Episode 366: Endometriosis 101: Why Gut Health, Histamines, and Toxins Matter
Listen on Apple Podcasts | Listen on Spotify
If you've ever been told that endometriosis is “just a hormonal issue”, this episode will challenge everything you thought you knew. Endo is not a simple diagnosis - it’s a whole body inflammatory disease, and conventional approaches often miss key contributors like gut dysbiosis, immune dysfunction, and histamine intolerance. Through powerful client case studies, Erin highlights how a root cause lens can bring real relief where protocols alone fall short.
You’ll learn how functional testing like stool analysis, SIBO breath tests, and even mold and toxin panels can uncover what's really going on beneath your symptoms. Whether you’ve been living with endo symptoms for years or are just starting your healing journey, this episode will help you reclaim your health.
In this episode:
Why up to 90% of people with endo ALSO struggle with irritable bowel symptoms
How LPS-producing bacteria and gut imbalances can drive immune dysfunction in endometriosis
The connection between estrogen, histamine, and mast cell activation (and why it matters for symptom relief)
What high beta-glucuronidase on a stool test could tell you about hormone detox pathways
When it’s time to look beyond gut and hormone tests and look to mold, toxins, and deeper functional markers
Resources mentioned:
1:1 Functional C.A.R.E with Erin & her team
Organifi supplement powder (save 20% on your order with code FUNK)
LMNT Electrolyte Replenishing powder (Use code FUNK and get a free sample pack with any purchase!)
Qualia Senolytic (get up to 50% off and an extra 15% off your first purchase with link + code FUNKS)
Bon Charge (Use code FUNK to save 15%)
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Endo is really a whole body inflammatory disease. There is immune dysfunction associated with endometriosis. Whether or not endo should be considered an autoimmune disease itself is pretty controversial. We know that there's a lot of inflammation and we know that there's some immune involvement in endometriosis. And because of that, there's multiple factors that can contribute to the overarching immune dysregulation and inflammation that is associated with endometriosis.
Welcome to the Funk'tional Nutrition podcast, spelled with a K, because we do things a little differently around here. I'm your host, Erin Holt, and I've got 15 years of clinical experience as a functional nutritionist and mindset coach creating a new model that I call Intuitive Functional mMedicine where we combine root cause medicine with the innate intelligence of your body. This is where science meets self trust. Your body already knows how to heal and this show is going to show you how to. If you're looking for new ways of thinking about your health, be sure to follow and share with a friend because you never know whose life you might change.
Hello out there. I hope everyone has enjoyed your June so far. I'm gearing up, getting ready to head up to the lake for a good chunk of the summer. So I am getting ahead of all the podcast content. So I don't leave you with a big gap, you know, an entire summer without podcasting. I don't think so. So I've got good stuff coming your way.
Today is really focus on endometriosis.
A recent conversation with a friend about endometriosis really inspired me to create this episode. We were talking about stuff more from a marketing perspective, talking about complex cases and I was explaining to her how we often work with people who have struggled for a long time, probably years with symptoms, have worked with multiple practitioners by the time they get to us., but I was saying that I don't necessarily want that to be the most prominent forward facing marketing, like, hey, are you a total mess? We can help.
Like, not everybody sees themselves as a complex case. And she was like, yeah, totally, that would leave me out because I just have endometriosis. That's my only diagnosis. That's all I have. So I'm not a complex case. And it was so funny to me because as a practitioner, I view endometriosis as one of the more complex conditions because there's a lot of moving parts, a lot of contributing factors (which we'll talk about in a second) but her viewpoint, not being a practitioner, just a human being with a body saw it as very straightforward, like, oh, one diagnosis, easy, right? I only have this one thing.
And so today I wanted to talk about endometriosis because it's definitely something that we see a lot in practice. And in case you are someone who has received this diagnosis, I want you to know, especially if you've been working from more of a conventional standpoint, I want you to know what we would do from a functional standpoint.
This person that I was talking to said, I've learned more about endometriosis from your podcast and talking to another friend with endometriosis than I did from my own doctor. So the education isn't necessarily getting out there in a way that it probably should be from a conventional standpoint. And I really think that endometriosis is one of those conditions where a functional root cause approach and a conventional approach, conventional medicine can blend really well together. Like I said, we work with a lot of people with endometriosis. Endometriosis is a condition in which tissue that is similar to endometrial tissue grows outside of the uterus. And so that can cause a lot of pain and other symptoms, most notably pelvic pain, painful periods, sometimes pain during or after sex, pain when you're going to the bathroom.
And when I'm talking about period pain, it's not like, oh, I have some cramps. This is like debilitating in bed for several days, if not weeks. We've worked with a client who two weeks out of the entire month, she just felt laid out because her period pain was so bad. So this isn't a situation where it's like, suck it up, buttercup. When I'm talking about pain, I am talking about extraordinary extreme pain. And this pain, these symptoms can sometimes be improved by surgery, excision surgery, which removes lesions, tissue growths. And sometimes people need the surgery to remove those lesions. And if they do, this is not a moral failing on their part. This is not a failure on their body's behalf either.
This is where the two philosophies can merge together really well, where we can use effective conventional strategies and also look for root cause drivers using a functional lens. So let's get a little bit more into the nitty gritty of endometriosis.
Endo is really a whole body inflammatory disease. There is immune dysfunction associated with endometriosis. Whether or not endo should be considered an autoimmune disease itself is pretty controversial. Lara Bryden has talked a lot about this, and she's kind of like I'm not touching that with a ten foot pole but what I will say is that it looks and behaves very much like an autoimmune disease. We know that there's a lot of inflammation and we know that there's some immune involvement in endometriosis.
And because of that, there's multiple factors that can contribute to the overarching immune dysregulation and inflammation that is associated with endometriosis. So like I always say here in our practice, we go inflammation hunting and endo is definitely one of those scenarios where we would have to go inflammation hunting.
So I want to give you some real examples of what we do in practice so that you can think about options for yourself if you do have an endometriosis diagnosis and you are feeling symptomatic. So I actually met with my clinical team and I'm like, hey, I'm going to do a podcast on endometriosis, what are the biggest things that you would want people to know in terms of what you would be looking for if somebody came to you with Endo?
We put together these six:
Gut health
lps
Gluten sensitivit
Immune system dysfunction
Toxicity
Histamines
Now, this is based on endometriosis research, but also what we're seeing play out in our real life clinical practice as well.
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So I want to speak into the histamine thing a little bit because sometimes when somebody's coming to us with an endometriosis diagnosis, or even just suspicion of endo, they'll also have histamine reactions and histamine symptoms. And there's this connection. I've talked about it on the show before but bears repeating in this episode. There's this connection between estrogen, histamine and mast cells. So we do see mast cell activation with endometriosis. They can play a role in this condition, which is why use of mast cell stabilizers and inhibitors can sometimes be effective to reduce symptoms and endometriosis. So that might be something that we have to consider again, especially if somebody has a lot of histamine type symptoms. But where we start to go inflammation hunting really depends on your intake appointment.
You come to us and we have a full blown conversation with you after a full blown health history. In during that health history, you may be submitting labs that you already have. You're talking about things that you've already tried. What has gotten you feeling better, what has gotten you feeling worse, like the whole nine yards. We need a full debrief on you before we decide next step. So it's not like you come to us and we're like, oh, these are the four labs that we always start with, with every single endometriosis client. That's just not the way that we operate. It's not the way that we practice
But what I will say is that like 9 times out of 10 we are starting with the gut. And that's because gut health and endometriosis are highly correlated. Up to 90% of endo patients have an irritable bowel. And this gut/Endo connection can work both ways. So if you have a lot of lesions, adhesions, tissue growth that can affect the bowel because it's all in the same region. And this can lead to things like small intestinal bacterial overgrowth growth, SIBO, but then we can also see issues in the gut drive and worsen endometriosis.
So one of the gut drivers of endo is this bacterial contamination hypothesis of endometriosis. Where there is a high prevalence of gram negative bacteria. So this is a type of bacteria that has LPS lipopolysaccharides on its structure. And so there's a high prevalence of that bacteria and this LPS component in the pelvis of women with endometriosis. LPS - I've talked about this a bunch in the show, extremely inflammatory, particularly when it's in a place that it shouldn't be. And so LPS levels were 6x higher in the pelvis of women with endo versus without. So this could be an initiating factor in the immune dysfunction of endometriosis, but also the big inflammatory response.
What's interesting, just today, just today, right before I recorded the show, I was looking at a recent gut panel from a client who was doing the gut panel because she had very clear digestive issues and digestive symptoms. But she also had an endometriosis diagnosis. And right away we found E. Coli in Prevotella. Both of these are gram negative bacteria that do contain LPS. And so this could be one of the big inflammatory drivers of her condition. So we do like to see a stool test on our endo clients for that. So this hypothesis was first proposed back in 2018.
And then there is a newer paper that also links bacteria to endometriosis, but through a different mechanism. So what we know, there are at least two different mechanisms where the microbiome, the gut bacteria, can play a role in endometriosis. So important to get that information. So we'll run a stool test. We also might like to see, again, depending on the intake appointment, a test called the Wheat Zoomer. So the Wheat Zoomer is looking at leaky gut, it's looking at LPS, we can actually see LPS on that test, which is pretty important for endometriosis, as I just noted. But it's also showing whether the person is sensitive, reactive to gluten, or even has celiac disease.
Now, a gluten free diet can improve symptoms in some endometriosis clients. And there can be immune reactivity that is causing immune reactivity. So it could be something to try. If you don't want to run the labs, you could always just trial a gluten free diet as a strategy to manage painful endometriosis symptoms. But we know that what we're eating can increase our inflammatory load. And so if you are sensitive to gluten, that is something that you would want to figure out. So I like the Wheat Zoomer again, because we're not just looking at gluten, we're also looking at leaky gut, intestinal permeability, and we're looking at that LPS as well. And then potentially considering a SIBO breath test, particularly if symptoms are consistent with SIBO, More of the bloating picture.
So those are gut tests that we might want to run on an endometriosis client to get us that information to say what is going on in your gut could be contributing to your endosymptoms and your endo flareups. So I'll use a real world client as an example, somebody who did come to us with endometriosis. So she had very painful periods. She also had constipation. And that's a important note, is that oftentimes endometriosis clients will present with GI issues and digestive problems as well. Really, really common. And so on her stool test, we found low keystone bacteria so these are the beneficial bacteria that essentially build up our immune system. They make our guts healthy and strong to prevent that leaky gut, and they help to keep inflammation down in the the gut, but also outside of the gut throughout the whole body. So the good guys were low. There were elevated inflammatory bacteria. So we talked about why that's a problem. There was also elevated candida. So she also had a fungal overgrowth in addition to the bacterial overgrowth, and then very, very high beta glucuronidase. So this is something that is not uncommon to see with endometriosis client.
Now, I haven't talked about hormones yet, but we can see hormonal dysfunction with endometriosis. But it's just important to understand that it's not primarily a hormonal problem. And sometimes it can be a little bit misconstrued. A good way to think about it. The way I think about it, endometriosis is affected by hormones, namely estrogen, but it's not caused by hormones. And I think that there's some misunderstanding about that because the standard conventional treatment is to switch estrogen off, basically. And that is because estrogen can worsen endometriosis symptoms and can exacerbate a lot of the stuff going on with endometriosis.
So when we're doing a functional medicine deep dive, we're keeping all of this in mind. And we might be looking at estrogen levels, but we're also looking at how the body is clearing estrogen out. And the body does this in three different phases. So we have phase one and two detoxification, or hepatic biotransformation that happens in the liver. And then we have phase three, which is happening in the gut. And so based on her stool test, we could see that her phase three was not operating great because that beta glucuronidase enzyme was elevated. That is an enzyme that helps the body clear out a lot of different toxins, but also estrogen. So we can see that her detox pathway there not so great and she's not clearing estrogen out.
We did actually pull a DUTCH hormone test on this particular client. And what's interesting is that her estrogen levels were not high. But we can look at that phase one and phase two happening in the liver and she showed poor clearance down both of those.
So in phase one, she was moving her estrogen down the more proliferative pathway, which is not good for a situation like endometriosis. And then phase two showed poor methylation. And so basically what her lab showed us is that phase one, phase two and phase three were all clogged up. And so we really had to support her in that. So we had to do some GI restoration, some gut work, but then also clearance work to support her detoxification pathway. So obviously in this scenario, having that DUTCH hormone test online was very helpful.
It isn't a lab that we run on all of our endo clients. Some women with endo, we run a DUTCH test, it's totally fine. Obviously, in this case, it was great that we saw it because hers was not totally fine. And that really gave us clinical insight into how we needed to support her as a unique individual. And then sometimes we have to do an even deeper dive than just gut or hormones.
So I'm going to share what that might look like, clinically speaking. I actually just did a riff on Instagram on this because what I'm seeing now, so definitely more than ever, is that the wellness industry and the social media wellness culture might have you feeling that that symptom resolution is just like a supplement away or just a 30 day protocol away. So people come to us being like, what do you mean you can't get me totally better in 30 days.
There's like this false expectation of what true healing and a true healing timeline might actually look like. I've been doing this work for close to 15 years now. It's always been my goal to lead with honesty and transparency. If you listen to the show for a minute, you probably have picked that up by now. I'm very honest. I'm very transparent. Transparency is a core value of my entire company. And what I want to tell you is that most likely, if you've been dealing with a complex multifactorial issue and you've been dealing with symptoms for years, there's probably not a 30 day or six week protocol out there that's going to get you all the way to, well, like true symptom resolution long term.
And part of that is because protocols might shift and change while you work with us. It's not just like a plug and play template for everybody, like, oh, you have endometriosis, we're going to put you on these six supplements. Done. That's not really the work that we do because it's not the work that actually works. And that's kind of the benefit of working with us. We can evaluate in real time is this working and if not, why? And sometimes it's because we need more information.
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And so these are a couple of cases where we needed more information. So I'll explain what I mean by that. This one was actually adenomyosis, so not endometriosis. Adenomyosis and endo are conditions that can be similar because they both involve endometrial tissue, but they differ in location. So adenomyosis involves the tissue growing within the muscle wall of the uterus, while endo involves endo tissue growing outside the uterus, but they can cause similar symptoms, pain, heavy bleeding, and even fertility issues.
So again, adenomyosis is not endometriosis. But the treatment overlaps can be similar or there could be overlap in the treatment protocols and how we go about inflammation hunting. So we did run a stool test on her that showed dysbiosis, not terribly shocking. We also ran an OAT test, an organic acid test that showed elevations of fungal overgrowth in Candida. So again, we had fungal overgrowth, we had bacterial overgrowth. And addressing these two things, we did get her some improvement. So her mid cycle discomfort improved, her energy improved, she had a very long cycle and that started to improve and to shorten, but it wasn't. We didn't get her all the way to where we wanted to.
So that's when we start scratching our heads as the practitioner and try to figure out what else could be going on here. So what we did was ran a tox panel on her and that was the deeper dive. Like this isn't adding up what else could be going on. Let's screen her for potential toxicant overload because we know that toxin exposure can contribute to immune dysfunction, immune dysregulation, hormone imbalance and inflammation. And what we found on that was clinically significant. So that is the area that we moved forward with addressing.
Now, another client where we had to do a deeper dive, but a different type of deeper dive. This person came to us with suspected endo. She didn't have the official diagnosis yet, but suspected it due to debilitating periods. She also had severe exercise intolerance in extreme pain during her luteal phase. And she was one of those people that presented with a lot of histamine issues. Issues as well. So ran a stool test because, like I said, that's really where we start with most of our endo clients. There was a lot of clinically significant overgrowths. There was also that elevated beta glucuronidase that we already talked about. So some common patterns that we might see with endo client noticed some improvement by addressing these things, but again, not all the way to well, so that's where we come back to the drawing board and say, what else could be going on here?
This particular client noticed that her symptoms got worse when she moved into to her home. And this can be a clinical clue that there might be some type of exposure that she's getting in the home. So tested her for mold and came back clinically relevant. She had her home remediated and was feeling so much better. So we had to do a deeper dive, saying, like, why isn't the protocol protocoling, you know, like, we expect this to happen. When that doesn't happen, we have to do a bit of a deeper dive. And sometimes addressing these complex conditions where there's a lot of moving parts in different contributing factors, it's not always as simple as fixing a stool test and then they ride off into the sunset. Sometimes it is, but sometimes we just need more clinical data.
Now, with all of that said, I do want to say one last thing here before we close out, because we just talked about a lot of different things that could be happening in your body. Body. And I want you to be aware and mindful of the fact that the no-cebo effect is real. And we see that kind of a lot in the functional medicine space, Especially if you are somebody who consumes a lot of health information, a lot of functional medicine information. You follow a lot of accounts on social media, you listen to all the podcasts, and you can hear all of these different things that could be going wrong in your body. And so sometimes clients will come to us and be like, I think I have this. I think I have this, this, this, and this. And so sometimes part of our work is actually talking people down to reduce the fear in them.
I'm thinking of a client right now who came to us convinced she had mold issues. Just convinced she had mold issues. And we ran the labs and she didn't. In fact, what she had was rip roaring gut issues. And so we actually just had to rehabilitate and restore the gut and mold wasn't the problem at all.
And that's where working with a really skilled practitioner comes in so handy. Because if you're telling yourself you have all these issues based on what you've seen and based on the fact that you have a lot of symptoms and you're trying to explain them, what we can do is actually look at the data and be like, this is what's driving your symptoms.
These are what your issues actually are. And then of course, like I started the show on the flip side of that somebody might just think that they have just one thing thing like just endometriosis because it's just one diagnosis when it's really a constellation of other issues. And we have to figure out what those other issues are and help you assess that and then also resolve that as well. So our goal is really to help you understand your body and what your body needs and what makes your body tick. That is important. We don't want people to walk away from us with more questions than answers. We want people to walk away from us not only with symptom resolution, but true health resolution, meaning that you trust yourself more when you're done working with us you feel more connected to yourself and like you can trust your body and you know what you're doing and you know how to support your body to feel good.
That is always my hope and my intention and my goal of the clients when they are done working with our team. So if that's you, don't hesitate to reach out and see if we can help you. You can fill out the application, I'll link it up in the show notes and be sure to send this episode to a friend or a family member or a coworker who has talked about endometriosis or even just painful periods in the past. Send them this so they can learn a little bit more about their potential condition and know some other alternatives to get well if they are not feeling well right now. Okay, I hope this is helpful. I love you guys and I will be back soon.
Thanks for joining me for this episode of the Funk'tional Nutrition Podcast. Please keep in mind this podcast is created for educational purposes only and should never be used as a replacement for medical diagnosis or treatment. If you got something from today's show, don't forget, subscribe, leave a review, share with a friend and keep coming back for more. Take care of you.