[00:00:53] Hello friends. I hope you've been well, welcome to the episode number eight of the health and science podcast. I'm Dr. Elaine, as usual super happy to be here. I always look forward to the episode recording day. I love it. And it's been raining a lot here in Singapore this week. It's raining right now. So I hope it doesn't affect the quality of the audio. You might hear some rain sounds or some cars splashing water here in the background.
[00:01:23] It seems very suitable weather for a Halloween week, which is what is happening here right now, right? We are looking forward to costume dressing this weekend and all of that. Okay. This episode today, we'll continue the series of what we started on the mind body therapies in relationship last week, we talked about a special focus of mind body on the side of gut.
[00:01:49] So connection between the gut and the brain, the gut and the body and how we could use mind- body therapies to address that. Today is another spin in that direction. Okay. We're still going to talk about gut and mind body, but. Today, this episode has a special focus for women. And specially people that suffer from endometriosis.
[00:02:13] Perhaps you don't even know that you do since it's such a underdiagnosed, misdiagnosed disease. Condition. But I want to talk a lot, a lot about how gastrointestinal symptoms could be connected to endometriosis and vice versa. And what he could be doing to address this side of your condition in case of suffer from it. Okay.
[00:02:35] So, let's dive in!
[00:02:40] And you might be wondering why are we talking about GI symptoms and endometriosis. And if you think about it, there is some aspects of it that are quite obvious, because our gut and our reproductive organs are sharing the same cavity in our bodies, right? The same pelvic space, what we call the abdominal pelvic cavity, our pelvis, basically they are very close to each other. So you could imagine that there is some effect happening in there, right? It makes sense to understand, first of all, how endo works and then how this could be connected to your GI symptoms. So let's start talking a little bit about endometriosis or endo as it's usually called, for short. So endo, endometriosis, is a condition that affects approximately one in 10 women, which is about 190 million women in the world suffering from it. Women and girls of reproductive age.. And there are many more who don't know that they have the condition. These are the ones that are diagnosed. And the symptoms vary a lot. They are very broad and they're very different. So that makes it really hard for the condition to be diagnosed.
[00:03:58] People tend to spend many years from the moment that they start developing the symptoms to the moment that they get the diagnosis. Okay. There is a huge delay between the onset of the symptoms and the final diagnosis of endometriosis, which makes it harder for the people that are struggling with the pain and all the symptoms that come out of it, and also makes it harder in terms of treatment because the earlier you know, that you have this, the earlier you can address all these conditions and reduce the inflammation and reduce the pain sensitization, which we'll be talking about. So it is important to get an early diagnosis, but unfortunately it's still seldom the case. It's even difficult for the healthcare practitioners to diagnose this early enough because people that have such a broad variety of symptoms will tend to go to many different specialists.
[00:04:49] If you started developing first the GI symptoms as we will be talking about, you might be visiting a GI doctor first. If you're having back pain, you might be visiting, you know, a specialist in back pain. It really depends on what kind of symptoms you start developing first. And they might spin into different symptoms. And if you really don't know that they are originating from this condition, you might spend a lot of time trying to find answers. And for the specialists themselves, it is also hard to figure out that this is coming from endometriosis. So that's why I believe so strongly in multidisciplinary, multimodal teams. That will be working together to figure out what is going on and passing information to each other.
[00:05:32] But it's still difficult to find this kind of teams nowadays, so you might be one of those people that still have such a variety of symptoms. So if you suffer from many different symptoms, it could range from back pain, to headaches, to period pains. And the pain itself could vary from tingling to sharp, for example, sharp abdominal pain.. It becomes more and more difficult to find answers. Because you don't necessarily know if they're connected to your reproductive organs or not. And since the symptoms change, the quality of the symptoms change, the intensity... you might take years searching for answers until you can finally get this diagnosis of endo.
[00:06:22] So it is important that we emphasize this need for multidisciplinary teams that are talking to each other. That are exchanging notes with each other. And also during the treatment, right? So that we can help people with this type of condition, not only endometriosis, but also as we talk a lot in the chronic pain aspects, and people tend to present this range of symptoms that range from psychological to physiological, nervous system, musculoskeletal, and digestive, of course, so many systems that get affected by It is important to have teams that address all the aspects of the symptoms and also of the quality of life of the patients. Okay. I know it's hard to find such teams nowadays, unfortunately. It is slowly changing, but it's still a progress. And as well, in terms of research, sadly endometriosis is still has no cure up to this day. Even though there are many more treatments, especially focused on this multimodal aspects that we are talking about, there's still no cure for the condition. There is more research being done. But it's still not enough. There, there are many more voices out there trying to bring awareness to the fact that more money needs to be invested in research for endometriosis. But the good news is that there is some progress being made in that direction. There is more research being done. So we really hope that for the next years is we're going to have more and more treatments that will be applied, for people suffering from this, but there is still a lot that you can do to reduce your symptoms and also to improve your quality of life. This is where the focus nowadays is in the treatments. Of course. As you can hear from this variety of symptoms, endometriosis has a huge impact on the quality of life of women suffering from it. So it ranges from psychological aspects such as depression and anxiety. There is the chronic pain side, as we just mentioned, but also fatigue. And in many cases, sadly, infertility. Difficulties for getting pregnant. And in some cases they can't get pregnant at all. Many people also have to have their organs removed. So it's a huge psychological impact for women. Of course.
[00:08:39] And this has to be addressed in the treatment itself, but today we are talking a little bit more about the gastrointestinal aspects of it. Okay. I will be for sure, doing deeper dives in other episodes towards these other aspects that we just mentioned. And the mental health especially.
[00:08:55] So it is important to have an early diagnosis. Because, especially in the terms of the chronic pain and the mental health impact, the earlier you can address that the better are your chances of improving fast. If you're hear this episode and you think you might have it, please start contacting your healthcare practitioners and say, look: I've read about it. Could it be that? What should I be doing to test for it?
[00:09:20] Okay. We won't be talking too much about diagnosis here today. But please seek help. If you think you might have endometriosis.
[00:09:31] One of the clues for some women, it shows up as intense period pains, back pain and also sometimes very intense blood flow during the periods. But it's not only that, those are not necessary for having endometriosis, many people have it and they don't display any symptoms at all. And people display, like I said, broad variety of symptoms. So, but those tend to show up a lot.
[00:09:56] Now let's focus on the GI aspects. The gastrointestinal symptoms that could be connected to endometriosis. Okay. So one of them, which is very famous is the so-called endo belly. These are people that suffer from so much bloating that it looks like they're pregnant. They keep being asked by people if they could be pregnant. Especially for people that already had babies because the skin in the abdominal region is a bit more elastic, with the bloating it becomes like really intense. But also for girls or women that have never been pregnant, they tend to have this huge bloating belly that can happen a lot, very often. They also tend to alternate between constipation and diarrhea. And many times this could also be connected with the menstrual cycle. And that leads to many of these people being misdiagnosed or simultaneously diagnosed with IBS. Because in IBS, we also have this display, many times of this dance between constipation and diarrhea. So what you could start paying attention to is whether your bowel movements, the change in your bowel movements are somehow connected to your menstrual cycle or not. You could take a diary and start paying attention to that. But not for all people this will be connected. Okay. Many people suffering from endo have symptoms that are not necessarily synchronized with their cycles, but this could be one of the warning signs.
[00:11:20] Also nausea to the point that people feel like they need to vomit, but just being nauseated. And this feeling of never really emptying the bowels. Sometimes you sit very long on the toilet and either it takes you very long to even get a bowel movement started at all. And once you do, it feels like you didn't really empty it. So you are still there waiting for more things to come out, but they don't really, so you get out, but you still have this discomfort in your belly feeling like, is there still something left in there. Those are the main gut symptoms that tend to show up for people with endo. It is interesting because there was a big study, an important study done, that showed that 90% of women with endometriosis displayed gastrointestinal symptoms, even though only seven or 8% of them had actually implants on their bowels. And what are those implants that we are talking about? So it's important to explain what endometriosis is in the first place, right?
[00:12:29] So endometrium is the lining of our uterus. When we have our periods, this lining sheds, and that's why we bleed. Usually. Unless you're on the pill or on some hormonal therapy. Then there might be other reasons for you to bleed, but normally in our bodies, in their natural flows, this lining of the uterus is created there for the baby. And when we don't get pregnant, this lining sheds, it comes out of our bodies as menstrual flow. In people that suffer from endometriosis, those cells that are part of this endometrium, they start growing in different places outside the uterus. So they are found in different locations. It can be many different places in your body. For some people they show up in the lungs area and the diaphragm, also in the gastrointestinal organs, like the gut. Or even the bladder region, so many different regions throughout the body. So those cells can start growing.
[00:13:30] And the thing is those cells, they tend to thicken and to expand just like they would do inside our uterus, depending on the hormones. But they are not meant to do that outside of the uterus. So what happens is this leads to inflammation in our bodies.
[00:13:50] So there are two aspects to it. On one side is the inflammation. And in the other side, is this thickening and expanding of the cells that can lead to pressure, to anatomical distortion of the walls of the organs, where they're attached to, or of the muscles or of the fascia. And this combination of inflammation and anatomical distortion can of course lead to pain.
[00:14:17] So there are two sides to it, right in one side is the inflammation. And the other side is this anatomical distortion of the regions close to the cells that are expanding and thickening.
[00:14:33] Like I mentioned just now. It could be that you don't have the cells growing in the gastrointestinal region. You don't have endo cells in there. And you still feel the GI symptoms, right? So this could be due to the inflammation itself. Or it could be due to the pain sensitization. So what happens in people that suffer from pain for a long time. It starts affecting how the nervous system is processing the pain. So we call this the central nervous system pain sensitization. Or just central sensitization for short. And I mentioned this in the previous episode, if you haven't listened to it, I think it makes sense to go back there and listen to that episode as well. Where I'm talking about, if you suffer from IBS, for example, how your nervous system changes the way that it detects the pain, how this feelings in the walls of your abdomen and your gut get more sensitized. So there are people reporting that they feel, for example, where their food is traveling in the digestive tract. There are people that feel a lot of pain when they're trying to pass a bowel movement. And people that just feel constantly this discomfort in the region of their gut, because they are feeling what is inside in there. So this doesn't mean necessarily that is the inflammation, but it could also be that you've been suffering from pain for a while. So your pain became chronic and it has affected the way that your nervous system processes the pain information. So your threshold for pain becomes lower, which means it takes less triggers for you to create a higher intensity of pain.
[00:16:16] It doesn't necessarily mean there is something very wrong in that region of your body, but your brain is interpreting those triggers or those stimuli as a lot of pain. And this plays an important role also for both chronic pain and endometriosis in general, because it's a cycle that we are trying to break. We are trying to tell our nervous system that there is no need to produce so much pain for what is happening there. It is really important to address the chronic pain aspect of endometriosis because of the central sensitization. I will be making another podcast episode only discussing the central sensitization, what it means, how this can impact your treatment, and how you can change your quality of life and feel much better and reverse this whole cycle by addressing also your mental health, and so on and so forth.
[00:17:09] The other aspect of it is the influence on the bowel motility. So because of both hormonal changes and maybe because of this endo cell growth in the GI region, or the inflammation or all this combined. Right? All those things combined, this could affect your bowel motility. How fast or how slow your bowels can move.
[00:17:33] The combination of your inflammation and the reduced bowel motility can increase our chances of developing something that we call SIBO, which is small intestine bacterial overgrowth. You probably have heard of it because it became very popular in the media in the last few years. A lot of people got misdiagnosed with SIBO and started taking a lot of antibiotics. So this is something you might want to check if you're feeling gas, bloating, abdominal pain, have a look with your doctor also with your GI doctor, not only, if could be IBS or endo, all of this, but also get tested for SIBO. There is a breath test that you can do that it tends to be quite accurate, that can help you detect that.
[00:18:20] So I hope you can start to see how this condition is so multifaceted. So complex. There are so many things involved, right? There is our nerves and our nervous system that can create the pain. There's the inflammation being caused by this growth of the cells, which are not supposed to be outside of the uterus. There is the side effects of everything that is going on there that can affect our gastrointestinal symptoms and create all this GI symptoms that we talked about. Bloating, diarrhea, constipation, nausea. There's for sure the mental aspect of it, the impact on our psychology, depression, anxiety. All the things that could be connected. You're not performing the way you would like to. The clients that I have that suffer from endo, this affects also their work productivity in such a strong way, because sometimes it's a whole week or even 10 days that they're not able to work or perform the way that they should, because of the pain and all the discomfort and all the other symptoms, but also they're not able to perform the way they would like to as a woman. As a mother, as a partner, as a friend. And this has also so many social aspects to it. So, how do we deconstruct all this complex conditions and symptoms and create a treatment that can address you as a whole body and as a whole person. Of course, first of all by looking at the connection between the mind and the body. So how you connect to this condition or to the symptoms, how you relate to them, can have a huge impact on how you're going to treat them.
[00:20:04] And I talked a lot about that in the first three episodes of our chronic pain series. For sure they also apply in here, right. How you can build your resilience, your self-efficacy and work on how you deal with your thoughts and emotions can head have had a huge impact on how you move forward to treat your endo.
[00:20:24] The other thing is because of those anatomical distortions that we mentioned, it becomes very important to work also on the body aspect of it. So doing physiotherapy is something that has shown huge benefits for people with endo. Working on the pelvic floor muscles in general. Yoga can also be a great therapy for people suffering from endo. Because you get not only the benefits of the muscle work, right, the release of the muscles and of the fascia, but you also get the benefits of the regulation of your nervous system. As well as through breathing techniques, as you can see, because it also can impact your self regulation.
[00:21:08] Another aspect that becomes very important then is to address your gut because we mentioned all these GI symptoms. So how can you balance your gut in terms of microbiome and bacteria, right. This for sure can be through nutrition. So in terms of endo, what is very important is, because we are talking about inflammation, right? Actual inflammation happened in the body. It is so important to reduce this inflammation there. And nutrition has such a powerful impact on that. So what are three things that you could start today? Without getting a very complex diet and start talking about a whole protocol here. What are three simple steps that you can take in your nutrition to start improving your inflammation. Number one is to reduce the consumption of highly processed foods. So if you eat a lot of packaged foods it's time to start paying a little bit more attention to it and start moving towards a more whole food approach using ingredients as they come from nature. If you can cook at home, that is even better.
[00:22:13] You don't have to be a chef or a super talented cook to make simple meals at home. You can create simple things. Salad bowls. Buddha bowls, you know, those things that people put a little bit
[00:22:27] grain, a little bit of dark greens, a little bit of cooked vegetables, protein. I think batch cooking is very helpful for people that are trying to move more towards a whole food approach.
[00:22:38] Because if your fridge is already all organized and has the food right in front of you, it becomes easier than having every day to come and think, what am I going to eat now? And then you're hungry and then you're tired. And then you have to come up with something. It's more difficult. So consider doing batch cooking. It could be something that could have a huge impact for you.
[00:22:59] And number two is reducing sugar. For sure, this has a huge impact on inflammation. And sometimes we consume a lot of sugar without even paying attention to it. Just by reducing the consumption of highly processed foods you will be automatically reducing our consumption of sugar as well. But then if you have this cravings, and this tend to happen a lot for people to have hormonal imbalances, try to figure out how you can replace those cravings by things that are more nutritious to you. For example, if you always reach for candy or for chocolate, try to see how you could try to eat more dark chocolate or nuts. Things like peanut butter and whole nuts. Or, you know, try to see what are actual natural foods that could still satisfy your cravings without being candy or highly processed foods.
[00:23:58] And then the number three tip that I would give in terms of nutrition would be to reduce dairy. If possible, completely eliminate dairy from your diet. Research has been showing more and more that there is really no benefit on consuming dairy at all. If you suffer from inflammation. Many people are lactose intolerant as well. You might not even know that you are. And the other thing is the way that factory farming is done in our society. Nowadays, the cows are pumped with so many hormones, right? They are artificially inseminated. They're constantly pregnant in order to produce milk. And those hormones are also in the milk. So definitely they're not going to help you with your hormone balancing situation. I know it's hard. If you're used to consuming a lot of it. So you can start in small steps or you can go cold turkey. That really depends on your type of personality. And what do you think would work better for you, but start paying attention more and more to how much dairy that you're consuming and how you can replace it. There are so many interesting alternative options nowadays in the market. Right? You can start with oat milk, nut milks. But if you're really trying to reduce the processed foods, try to see how you can replace them for something else completely. You can make homemade cashew sauces. And things like that.
[00:25:15] So that would be my first three initial tips in the side of nutrition. So we talked about using the mind body therapies, such as yoga, and breathing, mindfulness... We talked about physiotherapy as well to address the body side of it. We talked about a bit nutrition. And the last bit that I want to talk about is how we can address the mental health side of the condition, because since it has such a huge impact on your quality of life and your self worth and your self esteem. And all of that. it is important to apply some psychotherapy techniques as well in the treatment, if you can. Searching for a psychotherapy professional or a professional that can include some psychotherapy techniques in your treatment. It's very important to complete this whole person whole body approach. This multimodal approach to deal with your condition.
[00:26:11] There are many things that you can do by yourself. ? I know for some people that might be listening to this episode today, they might think, I can't afford to have so many professionals to take care of me or where I live right now there is no such a thing as a multidisciplinary team. And I don't even know where to start with all of that. I already know that I have this diagnosis, but I've been just given options regarding my hormonal therapies and whether I should do a surgery or not, but the healthcare professionals that are taking care of me haven't been discussing all these other aspects that you're mentioning there and how am I going to start now searching for a nutritionist or for mindfulness professional or a yoga teacher or all this things that you mentioned there. It sounds like a lot. I know what I want to tell you is okay, let's take a deep breath and take a step back and figure out what are things that you can do by yourself. I really believe in the power of educating people, using education, to empower people, to take care of their own health. This is what I'm here for. Right? I'm providing you all this information so that you can do a deeper dive yourself, search for more education and more tools on what you can do. Not just wait for people to create a treatment for you or to tell you what to do or keep seeking more professionals, but also what you can start taking as small steps in your day life right now. For sure there is a lot of free resources out there that you can do in terms of yoga and mindfulness and breathing techniques.
[00:27:46] There is a lot of resources in terms of chronic pain as well. Many professionals out there putting interesting free content that you can tap on. And I'm here. Of course, if you want to work together with me, we can do this on a one-on-one basis where you get all my time and dedication to you where I'll guide you step-by-step. But also I am creating a course. I've mentioned that in the previous episode, which will be using these connections between the gut and the brain and the body. And this can have a huge impact, especially if you suffer from gastrointestinal symptoms. Those that we mentioned here in the episode today, Solving those can already have such a huge impact in your quality of life. Right? So get in touch with me, if you would like to learn more.
[00:28:32] For all of you women out there and or partners that would like to learn more to help the women in their lives or health professionals. I hope this episode has helped you with think a little bit more about aspects of either chronic pain or GI symptoms that could be connected to endometriosis or to our reproductive organs. And how this should have a special focus and attention for, especially for women, or people leaving in female bodies. How we can help them figure out, first of all, if they need to seek this diagnosis. If they could have this condition. And how we can help them seek ways to treat this using a multimodal approach. To cover all these different aspects of the condition.
[00:29:22] Understanding the connections between. Our mental health. Our digestive health. Inflammation. Our reproductive health, right? All, all these connections and the different impacts that they could have in terms of symptoms. It's so important. It's so complex and for sure, the medical community at this point regarding endo has more questions than answers, but we are navigating this together.
[00:29:50] It's so important to educate. Spread more information, seek community. And specially seek tools that he can use in your own life that fit your lifestyle, that fit your values. And keep your mental health always at the forefront. You're not going to be able to take care of yourself if you're not taking care of your mind, of your mental health.
[00:30:13] If this episode has resonated with you and you think you might have endo or you display many of those symptoms that we mentioned here. Seek help. Mention this to your health professionals. And let them guide you and help you find a way to get the proper diagnosis. But also don't just stop there. But really seek ways to treat your body as a whole. If you haven't engaged in any sort of physiotherapy, yoga or physical activity, start considering how you could do more of that, also using free resources, if you can't afford that. Mainly just try and stay positive because honestly, people that had this condition 20 years ago didn't have the resources that we have now. We've come a long way, especially on understanding all these different connections.
[00:31:04] So I would like to end this episode on a positive note, right? Because even though it's hard to hear all these facts about how endometriosis can affect your life. And how are we still have to go a long way in terms of research and treatment and diagnosis. Of course, this is all not great to hear, but the truth is, we've come a long way already. And the fact that we have all this understanding and all these different connections, especially in terms of chronic pain, we have all this new understanding on their relation with the nervous system, in terms of the gut, how we've come all this way in understanding how the microbiome affects our health and even our mental health and how we understand now, all these connections between those and endometriosis means that there is only much more to come.
[00:31:49] That there'll be more research being done. And for sure these will reflect in the treatments that will be available, but for now, what we know is that there is so much you can do in terms of treating your health as a whole, really in an integrative form and just improve yourself in all aspects so that you can leave a happy and fruitful life. And I really hope this helps you to focus not only on the disease and not only own this really minimalist sides of how you can fix it or repair it, but also that it can expand your mindset towards how can I focus on the other aspects of myself. Of my health, of my wellbeing, of my mental health, so that I can thrive and be happy. And then as a consequence, this will reduce the stress, this will reduce the inflammation. This will reduce the symptoms. And I might still have a wonderful life, right. Instead of really being focused on only the negative side of it.
[00:32:45] So I'm here. And I hope this episode has helped you think about the broader aspects of endo and the connections between the gut, the brain and our reproductive organs and the side for female health.
[00:32:58] Take care of yourselves. Stay well. Bye.