Shining a Light on Pelvic Pain & Endometriosis – with Cindy Dabrowska

Welcome. I am excited to introduce you to Cindy Dabrowska today. She is a registered dietitian who specializes in helping women with endometriosis. This is such an important.

Topic and condition for women to have help with. I reached out to Cindy and said, can we please have more of a conversation about endometriosis? Thank you so much for joining me today.

You're so welcome. And thank you so much for having me to chat about this important topic with you.

Absolutely. I mean, let's start just by how this became a focus for you. Like, how did you, even if you want to share, like, how did you get inspired to become a dietitian and how did you get inspired to specialize in endometriosis?

Yeah, so much like many other healthcare professionals who enter their respective spaces in healthcare, I have a personal connection to endometriosis because I happen to have endometriosis myself. So, you know, since my very first period, ever at 12 years of age, I did struggle with very intense debilitating periods, you know, to the point where I would faint or vomit. It very much interfered with activities of daily living, work, school, relationships, you name it.

So I'm one of those people that actually did quite a bit of education before I entered my now profession of dietetics.

So when I entered my, my second degree, my, my nutrition and dietetics degree, I already had started kind of digging into the power of nutrition. And so at that time already I knew that, you know, I was struggling for so long. I was getting a lot of pushback from, from doctors, which is an unfortun for many people with endometriosis. And so I just kind of got fed up and I decided, you know, I'm studying nutrition, I'm studying to become, you know, a dietitian. There has to be something I can do from the diet and lifestyle perspective to support my body with endo. And I started digging, researching, and reading. And it definitely wasn't a linear process. Even though I was already sort of, I guess, more educated in the space of nutrition than your average person. And I still struggled. So for anybody who's listening who has endometriosis and you know, has very little knowledge in the nutrition space, just know that, you know, I too, even though studying to become a nutrition professional was really struggling in that space also. So it wasn't a linear journey. You know, there was, there was a period of restriction that I went through that made me absolutely miserable. Which is, you know, the reason why now in my, the way that I practice, I focus on Non restriction with endometriosis. So I am a non restrictive endometriosis dietitian. I do believe that there is a way to support symptom improvement or management of symptoms by not having to restrict massive food categories. I mean, obviously there are exceptions to that, but.

So that's really my story. And when I entered my master's degree, I just knew I would start a private practice in this because nutrition is so, so, so powerful. And although we don't have a lot of really small solid literature in the space of endometriosis and nutrition, we do have enough where we can sort of define the hallmarks of the disease and kind of, you know, put interventions into place based off those hallmarks using, you know, diet, lifestyle, supplemental supports and that sort of thing.

Yeah, it's. Well, and it's very interesting to me listening to, to your story because it reminds me like when I, when I came out of high school and I was in college and I was doing a pre med degree, I became so interested in nutrition and really had this idea of, oh my gosh, could food be medicine? And I, lo and behold, that wasn't just me having that thought, but I was really so connected with the thought. It felt so, you know, new and brilliant to me. To be like, wow, we can get so much medicine from our food or potential dietary changes. And so that's how I ended up getting a degree in nutrition in addition to my pre med degree was because I was just, I was so passionate about learning about nutrition. And that's what led me to become a naturopathic doctor because I was like, hey, I really want to know more about how to help people when they're in a situation where they might be in pain and kind of hitting a dead end when it comes to medicine for their health issue like endometriosis and feeling like, what are my other options? And I too am very inspired by women's health. I had, it reminds me I had very painful periods for, I don't know, I think probably at least 15 years of my life. I was never diagnosed with endometriosis. I never had, you know, imaging or a laparoscopy to have it diagnosed. But I get it. It's like to go through every month, you know, pain and also the unknowns, you kind of can know, okay, I'm going to be in pain. But each month it might be a little bit different timing. Sometimes there's vomiting, sometimes there's not. Sometimes, you know, you're just like, you feel like you have this constant anticipatory anxiety about how am I going to feel and am I only going to have a week or two of the month where I feel good? And this is kind of leading us into some of the symptoms of endometriosis because I think probably like me, there's a lot of women out there who've had painful, severely painful periods, but maybe never actually had a diagnosis of endometriosis. How common do you think that is?

Oh my goodness.

I think it's incredibly common. I think the statistic has shifted a little bit from 1 in 10 women to about 1 in 9 women now. And just, just because, you know, I work in this space and so I talk to a lot of women who have, you know, symptoms of endometriosis but haven't been formally diagnosed. So if the statistic now is, you know, 1 in 9 or 1 in 10 and you still have this really large group of women that are not yet formally diagnosed, I imagine that statistic is probably a lot higher. You know, like one in, I mean, I can't even begin to guess, but I imagine it's probably much, much higher.

Yeah, well, I think it's one of those things where a, of times women struggle because you're in pain. So you, and to some degree women almost feel like, well, isn't a menstrual cycle supposed to be painful? So I come across a lot of women who kind of like almost under play the pain because other women in their life are in pain and they just figure this is the way it's supposed to be. But actually it doesn't have to be painful, the menstrual cycle. Right. So even just, just saying, hey, if you're in pain with your menstrual cycle, it's time to figure out what's going on and get some help with that.

Yeah, absolutely. And you know, it's not, it extends far beyond just pain, even though that's really important. Right. To recognize that pain, you know, is not normal. Particularly debilitating pain that prevents you from being able to function like a normal human being. But the last couple of posts I did on my, on my socials.

Really kind of put some perspective into place for me in terms of what are some of the other themes and the other things that women are thinking are normal. So for example, I recently did a post on heavy bleeding and I was overwhelmed with the amount of comments I got and DMs I got about, wow, I had no idea that that wasn't normal. I just assumed that my extremely heavy bleeding with large Clots was just part of menstruating and, you know, and part of, part of life. And then I did another post about breast tenderness and again, the amount of feedback and commentary and DMS I got about, you know, I get breast tenderness for 10 days of the month and I just assumed it was normal. These are not normal symptoms. Right. Like, they are not, you know, mild breast tenderness with the fluctuations in the cycle. Sure. You know, we get that it happens. It's a change that happens in the body with the cyclical changes of the cycle, but not to the point where your breasts are really tender to even a gentle touch or you can't put on a bra that is too extreme to qualify as normal. So, yeah, it's very unfortunate that in the women's health space.

So many things are brushed off as normal. And that's likely the reason why, you know, so many women go undiagnosed with endometriosis, as per your question there.

Yeah, and I think too, like, say you go into the gynecologist and you say, hey, I'm having these symptoms. Now some doctors may do, you know, they can do blood work, but endometriosis is not going to show on the blood work. They could even do pelvic ultrasound looking for like fibroids and other causes of heavy bleeding and cramping, but it's probably not going to show endometriosis. It's also not easily discovered on some of the simple things that a doctor might start with. Tell us a little more about what do you suggest and what do you find in terms of if a woman is wondering, do I have endometriosis? What do you suggest she does? Or what conversations should she be having with her doctor?

Yeah, it's a great question to the comment you made just a moment ago about really the difficulty of getting diagnosed with endo. So again, I did a couple of recent sort of posts on this topic. So there are a couple things and you know, you as a, as a doctor would probably, you know, be better equipped to speak to these things. But for example, in my research, having a look at CA125, even though we know it is not definitive of a diagnosis of endometriosis, it could be a great place to start. Right. Particularly, you know, if you are susceptible to some kind of growth of endometriomas or cysts or fibroids or something like that, that could be a good place to start. But I do want to highlight that this is not a diagnostic test for endometriosis.

Other things can cause the CA125 to go high. So when you look at it, you're like, well, it could be this, but it could be these other things. And then you have to investigate further.

Exactly. So if you have the typical sort of symptoms of endometriosis, the really painful, debilitating periods, the heavy painful bleed, even though not everybody with endo has heavy bleeds.

Pain with bowel movements or urination, pain with sex.

Other bowel symptoms, constipation, diarrhea. Right. Loose stools.

And the symptoms can extend far beyond that. It could be joint pain, it could be fatigue, trouble sleeping, it could be headaches. And then that extends beyond the more direct symptoms into sort of more indirect symptoms of endometriosis, like its effect on mental health, for example, or your ability to concentrate and focus, for example. So anyway, where was I going with this?

I love that you're pointing that out though, because.

When you're going through this pain, it starts to affect other things and it might other people. And if you're observing someone else in your household, you might be like, oh, why are they always irritable and tired? Well, it could be that they're in pain and have endometriosis. Sometimes it's these other ways that it shows up that are also important ways to identify it and important ways to know that, hey, maybe it's time to get some more support with it. Thank you for mentioning those other additional. So we can see this whole picture of what is someone with endometriosis experiencing or potentially experiencing? Then they might say this. Even for a practitioner, say you go into the doctor, I would share all of that. Like, don't just say I have heavy, I have painful periods, say I have this and this and this and this. So the doctor really understands the severity of the whole experience.

Yeah, like the full picture. Exactly. So, yeah, I mean, so to that original question, I mean, you know, you can start there CA125. Some doctors will do receptiva. Right. That's a new one. That's, that's coming up particularly more so in the infertility space. Right. So if you've been trying to conceive for a really long time, which also happens to be a symptom of endometriosis, and for many women, it's the first symptom. Right. You can have silent endometriosis where it's not really causing you a whole lot of debilitating pain or any of those typical symptoms, you know, if we can call them that. But maybe your first symptom is that you have, you're not able to conceive, right? And then you go and start the, investigate the investigative process and then you uncover.

So the one, the one takeaway point I really kind of want to stress here is because it's women's health and because unfortunately there is this theme of women's health sort of being neglected a little bit. My, I guess, foremost advice to somebody who suspects maybe they have endometriosis is come prepared.

And advocate. You know, if you want something specific, maybe, maybe lay out what that start to finish looks like for you. Maybe you have done enough research and you're convinced you have endo. Come prepared to your GP appointment with three or four or five names of endometriosis specialists or excision surgeons in your area and request a referral like, get the ball rolling, right? Because you likely will get a lot of pushback. I hope that you don't. I really, really hope that you don't. There are still some wonderful doctors out there, so don't misunderstand me. But more often than not, when I'm speaking to people in this, it takes them 10 plus years to get a diagnosis. I was just talking to one of my clients yesterday. It took her 16 years to get diagnosed. Depression, heartbreak, the pain just getting more and more intense. Disordered eating, eating disorder, broken relationships, because nobody would take her seriously. So don't let that happen to you. Be firm, request what you want, you deserve it, you deserve that support, you deserve to be pain free, you deserve to be taken seriously. So I think that would be the most important takeaway for if you're somebody who is preparing to talk to your doctor about getting a diagnosis, I think that would be the most impactful. Really come prepared and demand what you're after.

Well, I think that's a really good point because sometimes you could go into a doctor's office kind of feeling like I'm in pain and I'm hoping they can help me and kind of like this, but then it's less, you're more likely that's going to take longer and not, you know, you might not get the help you're looking for. But if you're already like listening to this and doing your own research and you're like, you're starting to track your symptoms and you're starting to say, hey, I really want to know for sure if this is what's going on and what my options are. I love that. To be able to just kind of go into the doctor's appointment with an agenda and being your own health advocate and saying, here's the reasons why I think I might have endometriosis. And from my understanding, here's what my next step should be. But I think it also helps, whenever you're talking with a practitioner, to let them know, hey, I'm here for your opinion. I respect your opinion. I really need help, and I'm wondering if you can help me, can I have this referral, or what do you think I should do next? Because then it really then can be a conversation. And that as soon as a practitioner, what I find is the more the practitioner understands that you're researching and you want to have a conversation, figure something out, it's much more likely that they're gonna, you know, be able to work with you to make that happen. So I love that suggestion. I think that's. That's a really good suggestion for people. And it also helps you to feel more empowered because so much of this is feeling unempowered, right, by the pain and the discomfort. So to be able to say, hey, I'm like you said, I deserve this and I feel empowered to ask for help comes across, you know, very differently and is likely to lead you to more help, which is what we would want for you. And the thing, too is, I think over the years, of course, for many conventional medical offices, if they hear some of these symptoms, the most likely suggestion is to take a birth control pill. Because for so many years and still, I think.

One of the only solutions that gynecologists and other practitioners have for painful periods and some of these other symptoms is to say, hey, let's take over for your ovaries using synthetic hormones and just use a birth control pill. And sometimes it does. Sometimes it's necessary, sometimes it helps because it does take over the hormones. But it's. The point I'm trying to make is that they're not going to share other options. They're not likely to say, or you could make these diet changes or look at these other possible underlying causes and maybe not need to be on a birth control pill. I'm curious on your take on that. What do you think about that? How likely is it that birth control pills are going to get prescribed to someone with the symptoms of endometriosis?

I'm laughing because I think the likelihood of it is. It's very, very likely. The reality is that we don't have good options. Right? It's birth control. It's.

You know, putting. Putting a woman into, you know, early menopause with hormonal suppressants it's surgery potentially, right. These are, these are the best options we have, right. We don't have anything really better than that unless you start looking into like the health space, right? Looking to work with a dietitian, looking to work with a naturopath who can really help you optimize your omega 6 to 3 ratio, have a look at your diet, make sure you're, you know, controlling those blood sugars, maybe getting you on a good anti inflammatory supplement protocol, optimizing gut health and hormone health. But anyway, that's kind of digressing a little bit from the, from the original question. Very likely, which is why coming prepared to the appointment, saying, look like if you can, if you come to an appointment and you say I have really debilitating periods and that, and you leave it at that, right? Versus if you show up to the appointment with a calendar where you've tracked all of your symptoms, you've tracked when you've had painful intercourse, you've tracked spotting potentially, you've tracked mood changes, headaches, the consistency of your bleeding, your clots. Maybe you've been on birth control before for other reasons and maybe you can provide some feedback in terms of how you in your unique body have responded to that birth control, whether it was positive or negative. Then the doctor's forced to give you another option.

So.

Anyway, I mean, it's very likely you'll get prescribed birth control.

Which again, just goes back to that point that I made earlier. Make sure you're prepared because if you don't want to go on birth control, then you need to ask for those other options. You need to be prepared with names of surgeons potentially if that's the next avenue you want to take for the laparoscopy or excision surgery.

So yeah, I guess that, I guess that's my answer to your question. To your question.

Yeah. And it's, I mean, again, the idea is like, you know, and I think a lot of women can feel this way. They, you just, when you're experiencing this kind of discomfort, you just literally would rather be out of your body somehow. You're like, where can I get a different body? Or how can I get a break from this? Essentially? And so sometimes, you know, using the, either, you know, birth control, which is essentially using these synthetic hormones to take over for the ovaries. The idea is, I think, good idea in terms of like, hey, let's give your, let's try to put in some balanced hormones to take over for the imbalanced hormones. But what can happen is those birth Control pills can have a lot of side effects. That's what happened to me, using birth control pills at a young age for painful periods. I ended up with severe side effects to the birth control pills. And being told, you can't take a birth control pill then at that point, now later, I know I have MTHFR gene variations and other. It makes sense why I was having side effects to the birth control pills. And I'm glad I didn't take them because I probably would have ended up with more side effects. But it put me in a position of like, okay, you can't take these synthetic hormones. So then I was in the position of like, okay, well, what else am I going to do? And so I think more and more women are starting to realize, well, maybe I don't really want to take the risk of being on birth control pills for a long time. Or maybe as, as you mentioned, maybe they're trying to get pregnant, in which case the birth control pill doesn't make sense. You're trying to conceive and so you want your ovaries to be working and you want your hormones to be balanced. And so if you're listening and you're thinking, hey, what else can I do besides using synthetic hormones? Can I get my ovaries working right again? Then I think the answer you and I both would say is that yes. I mean, I over for myself for sure, but Also over almost 22 years or more of helping women balance their hormones and get their cycle going, it's definitely possible. So I want people to be able to hear. There's so many other ways that we can help your body and your ovaries to be ovulating and producing hormones in a balanced way. But that's not the only contributing factor to endometriosis. So maybe let's touch on that first is just what causes endometriosis. If we're going to think of like, how do we reverse it or how do we treat it differently? I think we need to start by, well, what caused it in the first place? Because my mind is like, the way we can address it is by treating the cause. And it's interesting because way back when I was in naturopathic medical school, this is in the 90s, I was researching endometriosis actually, and I was looking at all the studies at that time on what were the contributing causes. And now again, this is over a couple decades ago. So it's interesting to me that some of those same concepts are still coming up today, and it still isn't like if you asked most practitioners what causes endometriosis, they're probably not going to have a single answer. They're going to say that maybe this or there's this theory or there's that theory, and it can vary from person to person. Some of those same theories existed, I can tell you, 25 years ago when I was doing research on it then. So I want to talk about that more. And you gave us little hints a few minutes ago, but let's talk about these. What are the underlying causes of endometriosis in a way where listeners can start to think, hey, maybe this is where I would go on my path to decreasing my symptoms.

This is such a great question, and it's a really frustrating question, too. And I've been asked before.

Like you said, right? Like, like you alluded to, there's a lot of theories kind of floating around. My understanding is that a lot of those theories have been disproved at this point. And we kind of just circle back to we don't really know, like it. There's not really a solid answer to this question. We do know there is a genetic factor for sure. I do believe the statistic that I read was that if somebody in your, a woman in your immediate family has endometriosis, then you're about six times as likely to get it than somebody who doesn't have that genetic link, which was the case. It is the case for me. My mom has endometriosis as well. So unfortunately, I did get that gene passed down. So we know that there's that genetic link, right? Which there is a lot of really wonderful, fantastic research going on in the space of genetics and nutrition and how to manipulate your genes with nutrition. But I don't think that research is very developed quite yet. I think it's still growing and there's still a lot that we need to learn there. I'm not personally aware of any diet that can alter your genes when it comes to endometriosis. We know that there are some nutritional.

I guess, underlying potential contributors. So there were some studies done on this and surprisingly, they did find that higher intakes of dairy were actually associated with lower risk of endometriosis, which is quite funny because many people who try to support themselves with endometriosis actually go dairy free or think they have to go dairy free. So that's really interesting. And then diets, of course, that are higher in fruits and vegetables tend to be associated with a lower risk of endometriosis or developing endometriosis. And then of course diets that are higher in processed, processed meats and you know, fried foods and highly processed foods. Also there's a higher association there with endometriosis.

And so we know that there's that nutritional piece.

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Be very transparent and say I don't to want really do a lot of reading into those theories that have been floating around for the past, you know, 20, 30 years because many have been disproven and.

And I don't really even know how to speak about them to be honest. Like, like the retrograde menstruation and that sort of thing. I mean I don't, I don't.

Yeah, I don't think even when that one was, was coming out I was like I don't think that's going to be the thing, you know because it just doesn't quite add up in terms of the number of women who experience it and how common it is. But I do one other one that I and let's come back to, we're going to circle back to some of the places where women can start to think about helping with endometriosis. But one of the areas that back then there wasn't the research that I think is still important thing to consider would be toxin exposure, including.

Plastics and other kinds of toxins that we're exposed to and how they can disrupt our hormones. And that research back then really caught my eye because I was like wow. To think that something that say we're breathing in or we're ingesting or we're in contact with could be disrupting hormones and causing.

These kind of symptoms. To me that was like, okay, now there's something I can do something about. I can shift my exposure in my environment, and that could have an impact on my hormone levels, but also inflammatory levels. Because when we're. The thing with endometriosis is it's sometimes hormone imbalance involved, but there's also this inflammatory picture. And so it's how to address both at once, how to address the hormones and the inflammation and oxidative stress and all of that at the same time. But I thought that was really interesting to think of toxin exposure. And then, of course, my interest over the years has been really about stress. And so I look at it as.

Of course, we know that when we have various different stress exposures, whether it's an emotional stress, a physical stress, a toxic stress, food as a stress, if that turns on our genetic predispositions, then. And if a person's already genetically predisposed to the symptoms of endometriosis, then that is just a matter of what kind of load of stress is enough to turn on that symptomology. And so to look at it as, how do we really help with stress recovery, then how do we help our bodies be resilient to stress and still be able to be healthy and not have symptoms? But of course we're going to have stress. It's not like we can avoid it. There's going to be stress that comes along. So how do we become resilient to stress so that we don't have to experience these, you know, such severe symptoms? But again, I'm curious, maybe we can go into this a little bit, is like, what are some of the, you know, and you had mentioned from the beginning, in terms of diet, you don't like to go so restrictive, but what are some of the dietary suggestions and some of the supplements and sort of directions you go with your clients to help them explore this path of alternative approaches to endometriosis?

Yeah, so big, big question. So to simplify it a little bit.

The sort of pathway that I take with my patients is firstly to focus on the gut health. Right. I don't know if it's similar in naturopathic medicine, but absolutely.

And I love that you're mentioning that because you necessarily think, oh, this is here, this is with my uterus and my menstrual cycle. We aren't often thinking about. The woman might not be thinking of the gut health, but absolutely, you know, from a naturopathic perspective, gut health is so huge. But let's. So let's talk about that some more. I love it.

Yeah. So. Well, we know that a big chunk about 70 to 80% of our immune system is located in the gut. Right. So and we know that there's an immune system dysfunction piece in endometriosis. Right. That the immune system is just not responding appropriately to this tissue that shouldn't be outside of the endometrial, like tissue that shouldn't be outside of the uterus. So we know that there's that sort of immune system dysfunction piece. And with 70 to 80% of our immune system being located in the gut, we can absolutely, you know, modify the gut, support the gut with proper nutrition, you know, pre and probiotics resistant starches, you know, really just making sure those, those commensal good gut bugs are being supported so that they can go on to produce short chain fatty acids and other anti inflammatory, you know, chemicals that have localized effects on the gut. So really support that gut integrity, support nutrient absorption and breakdown.

You know, support the absorption of other nutrients. So where was I going?

Well, I love this because as a nutritionist, I mean, I don't know if people realize this but I mean I from my nutrition program too when you're studying food, but a huge amount of a nutrition program is studying the digestion. So we have to learn like how do you digest your food, how do you, you absorb the food, how does the digestion work? So it's so interesting to me like here knowing you now as someone who specializes in endometriosis, it makes total sense like that you would be, you know, you'd like be like, hey, let's focus on your food. Yes. But let's make sure it's getting digested and the nutrients are getting absorbed because it can be, you're mentioning like the microbiome if it's out of balance, that's a huge source of inflammation and toxicity in the body, let alone the leaky gut. Which then just makes it more likely the inflammation and toxicity is going to spread. And it could show up in different places for different people. Right. One person, it might be Hashimoto's autoimmunity. I don't know, could be or you know, could show up anywhere in the body. But I think for you know, there's going to be a certain percentage of women, it's going to show up as endometriosis. So it's so important I agree to, you know, so it makes sense to me that you're and you're like, it's a perfect place for you to be focusing is you know, like digestion let's get it back to healthy.

Yeah, absolutely. And the one thing that I think a lot of people don't realize with endometriosis is you're dealing with chronic inflammation, right? And so when your body is chronically inflamed, you need more tools than the average person to be able to quench that inflammation. So not only do we really, really, really want to optimize your nutrient absorption, but. Or, sorry, your nutrient intake, but we also want to optimize that nutrient absorption. Right? There's that new little quote that's going around. You're not what you eat, you're what you're what you can absorb, right? So that is really, really key with endo. And like you mentioned.

When you, when you're, when your gut is out of balance, then, yeah, you're, you're. It's a big source of inflammation, right? And then there's the estrobolone, right? We have that. I mean, I don't know how well versed your audience is, but the strobiloma is basically that cross between hormones and the gut health. So here we're talking about estrogen and beta glucuronidase, right? We have this enzyme in the gut that can essentially unpackaged package estrogen, right? Estrogen that's been packaged for excretion. And if we have a lot of this beta glucuronidase, it can go ahead at the level of the gut, unpackage this estrogen, and then send it back into general circulation for, you know, to further contribute to potential estrogen dominance. Right? Which, you know, estrogen can also be a source of inflammation. So there's a massive, massive role, you know, when it comes to gut health and endometriosis. And I can just say from my personal experience, for myself as well as in my clients, as soon as we kind of quench the inflammation focused on the gut, they immediately see improvements in symptoms. For some people, those are massive improvements. Pain going from a 10 to a 2. For some people, that's minor changes, but there's always some improvement, right? Because if the gut is out of whack, if you're having loose stools, if you're chronically constipated, then these are all kind of red flags in the way of endometriosis. So always start there. We always, always start with the gut for, you know, all those, all those reasons I listed. It's a source, potentially a source of inflammation. It can potentially be encouraging, you know, further hormonal imbalances. And we want to be able to excrete, you know, the toxins that you mentioned and potentially, you know, elevated hormone level. We want to be able to excrete those through the stools. Right. And if you are somebody who's been on a hormonal suppressant or on hormonal birth control, again, it's extra important for your gut health to be well supported because you're going to want to support, you know, your liver and the rest of your body with excreting any sort of excess hormone that entered the body through those. Through those medications or through the birth control. And we also know that birth control can deplete us of some really, really important nutrients. So that's another reason why we really, really want to support the gut health there. So.

That. That's sort of step one for me. And then step two, I'll move into hormonal balance. Right. So in my opinion, there isn't. You're not going to effectively balance hormones if you're chronically constipated or if you're having loose stools. That is step one. We have to address that first. And a perfect example of that is that connection I made with beta glucuronidase.

Great. Maybe you're clearing estrogen through, well, through your liver. You're doing a fantastic job. You're methylating. Well, your phase one, phase two looks good, but. But if you can't get it out, it's just going to circle back and it's just going to continue to cause problems. So we do want to support the gut health and then we can comfortably move into hormonal balance. And with endo, we really want to support progesterone production because it offsets the effects of estrogen. It's very good for mood and anxiety reduction in sleep. We know about that.

Oh, my gosh, you're reminding me that. I mean, progesterone. Yeah. Is such a favorite for this. And I'm thinking of a case. Well, I do a lot of help with fertility in general and miscarriage prevention, in which case natural progesterone is really key in that before pregnancy and in early pregnancy.

And especially with the endometriosis cases, I think sometimes women can feel a little hesitant about progesterone, especially because, like, sometimes when you go into, say, the gynecological office, they might prescribe a synthetic progestin instead of natural progesterone and they might prescribe a high dose. And so you might have. I just like to mention, like, you might have had a bad experience with a progestin and just to be able to kind of like realize, okay, there's other ways to address progesterone that don't have to be over the top. Like so much of the time. I find it's a matter of supporting progesterone gently, gradually increasing until we find the right dose for you, which is very different. You know, some personally might need a little bit of progesterone support, maybe even just from an herbal support. And like you said, the gut health, when you improve the gut health, all of a sudden the ovaries start working better and making progesterone better on their own sometimes. So we don't even have to add much. Right. And then, or if you need a little more progesterone support, we can use natural progesterone certain days of the month and you can find the amount that really works for your body. It doesn't have to be without trying to use amounts that are suppressing ovulation or causing symptoms. And so just to know that you can find a practitioner who can help you with the progesterone support in a more, you know, graded way, you know, like starting low and increasing until you find the right amount for you can make such a big difference. But I love that you're pointing that out and I love how you're point talking about estrogen too and how, because I think sometimes we don't always realize that, you know, once estrogen is produced by the ovaries, it circulates around the body and causes, you know, potentially symptoms anywhere. Right. It doesn't just cause.

Menstrual related symptoms and then it has to go, the estrogen has to go through the liver and get detoxified to go out in the stool like you're mentioning. And so to realize, wow, if you think you might be having symptoms related to estrogen progesterone imbalance, we can actually do testing to find this out. Like we can see how, what are your, not just estrogen levels because in blood work you can measure estradiol and we can see that. But in the blood work you can't look at liver detoxification or glucuronidase activity, but we can see that through urine testing. I don't know if you use a precision analytical Dutch urine hormone testing. So we can see how well is phase one, phase two working. And we can also use say stool testing to look at glucuronidase activity. So these don't have to be a mystery. Right? This is, this is information we can get. It's Just not going to probably come through the regular doctor's office and you're likely going to have to pay out of pocket. But having that information is so valuable because then you know what your body needs in order to feel better.

Yeah, absolutely. I'm a big, big fan of the Dutch test and I do stool testing as well.

It's just there's so much information we can get and the connections we can make. Right. Like, for example, again, I don't know how well versed your audience is. We produce three types of estrogens, right? Estronestradiol, estriol, and then those essentially get converted into free radicals. Right. 2 hydroxy, 4 hydroxy, 16 hydroxy. And depending which one your body is favoring, for example, we know the 16 hydroxy is the one that's more associated with a lot of those estrogenic proliferative symptoms like cysts and heavy bleeds with clots and fibroids and proliferating endo. So it's especially, I feel like, valuable for somebody with endometriosis because if we can kind of target exactly what's going on with your estrogen and supporting methylation so that it can, you know, get through phase one and phase two well and comfortably, for the lack of a better word, then that can. That can be, you know, night and day for you in terms of your symptoms. And again, this is something that, that I've seen in so many of my patients, just night and day, going from severe breast pain, heavy bleeding pain.

Migraine, anything that's related to estrogen dominance and inflammation, especially if you're not methylating well, because you're essentially just getting an accumulation of free radicals. And that's just on top of the inflammation from your endo and your immune system responds. You're now getting this crazy amount of inflammation from your estrogen detox. I love that test. And you're right, it is something you have to pay for out of pocket. But it's well, well worth it, I promise you, for anybody who's listening, who's contemplating doing the Dutch, it is such a great test. And, yeah, I'm confident that you would see improvements in your symptoms because it's just so good. And if you have a test like that to rely on for information, then it tends to be, you know, more black and white versus kind of trial and error. Trialing and erroring? Is that even a word, trial and error?

That's what I did. Wait, you know, before the Dutch test existed, it was, you know, and way back when I was in Pain. There wasn't. There wasn't. We couldn't, we were guessing. We were really, you know, let me try this. And I'm telling you like, and here I was in nature baby medical school try. And I was going to the clinic and they were saying, try this herb, try this, this nutrient. And I would feel worse. I would have been. And so then I was like, well, I don't understand what's going on. And they didn't know it was. Understand what's going on. If we had had this test, it would have helped us so much. But this is 25 years ago when this test didn't exist. And so when it, you know, when it. Now that it does exist, I completely agree. It's like being able to have information about what's going on inside your body, but now you have it objectively on a piece of paper with charts that are easy to read and information. And then we can implement and we can retest so we can be very strategic in your follow up. And it can feel like again, you're being that empowered health advocate with information versus feeling overwhelmed and not knowing what to do next. And so it really can make a difference. And it's not information you can get from a regular blood test. And so it's like just, yeah, so life changing. I agree. And it's. And to be able to see patients who are going, I'm sure you see this all the time too, struggling with endometriosis, to being able to manage the endometriosis or reduce it or eliminate it or have it removed and prevent it from coming back again and then be able to successfully get pregnant and have healthy pregnancies. I mean, that's huge because I think for a lot of women with endometriosis, if they want to have a pregnancy, there can be a fear, am I going to be able to get pregnant? And how is this going to work? And to live with that kind of fear is another stress that just perpetuates everything, you know. So how to, you know, to be able to have a strategy and some hope to know, hey, there's ways, you know, that we can help, that can help you through so you don't have to be in living in that, you know, in that fear of what may or may not be able to be possible.

So yeah, absolutely. And I mean, I guess to go back to that original question, that kind of sent us down this train of thought.

So we talked a bit about the gut health and the hormone health and then once you address the gut health and the hormone health already you're going to reduce quite a bit of inflammation in your body. It's just sort of, if you address two big contributors to inflammation, then you likely will see a lot of inflammation reduction. So on top of that, we really just want to support.

Reduction of inflammation further with diet. Right? So optimizing that omega 6 to 3 ratio. So the statistic in North America is something crazy like 25 times the amount of omega 6 intake to 3. Right. And omega 6s are pro inflammatory fats, omega 3s are anti inflammatory fats. So we do need pro inflammatory fats, right. When we have an infection or a cut or something, or some kind of inflammatory response. I mean, we need those, those pro inflammatory fats in order to, you know, respond appropriately. But that ratio is quite, quite big, right? It's quite excessive. We're looking more for something like 4 to 1, you know, maybe a little more than that. So really looking at, you know, if you're, if you are somebody who enjoys animal products, looking for grass fed or game meats as much as possible, that will really help to increase the omega 3 intake. Because conventionally raised.

Animals are fed higher omega 6 grains, right. Looking at things like omega 3 eggs, lots of the omega 3 rich nuts and seeds. We are looking to also.

Reduce intake of like those omega 6 oils, right? So my favorites are extra virgin olive oil and avocado oil. They both have pretty high smoke points, so can be used for cooking as well as on salads and things like. And if you wanted to just boost that Omega 3 some more on salads, you could do something like a walnut oil.

Or a flaxseed oil. Those ones are really, really good. So those are great ways to optimize those ratios.

It's such a good point too. And this is again, what we learn in nutrition is these different types of fat. So omega 3, 6, 9 and so on. And I was going to say, usually when we think Omega 3, we're thinking, okay, fish oil, but you reminded me, actually what I ended up figuring out that made a huge difference for my pelvic pain was to take flaxseed oil. And I still to this day take a tablespoon of flaxseed oil every day because it made such a difference for me. Now it's interesting because we also, in genetics, some of us can convert flaxseed oil to omega 3 better than others. And I happen to not have that gene. So I, I don't even convert flaxseed to omega 3 very well. But still for some Reason Having flaxseed oil. Not the. I mean, I. The flaxseeds are great too, as a fiber, but. And lignin source and all that. But the actual, you know, flaxseed oil, which I usually put in a protein shake, but I've been having that now for years because it made such a difference in my. In my pain. And I. So I'm glad you're. You're mentioning that. And I'm just saying it in case someone out there is, like, still trying to figure out which is the best oil for you. Sometimes you kind of have to experiment a little to see, like you're saying. Sometimes you go, okay, should I do a little more olive oil? Should I do more avocado oil? Should I do flaxseed oil? Borage oil is another one that's commonly used. Or evening primrose oil, you know, so you can, sometimes you have. And you can do tests for this, too. There are tests that measure these different omega 3, omega fats to see what are your levels. But a lot of times I find that you can almost kind of figure it out just by trying different ones and trying different ratios and until you find, you know, the amount that's really going to work best for your body. Because we do have, you know, our genetics influence that too, how we process fat.

Yeah, absolutely. That's so funny that you say that because I actually just did a genetic test on myself and I apparently don't metabolize fats very well.

Which is funny because. Well, anyway, I won't go into that personal story, but it's just, it's just funny that you mentioned that.

Yeah, yeah, yeah. So it's so. And to realize that the, you know, arachidonic acid that we're getting, like, you're, you know, you're pointing out from more like animal sources, animal proteins, those are going to be more inflammatory. And it's not to say that you have to be plant based. I don't think you're saying that either. It's not that you have to be entirely plant based, but you want to just look at the ratios and see. Okay, if I'm having some arachidonic acid and saturated fats, let me make sure I'm balancing that with these other fats, too.

Yeah, exactly. The balance is key. Right. And again, just to that point that I mentioned before, like, we do still need omega 6 fats. They are essential, but we really just want to have a really good ratio. Right. Because unfortunately, a lot of these sources of omega 6 oils right. Like our canola and our vegetable oils and our.

You know, basically, yeah, these vegetable oils, they're very inexpensive and so they're put into many, many different foods in the food supply. They're fed to our conventionally raised animals. They're in our frozen foods and in our cereals and things like that.

So way more than we would ever realize. If you look on the packaging, usually it says some sort of. Yeah, canola oil, safflower oil, something like that.

Yeah, exactly. So they're far more accessible. So when those, when those food choices start to sort of migrate over to whole foods, you will significantly drop, you know, the amount of Omega 6s you're taking in. But I'm a very realistic dietitian and I know that we have busy lifestyles and sometimes we need to rely on something quick. So, you know, it's just being equipped with that knowledge of like, okay, what would be a better option? What's going to give me a little bit less Omega six six versus something that's going to give me a bit more. If you are relying on like a takeout, takeout food or something frozen. Right. And also making sure, you know, you're pairing appropriately, appropriately with lots of colorful fruits and vegetables for the polyphenols and fiber and, and all that good stuff that also helps with, with combating inflammation and regulating hormones and supporting the gut health. Nutrition is definitely very complicated.

Well, it's in. And at the same time, it's like, that's why it's helpful to have someone like you to guide. I really get the sense that working with you, you give a lot of knowledge, but you also give a lot of room to just for a person to kind of feel into what food choices are going to work for them. It's not a one size fits all diet. It's a, hey, let's find a comfortable, happy place with you and your food. Because it's not going to help for you to end up being stressed or too restricted on your diet either. So, so it's, you know, to have someone to help you to just kind of, you know what I mean? Like, just, I feel comfortable when talking to you, like, okay, you're, you know, you can give it to me little by little and listen to what's working for me and help me come up with ideas of what to eat without feeling stressed. And that's, I think, really important.

Well, I mean, we already deal with so much stress and so many things are restricted to people with endo because.

We do struggle. I mean, depending on the pain level. Right. I would hate to also restrict a food that somebody loves. Right. And nutrition and our food choices, they're so personal and they, we get a lot of pleasure from these things. Right. And so. And we build a lot of habits around the foods that we enjoy and eat on a regular basis. So definitely dietetics is not all about just telling people what to eat. It's counseling for behavior change. It's finding ways to still incorporate the foods that you love, but in a way that's going to be helpful to your body. Right. And not the opposite. So I appreciate that compliment. That's very sweet. Likewise. Right back at you.

You're welcome. And if people want to be learn more from you. I know like you and I found each other on Instagram and you mentioned a bit of your posts that are so informative. But tell us more like where can people find you, you how best to connect with you.

Yeah, sure. So I'm most active on Instagram and so my, my handle is ndo Fertility dietitian with two T's. No C. I also have a website, endometriosisdietician Ca and on my website you can find a blog that I write on from time to time. And.

I'm launching very, very soon some very, very inexpensive like Endo specific meal plans. And I also have a program that I'm working on so that I can reach more women with Endo and support more women because.

It'S such a space in need. Like I have a massive wait list. There's so much need in this space. I want to be able to support as many women as possible. So that's how you can find me. That's what I do. That's how you can work with me and, and how I might be able to support you. And yeah, thank you so much for giving me the opportunity to be able to share that.

Oh, of course. And I definitely am so grateful for you putting together that information and those resources and being available for women to contact, because I really do. I mean, just being able to have that feeling of like there's someone out there who can help and who's been through this and who can guide and then, you know, be able to know that there's so much more we can do to be able to help and to get you out of that feeling alone and feeling afraid state into feeling empowered and strategic and unlike there's, you know, there's a lot that can be done to help. So yes, I'm so glad to be able to share this Message with you. And. And thanks again so much for joining me today, Cindy.

Yeah, thank you so much again for having me as well, Donny. I really had a good time chatting with you today.

Hey, I just got finished talking with Cindy, and I wanted to mention to you all that I had these insights during that conversation and after that. Because Cindy specializes in endometriosis, which I also help with in my practice, I specialize especially in helping women with HPV and cervical dysplasia when they get an abnormal Pap smear, abnormal cells, or inflammation on the cervix. I started to really think some of the same tools that she and I use for helping with endometriosis are some of the same things that I find to be effective for helping with fending off HPV and cervical dysplasia, including dietary changes, and helping with gut health and hormone balance and nutrients. Some of these same key strategies we just discussed, I also find are super helpful for helping women to fend off HPV and to heal their cervix from inflammation and abnormal cells. And so I just wanted to mention that connection and how much I see the similarities in the story of women who struggle with feeling alone, in pain and feeling alone, say, with an abnormal Pap smear and feeling afraid. I'm just wanting you all to know that we're here to help you, that there are solutions, there are options. Yes, diet can make a difference. Yes, gut health can make a difference. But even sometimes I talk to women who are saying, hey, I already eat healthy and exercise and think my gut health is pretty good, but I still have these health issues going on. Now what do I do? And that's exactly when we need to do some more testing and find out. For your body, we need to do more specific nutrient and methylation testing and hormone testing, detoxification. Sometimes we need to look at genetics. We need to look at the gut microbiome, even the vaginal and uterine microbiome, to help get the healthy population of bacteria working for you and not against you. And so we just can just know that we can look. We have the systematic way of looking at all these different reasons. And to me, again, one of the biggest reason for these symptoms to develop is the effects of stress. So we need to look at how has stress affected you? Has it thrown off your cortisol, your adrenaline, your neurotransmitter levels? Let's get them back in balance again, because that's possible using nutrients and herbs. It's not just a quick fix or a crutch or a temporary solution. It's actually that we can use nutrients and herbs and stress reduction techniques to get your cortisol and adrenaline and neurotransmitters back to optimal, along with your digestion, your bacteria, your hormones back to optimal. And as everything comes back to optimal, then the inflammation drops, the oxidative stress drops, and you start feeling better. I just wanted to mention that.

There'S a lot of crossover and I'm actually really curious if any of you are listening. I would love to know how often someone may have endometriosis and abnormal Pap smear. Because if you think about it, endometriosis is in the endometrial tissue in the uterus or outside of the uterus, and cervical dysplasia is on the cervix, but those are connected to each other. And so I'm curious how often do women experience endometriosis and cervical dysplasia in your same body? So if that's your case, please write into me. I really am curious about that overlap and because I can see that the approach to helping you would have overlap would be a lot of similarities in terms of the strategies to help. So thanks again for joining us and be sure to check the show notes where you're going to find information about how to connect with Cindy and get more information when she comes out with more resources and also how to connect with me and the resources that I have to share as well. So you do not have to feel alone. We are here to help you through this and to feel like you can be enjoying your life without having to be in pain and in fear. All right, talk to you soon.

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