This EndoLife

Today we’re doing something a little different. For the past few weeks I’ve been recording testimonial videos with people who have taken my course, and I really wanted to share some of these stories because they’re just so incredible. I know a lot of you expressed an interest in hearing more positive and uplifting real life experiences with managing endo, and as I personally found these stories so inspiring, I thought you guys might as well. 

So I’m starting with Rachael’s story and I’ll leave Rachael to share her experience in the podcast, but to give you an overview, Rachael was suffering with PMDD, chronic fatigue that was affecting her ability to work and painful (endo) periods which required her to use opioids to get through. She’d recently had excision surgery but was still suffering with an array of symptoms and was feeling desperate and didn’t know what else to try.

Once Rachael started the course, through making nutritional and lifestyle changes, Rachael was able to:

• Stop using opioids to get her through her period and instead now just uses magnesium baths, ginger tea, paracetamol and BeYou patches. 

• Has gone from having to sleep for two hours every day during work (which was agreed through occupational health) due to severe fatigue to having sustained energy and has only needed these allocated sleep hours twice in the past 8 weeks! 

• Stopped suffering with PMDD symptoms and works with her cycle to keep her endo and PMDD symptoms at the minimum. 

Her transformation is really remarkable and so I hope that if you also struggle with any of these, Rachael’s story will shine a light at the end of the tunnel for you...

Listen and subscribe on your favourite player or listen directly/download MP3 here or just listen below!

Let's get social! Come say hello on Instagram or sign up to my newsletter.

My course, Live and Thrive with Endo is opening for enrolment again soon. Join the waiting list now to access early bird pricing and special bonuses. Sign up here.

This episode is sponsored my free workshop Creating a Roadmap for Endo Healing in 2021: Overcome Overwhelm, Identify Your Core Endo Challenges, Learn the 8 Key Pillars of Healing and Set Goals and Next Steps So You Can Begin Managing Endometriosis with Confidence and Clarity and take action after the workshop. Sign up here.

My cookbook This EndoLife, It Starts with Breakfast is out now! Get 28 anti-inflammatory, hormone friendly recipes for living and thriving with endometriosis. Order your copy here.

If you feel like you need more support with managing endometriosis, you can join Your EndoLife Coaching Programme. A 1-to-1 three month health and life coaching programme to help you thrive with endometriosis. To find out more about the programme and to discuss whether it could be right for you, email me at [email protected] or visit my website.

This episode is sponsored by The Pod Farm. Learn all about how to start your own podcast with the complete course from The Pod Farm. Aimed at beginners, this course takes a simple and straightforward approach to planning, equipment buying, setting up, recording, editing and hosting your own podcast. With hours of audio and video materials, and downloadable guides and useful links, this multimedia approach aims to have something for every kind of learner. From now until April 15, newsletter subscribers get 20% off the course price. Visit www.thepodfarm.com to enroll or find out more

This episode is sponsored by BeYou. Soothe period cramps the natural way with these 100% natural and discreet menthol and eucalyptus oil stick on patches and CBD range. Click here to find out more and to shop: https://beyouonline.co.uk

Show Notes

Creating a Roadmap for Endo Healing in 2021

Live and Thrive with Endo course

So, now you’ve learnt all about the link between HPA axis dysfunction and endometriosis, in today’s episode I want to provide you with some of the core foundational strategies for healing HPA axis dysfunction. 

Before I dive in, I do want to state that healing HPA axis dysfunction can take some time, especially if you’re prone to living in the flight or fight response – so what I mean is, you’re default mode is feeling stressed, or anxious, or you spend a lot of time rushing around or over-committing yourself to endless to-do lists. If this sounds like you, don’t worry, that’s me too, and it’s many of my clients and for those of us who are like that, it can take some deep unlearning of these patterns before we can really get to see significant improvement. We can certainly feel better, and many do, but I think to really thrive and not keep returning to this cycle of low cortisol burnout, we need to change some of these habits.

So, for example, one of my clients loves to work and runs her own business like I do, so we make traction with her HPA axis dysfunction, but then if she goes through a busy period, her default mode is to put her sleep, and the strategies I’m about to share, on the backburner, because that’s always been her strategy. To push through, to keep going, to reach for perfection. And I totally get it, because I’m exactly the same too. So for her, we’ve seen improvement with her HPA axis, most definitely. She used to not be able to get out of bed! But we still have a long way to go because it’s a few steps forward and a few steps back.

And the same goes for me. I could feel a noticeable difference, I could feel my energy returning and my sleep schedule becoming normalised, and then I released the course, and it was incredible, but it was one of the hardest things I’ve ever done. Now moving forward, it won’t be like that, because I’ve now made the course, but beforehand, I was building a course from scratch and learning how to market a course – and it was more work than I think I’ve ever done in my life. So my cortisol levels really depleted again, and I’d love to see where they were after the course, but with the SIBO treatment I just couldn’t afford more testing on top. 

I feel like they’re getting back on track, but until my SIBO is fully resolved (and if there are any other infections, having them addressed too) I don’t think my cortisol will be at optimum levels. I think it will be good, much better than it’s been for most of my life, but the chronic SIBO and maybe an underlying mould infection will be keeping my body in a state of flight or fight, and I’ll explain about that a bit later in the episode.

The length of time it can take to recover from HPA axis really varies. I’ve seen studies showing it taking weeks to recover, whereas someone who is completely burnt out, like chronically fatigued, can’t get out of bed most days, that can take much longer. I did have one client like that, and I consulted with Dr Jessica Drummond, and she said to me, you know, this could take two years to heal, and we’re about a year in and she’s waking up early and working, but she’s not fully recovered yet. So, it’s a journey and just know that your healing will really depend on what’s happening in your life, in your body and the strategies you choose to implement, which will all become clear in time. 

So please don’t give up if it doesn’t feel like it’s working, because honestly, what I’m about to share we should ALL be doing every day, for optimum health and a healthy stress response and circadian rhythm, so it will be benefitting you, but it may take time for your cortisol levels to fully recover. 

What I suggest is, if you can afford to do so, take a CAR test, and again, I’ve linked to some options in the show notes, and then take another test after three months or sooner, if you’re feeling a difference, and then at another three months after that, just to see what your body is doing. You can usually tell, because you’ll notice changes in your energy, sleep, when you wake up, etc. but it can be helpful and just interesting really, to see what your levels do in response. 

So, what I’m going to share today is four of the key strategies, there are a couple more and there are some additional strategies and tools which can help, but to avoid overwhelm, I’m just going to provide you with some of the initial key steps. These may be enough on their own to heal your HPA axis or you may need to do some further work later on down the line, but these are some of the key foundations to get started.  

 

1.  Number one is a nice and simple strategy, get sunlight to your eyes for 30 minutes as soon as possible in the mornings.

Your body relies on patterns, to set its internal rhythms and it especially relies on light and dark. Your circadian rhythm is essentially controlled by day light, so getting light exposure for 30 minutes in the mornings, is going to tell your brain what time of day it is. The light changes throughout the day, and your cortisol levels will respond to that, so getting that morning light is going to really help to raise your cortisol levels to healthy levels. Over time, this continued pattern will basically reset your internal body clock, and your circadian rhythm will be able to set its pattern to this once more and your cortisol levels will start rising when they should. 

You can get this light in a number of ways. It could be that you eat your breakfast in your garden in the mornings, if you have one, it could be that you sit by an open window to get ready, or you could go for a walk or commute to work ensuring you get lots of light along the way. As long as you are getting unfiltered light, so not through sunglasses or through a window, you’re all good. And if you can’t manage 30 minutes, just do as much as you can. 

 

2. Number two is probably the most important one, but I appreciate is often the hardest one. Get at least 7.5 hours sleep, minimum, each night, whilst also going to bed and waking at the same time every day. 

I know this sounds intense but let me explain why it’s important.

Your body needs regular sleep and wake times in order to know when to raise and when to lower cortisol. If you’re going to bed at 1am, of course you’ll struggle to go to bed at 9pm, because your cortisol isn’t low enough yet as it’s been programmed to lower around 1am, and if you have a flipped curve, as we discussed last week, where cortisol is rising at night, this training of a new sleep routine will be hard but will be essential to getting those cortisol levels down. 

It’s the same if your cortisol levels are low in the morning. If you’re going to bed late, then the body won’t be elevating your cortisol levels to their waking levels until about 8 hours later. Yes, they start rising before that, but not enough to wake you up, so if your alarm is going off and you’ve only had five or six hours sleep, your cortisol levels just won’t be high enough. 

So, if you have HPA axis dysfunction and your cortisol levels are low in the morning or generally low all the time, you can see why not having enough sleep or irregular waking hours is not going to help. The body needs to know when it should be elevating cortisol, and to do that, it needs a reliable pattern. We’re essentially resetting your alarm clock here. 

On top of that, the reason why our HPA axis is dysregulated is because of stress, and that comes from both physical and emotional stress, and a huge physical stressor on the body is lack of sleep. So, if we want to allow our HPA axis to regulate, we do need to invest in improving our sleep quality. 

Now this is of course easier said than done, so that sleep routine piece is going to take practice in order for your body to get into a rhythm, and in most cases, it’s going to take sleep hygiene practices. These are essentially strategies which help your cortisol levels to lower and melatonin levels to rise at night and improve your sleep quality. That’s a whole other podcast, but I have linked to an Instagram post I did on sleep hygiene strategies and of course, if you want to dive deeper, I cover both HPA axis and sleep optimisation in my course, which you can get on the waiting list for now – I’ve put the link in my show notes.

If you have insomnia, I understand and I go through cycles of this, which truthfully, I think this is down to a flipped cortisol curve because I so often default to living in a state of flight or fight, and I also truly think a large majority of insomnia cases are down to cortisol dysregulation. So, if this is you, rather than getting stressed about the sleep piece, perhaps look at working on all of the other areas, because they will start to regulate your cortisol levels, which over time, should help you to sleep. 

And I would start teaching your body a pattern of the same sleep times and wake times, if possible, even if you’re not getting to sleep, even if you’re not trying to – just sitting in bed and practice calming, restorative techniques to help lower cortisol at night. Don’t make the focus on getting to sleep, but rather on just lowering cortisol. So, a dark room, maybe candles or very soft lighting, breathing exercises, massage, listening to sleep stories (which you can now find on loads of meditation apps), just anything gentle or soothing and I hate to say this, but I would avoid watching TV, being on your phone or your laptop or computer like the plague. I know I’m often very careful with my language and say to do what works for you and to tailor each strategy, but there’s really no way around this one. Blue light from your TV, phone and laptop will elevate cortisol and suppress melatonin and not only that, but they’re also designed to engage, stimulate, and activate your brain, they’re not designed to help you wind down. 

If you need your phone for the meditation or sleep story, put it on night mode, ideally get an app that creates a red screen and wear blue light blocking glasses, and turn the brightness right down.

Now finally, I know you’re probably thinking – what about the weekend? Well, research has shown that we need this consistent pattern all day, every day, but I know that’s not realistic, so I would just try to do your best. If you’re out late at a birthday, it’s a one off and I wouldn’t stress about it. If you’re at home and you just tend to stay up later at the weekends, see if you can curb that slightly and bring it closer to your normal bedtime. So, if you go to bed at 10pm normally, can you make it 11pm at the weekends? That kind of thing!

 

3. Number three is to eat at regular times and to balance your blood sugar. Just like with light exposure and sleep, eating at similar times can help give your body reliable patterns to set its internal rhythm to. So, if you can eat at roughly the same time each day, that’ll help. This pattern is less important that the first two, so don’t worry if sometimes you’re travelling or something and can’t eat at the same time, but roughly and as often as you can will be helpful.

But what is really important is blood sugar regulation. You know I’ve talked about this so many times by now, but high and low blood sugar are stressors to the body and activate the HPA axis stress response. And even if your cortisol levels are low, it’s still going to activate, it’s just going to be pumping out adrenaline in cortisol’s place and so the stress response will still be occurring, just of course, not as it should. And as long as we keep repeatedly stimulating that stress response, the HPA axis is going to stay dysregulated. 

I’ve shared how to regulate your blood sugar in previous episodes, so I’ll link to that for full details, but in short, we need to include protein, fat, fibre, and complex carbohydrates with every meal. And the general ratios for good blood sugar balance are 50% of your plate consisting of low starchy veg which provides you with fibre and complex carbohydrates, 25% of your plate consisting of protein, and the final 25% being split into healthy fats and starchier, yet complex carbohydrates. For fat, we want at least two golf ball size servings, so that could look like say about a third of a large avocado or two tablespoons of nuts and seeds, and with starchier complex carbs, it could be sweet potatoes or quinoa, or beans if you haven’t got them as your protein source, and the serving size you have really depends on your energy needs. Of course, if you look at it in relation to the other ratios, it’s not a huge serving, about a handful, but you might need to increase it if you have a very physical job or you’re very active. Be guided by how you feel! If you find you’re getting hungry soon after meals, first try increasing your fat and protein sizes. 

The other key strategies for balancing your blood sugar are to not allow yourself to get starving or super hungry before you eat – if you’re shaky or hangry, you’ve waited too long, and of course, try to keep refined carbohydrates, and added sugar to special occasions rather than everyday foods. If you want to understand this in more depth, have a listen to the episode I’ve linked to or a read of the articles I’ve added to the show notes, and my course also has an entire module on blood sugar balancing and its impact on endo and our hormones, and how to balance it. 

I know the idea of reducing certain foods can be triggering, so if this feels that way, then focus more on the balancing of your plate and all the wonderful foods you can add in, and on eating regularly. Of course, if you have a history of an eating disorder it is always best to work with a nutritionist, coach or dietician who can guide you, as well as a mental health practitioner. 

 

4. Number four is stress management. I know I said sleep was the most important, but actually it probably ties with stress management!

Now in order for our HPA axis to recover and get back to some kind of normal regulation, we need to stop chronically activating it. 

This means we need to learn how to move regularly out of flight or fight and manage our stress response, plus look at any areas that may be a source of stress that we can address. Of course, there’s always going to be some element of stress in our lives, but we can change how we cope with and respond to stress, and even how we perceive stress.

So firstly, let’s begin with the simpler changes. We want to practice moving out of the stress response, called the flight or fight response, and move into the rest and digest response on a regular basis. This is particularly important if your default mode is anxiety, stress, worry, fear, etc. because for you guys, most of th

Today’s episode is all about probiotics which are suitable for SIBO and endo related IBS. Now of course, this is a huge topic and there are so many different probiotics out there, which can often just get confusing and overwhelming, so with this podcast my intention is for it to be succinct and easy to digest, with a smaller array of probiotics to start exploring on your initial steps to gut healing. 

Unfortunately, I think over the years probiotics have been a little misunderstood, and of course, we’re still learning so much about the gut microbiome (which is the good gut bugs found in our large intestine) that this area of research is still developing. 

But regardless, what often happens is that we’re led to believe that we should just take a broad-spectrum probiotic, meaning it has lots of different strains in it – and that we should take this if we have gut health issues, and that will sort the problem out.

Unfortunately, that’s really not always the case and for our community, I would exercise caution when choosing probiotics.

 We know that many people with endo have IBS related symptoms, and we now know that the majority of IBS is actually caused by SIBO – which stands for small intestine bacterial overgrowth, a condition where normal gut bacteria grow in the small intestine, rather than the large intestine. The small intestine is designed for the majority of our nutrient absorption, it wasn’t intended to house lots of bacteria, so this overgrowth damages the small intestine and our ability to absorb nutrients, but this bacteria also ferments our food, making gases that are harmful for us and cause symptoms like bloating, constipation, diarrhea and abdominal pain.

And we also now have recent research showing that up to 80% of endo patients have SIBO, so quite possibly, your IBS symptoms are largely down to SIBO. If you’d like to understand why SIBO occurs so frequently in the endo population, I’ve linked to some of my podcasts and articles on the subject in the show notes.

Unfortunately, when you have SIBO, taking probiotics can often make the situation worse, especially if you also have histamine intolerance, which I’ve talked about multiple times on the show already, and I’ve linked to a couple of episodes about this in the show notes, if you’d like to learn more. But if you think about it, if we’re adding bacteria to a small intestine full of bacteria already, we’re just going to be adding more fuel to the fire. 

So, when it comes to trying probiotics for SIBO, we have to proceed with caution. Some people with SIBO just can’t tolerate probiotics at all at first, so their symptoms tend to get worse, but often, they’ve tried a couple of probiotics with lots of strains, and that could be the problem. 

Instead, when it comes to SIBO clients or clients with very sensitive stomachs, we start with specific strains, so a probiotic with literally only one type of bacteria, and then we can build up over time. That way, if a person reacts badly to that probiotic, we know straight away that that particular strain is not well tolerated at this stage in time. 

So today, what I wanted to do was to offer you three probiotic options, which have been researched for specific IBS symptoms that are often reported by endo patients, and are in most cases, safe for SIBO and are also safe for histamine intolerance, which is very common with endo.

If you do have SIBO, I want to state it’s best to proceed with extra caution, as everyone’s tolerance is different and without knowing exactly what types of bacteria are overgrowing in your small intestine specifically, we can’t guarantee that we won’t be adding to the load. 

As always, what works for one person won’t necessarily work for another, so it’s very important that you tailor to your needs and approach this with an open mind – if these guys don’t work for you, it doesn’t mean all the other strains won’t either. I’ve only listed three to keep this simple, but there are a couple of others that are safe for SIBO and histamine, not many, but a few, so do some extra research if you find these aren’t the right ones for you. 

I also want to be clear that probiotics aren’t a quick fix. If there’s an imbalance in the microbiome, SIBO, a parasite, an infection, an allergy, or intolerance, we need to address those because otherwise we’re just sort of pouring water into a bucket with a hole in the bottom, so whilst probiotics are part of the healing picture, they’re supportive and won’t necessarily fix or treat the root cause if it’s as extensive as a parasite or SIBO. 

And finally, please let your GP know when starting with any new supplement regime. 

1.      Number one is lactobacillus plantarum 299v. Lactobacillus plantarum 299v is great for bloating and general IBS symptoms, so loose stools, pain, cramping, diarrhea, constipation, etc. 

In one large study of 214 patients, 78.1% who took l.plantarum 299v rated their symptom improvement as good or excellent, in comparison with just 8.1% of those who took a placebo. The study showed that l.plantarum was particularly effective for bloating and abdominal pain. 

Additionally, two meta-analyses (which are large reviews of all the studies) have proved the effectiveness of lactobacillus strains on IBS symptoms, including diarrhea and loose stools, but generally, they’ve been shown in multiple studies to be effective for all IBS symptoms.

If you’re concerned about the reaction of l.plantarum 299v on SIBO, l.plantarum was also included in a multi-strain probiotic used to treat SIBO, which was found to be more effective than one of the commonly used SIBO antibiotics, metronidazole. 

In my training with world leading SIBO doctors, Dr Allison Siebecker and Dr. Jacobi, they both recommend l.plantarum 299v for symptomatic relief, but of course, naturally say to proceed with caution as they can’t guarantee a patient won’t react. 

I also just want to be clear here that if you want to try and treat SIBO with probiotics alone, it’s not yet an industry standard, more research needs to be done and you would need to work with a practitioner who could provide you with the exact strains and take you through the treatment. But as it stands right now, antimicrobials, the elemental diet and antibiotics are the gold standard of SIBO treatment and I don’t know many practitioners who are attempting to use probiotics alone for SIBO.

So if you’d like to try l.plantarum 299v, start low and increase gradually over time – don’t rush to full dose, maybe stagger it over a few weeks. In my training with Dr Nirala Jacobi, she recommends taking l.plantarum 299v at a dose of one capsule, twice a day for SIBO related IBS symptoms. I’ve linked to a few brands in the show notes, and of course, if you don’t have SIBO, you can just follow the label dose.

Now, some probiotics actually increase histamines in the gut, but l.plantarum 299v should be safe as it’s been found to be histamine neutral, so it doesn’t raise histamines and actually, some strains of l.plantarum actually reduce histamines. I couldn’t find any research on l.plantarum 299v reducing histamine specifically, but it lowers inflammation, supports gut health as we’ve discussed and at the very least, doesn’t add to the histamine load. 

2. Number 2 is saccromyces boullardi. This is actually a yeast, rather than a bacteria, but it’s not a “bad” yeast – it’s not going to cause candida to overgrow. In fact, it actually helps to reduce candida and keep it at healthy levels. 

But it’s also wonderful for aiding with leaky gut healing, and as you guys probably know by now, leaky gut is super common with SIBO, is a strong risk factor for developing autoimmune diseases, causes chronic inflammation and is normally a root cause of histamine intolerance. I’ve linked to a couple of episodes on leaky gut in the show notes. 

In my training with Dr Siebecker, she also recommends saccromyces boullardi for abdominal pain and diarhhea, and it’s been found in multiple studies to be effective for various types of diarhhea.

It also improves immune function, by increasing the production of one of our essential antibodies, called immunoglobulin A . IgA lines the intestines and other surfaces in the body like the nostrils, and is often low in patients with SIBO, and when it’s low, we’re more vulnerable to bad bacteria, parasites, viruses, etc. because IgA is normally one of our first line of defence against these baddies. 

It also binds lipopolysaccharides (LPS), which are toxins released from pathogenic (bad) bacteria, gram-negative bacteria and often, the bacteria found in SIBO. LPS has been found in the pelvic cavity of people with endo and has been shown to contribute to the growth of endometriosis. IgA binds LPS and helps to eliminate it from the body, so there’s less of it to leak through out gut, and into our blood stream and pelvic cavity. I talk about this in a couple of episodes on leaky gut, so will share in the show notes. 

Because s.boulardii can improve the immune system and heal leaky gut, it can also have a very positive effect on reducing intestinal and full body inflammation, making it helpful for endo, which we know is an inflammatory disease.

The dose actually varies depending on the brand, so either follow the brand instructions or if you have SIBO, you can follow some of the brand and dose recommendations in the show notes, which are from my training with Dr Nirala Jacobi. Again, as always, try with caution and slowly build up to see how you respond, especially if you have SIBO.

3. Number three is lactobacillus rhamnosus GG. This is recommended in my SIBO practitioners course with Dr Allison Siebecker for diarhhea and has been shown to be helpful for various types of diarrhea, from acute watery diarhhea to travellers’ diarhhea, and diarhhea from antibiotic use.  But it’s also used in SIBO treatment by Dr Jacobi because it’s been shown in studies to aid with constipation, abdominal discomfort, and leaky gut healing and in general, has been shown in research to be effective for IBS. I will quickly say though, that from my understanding, it appears that the research for constipation is a little inconsistent and needs further investigation and the leaky gut evidence is mainly based on animal studies at present. 

Whilst more research needs to be done on this area specifically, it’s also been found to be helpful with histamine tolerance, as it lowers histamines receptors and allergy receptors in cells, so in the simplest of terms, allergens and histamines can’t lock onto cells to cause a reaction, and this calms down inflammation.  

Generally, the dose from my training with Dr Nirala Jacobi for SIBO is 1 capsule twice a day. If you don’t have SIBO, you can just follow the label dose.

So that’s it! Please be sure to try one probiotic at a time, and really, give it at least a month or so before adding in another.  

I hope this episode was useful to you, and if you’d like to learn more about gut health with endo and you’re interested in accessing some support from me on your journey, you can now sign up to the waiting list for my online course, Live and Thrive with Endo. If you’re looking for free resources on gut health, I would start with the articles and episodes I’ve linked in the show notes.  

I would love to hear if you try any of these and how you respond. Please feel free to let me know on Instagram!

Listen and subscribe on your favourite player or listen directly/download MP3 here or just listen below!

Let's get social! Come say hello on Instagram or sign up to my newsletter.

My course, Live and Thrive with Endo is opening for enrolment again soon. Join the waiting list now to access early bird pricing and special bonuses. Sign up here.

This episode is sponsored by my free guide ‘A Natural Pain Relief Tool Kit for Endometriosis’. This four page guide includes evidence based and effective remedies which you can use at home to reduce your pain with endo. Download your copy here.

My cookbook This EndoLife, It Starts with Breakfast is out now! Get 28 anti-inflammatory, hormone friendly recipes for living and thriving with endometriosis. Order your copy here.

If you feel like you need more support with managing endometriosis, you can join Your EndoLife Coaching Programme. A 1-to-1 three month health and life coaching programme to help you thrive with endometriosis. To find out more about the programme and to discuss whether it could be right for you, email me at [email protected] or visit my website.

This episode is sponsored by The Pod Farm. Learn all about how to start your own podcast with the complete course from The Pod Farm. Aimed at beginners, this course takes a simple and straightforward approach to planning, equipment buying, setting up, recording, editing and hosting your own podcast. With hours of audio and video materials, and downloadable guides and useful links, this multimedia approach aims to have something for every kind of learner. From now until April 15, newsletter subscribers get 20% off the course price. Visit www.thepodfarm.com to enroll or find out more

This episode is sponsored by BeYou. Soothe period cramps the natural way with these 100% natural and discreet menthol and eucalyptus oil stick on patches and CBD range. Click here to find out more and to shop: https://beyouonline.co.uk

Show Notes

SIBO

The SIBO, Endometriosis and Interstitial Cystitis Connection wth Dr. Allison Siebecker

How To Treat SIBO with Dr Allison Siebecker

Okay so today I’m talking about hypothalamic pituitary adrenal dysfunction. A mouthful, I know and for ease, it’s called HPA axis dysfunction.

If you haven’t heard of HPA axis dysfunction, you may be more familiar with the term ‘adrenal fatigue’. And yes, if you’re thinking adrenal fatigue was sort of debunked as not being real, you’d be correct, but HPA axis dysfunction is very, very real and there is a huge wealth of research and evidence behind it. Adrenal fatigue was essentially an attempt to describe what is happening with HPA axis dysfunction but it oversimplified the process and made it seem like the adrenals sort of ‘ran out’ of energy, which isn’t the what happens and misses a big part of the story.  I imagine, originally, when the term was coined, it did come with the full explanation of HPA axis dysfunction, but eventually through the spread of social media, it perhaps lost that meaning.

But anyway, the bottom line is HPA axis dysfunction is real, and it’s incredibly prevalent within the endometriosis and chronic pain community - and it may be the root cause behind your fatigue. So if you’re finding yourself exhausted all the time and overwhelmed by life, I really encourage you to keep listening.

So in order to understand HPA axis dysfunction, we need to break down the system behind it. 

The hypothalamic pituitary adrenal axis is a system consisting of the:

·      The hypothalamus (a part of the brain, found at the base of the brain)

·      Pituitary gland (a gland found at the base of the brain)

·      Adrenal glands (found above the kidneys)

This system works together to regulate our stress response and to also regulate our circadian rhythm, which is like the internal body clock that governs our sleep/wake cycle.

Let’s begin first by understanding how the HPA axis controls our stress response. 

First, our hypothalamus alerts the pituitary gland of a stressor, and then the pituitary gland sends a signal to the adrenal glands to go about making stress hormones, and neurotransmitters, to power us through the situation. 

The brain and adrenals respond by first releasing adrenaline, which is released quickly but also subsides quickly and then 15 minutes later, cortisol and DHEA are released, and these guys hang around for several hours. 

Adrenaline and cortisol increase blood flow to organs like the heart, brain and muscles; reduce blood flow from non-essential organs like the digestive tract and reproductive system and trigger the release of stored glucose and fat, so you have the energy to fight or run. And DHEA acts as a buffer to counteract some of the damaging effects that cortisol can cause.

An important difference to note between adrenaline and cortisol, in terms of pain, is that adrenaline is inflammatory. That initial stress response triggers inflammation because the body is anticipating that there may be an injury or infection that needs to be addressed. So for example, if the stressor was that we cut ourselves, the inflammatory white blood cells would help to heal the area and fight off any bacteria that may have entered the wound. However, long-term that inflammation would become damaging, so 15 minutes later, cortisol is released, which is actually anti-inflammatory in the short term to bring down inflammation to healthy levels. 

I’m going to dive into the link between chronic cortisol output and pain in future episodes, but just keep in mind that in the right levels, cortisol is anti-inflammatory. I think this can sometimes be confusing as you hear people talk about stress being inflammatory, so to clear that up, the acute initial response is inflammatory, for about 15 minutes, then it becomes anti-inflammatory when cortisol is released and these events are totally normal. It becomes a problem when cortisol remains elevated or keeps being triggered, that’s when stress becomes inflammatory, when the stress is chronic. 

So, adrenaline eventually lowers back down, but cortisol is left remaining in the system until the stressor passes and should reduce after a few hours. Adrenaline is basically the hormone that gets us through the acute moment of stress, where cortisol carries us through the aftermath so to speak. So, for example, when we had that crazy flood in our flat, it was adrenaline that got me through getting out our most valuable belongings, trying to turn the mains off, calling plumbers in the middle of the night, that kind of thing. But it was cortisol that stayed with me, that kept me awake on the drive to my mum’s at 5am. That got me up the next day so I could work, despite feeling super stressed out. That stayed with me when we moved into a temporary Airbnb and navigated all the stressors of trying to work in a new home without all my stuff, with dodgy internet and a drowned laptop charger that now needed replacing. 

And this is actually where the problem occurs. Originally, this stress response was designed to get us out of acute moments of danger alive. So back in cavemen days, this system helped us to outrun a wild animal that was hunting us, or to fight another tribe that was threatening ours and the stakes were high, but the outcomes were usually pretty black and white. We either died, or we survived. If we got away from the wild animal, and found our way back to the safety of our tribe, our stress response would have lowered and we would moved out of the flight or fight response and into rest and digest mode, which is the part of our nervous system responsible for digestion, repair, etc.

But in modern society, the stakes aren’t that high, but the situations aren’t as simple either. We’re now bombarded by stressors every day. Emails from colleagues who make us anxious, constant sensational headlines and 24-hour news cycles, traffic jams, struggling to balance our work and family or social lives, endless to do lists. You get the picture, I’m sure! And equally, it’s not just emotional stressors, but physical stressors that appear to the body as a threat or danger. So chronic inflammation, a low-lying infection or condition like SIBO, blue light exposure, late nights, physical pain, etc. 

And these stressors, to the brain, are no different to the wild animal hunting us. The brain sees it as the same – a threat to our lives - and the stress response goes off. This means that we’re potentially operating in a state of flight or fight the majority of the time, which means we’re experiencing elevated levels of cortisol on a regular basis. And cortisol is our survival hormone, it’s great in small doses to keep us alive when we need to it, but it’s not great for long-term exposure at high levels. 

Long-term exposure to cortisol can damage the gut, causing leaky gut and negative shifts in our gut microbiome, and it can also cause chronic inflammation, a suppressed immune system, increased blood sugar (because remember, part of cortisol’s job is to raise energy levels so we can fight or run, and it does this by releasing glucose from our cells into our blood stream, elevating blood sugar levels), and it can cause low progesterone (which results in oestrogen dominance), lowered thyroid function, and lack of ovulation. This episode isn’t about the effects of stress directly on our sex hormones and cycle health, but if you’re interested to learn more about this then I discuss it with Nicole Jardim in one of our podcast episodes, which I’ve linked to in the show notes, and I cover this process in detail in my course, Live and Thrive with Endo, which you can get on the waiting list for now. Again, the link is in the show notes.

So in short, the body knows this is a problem, and eventually adapts to protect itself. Firstly, the body has a sort of internal cortisol shutdown mode. The high levels of cortisol in the body trigger a feedback loop in the brain which encourages the brain to actually lower cortisol output, so the adrenals stop producing as much. Another possibility is that the adrenals may also become resistant to the signals from the brain to make more cortisol, so they lower cortisol production in that way. A third possibility is that the cortisol receptors, known as glucocorticoid receptors, become resistant, so cortisol may be being released, but it’s not actually doing its job. There are multiple different avenues for cortisol to become dysfunctional or lowered, but these are some of the main ones.

So this may seem like a good thing, as cortisol is now lowered and is no longer damaging the body, but the issue now is that the HPA axis regulation of the circadian rhythm is dysregulated. 

So, I’m now going to walk you through what that means.

Cortisol isn’t just your stress hormone. It’s your wake hormone. It’s the hormone that gets you up in the morning and powers you through your day. At night, cortisol lowers and our sleep hormone melatonin rises, to allow us to drift off. 

If you looked at your cortisol pattens on a graph, it would look like a roller coaster. It starts to elevate before we wake up, and it reaches its peak height about an hour after waking, so this is when we should feel our most awake (which isn’t the case for many of us with endo, right?!). After that, it begins to decline fairly sharply throughout the morning until about 12pm (so this is why many people find themselves needing an extra caffeine boost at 11am), and at midday the decline continues but is less dramatic. Your levels hit another drop at about 3pm, which again, is why people tend to get that afternoon slump and then they peter out as the afternoon and evening continues. This is to allow melatonin to rise, as cortisol actually suppresses it.  

Now what can happen with HPA axis dysregulation, is that if you’re chronically stressed, you may have high levels of cortisol at first. These may be at their highest in the morning, so you wake up feeling stressed and tense straight away, maybe you find your sleep is disturbed in the early hours of the morning, but your levels can also be high at night, which suppresses your melatonin, so you find yourself exhausted but wired and unable to switch off when you go to bed. You may also be gaining weight around your middle, have trouble stabilising your blood sugar levels and be experiencing fertility issues or hormonal imbalances. These are classic signs of high cortisol.

Then over time the cortisol levels lower, and this really depends on the individual as to when this happens, but it can be quickly, over the space of weeks in some cases, but I’ve seen it take much longer. And the cortisol pattern also varies from person to person. For some people, they have lower levels than usual at certain points in the day so they tend to feel like they have dramatic crashes in energy, or they have low levels all day long but high cortisol levels at night (which is really when you have those exhausted feelings yet you’re just wide awake or struggling to stay asleep), or they have low levels constantly, and that’s when we’re really fatigued. 

Now these scenarios manifest a little differently depending on the pattern of cortisol dysfunction you have, but the tell-tale symptoms include:

·      Chronic fatigue

·      Brain fog

·      Waking up tired (no matter how much sleep you get!)

·      Feeling unable to cope with everyday stressors and bigger stressors like COVID, etc.

·      Continuous feelings of overwhelm as the body struggles to respond adequately to stress

·      Anxiety

·      Depression

·      Blood sugar dysregulation

·      Exercise intolerance (you find it hard to do much exercise, or find it difficult to recover afterwards)

·      Get ill easily

·      Dizziness, especially when going from seated to standing

·      Frequent energy crashes, especially mid-morning and mid-afternoon as cortisol begins to fall

·      Insomnia, disturbed sleep or feeling suddenly energised at night (this would of course be more likely if your cortisol was creeping up at night)

And if this resonates with you, I wouldn’t be surprised. 

Low cortisol output is associated with nearly all chronic pain conditions, especially pelvic pain conditions, endometriosis and fibromyalgia. 

In one study of 92 women with endo and 82 ‘healthy’ volunteers, they found that the women with endo and chronic pelvic pain had low levels of cortisol despite reporting higher stress levels and a low cortisol awakening response, which is that rising cortisol level we need to be able to wake in the morning. 

Because pain is a stressor to the body, at first, when we first experience this pain, the cortisol output is likely to be normal for the situation or high, but overtime, if we become anxious, stressed, worried or scared of our pain, which is of course, a totally natural response to endometriosis, then over time, our HPA axis becomes dysregulated and our cortisol levels deplete because they have been high for so long as response to this pain-fear cycle. In fact, the high cortisol type of HPA axis dysfunction from chronic stress (whether the stress is from pain or not) has been shown to trigger the onset of some chronic pain conditions and worsen existing chronic pain. Then cortisol becomes depleted, and the pain continues, because the protective anti-inflammatory properties of cortisol are now lowered. So essentially, high levels of cortisol contribute to inflammation and pain, but so does low cortisol. We want the healthy level of cortisol for optimal pain regulation. 

So the stress of the pain doesn’t go away, but our body is now less able to deal with it. Remember, cortisol provides us with the energy to deal with stress, it literally gets the glucose and resources we need to power our body through a stressful situation and without it, we may feel unable to cope with the demands of every day stressors or bigger events. Usually, with depleted cortisol levels, our body begins to rely more heavily on adrenaline, so when we’re stressed, we may find that we experience symptoms of high adrenaline, like shaking, an increased heart rate, feeling jittery and wired, but yet we feel unable to cope with the situation because we don’t have enough cortisol to power us through.

So now you understand what HPA axis dysfunction is, what can we do about it?

The good news is, HPA axis dysfunction can be repaired and the are very key, often simple steps to repairing it. And for us, for those of us with endo specifically, it’s about giving our body reliable patterns in the day to normalise our circadian rhythm, and changing our response to stress and pain. So in a future episode, which will be out very soon, I’ll provide you with some of the initial key steps for repairing your HPA axis and alleviating yo

So last week I took you guys through the ways in which inflammation, gut health and hormone levels can increase bloating in the lead up to your period.

This week I want to give you some tools to actually alleviate that bloating, now you know why it’s happening. I’m going to give you two types of tools, one set to deal with in the moment of bloating and another set for which are long-term strategies to help you to address the root cause. 

So, let’s start with the tools you can use in the moment. Many of these tools I’m about to share are based on my training with world leading SIBO doctor, Dr Allison Siebecker. I’m using her doses, which are safe and effective and if you’d like a reference for these doses, they are actually available on her website, under handouts, in a handout called Symptomatic Relief Guide. So these doses are available publicly, you don’t need a prescription for them, but always consult your doctor before starting new supplements. 

 

1.  Number one is using a prokinetic. A prokinetic is either a pharmaceutical drug or natural supplement which improves gut motility in the small intestine, so it increases transit time in the small intestine and also stimulates the migrating motor complex in the small intestine, which is the wave like motion that clears bacteria from food out of the small intestine and into the large intestine. When the migrating motor complex is slowed, this is when we are at risk of developing SIBO and one study actually found that 100% of participants with endometriosis had gut motility dysfunction.

A prokinetic doesn’t stimulate a bowel movement by the way, so it’s not a laxative. It doesn’t get to work on your large intestine, but on your small intestine, so it’s essentially aiding you to digest and move your food into the large intestine, and to clear gas and bacteria out of the small intestine too. 

To stimulate the migrating motor complex, we can use a prokinetic at night, but for bloating, you can take it during the day, and this will support healthy transit time of gas accumulating in the small intestine. This can be really helpful in the second half of our cycle, when progesterone is naturally causing things to slow down!  

So the two natural supplements you could try are ginger and STW5, which is also known as iberogast. For ginger, there are many different prokinetic formulas and I’ve put some of the best ones in the show notes, and you would just take the label dose, twice a day, one to two hours after meals or as needed, just be sure not to exceed the recommended dose on the label or to exceed 2000mg of ginger per day. 

STW5 is a tincture, and you would take 20 drops with meals as or as and when needed. 

I do just want to caution here that some of the ginger formulations can cause ginger burn, which is like a hot burning sensation in the diaphragm area, so if you have acid reflux this may not be the best option for you. You can normally get rid of the feeling through drinking water, but some formulations are less ‘ginger burn’ causing and I’ve highlighted which ones in the show notes. Ginger, being a spice, can also irritate bladder symptoms if you have interstitial cystitis, so this is something to consider and normally, I find the formulas which cause less ginger burn, cause less bladder problems.

Secondly, because STW5 also contains alcohol, I find this to also irritate the bladder in people with interstitial cystitis, so just be cautious with these two and experiment until you find a formula that works for you.

Finally, if you experience pain with prokinetics, it’s normally due to motility actually starting to get to work, which can cause muscle contractions at first, but if the pain is severe or persistent, it may be that you have an obstruction or adhesions disrupting the motility flow and working against it. If that’s the case, stop using and see a visceral manipulation therapist who can access your gut for adhesions and obstructions.

 

2.  Peppermint oil

Next up is peppermint oil. Peppermint oil is actually a smooth muscle relaxant and is great for abdominal pain, if you get pain with your bloating and generally, it’s really wonderful for pretty much all IBS symptoms. Recent research has shown its effectiveness in multiple symptoms of IBS, so this is a great option if you have IBS issues frequently with endo and in the lead up to your period.  

So, you could of course try the tea, and some people do find that to be effective, but generally, peppermint oil tends to be stronger. If you wanted to go for tea, I would make sure it’s strong for it to work!

For capsules, you want enteric coated peppermint oil, which are capsules that have a coating on them which protects them from stomach acid, so that the peppermint is released lower down in the intestines where we want it.

You would just follow the label dose and take as needed, though you could take them every day during the second half of your cycle as the effects are stronger when taken consistently. 

However, if you have acid reflux, peppermint may not be the best option for you as it can sometimes cause acid reflux. Another possible side effect is nausea. You could test yourself on one dose and see how you respond of course and take it from there, but if you’re prone to acid reflux or nausea, you might want to consider some of the others. If you do want to give peppermint a go, pills are less likely to cause acid reflux or nausea as opposed to peppermint tea or say, a tincture. 

Lastly, peppermint oil can slightly slow down motility, so if you are noticing sluggish motility already due to progesterone in the second half of your cycle, either use one of the other options or if you really want to take peppermint oil, also take a prokinetic. 

Oddly, if you have interstitial cystitis, it appears peppermint oil may help or it may actually irritate. There’s some research going on at the moment, specifically on peppermint oil for the treatment of interstitial cystitis, and some practitioners advise using the tea, etc. whereas I’ve heard others warn against it. Personally, applying topical peppermint oil helps with my interstitial cystitis pain, and this would be because it’s a smooth muscle relaxant, so it’s calming down any contractions and cramping, but if I drink the tea, I find it causes a burning feeling inside my bladder, so I think you’ll have to see how you respond personally, but I’m very curious to find out the outcome of this study!

 

3.  Number three is activated charcoal. Activated charcoal absorbs gas, so is really helpful for any bloating which is being causing by gut issues during the second half of our cycle. 

You can take activated charcoal in supplement or powder form, you would just mix the powder into water, as and when needed, but you do need to ensure that you’re taking it at least 30 minutes before a meal and an hour after a meal, because it doesn’t just absorb gas, it absorbs nutrients too! This would be the same for supplements. You don’t want to be spending money on lovely supplements for the charcoal to be absorbing it all!

You can take up to 1000mg per dose or just follow the label dose, and you can do so four times a day, spacing the doses out by at least two hours, just don’t exceed more than 4 grams of charcoal a day.

Lastly, charcoal can sometimes cause constipation, so of course, we don’t want to worsen that if you already struggling with sluggish bowels in the second half of your cycle. If you are, then you can take magnesium in addition, which I’ll share in the next point. 

 

4.  Magnesium

Whilst magnesium won’t directly help with your bloating, it is great for constipation, so if this is one of the root causes of your bloating in the second half of your cycle, magnesium is a good tool to aid with this. 

Magnesium is also a nutrient that most of us are deficient in and gets used up with chronic stress and during menstruation, and when we’re low in magnesium it can worsen PMS, pain, and fatigue so this is a great supplement for endometriosis. 

The best options for constipation would be citrate or oxide, and I personally prefer oxide for anyone with interstitial cystitis, as the magnesium citrate can be irritating to the bladder for some. 

You can take between 500mg to 1000mg in the evening, at bedtime, and it’s best to start at a lower dose, like 500mg, to see how you react to it, as if you take too much you may get diarrhea. The aim is to have a bowel movement come the morning, so that’s the sign you want to know it’s working and normally, it takes about 2-3 days to get to work, so be patient. If you don’t have a bowel movement in this time, move up to a higher dose. Often, 1000mg is the dose most people find works for them, however, as I said, you can go higher, you just can’t exceed 2000mg and you need to ensure you’re increasing your dose slowly. 

Finally, make sure you take your dose two hours after food because otherwise this can interfere with the effects. 

Hopefully, by supporting your gut to keep to a healthy flow during the second half of your cycle, you’ll experience lessened bloating as waste and gas isn’t hanging around for so long. 

 

5.   Number five is abdominal massage and for the purposes of bloating you could use either the I Love You massage or Arvigo Therapy, both of these you can do at home by yourself. Additionally, these massages are great for constipation and sluggish motility, so if you’re noticing those to be an issue in the second half of your cycle, I would recommend trying one of these. They also put your body into the rest and digest state, so if you’re working on trying to calm your nervous system down so your pain decreases over time (which I’ve been talking about a lot recently over on Instagram), then these are a great addition to your routine. You don’t need to do both, one or the other is fine, however, if you want the added benefit of adhesion release and better periods and less endo pain, Arvigo Massage is the way to go.

The I Love You massage is a simple massage where you literally trace the letters ‘I’, ‘L’ and ‘U’ over your intestines repeatedly. There are free YouTube videos on how to do this and I’ve linked to one in the show notes. 

With Arvigo Therapy, you first need to be taught how to do it on yourself by a practitioner. The sessions are usually pretty affordable and can be taught in about 30-45 minutes, after which you don’t need to pay for anyone more sessions, you can just start performing the massage on yourself. I’ve linked to a wonderful practitioner in the show notes and to the practitioner directory. 

You can do these massages daily, and I personally recommend using them in the evenings before bed, which is when the migrating motor complex really gets to work and as these help to stimulate it, they’ll give your motility a nice boost overnight. Of course, if you’re feeling bloated in the moment and want some instant relief, if you feel like it’s not painful to do, you could perform these massages when needed. Both of them take just 10-15 minutes at the most, so they’re quick to do.  

 

6.  Number six is a slightly different one and that’s lymphatic drainage. We’re not addressing the bloating directly but more the water retention and fluid build-up in the body, which could in turn help to reduce the bloating, depending on whether your bloating is coming from water retention or from fermentation in the gut. 

So the lymph system is a collection of vessels that run like a map across the body, under the skin and around organs. They are connected to lymph nodes which can be found in places like your armpits and groin, they’re the small shaped bumps you feel when you’re unwell.

The lymph vessels contain fluid that collects waste products, toxins, bacteria, viruses, etc. from around the body. These products are then delivered to the lymph nodes, which attack any pathogens (baddies), and this is usually when the swelling occurs if you have a really active infection - that’s why you’ll get raised bumps under your arms when you have a virus for example.

Once the most harmful pathogens have been killed off, these toxins, waste products and dead bacteria are sent to the liver and kidneys through the blood stream, where they’ll eventually be filtered out of the body.

What’s important to note here is that the lymph system cannot transport waste on its own - the fluid begins flowing with assistance from movement, such as massage or exercise and if we don’t assist it, it can stagnate, like a stream that’s become blocked. 

Helping to get the lymph system moving will help to shift any build-up of excess fluid and water retention, and it can help to get rid of the excess LPS which may be circulating in our blood stream before menstruation and would certainly be adding to our inflammation levels. 

There are multiple ways to get lymph fluid moving, but two lovely self-care methods you could try are dry brushing before your shower and then using a sort of lymphatic drainage paddle after your shower on your skin. 

So before your shower, you would use a dry body brush and starting at your ankles, brush upwards in short bursts, going over them same area three to five times before moving to the next section of your leg. The brush strokes should be fairly firm, and short, so say from your ankle to mid-calf and then from mid-calf to your knee. You would work your way up your legs, bum, torso, all moving up towards your heart, and then you would go to your arms, starting at your wrists, and working your way up to your shoulders. The process should take about 5-7 minutes. 

Then you can jump in the shower, and you can totally stop here if you like. A body brush is about £10, so it’s a nice and affordable option. 

If you want to add another layer, you can get a lymphatic drainage body tool, which looks a bit like a paddle and is made of wood. I think it originates from the gua sha technique. You would essentially follow the exact same pattern you took with the body brush, but this time more lightly, it can be very gentle, and you would apply oil first, so you don’t pull your skin. I tend to use coconut oil and my paddle was £18 from Amazon. I’ve linked to it so you know the kind of thing you’re looking for.

Now of course, this process is most effective when done every day but honestly, I struggle to fit it in, so you could try a couple of times a week or whatever works for you!

 

7.     Number seven is taking an anti-inflammatory supplement. Now as we discussed last week, I don’t think the swelling and bloating is purely down to inflammation alone, but it certainly plays a role as inflammation is

Transcript:

Recently I polled my Instagram to find out just how many of you are suffering with PMS on top of your endo symptoms and the results were pretty staggering! Unfortunately, Instagram didn’t keep the number of votes so I don’t know how many people actually took part in this pole, but the percentage of people who did and who suffer PMS was 86%. 

I know from past experience that the week leading up to your period and the week of your period, can often be when endo really rears its head for a lot of us, so adding PMS symptoms as well is of course not what we want!

I went on to poll your symptoms specifically and there was not one symptom that fell beneath the 50% mark, with most of them being around 70-90%, so you guys are dealing with a lot of symptoms. I was originally going to do one podcast episode dedicated to PMS and endo, but after I saw these stats, I felt like it really would be too much to take on in one show and that some of these symptoms that you guys really scored high on deserve more focused attention.

So today, I’m talking about bloating before your period, why it happens and some strategies to reduce it. I chose this one to start with because this was the highest score, with 94% of you suffering with it. 

So let’s dive in.

Now of course, when it comes to bloating, you know that I’m always going to talk about SIBO, which is small intestine bacterial overgrowth and research estimates that up to 80% of endo patients also have SIBO and that SIBO may even play a role in the development of endo. But, today I am not going to talk about SIBO. If you have bloating all the time, or most of the time, I really do recommend you also listen to my podcast episodes on SIBO, as that may be worsening the bloating you’re getting around your period. But if your bloating is mainly around your period or it’s at least worse around your period, then this episode is for you.

So other than SIBO and gut health infections or more serious gut health conditions, let’s look at some of the two of the key causes of bloating around your period. 

1.  Number one is hormonal imbalances, mainly oestrogen excess or oestrogen dominance and/or low progesterone.

So to be clear, excess oestrogen is a hormonal imbalance where we have too much oestrogen in the body, whereas oestrogen dominance is when our levels of oestrogen dominate over progesterone. 

So in a normal healthy cycle, oestrogen should be higher in the first half during the menstrual phase and the follicular phase. It actually starts off at its lowest point on Day 1 of your cycle but it will begin to build. After ovulation, progesterone is higher than oestrogen, but what happens with oestrogen dominance is that oestrogen is higher than progesterone throughout the luteal phase, which is that second half of your cycle after ovulation.

This can occur in four ways:

·      Progesterone is too low but oestrogen is normal so naturally oestrogen dominates.

·      Progesterone is normal but oestrogen is in excess. 

·      Progesterone is low and oestrogen is in excess.

·      Progesterone is low and oestrogen is low, but progesterone is lower.

Two of the most common symptoms of these hormonal imbalances are water retention and bloating. Why? Because progesterone and oestrogen actually play a role in fluid regulation, fluid retention and sodium (that’s salt, essentially) retention in our body! There are actually oestrogen and progesterone receptors in parts of the body that affect fluid regulation, such as the kidneys. 

Research has found that in healthy participants, when they’ve isolated progesterone and oestrogen, separately, and administered them in normal doses, fluid regulation and sodium retention were acutely affected. So for example, the hormone that triggers the kidneys to recirculate water back into the body rather than excreted in urine was higher.  However, in normal healthy participants the effects of these changes were minimal so fluid retention wasn’t dramatically increased.  

But of course, we’re then left to wonder what happens when hormone levels aren’t normal and are in fact higher, like with oestrogen. 

So, when they isolated normal levels of oestrogen in these studies, they found there was a small increase in water retention, which was because oestrogen encouraged the kidneys to recirculate water rather than excreting it.

However, despite higher levels in the hormone responsible for this process, which is called arginine vasopressin, the kidneys were not responding as expected, meaning there wasn’t as much water retention as they would have expected there to be given the levels of arginine vasopressin. This has left scientists wondering whether oestrogen has the ability to make the kidneys less sensitive to this hormone, which has actually been shown to increase in the second half of the cycle. So basically, the effects aren’t that dramatic and they’re still trying to work out why because giving these findings, they should be. 

Now sodium retention does increase with oestrogen and so scientists believe that the small change in water retention that they observed, was really down to the higher levels of salt in the body, rather than the higher levels of arginine vasopressin, which didn’t seem to create a huge change in the kidneys.  And higher sodium levels increase the amount of fluid that surrounds our cells, so that would explain why we feel extra puffy and swollen.  

Additionally, oestrogen increases the amount of plasma in our body, which is a clear liquid fluid that makes up the bulk of our blood. This results in swelling in the body and alterations in where fluid is distributed. Progesterone has also been found to do the same thing, but this result hasn’t been consistent across studies. 

So, if progesterone can increase swelling potentially, and very slightly in healthy adults, and oestrogen can increase it too, again, slightly, then you can see why having normal levels of progesterone and higher levels of oestrogen could result in excess swelling around the body water retention and ultimately, bloating. 

So if we’re able to bring our hormones into balance, we may see some normal small increases in swelling and bloating as we enter the second half of our cycle, especially if this research on progesterone increasing plasma fluid is accurate, but we shouldn’t be experiencing dramatic bloating and noticeable swelling.  

This leads me to my next cause. 

2.  Number two is your gut health.

 If you listen to my podcast you’ll know already that gut health problems cause symptoms like bloating, especially problems like candida, SIBO and fungal overgrowth. 

Even if you don’t have an infection, parasite or one of these problems, general gut dysbiosis can cause bloating. Gut dysbiosis is when the bacteria that live in your gut, become out of balance and this imbalance creates an inflammatory environment, excess fermentation which results in gas and bloating, and symptoms like IBS.  

These issues can be worsened by the changes that happen to the gut during the lead up to menstruation. When progesterone rises in the second phase of your menstrual cycle, it actually slows down digestion – this is why you may experience constipation before your period or at least slower, sluggish bowels. This is because progesterone is a muscle relaxant, it actually helps to loosen muscles and ligaments during pregnancy to allow your pelvis to expand. 

So yes, naturally and normally, your bowel movements might be a little slower in the second half of your cycle or you may just notice that your food doesn’t seem to go down as quickly after a meal, creating some degree of bloating or fullness. But these changes shouldn’t be to the point where you can hardly go to the toilet in the second half of your cycle or that your bloating is painful, your belly is really extended so you look six months pregnant or you can no longer wear the clothes you wear in the first half of your cycle.

If that’s happening, we need to look at your gut. If you have dysbiosis or a condition like SIBO, you’re going to be having more fermentation anyway, so that means you’re going to be more bloated generally. Now if we slow down the transit of food through your gut, of course, this gives the bacteria and archaea even more time to munch on the food, creating even more gas! Then, because you have slower peristalsis, which is the movement that pushes food and waste through your intestines, it’s going to take gas longer to exit. So essentially, you have more food and gas hanging around in your gut for longer, so it’s no wonder that you feel bloated!  

On top of this, if you have gut dysbiosis, SIBO or another gut condition, your gut microbiome may have higher levels of an enzyme known as beta-glucuronidase. This is an enzyme that helps to regulate oestrogen, by recirculating waste oestrogen if needed, rather than allowing it to be excreted through a bowel movement. Researchers looking into the alterations of the gut microbiome and its connection to oestrogen dependent diseases hypothesise that people with endometriosis may have higher levels of beta-glucuronidase, and this is certainly the case with many of my clients when we test them. In fact, another study, sadly on monkeys with endometriosis, found significant dysbiosis including low levels of lactobacillus, which is a bacteria that helps to keep beta-glucuronidase in check and at the right levels. 

This of course means that the gut dysbiosis could be the cause of or worsening any excess oestrogen or oestrogen dominance you may have, and that can in turn be worsening your water retention and swelling. 

Another point to add here is that the same study on monkeys also found high levels of gram-negative bacteria in the microbiome. Gram-negative bacteria can be disease or illness causing, such as for example, certain strains of e.coli, but there are also normal gram-negative bacteria found in our guts that don’t cause disease, again, like certain strains of e.coli, but they have the potential to evolve and cause illness.

What’s really important here is that gram-negative bacteria break down, they release parts of their cell walls called lipopolysaccharides or LPS for short. Lipopolysaccharides trigger a huge inflammatory response from the immune system, and these monkeys were shown to have higher levels of intestinal inflammation, which would make sense!

More recently, research has found LPS in the pelvic cavity of people with endo and it’s believed that this LPS has been transferred from the gut, through leaky gut, and it has also been found that LPS contributes to the inflammation and disease growth of endo. 

But what’s even more interesting is that recent research (though on a small study of 40 and this study does have its limitations) has found that gram-negative bacteria and LPS may actually increase in the blood in the lead up to our periods. They studied the immune responses to LPS throughout the cycle at four stages (Day 7, Day 14, Day 21, and Day 28), and found peak levels being on Day 28, indicating that there were higher levels of LPS in the blood stream around this period of time because there were higher levels of LPS antibodies. 

They suspect that LPS and gram-negative bacteria actually increases in the blood due to translocation, so just to remind you that’s the movement (usually of bacteria) from the gut to outside of the gut. This, they believe, could be due to changes in the gut wall caused by progesterone rising in the second half of the cycle, so essentially, progesterone is causing temporary leaky gut. This in turn is creating an exaggerated inflammatory immune response, and one of the trademark symptoms of inflammation is a swelling of the inflamed area. 

Now prior to this study, much research has shown that the immune system is actually suppressed in the second half of the cycle, and the theory is that this is to support healthy implantation and fertilisation of the egg, without the risk of the immune system attacking it. This occurs when progesterone rises following ovulation, so early to mid-luteal phase your inflammatory immune reaction should be somewhat dampened.  However, as progesterone begins its decline ahead of your period about 9 to 11 days after ovulation, inflammation returns as the immune system begins to return to its normal strength.

This correlates with the findings of this study on LPS immune reactions. The strongest reaction from the immune system comes at the end of the cycle, around Day 28, and this would make sense given that the immune system is pretty much back to full strength by then. They also show that Day 14 has the lowest reaction to LPS, which would make sense of course as this is roughly around the time that ovulation occurs, although it varies from person to person and from month to month, the idea that we all ovulation on Day 14 or 15 is actually a myth!

So, as the immune system is only suppressed between say day 14 and day 25-ish, if the LPS and bacteria were present all month round, we should have seen a higher level of immune reaction on Day 7 when the immune system is still fully functioning, but we’re not, the immune response is in fact at its lowest point here, along with Day 14. 

So, in this study it was the antibodies to the LPS which were measured, not the LPS levels or the gram-negative bacteria, but they have concluded from the rising antibodies that this indicates rising LPS and gram-negative bacteria levels in the second phase of the cycle, with a strong immune reaction towards the end of the cycle when the immune system returns to fully functioning. Now the limitation here is that we don’t actually know for sure the levels of LPS or bacteria as the microbiome was not studied itself and there were no stools tests taken at all, we’re simply going off the LPS antibodies in the blood, so I hope that more research is done to look into this further and see whether these findings are consistent. 

But if this research is correct and we’re able to replicate it in future studies, then it would make sense that people with endo, who have a higher load of gram-negative bacteria in their guts, and maybe even more so in the case of SIBO or some other pathogen, would have more LPS in their blood stream in the second half of their cycle. Especially because there’s the possibility of leaky gut already being present, which is often the case when we have dysbiosis, or SIBO or another gut health condition. So if progesterone is expanding those tight junctions in the second half of the cycle, there’s the chance that it’s making big gaps in the gut lining even bigger, allowing more bacteria and toxins to travel through. An

As some of you may know, I’m doing a lot of work at present to free up my pelvic area from adhesions and tightness caused by pulled fascia and a tight pelvic floor, which in physio speak is a hypertonic pelvic floor.

So I thought  this would be a great time to talk about some strategies you can bring into your daily life to help loosen adhesions and a frozen pelvis.

Transcript:

I’ve talked about adhesions and fascia before, but let’s do a quick recap of what adhesions and fascia are. 

So fascia is a thin sheet of tissue made from collagen that sits beneath your skin and holds your organs and muscles in place. It also surrounds all the organs, nerves, blood vessels, etc.

Fascia surrounding the body is like a bed sheet, if you pinch it or one end, the rest will wrinkle. So what can happen when we’ve had surgery is that these incisions create puckering and scarring in the fascia, which ends up tightening the fascia and pulling it in other directions. Fascia can also become distorted from inflammation, injuries and muscular problems like pelvic floor dysfunction.

Adhesions are a form of scar tissue. They are web-like structures and bands of collagen that grow in response to injury and trauma, to ‘knit’ back together a wounded area and as part of the healing process from infection and inflammation. Collagen strands bond together to protect the damaged area to allow healing to occur in a safe and isolated environment, and if an infection is present, they protect the rest of the body by preventing the spread. 

Adhesions occur in nearly all cases of abdominal surgery, the results vary from study to study but one large and long study found that between 55% to 100% of women who had pelvic surgery developed adhesions, and up to 90% of people who had major abdominal surgery - so something like a caesarean - developed adhesions. So, if you’ve had one or more surgeries for endo, it’s very likely that you have some adhesions. 

Adhesions can also form from inflammation, which we know occurs in those of us with endo due to the lesions and can occur in those of us with SIBO, because the body sees it as an infection. Again, as you probably know by now, research has shown that up to 80% of us with endo may have SIBO, so this could be an additional cause of your adhesions and frozen pelvis. It’s also worth noting here that adhesions can actually cause SIBO too, because they prevent the normal flow of gut. 

 So, what can we do about it? Thankfully, there are numerous ways to loosen adhesions and free up a frozen pelvis, and as a result, lower the pain and other challenges associated with them. So let’s dive in to my top 8 strategies. This list isn’t exhaustive by any means, and you don’t need to do them all! Just pick those that feel the most helpful for you and suit your lifestyle and budget. 

 

1. Foam Rolling

Number one is foam rolling, which is an effective and affordable at home strategy which you can use every day if you’d like to! With foam rolling, we’re really looking at loosening the fascia rather than working on the adhesions directly. As I said earlier, fascia can get tight, pulled, puckered, and wrinkled, and if it’s experiencing it in one place, it can affect other areas in the body. 

Foam rolling helps to release a distorted fascia and is when we literally use a long foam cylinder to roll back and forth across various areas of our body. With foam rolling for endo or other pelvic pain issues, we’re not just rolling back and forth on our pelvis, we’re rolling across our hips, bums, back, upper back and legs. 

In the show notes I have linked to videos on how to do this, by physiotherapist Dr. Nicole Cozean.

You can order foam rollers from Amazon for about £11 and in the beginning, I would suggest starting gently with a soft roller that’s smooth, especially if you’ve experiencing a lot of pain.

Now with all of these methods, listen to your body. Some discomfort is normal when we’re working with releasing facia and adhesions, but if it’s really painful, ease up and go lightly or if it doesn’t feel right at all, appreciate that this may not be the right approach for you at first. 

In an ideal world, we’d use these strategies under the guidance of a physiotherapist, but I know that’s not always an affordable option for everyone, so carefully watch the tutorials and if you’d like to do some further research to be really comfortable, I suggest reading Know Your Endo by Jessica Murnane, as she interviews Heba Shaheed, who I’ve had on the podcast before as well, and they talk about foam rolling extensively in the book.

 

2.   Visceral Manipulation 

Next up is visceral manipulation, which honestly, if you can afford it, I really believe is worth a try! Visceral manipulation is a form of organ massage which was designed by physiotherapist Jean-Pierre Barral with the particular intention to free up organs from adhesions and other structural issues that are restricting them. Organs are supposed to be able to expand and move gently as our body moves, and glide smoothly over muscles and nerves as we go about our day. When adhesions or some kind of other structural problem is keeping them stuck, that’s when we can experience pain and organ dysfunction. 

Visceral manipulation is very effective for releasing these organs and loosening adhesions and I’ve seen some incredible results with my clients. What I will caution here is that it can feel quite intense and aggressive at times, and if your pelvis is very stuck, you may be better off starting more gently with a different type of massage like some kind of womb massage such as the one I’m going to suggest in the next point. 

If you’re going to try visceral manipulation, make sure you’re comfortable with your therapist and be very clear with them about the pain or discomfort you experience within the session, so they know when to ease up or when to stop working on an area if it feels too much. I can tell you from personal experience that gritting your teeth and baring it does not always end well! 

Other greats forms of organ/abdominal massage include Mercier Therapy and Clear Passage. Clear Passage is really the holy grail with lots of research behind it for endo and SIBO, but it’s incredibly expensive, so you may be better off trying the other techniques first. However, I do highly recommend it if you can afford it! 

I’ve linked in the show notes how to find practitioners for all of these that I’ve just mentioned.

 

3.  Arvigo Massage

Third on our list is Arvigo Therapy, which is a form of abdominal massage that is much more gentle than the ones I just mentioned previously. The benefit of Arvigo Therapy is that you only need one session, which can be done over Zoom, to learn it from a therapist, and then you can just practice it daily at home every evening. 

Now in my conversation with Tara Ghosh, who is an Arvigo Therapist and actually taught me personally, she shares that whilst Arvigo Therapy doesn’t directly loosen adhesions like visceral manipulation does, it does encourage circulation to the area and helps to relax the muscles and organs in the area, which can then have the indirect effect of loosening a frozen pelvis.

However, I have seen some articles by therapists claiming it can loosen adhesions, perhaps they mean indirectly or perhaps there are differing opinions, but you can listen to the interview with Tara in episode 127 to learn more. 

I highly recommend working with Tara because she’s just the loveliest person, and you can reach out to her directly via the details she shared in the interview (and I’ll put her Instagram in the show notes) but if you want to find another therapist, I’ve linked to the directory in the show notes. I’m pretty sure Tara sees clients from all over the world.

 

4.  Breaking up your time sitting down

Number four is all about breaking up the time you spend sitting down at your desk, specifically by using a standing desk and by taking regular breaks. 

Now, there’s been a lot of debate and controversy over this in the past few days. You may have seen in my stories I posted about my standing desk, which I use at varying intervals during the day, alternating between sitting and standing. I do this because my own physios and my colleagues, many of who are pelvic floor physios and my pelvic pain training, have always taught me that sitting for long periods of time without a break can worsen pelvic floor dysfunction symptoms through shortening and weaking the muscles in the area and restricting blood flow. 

My understanding was that sitting down for long periods of time without breaks shortens the muscles in the front of our hips and pelvis, which means when we stand, walk or do anything else that isn’t sitting, we have restricted movement, tension, tightness and are more likely to experience pain. And if we have adhesions in the area, sitting down for long periods of time lessens the opportunity to stretch them and release them, making their hold on our organs stronger and tighter.

However, I had quite an strongly worded message form a physio informing me that this simply isn’t true and that muscles don’t shorten or lengthen, which absolutely threw me. So I went away and spoke to some colleagues and they all said that yes, muscles shorten and that sitting for prolonged periods of time causes this and can worsen pelvic floor issues. So I was quite confused! 

I wanted to dig a bit deeper to understand why this physio said they don’t and I think what it boils down to is terminology, and oversimplification to make physio language easy for patients to understand. From what I gather through my own research and conversations is that the muscles don’t actually change length, but they lose their ability to stretch so they become restricted. Here’s how one of the PTs I spoke to put it. 

Martha Spalding, Circle of Health Physical Therapy, CA: “Muscle length stays the same so no, they don’t elongate but they can be contracted, weak in both eccentric and concentric contractions, strained, sprained, torn and severed. Ligaments can be overstretched and they can have laxity, which is common during pregnancy and some people just have genetic ligamentous laxity. Prolonged sitting is stressful on the entire spine and pelvic floor as it is a prolonged static position in weight bearing on the pelvis. The pelvis is generally rotated posteriorly. Depending on the muscles, you can determine the stress component in the sitting position. This prolonged position does impact the fascial slings which can become restricted.”

So to help understand this better, eccentric contraction means when muscle length increases from tension during a movement, like a stretch. In contrast, concentric contraction is when a muscle shortens and tenses in order to bear weight and counteract resistance, so think about lifting a dumbbell in a bicep curl. So in short, the ability to perform these contractions can become weaker.

Laxity is defined as ‘looseness of muscle’, but I wouldn’t say this would be occurring here, it’s just an example she’s providing to demonstrate how muscles change.  

After these conversations, the physio who originally contacted me also replied to say that sitting all day without any movement would cause joint and muscle stiffness, but she was also very clear to state that there are no detrimental effects on the pelvis with sitting. 

So clearly there are some cross overs here, but also some differing of opinions. As I’m not a physio, I can’t really give you a definite answer so I’m providing you with the information I have gained and also what I have learned in my own time in training and working with physios. To my knowledge, yes, sitting without breaks and movement can have an impact, but I’ll leave it to you to decide. 

My practice is to alternate between sitting and standing throughout the day, as I feel comfortable. When I start to feel tired and my legs need a break, I sit down, and when I feel like I’ve been sitting for long enough, I stand. And every 30 minutes to an hour of sitting at my desk working, I get up and do some form of movement, usually it’s a couple of minutes of rebounding, stretching, walking around the house or a few minutes of exercise and literally it’s just like 3 to 5 minutes.

Now I appreciate that if you have chronic pelvic pain and a weak core from pelvic floor dysfunction and from living with chronic pain, that using a standing desk can be difficult to do. So I suggest starting when only you’re ready with smaller periods of time to build up the strength in the core and to also have a cushioned mat under your feet or cushioned slippers to soften the impact. If you need to first spend some time just practicing taking breaks with gentle movement to build up your strength, or if you need to do some physio first or work on pain alleviation, do that first. This is just an option and you have to do what feels right for you – don’t rush into using a standing desk just because I’ve talked about it today, make sure it’s the right choice for you. 

If you do buy a standing desk, you should also be swapping your positions when you’re standing up, so you’re not just constantly bearing down on your joints. I’ve linked to a helpful article in the show notes on different positions to adopt and how to stand in a healthy way when using a standing desk.

There’s now mounting information on the health risks of sitting for long periods of time without breaks or movement, including heightened inflammation, which you guys know is super important for us to keep on top of, so if you’re employed by a company, they really shouldn’t be surprised by you asking for a standing desk. And in fact, it should fall under reasonable adjustments to help make you feel more comfortable when living with endometriosis. If you have trouble getting your company to agree, I suggest having a listen to my interviews with Vickie Williams and Clare from See Her Thrive, which are both about your rights as an employee with endometriosis in the workplace. If you’re curious to learn more about the health considerations and research behind prolonged sitting, I’ve linked to a couple of articles in the show notes.

If you’re self-employed like I am, you can easily order a standing desk online. Prices range dramatically from whole desks which adjust to become either a seated or standing desk at about £1000 or cardboard desk toppers that you just put on top of your desk, and that you rest your keyboard and computer or laptop on, and these are around £15. 

If you’re not quite ready for a standin

If you have bloating or what’s commonly known as the endo belly - SIBO is something to pay attention to. Small intestine bacterial overgrowth is incredibly common within the endometriosis community, in fact, recent research has shown that up to 80% of endometriosis patients may have SIBO.

So how can you treat it if you test positive? One of the treatment options is the elemental diet, and today’s episode is all about my experience of the elemental diet for SIBO.

Those of you who are following my SIBO journey may know that I’ve already completed three rounds of antimicrobials, to find out how that went, have a listen to episode 126 - My SIBO Treatment: An Update. After three rounds my hydrogen was at 63ppm and my methane levels were at 10ppm, given that the elemental diet reduces gas levels by 70ppm on average, this seemed like a good time to try the elemental diet and potentially clear my SIBO in one final round.

So what is the elemental diet? The elemental diet is a powdered (sometimes liquid) formula that includes all of your calories and nutrients in a predigested state so that your gut can absorb your nutrients immediately instead of taking time to digest them. This means you get fed, but the SIBO archae or bacteria starve because there’s no time for them to feast on your food during digestion. It also allows your gut the chance to heal because it’s not having to do any work, and for this reason, the diet is also used for people with severe gut health conditions like crohn's, ulcerative colitis, coeliac disease, malabsorption and in hospitals for patients who can’t eat for other medical reasons. It’s safe (though must be followed carefully and correctly to be so), well studied and evidence based and includes everything you need, from macro to micro nutrients.

For SIBO, this powder is blended with water and oil (if fat isn’t included in your formula) and poured over ice. This shake is the only source of food for 12-21 days, with the purpose being to starve and therefore kill the SIBO bacteria or archaea. You are of course also allowed to drink water alongside this. Some patients have experimented with weak black teas and coffee, and plain boiled or baked chicken or steak (trimmed of fat and skin) and this has worked for some, but has not been proven in studies.

The elemental diet as I said earlier, reduces gas levels on average by 70ppm, but has in some cases has reduced by up to 150ppm, which is incredible! It’s 80% effective at eradicating SIBO after 2 weeks, and 85% effective at 3 weeks, so it’s a really great tool for those with high gas levels. However, it’s expensive, at about £600 to £1000 per round and is also emotionally and physically challenging, so the decision to go ahead with the elemental diet shouldn’t be taken lightly!

I wanted to share my experience of the elemental diet with you all, as it can be an overwhelming treatment to contemplate trying and so I hope my experience will help you to make an informed decision and will hopefully also help you to have a better experience if you do go ahead with this form of treatment.

So in this episode, I discuss:

• How much I spent on the elemental diet, and how I planned and prepared for it.

• The challenges of the first week - in particular, blood sugar dysregulation (severe) and die off.

• How I tweaked my formula to achieve better blood sugar regulation and how that completely transformed my experience of the elemental diet in the second week.

• How I felt emotionally, from my feelings about socialising and sharing my experience with friends and family to crying over my boyfriend’s pizza!

• The benefits I experienced, from stabilised and sustained energy in the second week to laser sharp focus.

• My SIBO results - they’re not what I expected - and why I’m back on the elemental diet (yes, really)!

I really hope that this episode is useful to you, whether you’re about to start the elemental diet or you recently had your SIBO diagnosis and you’re contemplating what’s next for you. Please feel free to direct message me on Instagram if I’ve missed anything that you’re particularly interested in!

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This episode is sponsored by my free guide ‘A Natural Pain Relief Tool Kit for Endometriosis’. This four page guide includes evidence based and effective remedies which you can use at home to reduce your pain with endo. Download your copy here.

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If you feel like you need more support with managing endometriosis, you can join Your EndoLife Coaching Programme. A 1-to-1 three month health and life coaching programme to help you thrive with endometriosis. To find out more about the programme and to discuss whether it could be right for you, email me at [email protected] or visit my website.

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Show Notes

The SIBO, Endometriosis and Interstitial Cystitis Connection wth Dr. Allison Siebecker

How To Treat SIBO with Dr Allison Siebecker

Understanding The Endometriosis Belly, Part 3: SIBO Symptoms

How Do You Know When to Test for SIBO?

How to Test for SIBO at Home

Understanding The Endometriosis Belly, Part 1

Understanding The Endometriosis Belly, Part 2

 

 

As you guys know, endo is a full body disease which causes a host of symptoms throughout the body and also often comes with co-conditions that trigger these symptoms, heighten them or add new ones.

IBS issues are a problem for many people with endo and it’s important to address these, not by masking but by getting to the root causes.

The reason why getting to the root cause is so important is because gut inflammation is a key cause of pelvic pain and could even contribute to the continued growth of endo. Seventy percent of your immune system is in and around your gut and inflammation is simply a normal immune response. Inflammatory immune cells are released in response to injury, infection, bacteria or some kind of threat and these inflammatory cells cause swelling, pain and heat as they get to work on healing the area.

Now leaky gut or intestinal permeability occurs when tiny holes appear in the gut lining. Think of the gut lining as a sausage skin, it’s a tube from the mouth to the colon that seperates what’s coming in and going out from the rest of the body. The lining is incredibly thin, just one cell thick and these cells are tightly packed together with only the tiniest gap between them, to allow for the absorption of nutrients. When the gut gets inflamed from chronic IBS reactions, infections, SIBO, allergies, intolerances, an inflammatory microbiome, etc. the gut lining gets damaged and the gaps begin to wide. Other issues can also cause damage to the lining, like medication, stress and alcohol to name a few.

When this happens, food particles can pass through the gut lining alongside bacteria and toxins from bacteria, known as LPS. While some of the immune defences are inside the gut, there is also a large amount on the outside of the gut lining, waiting to attack anything that passes through which shouldn’t be there. It doesn’t matter if this is food or bacteria, inflammatory immune cells will be released and because the blood stream is also on the other side of the gut lining, the inflammatory cells can get swept along the blood stream, causing full body inflammation.

If you have leaky gut, this is going to be happening every time you eat, putting you in a state of chronic inflammation.

Of course, as you probably know, chronic inflammation causes chronic pain, and so, calming down your gut is key for calming down your pain.

But there are many other reasons to heal leaky gut.

Leaky gut causes symptoms like brain fog and fatigue, but it’s also now showing up in the research as a leading cause behind many autoimmune diseases. The reason being is that as the immune cells become more and more exposed to food particles (and whatever else is coming through), they start to develop antibodies for them, and these antibodies accidentally start attacking certain cells in our body, leading to an autoimmune condition. Research has shown people with endo are significantly more likely to develop certain autoimmune diseases and that autoimmune diseases are strongly associated with endometriosis. So, for us to keep ourselves as healthy as possible, healing leaky gut is really important.

Then there’s also the presence of LPS. Lipopolysaccharides are parts of the cell wall from certain bacteria that trigger inflammation in humans. LPS can move from the gut to other parts of the body, known as translocation. LPS have been shown to play a key role in autoimmune disease development and also play a lead role in endo development too, alongside oestrogen and inflammatory chemicals like prostaglandins.

So, whilst there are more extensive protocols for healing leaky gut that I take my clients and course students through, I get that for some of us, starting slower and with fewer steps is a better way to get going with healing.

Because of this, today I wanted to pay attention to three leading causes of leaky gut that commonly affect our endo community and tips for managing their damage. There are;

• Stress

• NSAIDS

• Gluten

Listen to the episode to hear about the research and the studies and for tips for healing if these specific causes are affecting you personally.

Do you have endometriosis and struggle with the ‘endo belly’? Do you have fatigue and brain fog? Maybe you have other unusual symptoms like swelling or puffiness, rashes or skin conditions like eczema or rosacea. If any of these sound familiar, you may not just be dealing with endo alone.

I’ve only ever done one other client story, but judging by the number of downloads, you guys found it helpful so I thought I’d share another! This is Sophie’s story of treating SIBO, candida and histamine intolerance whilst living with endo. I wanted to share Sophie’s story because her case is complex and her healing path hasn’t been easy or linear, and so for those of you who are struggling right now or feel overwhelmed by the idea of taking on SIBO, I think you’ll find Sophie’s experience, her hope, her patience and her perseverance inspiring.

Sophie came to me due to her painful sex symptoms, bloating and histamine reactions. We quickly discussed that severe SIBO was at the root of most of her issues (the painful sex we also addressed with pelvic floor physiotherapy and other strategies) and so Sophie began treatment early on into our coaching.

Her treatment was a great success and she was negative for hydrogen and methane by the end of it, yet was still having some bloating symptoms and histamine symptoms. Her test results following her treatment showed a flat line, so the question was has the elemental diet really just wiped everything out, or is hydrogen sulphide at play here? In the UK we don’t have testing for hydrogen sulphide, so deciding whether to treat that is down to the presence of H2S symptoms. We consulted Dr Alison Siebecker, who agreed that it was a tough one to call but suggested we consider trying some hydrogen sulphide treatment to see whether it helped. What we observed from this treatment was severe die off, an inflammatory reaction that occurs when bacteria, fungus or viruses die, and it can cause a flare up of symptoms. Something was dying, but it was a struggle for Sophie to continue through with the symptoms. We added in die off strategies and tried different treatment options, but even after treatment, some of her symptoms still persisted.

We sought out a nutritionist specialised in gut health in her area to do some further testing, and they discovered severe gut dysbiosis (which is definitely expected with SIBO and following treatment) and candida (yeast overgrowth). Both of which can cause bloating and worsen histamine reactions. She’s also spent several years exposed to mould, including black mould and so at present, she is working with the nutritionist on a specific mould protocol whilst also rebuilding her gut, and continuing with the physiotherapy, visceral manipulation and the practices we established during our time together. She’s also investigating the root cause of her SIBO, so she can do her best to prevent relapse.

Sophie’s journey is complex and a long one, but she’s made huge improvement along the way and she feels empowered, hopeful and relieved that she’s finally getting to the root of her symptoms. I really hope you find this episode helpful if you are also experiencing the same challenges!