, if this is something that you're using for contraceptive purposes or because it's that one thing that's returned some quality of life for you, absolutely.
(00:18:42):
I support you in that. But just know that you need to be supporting your body. If you're going to be taking this hormone therapy, maybe you do a quality multi, or maybe you lean into some of these extremely nutrient dense foods in the diet like seafood or organ meats or something like this, just so that you're confident that you're getting enough of these vitamins and minerals that support your body with endo. But do you get what I mean? Certainly, yes, they can give you some quality of life back. They can help with pain symptoms. And I think that these are tools that we can certainly tap into in very severe situations for sure. Or if somebody just has such a busy life that they don't have the mental capacity or the energy, for example, to be able to tap into holistic interventions, but just be aware of what they're doing in your body. And then maybe if you opt to pick something like this to help manage symptoms of endometriosis, then maybe you're simultaneously making regular use of asana or placing a cast oil pack over your liver, or maybe you're prioritizing those liver loving vitamins and minerals just so you're supporting your body simultaneously while taking that hormone therapy. You know what I mean?
Speaker 1 (00:19:59):
Absolutely. Which there's such a lack of education around, because you're not going to get that informed consent from your provider. That's just not really their job, even though it should be. They don't have time for that. They maybe don't even have that information or education themselves. So it's the amount of advocacy that you have to learn to do when you're dealing with any chronic health condition is so important. And again, not something that we're taught, and you can feel, so, I mean, you're just trying to make it through the day, and then you add to your plate, oh, now I have to advocate for myself. And those medications can be a good leg up of like, okay, well, I'm taking this medication. I can get my life together. I can get the support that I need. I can start making some of those changes. But it is a let down when you realize, oh, this didn't actually address any of what was going on, and maybe potentially in some ways made things worse for me.
Speaker 2 (00:20:52):
One thing I would love to add too, and I do want to preface by saying that this isn't science backed. I hope that maybe someday they do some research about this, but this is the source that this is coming from is a surgeon who regularly performs excision surgery on her patients. I did an interview with her as well, which is on my YouTube channel, Dr. Naomi Whitaker, and she mentioned just anecdotally that she has noticed a huge difference in the visibility of lesions when she does a laparoscopic excision in people who were taking some kind of hormone therapy like oral or Lupron or birth control. So basically the visibility of the lesions reduced in somebody who was taking those prior to excision. And so just something kind of a little nugget of information to be mindful of, because if you're going to be pursuing an excision surgery, which very often takes months or even years to access, you want the surgeon to do as comprehensive and complete of a job as possible. And if these hormone therapies are making those lesions a little bit harder to see, then will it be as comprehensive and complete? So that was just a really interesting piece of info that she shared with me that I think is just fascinating.
Speaker 1 (00:22:07):
Wow. Yeah, and I mean that's what we're relying on is anecdotal information for so much of this, because, I mean, I don't know how it is in the endo world. I've looked at some studies, but with PMDD, there are so few studies. So it's kind of like, where do we go from here? And then you have to ask a question of who's funding this study? It's not all study, not every study is reliable in the first place. So
Speaker 2 (00:22:38):
I agree. I agree.
Speaker 1 (00:22:41):
Talk to us a little bit about the diagnostic process, because I feel like with Endo, this is one of the, and we're going to put a positive spin on this. Okay, so stick with us here, but we have to be real about the reality of the condition and the situation. The diagnostic processes is a bummer. Is that
Speaker 2 (00:23:04):
Yeah. I mean, do you mean how it's diagnosed or the length of time to diagnosis or all of the
Speaker 1 (00:23:10):
Above? Yes. So there's not going to be, at least I've have seen some interesting things coming out about hopefully the future of diagnosis, but there's no blood, urine, saliva genetic imaging test that can say, oh, this is what it is. It is quite invasive to get the diagnosis.
Speaker 2 (00:23:30):
Yeah. Yeah. So yeah, I would say up until pretty recently, the gold standard for diagnosis was a laparoscopy with excision where the lesions were biopsy to confirm endometriosis. I had my excision in 2018, and they excised a few spots, and it turned out that the whole, I don't even know what to call it, but what they found on the left abdominal wall turned out to be scar tissue, not endometriosis lesions. So I had so many questions about that. It's like with all of these new non-invasive innovative diagnostic techniques, how are they differentiating between the two? Because my surgeon went in excise, both couldn't tell the difference between the two while he was in there. And then we had to wait for pathology to come back and tell us, oh, that was endo. That wasn't endo.
(00:24:24):
I don't mean to hijack your community here and advertise my YouTube channel, but I did just do an interview with Dr. Matthew Leonardi, who's one of the leaders in diagnostic ultrasound. So we spoke all about that, and we spoke all about how they're able to tell the difference between lesions and scar tissue or in the effects of pelvic inflammatory disease. My understanding is can cause a lot of scar tissue and adhesions and this sort of thing. And through experience and through playing around and wiggling the lesions and using fluid to see how the lesions respond, they've actually been able to quite accurately diagnose endometriosis through advanced ultrasound. So it's not perfect and deep infiltrating Endo is much, much easier to diagnose that way. But they are beginning to diagnose superficial endometriosis with a pretty significant degree of accuracy. So up until recently, the lap with excision was the gold standard. IM team as much non-invasive diagnostic tools as we can get, right? Because they're cheaper, they're more accessible, they'll cut diagnostic times probably by way more than half.
(00:25:43):
They don't require weeks and weeks of recovery time. So I don't know, Jess, if you agree, but I would say that we do have some non-invasive diagnostic techniques available now. So we do know that advanced ultrasound is one of those. And so like I said, much, much more accurate at diagnosing the deep infiltrating the ones that are quite more visible on ultrasound. You can also see deep infiltrating endo on MRI. So that's another diagnostic tool. And my understanding is that they're able to tell the difference between lesions and scar tissue or adhesions by the way that they respond to fluid, or it sounds kind of funny to say, but like jiggling with the ultrasound wand. And so yeah, there are more and more of these non-invasive diagnostic techniques coming in, advanced ultrasound being one of them. I also just connected with this team probably about a week or two ago called Endo Shore, and it's basically, it's a little machine the size of a TENS machine if anybody's familiar with a TENS machine like an Vera or a Mira Pro or something.
(00:26:54):
Or you can get those noname ones off of Amazon, but they're about that size. And basically the doctor who came up with this diagnostic tool is using, and don't quote me on this because I'm not an expert in this, this is just what was described to me, but they use the movement in the abdomen or some kind of sound waves or something like that to diagnose endo with some degree of accuracy. If you're under 35, 90 9% over 35, it decreases by 1%, so 98% accuracy. So while these diagnostic techniques are not widely available, I mean if you're in Hamilton, Canada area, there's also advanced ultrasound being practiced in parts of Australia. I know it's popping up now in different parts of the US then that may be accessible to you, but definitely more and more promising non-invasive techniques on the horizon. I have no idea if I answered your question there.
Speaker 1 (00:27:56):
Absolutely. I'm so happy to hear that because like I said, I'm not tapped into this world in the way that you are, which is why I'm so excited to have you here, and that's fantastic news. Where we are located, there are very few resources of any equality, but it's exciting that they're coming to places near us maybe. And so important because the time to diagnosis and then now, I mean, would've never thought about this previously, but now I'm 35 and we've been trying to conceive for, we're going into year four, and that's a whole new world of devastation that I have not faced before. So you start asking questions of, okay, you're going through all of these tests and you're trying to figure out the answer. And so often for everyone, there is no answer. It's unexplained infertility. But it was interesting in with the ultrasound text. She was saying, oh, these are signs of endometriosis. And I'm like, I'm pretty sure you shouldn't be saying that this, you probably shouldn't say that, but it was interesting to hear that maybe that could be a factor. My grandmother certainly had endometriosis and had a hysterectomy due to it, but it's a question lingering in a lot of people's minds who are unable to conceive.
Speaker 2 (00:29:20):
Yeah, I think that we do have literature that shows various environmental chemicals are part of the reason. I mean, just to preface, technically, we don't know what causes endometriosis. I mean, we have our theories, but we definitely know that environmental chemicals are at play for sure in how it behaves and the spread, maybe even the start of endometriosis. I would argue that that's probably true, and I think that that's consistent with the more polluted our world gets, the more people seem to be diagnosed with endo or experiencing symptoms of endometriosis. So I forgot where I was going with this, but yeah, I would definitely argue that because the world is becoming more polluted, more and more of us are unfortunately developing endometriosis probably as a consequence of that. And so yeah, it's really sad to hear. I hope you guys do end up growing your family. I'm in the same boat. We're on year eight, but we have other issues besides endometriosis. But I mean, you're a professional in this space. I'm sure that you're in your own good hands to help.
Speaker 1 (00:30:33):
It's interesting. It is an interesting place to be though, because at some point I'm just like, I don't want to be my own practitioner. I hear you. I'm a practitioner for so many others, and it's necessary to get, you're too close to it. So often it is great that there are so many other or so many amazing people in the endo realm to support, but it's hard when you don't know what the cause is. And with Endo or any other chronic health condition, like you're saying, there are so many factors, which I think this was a question I really wanted to ask because I face this so often. So how I'm going to ask us is what's the most common question you get? And let's see if that reveals
Speaker 2 (00:31:22):
Most common question. I I don't know. I mean, I get a lot of, what is endo symptoms of endometriosis? Oh, dietary factors or holistic strategies for managing endo maybe is a common question I
Speaker 1 (00:31:40):
Get. Yeah, so some version of what's the solution, I'm guessing, is a question that you get a
Speaker 3 (00:31:47):
Lot.
Speaker 1 (00:31:48):
I would say that's the most common question that we receive here, and you can't really answer. I mean, that's an impossible question to answer as a practitioner, when you recognize, okay, there are so many factors, like you're saying, the environmental factors, any kind of heredity factor. I wonder what the trauma role is in endo. Maybe some of that is in there, but on and on, you have to really zoom out and look at each individual. It's so hard to answer the question of what is the solution when there are so many factors driving the symptoms.
Speaker 2 (00:32:27):
Yeah, I agree. Are you asking me the solution is
Speaker 1 (00:32:30):
For Well, I just was curious if people are asking you that a lot, and if so, how you're navigating.
Speaker 2 (00:32:38):
Yeah, well, I mean, you're right. There's so much, and Endo I feel like is exceptionally complex. I don't know a lot about PMDD. I do have some clients kind of overlap. They have a bit of like PMDD symptoms or diagnosis and endo. But I mean, we know that endo, to simplify this, I'll be talking for like 45 minutes, but we know it's a condition of immune dysfunction. So when you think about, okay, immune dysfunction, what can I control? What's within my control? And I try and focus my efforts and energy on things that are within your control because if it's something like an environmental exposure or genetics or something that somebody in your extended family was exposed to 50 or a hundred years ago, I mean, that's a little bit less outside of your control at this point. So gut, right? We know that gut is 70% of the immune system is located there.
(00:33:28):
That's a huge area where we have a lot of control. If you're waking up every day and getting bloated immediately and then your whole day is just bloat and then you're having issues with passing stool or you're seeing undigested food in your stool, you're getting heartburn or reflux or the list goes on in terms of digestive symptoms, I want to address that because all of those things are either pointing towards something going on in the gut that shouldn't be going on to help you improve your symptoms or to reduce body wide inflammation. Maybe you have h pylori, maybe you're showing signs of digestive dysfunction, which obviously we want to resolve because the more nutrition you can pull out of your food, the better equipped you'll be to fight inflammation. So that's something within our control. You can also support elimination of waste. So if you are being exposed to chemicals in your water or in your food or whatever it might be in your beauty products or cleaning products, then let's support that elimination as best as we can.
(00:34:29):
That's within your control, right? Next thing would be hormones. Let's optimize those as best as we can. Sure, there are maybe some things that are outside of your control, but let's focus on the things that are within your control. Let's work on estrogen elimination, on optimizing progesterone production since and antiproliferative, right? Progesterone is incredible for endometriosis. It can be so transformative for endometriosis. And then if your androgens are high, your testosterone and DHA, that's going to drive a lot of inflammation, so let's bring that down. If they're low, they can affect your immune function. So let's try and normalize them. So it's kind of like I'm giving you a very simple version of this simple answer, simple version of the answer to this question. But yeah, there's that. And then there's the inflammation piece. So looking at all those big sources of inflammation, the gut, the hormones, the diet, your environment, what can we do to create as much of an anti-inflammatory diet and environment as possible?
(00:35:26):
And then we have the foundation's sleep quality movement. How can we support some consistency in these things to support your adrenals, your energy levels, the messages that your body is receiving if you're living with a chronic inflammatory condition, and then the messaging that your body is getting is on top of that, you're also stressed because you're undereating or you're not getting enough sleep or whatever the messaging is. We really want to help that as much as possible because for obvious reasons, we don't want your body thinking that it's in a stressed state. We don't want it thinking that it's in chronic fight or flight. It's not going to help the way that your digestive system functions the way that you're making hormones. It's not going to help be helpful for nutrient absorption, for sleep quality.
(00:36:17):
And then I kind of go through this process with every unique individual person, and we try and pick out which of these things applies to them. How can we improve these things in that unique individual? Sometimes there'll be some natural supplements if somebody is really, really inflamed or is really, really deficient in something like zinc or vitamin D, because we know those are risk factors for endometrioma growth. But again, I don't know if I'm answering your question, but this is my framework anyway. That's how I work through it. And if somebody has a chance of seeing quality of life improvements through natural holistic strategies, it would be through these methods, I guess, for optimizing health.
Speaker 1 (00:37:02):
It's so exciting to see that. And nothing that you're sharing is surprising me because you're looking at the whole body and you're saying, okay, stress begets stress. Inflammation begets inflammation. We can't just look at this one area of our lives and leave it at that. It's touching every single aspect. And also the emotional factors of how are you feeling about this? How are you feeling about the diagnosis? I mean, I know with the PMDD diagnosis, it lands so differently for everyone. There can be a lot of fear. You get into this relationship with your body where it feels like you're being attacked by your body, you hate your body, and then there's all of that that you have to work through. So it really touches every corner and every aspect of your life. And then with endo two and the bloating, I mean your body image just, and then you're not eating because you're bloated because you have a poor body image, and then that's driving more inflammation. And something that is so common that it seems that there's a disconnect, at least in the population that I'm working with, is not understanding that stress is not only external. There's a lot that's happening. The inflammation is a stressor, but the choices that we're making, how much caffeine we're drinking, how our sleep hygiene is if we're pushing ourselves to do a hip workout when we're menstruating, all of those are additional drivers for stress and for inflammation in the body that it seems a lot of times we forget to recognize.
Speaker 2 (00:38:29):
I totally agree. It was actually before the call, I was doing a Dutch interpretation for one of my clients, and she's somebody who I know regularly travels. I don't know exactly what kind of job she does, but she's regularly on the train. She's flying somewhere, and I was looking at her, I think it was her cortisol metabolism, and I'm thinking to myself, I know how to fix it. But when you know that probably something super foundational to her day-to-day life is contributing to that, I truly believe we're in the wrong, I dunno what I'm trying to say, but I feel like if we could all just work from home and have a little plot of land where we can grow our own food, and we weren't on a nine to five schedule, I don't think anybody would have these problems. I think the way that society kind of works are nine to fives or stressful jobs, the commutes home and from work.
(00:39:28):
I really think that these things are so foundational to why people have these problems. So anyway, that was just an example I was thinking, I'm like, okay, I know she travels. I know this is probably part of fixing the whole cosol thing, but this is her lifestyle. This is going to be tricky. But yeah, back to what you were saying. Yeah, I can't even tell you how many people, probably close to a hundred percent of patients that I work with under eat significantly under eat. And I'm like, how do you expect your body to make progesterone? How do you expect your digestive system to function properly? How do you expect to sleep? Well, how do you expect to have a stable mood? How do you expect to have a libido when your body needs X amount of resources to function properly? And it's getting like 50% of that on a daily basis.
(00:40:18):
It's like, yeah. And I think there's so many things that are rooted why that's become a problem for people. I think something outside of the scope of this conversation, but how is your car going to run if you're not giving a gas? Do you know what I mean? It's like, yeah, yeah. And Shannon's making a good point. I'm not seeing the full length of your question because just the first line popped up there. And there could be physiological drivers of that too, right? If you have h pylori or if you have fat mal absorption, these things can make it harder for you to tolerate food without feeling nauseous or feeling full really, really quickly. Or if you have a slow transit time through the bowels if you're eating, and then food is not moving through you at an appropriate speed. And this is something I see a lot in the endometriosis population.
(00:41:11):
I've had people who have a five, six day transit time. That means from the moment that food enters their mouth to coming out through the stools five, six days, that's insane. That's really, really long. That's giving your body a massive amount of time to reabsorb waste, toxins, hormones. That's not good. And so to the point I was making before, if waste and food and hormone are moving through you so slowly, it makes sense to me that you would feel a little bit fuller or have a hard time eating enough. But then you have to identify what that problem is and work on resolving that issue so that you can actually start eating enough. So Jess, you're shaking your head. I think you agree with me.
Speaker 1 (00:41:57):
Well, that's why that personalization is just, you can't not have it. It has to be there if you're really wanting to feel better with any chronic health condition, because we're saying the drivers are also different, but you made me laugh about the undereating, which isn't funny, but when people ask me what I do, a big percentage of the time, I just say, I try to get women to eat food. Because when I run food in mood journals, I've had to figure out how to ask the question of, is this everything that you're eating in the day without any just flat line? Ask the question because I am in awe at the undereating that's happening. And a lot of times that is because we're on a DH ADHD medication or we're using stimulants like coffee or there's some sort of nausea going on. There's more reasons why it's happening outside of disordered eating, but it results in disordered eating either way.
(00:42:53):
And it's wild how we would expect ourselves to feel functioning in any capacity without adequate nutrition. I mean, many of these women are eating less than a toddler would eat in the course of the day. So it's so heartbreaking. But at the same time as a practitioner, you're like, oh, I can see so many ways that we can help you here based on your case. So let's take some steps towards that. And I think that really is to bring it back around to the hope. I mean, you're working with women every day. You're helping them feel better. You're helping them live fuller lives, and they still have endometriosis. It is a part of their lives, but it doesn't mean it has to shape the story of their entire life.
Speaker 2 (00:43:42):
For sure. At least we try and minimize that as much as possible. So it's not at the forefront of your mind always. And I don't know if you would agree with this, sorry. This is the last thing I'll say on the topic we were just talking about, but in my experience, 100% of the time, if we just slowly start to tweak the diet, slowly, start adding a little bit of something in your coffee or your matcha in the morning just to add a bit of amino acids or protein, or maybe if we just add a little bit of fruit or just take those baby steps 100% of the time in my practice, at some point a couple weeks down the line, I'll hear the words. I woke up and actually had an appetite. I actually felt like I could eat something. And so that's just been my experience a hundred percent of the time we've been able to go from, yeah, I'm not hungry in the morning to, I actually have an appetite when I wake up in the morning now. And that's really good.
Speaker 1 (00:44:36):
You really have to train that. And it seems it can be a badge of honor of I'm not hungry in the morning. Okay, well, you've been fasted all night. So that's a sign of metabolics function. That's not a badge of honor that we need to be wearing here. We want you to be nourished. We want you to be full of energy and life. And it does take some training to bring that back. But that's such a great signpost to healing too of, oh, I'm feeling hungry in the morning. That's amazing. That's great. That's feedback from the body that we are moving in the right direction, and these things take time. They really do, especially when you're working with inflammation.
Speaker 2 (00:45:11):
I agree. And yeah, to add to what you were saying, I always break it down for people when they say, oh, I'm not hungry. I say, okay, when was the last time you ate? Oh, probably somewhere around seven. And then what's the first time? What time do you wake up in the morning? Oh, I wake up at like eight. Okay, so we're already 13 hours later. Do you think your body doesn't need energy? Even if you're not feeling hungry or you're not getting hunger pains, your body needs energy at that point, right. So yeah, that's just something I like to break down for people.
Speaker 1 (00:45:46):
Something I notice a lot, and I think it's probably because so many of the women that I work with are neurodivergent also, but just a misunderstanding of what hunger cues feel like and not really understanding signs. So many times I hear, oh, I'm nauseous, or I'm lightheaded. And it's like, okay, there are hunger cues outside of just you feeling hungry and your stomach growling. And we have to learn often what that looks like and what that feels like because we just might not be tapped into ourselves. And something else that I thought of while you were talking earlier was just the kind of cortisol addiction and waking up and just having that cortisol awakening response that's fueling you rather than food, and that we can become addicted to those stress hormones. And we're living in such a stressful time right now where we're working all day. We are managing families, we're managing a household, we're commuting, we're all of the things in a day, and it is a lot.
Speaker 2 (00:46:51):
I agree. I agree for sure. And there was something you said there, what was it? Oh yeah, the hunger feelings for me with my patients, I don't like them to be feeling hungry. If from meal to meal, the first thing that you're feeling to know that you need food is hunger pains. No, you've gone too far. I want you eating your meal when you're at about a four out of 10, hunger, fullness scale. I don't want you to be getting to the point where your energy is dipping or you're getting dizzy, or you're getting really low energy. You really should be feeling that between meals. So yeah, I totally agree. Yeah.
Speaker 1 (00:47:35):
So before we get to answering the community's questions just briefly, I know that we've already said how important it's to work with a practitioner who's first in Endo, if you're looking for support to really get a personalized approach for you. But if someone was thinking that they had endo or having some suspicions, wanting to make some moves to feel better, any ideas that you can throw out to help them on their journey, direct them where to go if they're just starting out?
Speaker 2 (00:48:11):
Yeah, I mean, I have tons of resources, blogs, YouTube, all my socials. I would say if you're highly suspicious that you have endometriosis, I mean, besides the foundational stuff we talked about today, like optimizing gut health, making moves to help yourself with better elimination through the bowels, better understanding your hormones. I know that that stuff is a little bit complex. But besides that, I would suggest get on Google, look up excision specialists or endometriosis specialists in your area, and then just kind of get the ball rolling about connecting with that person, because you're probably not going to get very far with a regular OB or gynecologist or family doctor. You want to talk about your options. Although honestly, when it comes to western medicine, I'll be honest with you, it's not a very comprehensive list. It's basically hormone therapies. I really love NaPro doctors for this NaPro technology.
(00:49:16):
I don't know if anybody's familiar with this special kind of little subset of medicine, but they work more with the body natural. So for example, they'll provide bioidentical progesterone as opposed to hormone therapy like a synthetic birth control or vaan or something like that. I personally take bioidentical progesterone just in the luteal phase, so it works with your cycle. It doesn't stop ovulation, it doesn't affect fertility, nothing like that. And it really does help with heavy bleeding. It helps with pain, it helps with proliferation of endometriosis. So maybe even take it one step further and seek out both a NaPro doctor in your area, also an excision specialist, just to kind of get the ball rolling on that. They also prescribe things like low dose naltrexone, which can be really helpful for that immune dysfunction component. So still meds, but a little bit different and truly helpful. Very, very helpful. What else can I offer you?
(00:50:19):
Maybe seek out a referral to some of these allied health supports, like maybe a pelvic floor physiotherapist. We know that a lot of people experience improvements and symptoms through pelvic floor physio, maybe referral to a dietician to help you with diet so that you're eating enough and that you're not not having any gaps in your nutrition, right? Because nutrient deficiencies are a super easy way to support pain reduction and symptom reduction. With endo, we know that there's a few nutrient gaps that can really drive a lot of pain and inflammation. Maybe request a referral to a pain clinic, see what options slightly more natural options are available to you that way, but shy of working with somebody one-to-one on supporting you, specifically identifying what may be going on in your body. That's probably the best that I can offer.
Speaker 1 (00:51:09):
So helpful, Cindy. Thank you so much. So let's come over to the chat here and see there is a question about any types for increasing food intake outside of the setting alarms that Shannon has.
Speaker 2 (00:51:29):
Any tips for increasing food intake outside of setting regular alarms, or is that the best strategy? Okay. It's a bit tricky for me to answer because I don't know how much energy you need. I don't know a lot about your history, but I would aim, I mean, the structure that I like to educate on in my programs is protein, fat, fiber. And ideally, if you're struggling to get a lot of food in, then my suggestion would be, do your best to make every bite count. Make that bite as nutrient dense as possible. So even if the quantity of food isn't a lot, you're getting a lot of caloric density, you're getting a lot of energy from that food. So for example, if you're doing, I dunno, what's a standard breakfast for you? Maybe I'll give you my standard breakfast as an example. But if you're doing something like eggs with today, I had eggs with a little bit of cheese and I had this banana oat loaf that I made and some sweet potatoes, leftover sweet potatoes. Again, this is not that standard actually now that I think about it. And then I had a big bowl of blueberries and a matcha. So maybe you can only stomach one egg.
(00:52:45):
That would be a very nutrient dense food that you go to maybe for your fat, you do a small amount of avocado or maybe you do some prepackaged, you can get them in those little prepackaged packs so you don't have to open up a full thing or open up a full avocado if you know that you're not going to be able to get through it. And so maybe do a little bit of avocado as much as you can stomach or alternatively nuts or seeds or nut butter if that's something that feels a little bit better to you. And then maybe for your fiber, you do some berries or a banana or maybe some slightly more filling or starchy fruit or something like that. And then maybe in your, I don't know if this is something that you guys talk about. I don't know if this is on brand with your messaging, but I really like to recommend quick, convenient, easy nutrient dense options.
(00:53:33):
So very often if somebody comes to me, they're like, I don't have a big appetite in the morning, I have a coffee or a matcha in the morning, then I'll say, why don't we start by just adding a scoop of collagen, 10 grams of protein in one scoop. It gives you amino acids. Many amino acids, particularly glycine, glutamine and cysteine are really important for inflammation. So maybe you just add a little bit of something like that in there. If you're doing something like a smoothie, add a lot of nutrient density into that. So maybe you do some nuts, nuts and seeds, some nut butter in there. And so even if you only consume a quarter cup of it or half a cup of it, it's actually quite a nutrient dense option. So I
Speaker 1 (00:54:10):
Don't know if I've answered that question, but I think that was a great answer. And thinking of it like every bite counts, because so often we're getting, we're eating things that are devoid of nutrients, and that's a big mindset shift to be thinking. But going towards whole foods, going towards protein, going towards fiber, going towards healthy fats are going to be more satiating, more nutrient dense. And again, you're kind of titrating that in a way that works for
Speaker 2 (00:54:36):
You. And I would say make the protein sources more. Again, I don't know about your history, I dunno if you have any digestive symptoms, but the animal sources tend to be a little bit more bioavailable, so your body won't struggle as much to pull nutrition from those sources. So if you do like poultry or seafood or eggs, maybe opt for those over something. And I just want to be clear, I'm not anti legume or anti tofu or any of these plant sources. It's just that maybe these will be a little bit easier for your body to pull nutrition from. If you're just working on eating a more nutrient dense diet.
Speaker 1 (00:55:14):
Every question is so hard to answer because there's so much nuance that's there. Yeah, I
Speaker 2 (00:55:19):
Mean, I do have clients set alarms. My strategy is just have a look at the clock when you're having your first meal and then just count three and a half to four hours ahead and kind of gauge in your mind, okay, do I have a meeting or something at that time or will I be able to take a break to have a meal at that time? And just with time, this will become a little bit more routine. Your body really craves that predictability and so it will support you in that when this becomes a little bit more consistent, I think
Speaker 1 (00:55:48):
There's such a learning curve as you're switching over to more whole foods and getting into cooking. It's so time consuming. It's having those little hacks of using hummus, using meat sticks, having frozen foods that you can just pop into frozen vegetables that you can pop into your dinner using canned food if you need to, however you can make it easier for you to get started is a great way knowing that there's a learning curve in changing your diet and it's not going to be this linear progression of perfection towards
Speaker 2 (00:56:23):
Perfection. A hundred percent. I agree with that for sure.
Speaker 1 (00:56:27):
We have one more question here, and actually I have a question that overlaps with this. So Sarah says, I had a laparoscopic in June and they found endo scarring as well as adhesions to my bowel. Anything I need to be aware of to prevent it happening again? I definitely noticed a connection between cramps and bowel issues even since surgery.
Speaker 2 (00:56:51):
This is probably the most common question I get actually now that I think about it. How do I prevent endo from coming back after excision? It's a hard question to answer, but my answer is, think about all of those hallmarks of endometriosis, right? That immune dysfunction, the estrogen dependence, the inflammation, the nervous system dysfunction component, blood flow, where we know that like slowed blood flow to the reproductive organs especially, can be a bit of a risk factor for endometrioma growth specifically. So I would say really consider all of those hallmarks of endo and just keep on top of keeping them healthy and optimal. So it's not a simple answer because if you do have digestive symptoms, well, in your case it would be a little bit harder. You'd have to tease apart what's actually being caused by the endo on the bowels versus what's a separate issue.
(00:57:50):
But the large majority of the time, in my experience, even when there's been a bowel issue caused by endo, we've been able to make a little bit of progress or a lot of progress to normalize the bowels as much as possible. But you're going to want to be extra on top of daily elimination through the bowels, complete normal form stools, no undigested or sticky stools, normal colored stools. You don't want to be experiencing any bloating, heartburn, reflux, the list goes on, but identifying which of those symptoms apply to you, what they could mean, applying strategies to improve that. And then, I don't know if I'm doing a good job answering this question, but basically the answer to your question is those hallmarks of endo, identifying which one applies to you, and then applying interventions. And this can be very dynamic. It can change from year to year as we get older. Hormones change based on work, personal life stressors. This can change. It can change based on age, and so you really just, you need to identify the hallmarks which apply to you, and then applying interventions to keep it at bay. That's really the best answer I can give you. I know it's not the best answer, but,
Speaker 1 (00:59:04):
Well, and that's the perfect word, city dynamic because it is going to be dynamic throughout the course of your life. What factors are happening in your life, what you're able to do at that time to support yourself is going to ebb and flow. What I'm hearing you say is it comes back down to the foundations and the foundations are going to be tilted in each direction for each of us, depending on those dynamic circumstances. But it all starts with a foundations of are you nourished, are hydrated? Are you working on managing your stress? Are you protecting your sleep? On and on and on? Are all going to be beneficial to healing the immune system, strengthening the immune system, and reducing inflammation in the body.
Speaker 2 (00:59:52):
Yeah, well, that's exactly right, right. I talked a little bit about immune system and the overlap with gut, but yeah, sleep, if you're not sleeping well routinely, that's going to have a massive impact on your immune function. If you've got a lot of blood sugar dysregulation that's going to affect your hormones, it's going to affect your digestion. It's going to affect your immune response. I would also add to just those vitamins and minerals that support optimal immune functions. So things like vitamin D and amino acids and retinol, which is active form vitamin A and zinc and selenium. Making sure you don't have nutrient gaps there. But it's not a super simple question to answer
Speaker 1 (01:00:30):
Because it's different for each person. And I think we could say that a hundred times and we still would need to say it endlessly because one thing is not going to apply to every person. It is nuanced, and that's one of my favorite parts about this work is that there isn't always an easy, quick answer that fits everyone's life because we're all unique. All of our bodies are unique, and that's actually a wonderful thing. So we have to find what works for you. And luckily there are people like Cindy helping you do that, helping us do that. Where can our community find you, Cindy, and learn more? Your Instagram page is such an inspiration. Love following you. It's so fun.
Speaker 2 (01:01:12):
Right back at you. Well, Instagram is my dominant platform, so fertility, dietician with two T's is my handle there. I also have a TikTok where I have different content altogether, and it's the same handle. Endo fertility, dot dietician. I also have a blog on my website and I also have a Pinterest and I also have a YouTube channel, a new YouTube channel. And so that one in the YouTube videos, I dive into some of these topics in a little bit more detail. So I do have a video where I talk a little bit more in depth about what you can do to prevent endometriosis progression or regrowth after excision. And then I also do interviews with specialists and surgeons and things like that. And that the name of the channel's, endo Fertility Space Channel. That's about where you can find me.
Speaker 1 (01:02:03):
Yeah, many places love it. So give Cindy a follow, share some love with her and her dms. If you enjoyed this conversation today. And thanks again for being here and sharing your wisdom with us. Cindy, it was great to have you.
Speaker 2 (01:02:17):
My pleasure. Yep. Thanks for having me. It was nice to chat with you all and connect with you all.
Speaker 1 (01:02:22):
Amazing. Have a great day, everyone. Bye guys.
Speaker 2 (01:02:25):
See you. Bye.
