Episode 428: Endo Uncovered Part 3: You’re Newly Diagnosed With Endometriosis - Now What?
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You finally got the endometriosis diagnosis. Now what do you actually do after years of pain, dismissal, weird symptoms, confusing imaging, surgery, or being told everything looked “normal”?
While a diagnosis can feel validating, it can also bring a whole new wave of fear, especially around fertility, surgery, symptom management, and whether this condition is going to define the rest of your life.
In part 3 of the endo series, Erin and Rachel walk through the labs, nutrition, lifestyle shifts, gut support, hormone testing, nervous system work, and supplements they think about when supporting clients with endometriosis. Rachel also talks about excision surgery and why you still need a whole body approach.
In this episode:
The two biggest questions Rachel hears after diagnosis: “Can I still have kids?” and “How do I manage this?”
Why Rachel considers the DUTCH test a necessity for endometriosis, especially for hormone metabolism
Why broccoli sprouts are the little overachievers of cruciferous vegetables
How emotional suppression, people-pleasing, over-functioning, trauma history, and chronic stress can amplify symptom expression
The supplement Rachel used after excision surgery that helped with her post-op period pain
Resources mentioned:
Manifest Your Health is the neuroscience-backed membership that helps you regulate your nervous system, integrate the parts of you that keep you stuck, and become the version of yourself your body can actually heal as.
Episode 425: FNA Case Study: Stage Four Endometriosis, 8 Years of Infertility & a Natural Pregnancy
Apply for 1:1 Endometriosis Support here if you’re navigating painful periods, suspected or diagnosed endometriosis, gut symptoms, hormone issues, or inflammation.
Order The Gut Panel to uncover the hidden root causes behind your “mystery” symptoms.
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Rachel Heintz:
Surgery can absolutely remove those endometriosis lesions, but it can't rebalance your microbiome. It can't support hormone metabolism. It can't address systemic inflammation, normalize immune system dysfunction, or support the nervous system. So while you can remove the tissue, if the underlying inflammation or immune system dysfunction isn't addressed, the disease absolutely can grow back. And Again, we're thinking about it as a whole body condition, so your treatment should take a whole body approach. The good news is that there's so much you can do with your nutrition, your lifestyle, your lab testing, supplements to support yourself too.
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 Medicine™, 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. 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.
Erin Holt:
Hi friends, welcome back to our endometriosis series. This is part 3. And so just as a reminder and a recap, especially if you're new here, in part 1, we talked about when to suspect endometriosis. Endometriosis, what signs and symptoms to be looking for. We talked about painful periods and what differentiates endometriosis from painful periods, even though there can be some overlap. We talked about what's normal and what's not normal for your period. So even if you don't suspect endometriosis, part 1 is still a really good episode and a good listen for you if you struggle with any type of cycle irregularities or difficulties with your period. And then in part 2, Rachel, who is our lead practitioner here at The Functional Nutritionist, she shared her whole story with endo, including her own health struggles, her period issues, her history with birth control use, her functional medicine approaches, and all of the things that led up to her endometriosis diagnosis and her recent surgery.
And the reason that she really wanted to share that is because we know that listening to other people's stories and listening to her story can unlock some parts of your own or some clues to your own puzzle. When we hear other people talk about their experience, it just really helps us to reflect on our own experience. And that can elicit some lightbulb moments, some aha moments for ourselves, and really give you other opportunities and options to explore, especially if you feel like you're kind of at your wit's end with your health. So just be sure to go back and listen to episode 1 and 2 in our endo series. In today's episode, we are talking to anyone who has been recently diagnosed with endometriosis. So if you've got the diagnosis, and now you're like, okay, now what do I do? This one is for you. And Rachel is back here with me to talk through it all with us.
Rachel Heintz:
I'm excited to be here. And if you're one of the many women who did not get an endo diagnosis until after laparoscopic surgery confirmed it, this episode is for you. Excision surgery really is the gold standard way to diagnose endo. And it— what it means is that a lot of women spend years being dismissed, misdiagnosed, or being told that their pain is normal before they finally do get an answer. And today we're chatting about What actually happens after you get that diagnosis, because that diagnosis, while it can be a relief and it can feel really validating, it can also bring a wave of fear. And in practice, 2 of the biggest concerns we hear are, can I still have kids? And how do I manage this? And today we're gonna chat through what you can do once you do have that endo diagnosis, because endometriosis won't define you, but it will change you and your health trajectory as well. Your path to motherhood might not look the way that you imagined, but that doesn't mean that it isn't possible.
Erin Holt:
Yeah. And before we like tuck and roll into the whole conversation today, I do want to take a moment to say that the reason that we're sharing this whole series is not just to provide you with education and resources and options, but also hope. When we hear things about endometriosis, like Rachel says, it can feel really scary, it can feel overwhelming, and it can induce fear. And with endo, like autoimmunity, which I've talked about a ton on this show, there technically is no cure. And so as soon as somebody hears that, it can feel like solutions and hope are taken off the table for them. And I say this as somebody who was diagnosed with a pretty scary autoimmune condition 10 years ago. I kept hearing that there's no cure for autoimmunity. So I really understand how frightening that can feel when you hear it.
But with my whole journey with functional medicine, with my career with intuitive functional medicine, which is the way that we practice and teach here, what I can tell you is that that's not the whole truth. So sure, we can say that there's no cure right now for autoimmunity, for endometriosis, But it isn't the whole truth. There is absolutely ways to reestablish or restabilize an unstable or a dysfunctional immune system. There's ways to halt the progression of a condition. There's ways to reverse and completely eliminate symptoms, which has been my experience with autoimmunity. And there's even ways to reverse an autoimmune process. And I know that this is possible because I've seen it with my own lived experience. But we also see this play out in practice A lot.
So once we understand— and I'm talking about any inflammatory chronic condition, endometriosis, autoimmunity, or something else— but once we understand the drivers of immune system dysregulation, once we understand the drivers of nervous system dysregulation, once we understand the drivers of unchecked inflammation, we can make really specific targeted changes to address and even reverse those things. And that can have really positive, powerful effects on your body and on the condition itself. I also want to highlight that before we started this endometriosis series, in episode 425, I interviewed Alyssa Chavez, who's an FNA grad, but she's also somebody who has stage 4 endometriosis like Rachel. And Alyssa struggled to conceive for years and ended up conceiving naturally through her lifestyle changes and through functional medicine modalities. So hope is possible. We are absolutely putting that on the table for you. In this series, we want to be honest with you. We want to be truthful with you.
We want to give you the facts, but not in a way that pulls hope off the table for you, because that's just not the way that we see it. So Rachel, we left off last week talking about your excision surgery. So why don't we start there?
Rachel Heintz:
So excision surgery is powerful, but it isn't a cure for endometriosis. Like you said about autoimmunity, there technically is no cure for endometriosis. But we know there's a lot we can do. Excision surgery—it's the gold standard for removing the disease. It can help to significantly reduce pain. It can restore anatomy, and it can also really help with fertility. But surgery doesn't address why endometriosis grew in the first place. When we think about causes of endo, genetics account for about 50% of the risk of developing it.
The other 50% of the time, environmental and lifestyle triggers can absolutely be driving that endometriosis. And we've said this before, endometriosis is a whole-body inflammatory condition. We know that it's driven by immune system dysregulation, and this is why women with endo oftentimes have symptoms throughout their bodies. We know that having endo triples your risk of having IBS. Women with endo have an increased risk of cardiovascular disease, and then having endo also increases your risk of lupus, RA, Sjögren's, There's an association between endo and celiac disease, and this connection between endo and autoimmunity, I think, really just speaks into the immune system dysregulation that drives this condition overall. Surgery can absolutely remove those endometriosis lesions, but it can't rebalance your microbiome. It can't support hormone metabolism. It can't address systemic inflammation, normalize immune system dysfunction, or support the nervous system.
So while you can remove the tissue, if the underlying inflammation or immune system dysfunction isn't addressed, the disease absolutely can grow back. And again, we're thinking about it as a whole body condition, so your treatment should take a whole body approach. The good news is that there's so much you can do with your nutrition, your lifestyle, your lab testing, supplements to support yourself too.
Erin Holt:
I mean, if you have been listening to this series all along, I think it's really clear that Rachel and myself, our practice really takes a both-and approach. So you can do these things and have surgery. We really want to put all options on the table for you. And if you listen to Rachel's story, you know that that is exactly how she approached this herself in her own body. Not everybody goes the route of surgery. Some people are completely fine just with lifestyle and some of the approaches that we're going to talk about. I think Alyssa is a great example of that. She is not somebody that has had to have surgery.
But I think in the world of functional medicine, in the world of holistic health, there's this idea that surgery is somehow failing. And that is absolutely not true. That is not the case. And it's not the way that we see things. So we're really taking an and both approach. But even if you get the surgery, it doesn't mean that you discount all of these things.
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Erin Holt:
So let's really drill into some of the specifics for our listeners. Like Rachel says, we take a whole body approach with our clients. This is a whole body condition, so it requires a whole body approach. And it's important to note that we treat every single person individually with a true root cause approach. We're not treating the condition. So like, it's not saying, oh, you have endo, oh, you have this diagnosis, okay, this is what we're going to do. We're really approaching the individual in question. So no 2 approaches to endometriosis are going to look exactly the same.
So I just want to preframe this conversation with that. But having said that, there's inevitably going to be some overlap in what we're looking at and addressing with endo. So Rachel, how are you looking at endometriosis clients when they come to you? And how are you addressing them?
Rachel Heintz:
So we of course start with a really comprehensive intake form, health history, and an intake appointment. This is really going to drive and influence what labs we're going to start running on them. It's not the same labs for every single endometriosis patient that we see. However, there is a lot of overlap because there's a lot of different organ systems that can be affected by endometriosis. So labs that we might be considering after someone's received an endometriosis diagnosis. And I want to clarify, we're not recommending that you're running these labs 2 weeks post-op or 4 weeks post-op. Surgery can stir up a lot of inflammation. And so I'm coming up on 3 months post-op.
I'm planning on running some of these blood work markers on myself. Speaking of blood work, so some of the markers that I would want to pay special attention to would be looking at hs-CRP, high sensitivity C-reactive protein, to act as a marker of inflammation, but this is a marker of inflammation that's specific to blood vessels because endogals, we just have a higher risk of cardiovascular disease. I'm also wanting to monitor ANA or antinuclear antibodies because this is going to give us kind of a touchpoint on what's going on with autoimmune activity in the body. This marker can go positive for up to 5 years before an autoimmune diagnosis is made, so it's great to monitor this Often, I should say, like not sooner than every like 6 months or so. Once or twice a year is perfectly fine. And then glucose control is a biggie really for any hormone condition because it affects your entire endocrine system. But I'm wanting to look at glucose, insulin, and A1C because high levels of insulin or poor glucose control can absolutely influence testosterone levels and estrogen levels in our bodies. We know that high levels of insulin upregulate this enzyme called aromatase, and this enzyme is going to take that testosterone that we have in our bodies and convert it into estrogen.
And endometriosis is an estrogen-driven or estrogen-dependent condition. We also know that high levels of insulin increase this enzyme that increases prostaglandins, and high levels of prostaglandins are associated with more pain, more inflammation, and then also abnormal tissue growth as well. That, that's a diggie. With endometriosis. Some of the other panels that I like to take a look at would be white blood cell. This is like part of a regular CBC. Consistently low levels of white blood cells absolutely can suggest chronic immune system suppression. I've seen this a decent amount in some of the endo patients that I've worked with.
And, you know, again, we know endo affects the entire body. And then an iron panel that includes ferritin is definitely something I want to check in on. We want to rule out anemia. We also want to make sure that ferritin isn't too high because High ferritin can also be related to inflammation in the body.
Erin Holt:
Do you find that a lot of endo patients, clients that have heavy bleeds tend to be low in iron when you're running these panels?
Rachel Heintz:
It's like 50/50. Honestly, I wish I could say that we're all anemic and it's a trend that we see, but not necessarily. Sometimes we can see the pattern. It's called anemia of chronic disease, where you'll have low iron markers in the blood, but then ferritin is really high. So you really wanna take a comprehensive approach when you're evaluating that iron panel. But yeah, it's really 50/50 when it comes to the iron and blood loss too. And then finally, this is optional. All of these technically are optional.
AMH is anti-Müllerian hormone. I never say it correctly, but AMH can help you to assess your ovarian reserve. This can be a very empowering marker if you are not sure where you're at in your fertility journey. If you're not sure if you want to have kids, or if you're like, I want to have kids, but I'm not sure if I want to have them now or if I want to wait 4 years. If you have a lower AMH, this may suggest that you have lower ovarian reserve, you have less eggs to ovulate, you might be better off trying to get pregnant sooner rather than waiting later on down the line. This is especially important to consider if you were found to have an endometrioma, which is basically endometriosis on your ovary, because endometriomas are linked to a reduced ovarian reserve as well.
Erin Holt:
So this is all bloodwork that you can get just like by, you know, getting bloodwork. These aren't like fancy functional labs. I appreciate the emphasis on insulin, because I think a lot of people when they think about endometriosis, they start thinking about hormones, which isn't wrong, and definitely something you'd want to consider. But when I'm thinking about hormones, I always put insulin and blood sugar signaling kind of at the top of that hormone hierarchy, Because insulin, high insulin can really impact sex hormones, to your point. So thank you for sharing that. And then I think we touched on this last week or the week before, but we know that we want to look at the gut too. I think we both consider this a non-negotiable for endometriosis. And I just want to say, because I know Rachel will talk a little bit about a stool test, but this is one of the reasons that we do offer the gut panel.
It's the only lab that we offer à la carte. We just really want people to have this data, even if you're not going to work with us. It's such important data to get. We really want to see the health of your gut with endo.
Rachel Heintz:
Definitely. And we clear hormones out of our body, including estrogen, through our stool. So we really need to make sure you're having a daily complete bowel movement— not just a daily bowel movement, but you need to feel like you're clearing it all out. We love the GI Map to evaluate the microbiome and the estrobolome We love evaluating beta-glucuronidase so we can make sure you're not reabsorbing that estrogen that should be pooped out. And then a really common pattern that we can see with endometriosis is that histamine issues and mast cell issues can be really common as well. Treating the gut can absolutely help to address these histamine issues. And then in addition to that, increased intestinal permeability increases inflammation. The more inflammation you have, the more exacerbated your endometriosis can be.
So we absolutely want to treat the gut again to make sure we're addressing endo holistically. And then in addition to that, we might be considering a SIBO test as well. Research does show that a high prevalence of women with endo also have SIBO. Small intestinal bacterial overgrowth can worsen bloating. This is already common with endo. It can exacerbate acid reflux. It can affect motility, like how stool and food is moving through your digestive tract. But also, if someone's testing positive for SIBO, we do want to ask why is SIBO occurring in the first place? And we see this a lot with our clients in practice.
Maybe they have poor motility, maybe they have low stomach acid, maybe they have a certain type of bacterial overgrowth that is affecting motility in the first place and how things are moving through the digestive tract. I will say, for women with endo, the endometriosis This itself could be a cause for the SIBO as well due to adhesions and scar tissue and how that motility is affected. Endometriosis causes inflammation, which disrupts our normal gut function. It can weaken the gut lining. And then like I mentioned, the adhesions can affect the motility and just contribute to some of those wacky, weird bowel patterns too.
Erin Holt:
Yeah, so it's a little like the cat eating its tail sometimes because endo can for sure impact the gut and the gut can impact endo. Other things that we would be Potentially screening for with a stool test are LPS, lipopolysaccharides, because we know that there's a link with that. And endometriosis, super, super, super inflammatory, especially when they gain access to systemic circulation, meaning they get outside of the gut. So there's just a lot, lot, lot of gut endo overlap. So it needs to be a part of, I would say, like everybody's treatment protocol. And this is irrespective of surgery, whether you're going to get surgery or you had surgery, like We have to be looking at your gut. And then we mentioned hormones earlier, but thoughts on testing hormones with endometriosis?
Rachel Heintz:
I think that a Dutch test is a necessity for endometriosis. I wanna tell you that I've run a Dutch test on almost every single endo patient that I've worked with, not only because we wanna take a look at hormone levels, but we want to take a look at how the body is processing and metabolizing those hormones. Genetics absolutely can affect hormone metabolism, but there's so much we can do with nutrition, lifestyle, and supplements To support this. We have 2 phases of estrogen detox that occur in our liver, and the DUTCH can really help us visualize what's going on, which enzymes you're preferring, which pathways you're pushing down. And, I want to be so transparent, treatment recommendations are so individualized based on results. I wish I could say, like, just take this supplement and it'll normalize your estrogen metabolism, but it's so, so personalized as well. So I absolutely recommend a Dutch test for anyone with endometriosis. And then we do use additional labs as needed.
Again, this is going to depend on the individual's progression and their other concerns as well. We sometimes will use a Wheat Zoomer in practice to rule out issues with gluten or a leaky gut. There is some research that suggests gluten sensitivity and endometriosis may be associated. Like Erin mentioned, LPS, so toxins produced by bad bacteria, can also also worsen endometriosis, and we can actually measure that level on a Wheat Zoomer as well. And then another profile that we use, not always, but we use tox profiles to rule out environmental toxins. So sometimes this might be like a mycotox or a mold profile. Sometimes it's a total toxin profile looking at phthalates and environmental toxins. Again, we know many women with endo have histamine and mast cell-related issues, and Environmental toxins can absolutely aggravate our mast cells, causing them to overproduce histamines, and then we have higher levels of estrogen as a result.
Erin Holt:
And then what about nutrition? Because obviously we like to take a food as medicine, nutrition-first approach. What specifically should people be considering with endometriosis?
Rachel Heintz:
So a low inflammatory diet, of course.
Erin Holt:
I feel like we say this every episode.
Rachel Heintz:
I know, but it's the foundations, really, really, really. is the foundations. Okay, this is a little bit of a sidebar, but there is that girl, Kate Toto. Do you know who I'm talking about? She's dating, or she's in a relationship with that like biohacker guy that has that show on Netflix.
Erin Holt:
Oh yeah.
Rachel Heintz:
And she was recently diagnosed with endometriosis. And so she is like tracking all of her data on her Mira, all of her stats. I think her, on her social media, she's like, I'm becoming the most measured woman in America or in the world or something. And she's seeing all these great changes. to her hormones, her periods. And really a lot of the changes that she started implementing are the foundational nutrition, the lifestyle, the sauna, the stress management too. Don't get me wrong, she's doing supplements, she's doing labs, but it is a lot of the foundations, honestly.
Erin Holt:
So crazy how that works.
Rachel Heintz:
Yeah. So low inflammatory diet, things to minimize: alcohol and sugar and refined carbohydrates. It doesn't mean that these have to be Absolutely off the table, but you want to be intentional about how often you're consuming them. Some endo gals are caffeine sensitive, so I say possibly caffeine. It may be helpful to audit your relationship with caffeine. I do weaker coffee than my husband does, and if I need a little second afternoon pick-me-up, I need to do matcha cuz a second cup of coffee isn't gonna go well for me. And I've definitely noticed improvements with my periods when I'm not doing too much caffeine, but it's very individualized too. Yeah.
And then a note on alcohol, really alcohol should be limited in any estrogen-dependent condition. So just something to be aware of. And I think it's also really important to identify food sensitivities. The most common food sensitivities that I see in my endo gals are gluten and dairy, but we also do know that a nickel allergy is associated with endometriosis. And so a really easy screening tool for this would be if you ever wore cheap jewelry, And you had an adverse reaction to it, that could give you clinical clues. Hey, I might not do super well with nickel. The most concentrated foods that nickel is in are your nuts and seeds, legumes, chocolate, like some of the foods that are really good for you, actually, your cruciferous vegetables too.
Erin Holt:
Bummer.
Rachel Heintz:
But that is something to consider. This does not mean every woman with endo needs to avoid their nickel-rich foods. And then of course, when we're thinking about a low-inflammatory diet, we want to be prioritizing those antioxidants. So your omega-3s, your berries, your citrus fruits. And of course, like we've spoken to, we want to make sure you're balancing your blood sugar because healthy levels of insulin absolutely are important for endo management. And then a group or a family of foods that I love, love, love are those cruciferous veggies to support estrogen clearance.
Erin Holt:
And I just wanna, like, when we talk to people about this, sometimes they're like, yeah, yeah, like I'll have broccoli, but there's like, A really big difference between eating broccoli or cauliflower or cabbage once in a while or a couple times a week versus the high-dose daily cruciferous consumption that we're kind of talking about here. And I want to speak into this just with the uptick in GLP-1 use. I'm really doing a lot more basic nutrition education because people are losing their appetite. And so there's more of an emphasis on having to focus on deep nutrition and be like, no, no, like, how much broccoli are you eating? Like, what is the volume of this food that you're actually eating? Because Rachel, to your point earlier, this is the stuff that actually moves the needle. It's like sometimes the basics we kind of forget about, or we overlook, or we undermine. And it's like, this is the stuff that's going to make or break you. So just some examples of ways that I would get cruciferous veggies in, just to give people kind of a frame of reference and some ideas. I love shredded raw cabbage, so I always have a head of cabbage.
And then I like thin shred it. Some people will use— what kind of peeler is like just a veggie peeler?
Rachel Heintz:
Like a mandolin?
Erin Holt:
No, it's like a, like a handheld, like veggie peeler, but a long one. There's got to be a name for it. And I see people shredding cabbage that way. I've never done it before. I just use a sharp knife. But that's a really great way because it's pretty tough and fibrous. And so not everybody enjoys it. But if you thin slice it, it's really good in salads or in wraps.
Roasted cabbage, you can just quarter it and roast it. I just love All roasted cruciferous veggies, so roasted cauliflower, broccolini, broccoli. You can make those in batches. Your fridge is going to smell like farts, but you know, it's fine. It's totally fine. I'll do cauliflower Alfredo sauce where I will steam cauliflower and then blend it with— I'm dairy-free, so I'll do ghee and like cashews and sometimes some like almond milk or even bone broth and just use that for a pasta sauce. I'll use frozen cauliflower rice in smoothies a lot. Broccoli sprouts, they're so easy and cheap to make on your own.
You can just get a sprouting lid on Amazon and put it on a mason jar and make your own broccoli sprouts. Super, super easy. Brussels sprouts, these are all ways to get cruciferous veggies in. Am I forgetting anything?
Rachel Heintz:
I don't think so. I was gonna say the broccoli sprouts, I recommend those a lot to people who are like, I don't like the cruciferous veggies, or I can't tolerate them. They cause a lot of digestive distress as well. The broccoli sprouts are extremely concentrated in that sulforaphane antioxidant. I wanna tell you, it's like a tablespoon or 2 of broccoli sprouts has the same amount of sulforaphane as 2 cups of broccoli. And like, it's so easy to sprinkle over a soup, a salad, a smoothie, things like that too.
Erin Holt:
Yeah, you get like more bang for your buck. I'm not like a huge fan of putting them in my smoothie, but if you are only doing like a tablespoon or 2, you wouldn't really taste them.
Rachel Heintz:
Exactly. And then another category of foods that we're thinking about would be bitter foods and cholagogues to support your bile flow.
Erin Holt:
It's like bitter foods is anything that you eat when you go like, you like make that face. So think endive, radicchio, arugula, dandelion greens. I never eat those. I always like list them as a bitter food, but I don't like them at all. I think they're gross. But dandelion root tea is really good. And I like that grapefruit, you can make your own grapefruit juice, just like from a grapefruit. Cranberries, another bitter food, you can throw those into smoothies.
Also great to help grow out healthy gut bacteria, those red polyphenols. And also be thinking about fiber foods. A lot of the foods that we just mentioned are fiber-rich, but that also is going to support the healthy growth of gut bacteria and help to clear out estrogen from your gut. We did a whole fiber episode last year, so you can go back and listen to that. And then I also want to mention, just in case you're somebody who does well with like a little bit more of a plan and a guide, we have our free hormone food guide. We'll link that up in the show notes. But that has recipes and basically an outline for everything that we're describing here, so you can link that up.
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Erin Holt:
Just to kind of stick with the same thought process of lifestyle. I mean, you already mentioned that these are the things that are going to have the greatest impact. Supplements and lab testing, super important. We utilize them all the time in practice. But I kind of sometimes consider like labs as the thing that drives people to actually make the lifestyle changes. What would you consider to be the most impactful changes? Because I think when people hear this, they roll their eyes a little bit, but they really do make the biggest difference. And I just want to say this too, like our biology Our body is designed to have very specific inputs. And when we don't have those very specific inputs, then we can see chronic inflammatory conditions like endometriosis, like autoimmunity, like metabolic dysfunction.
It's why these conditions are growing at a pretty alarming rate. When we are moving ourselves away from the physiological requirements that our bodies have, like, of course, we're going to see imbalance. So not to belabor this point, but like this stuff really, really matters. So what do you think are like the top lifestyle changes people with endo should be making or considering?
Rachel Heintz:
First and foremost, prioritize your sleep. That is a biggie. Oftentimes we see that women with endo need a little bit more rest, and that is totally okay. Make sure you're getting enough sleep. Something else I counsel on often is minimizing exposure to those endocrine disrupting chemicals, even just swapping from scented products in your home to unscented can make a big difference. You know, evaluating the products that you're using every single day— your deodorant, your shampoo, your conditioner, your lotions, and things like that. These endocrine-disrupting chemicals, they can place burden on their liver. It's one more thing that your body needs to process.
And then also, they can sometimes mimic estrogen in the body as well, and we just want to do everything we can to support healthy estrogen levels.
Erin Holt:
We were talking about this last week, just like through Voxer. I will share that my daughter is in 7th grade. And she's been talking about some of the kids her age are being put on birth control because of the fact that they have really intense, painful periods. And so I was talking to Rachel about this, like, I'm like, oh my gosh, we gotta start working with preteens now to like get ahead of this. But you also have to consider, like, it's insane to me, how many products these kiddos are exposed to on a daily basis. I mean, they are being inundated with marketing, and with like influencers their age that are like the hair products and the makeup. It is like, probably I would say tenfold the exposure that I got when I was that age 30 years ago. And so we have to consider this.
And I mean, I'm sure the 11-year-old and the 12-year-olds aren't listening to this podcast, but their moms are. And so this is something that you kind of have to to be Johnny-on-the-spot about. And I know it doesn't make you the fun mom. But we're in such a great position that there are so many, like, healthier alternatives. I know your kiddo wants to wear perfume. Any synthetic fragrance is an endocrine disrupting chemical, you gotta get it out of your house. Like, I am so cutthroat with that one. But there's healthier alternatives, there are different options that your kid can use.
And I mean, if you want to set up your kiddo for success, like, we're just seeing endometriosis, infertility, hormone imbalances at an alarming rate. And this is such an important time to intervene. And obviously, I'm saying this with passion because I am a mom of a preteen. But it is, it's a really big deal, because then they're going to end up working with our practice, you know, like later on down the line. So, you know, save your dollars now.
Rachel Heintz:
So in addition to minimizing those endocrine disruptors, of course, we think about I love a castor oil pack. So this is a little woo-woo, people have their opinions about it. Just topical castor oil use can increase blood flow and lymphatic flow to the area. And so I actually use a roll-on one during the summer months because it's too hot to sleep with a big old pack wrapped around your abdomen. But castor oil packs are great. This is not a requirement by any means. I love to encourage cycle tracking. It doesn't have to be with a device.
It can be, but even just paying attention to patterns that you're noticing throughout your menstrual cycle to identify potential signs of hormonal imbalance, or, hey, this has changed, this is feeling a little irregular. Things we might be looking for would be spotting prior to the start of your period, or your period ends and then you're spotting for quite a few days after that. We're also wanting to identify a short luteal phase because this might suggest a progesterone deficiency. This might suggest estrogen dominance or a combination of both. And the more data that you have around these signs, the more helpful it can be. And then also managing your stress as well.
Erin Holt:
That's a biggie. I think that's another one people are like, yeah, yeah, yeah, I kind of get it. But sometimes we don't always consider all contributors to stress. So I want to mention a couple of the under-discussed Contributions to stress that I see on the reg. One is emotional suppression or repression. We know that this can activate the HPA axis. So if you're somebody who tends to like, just like push things down rather than deal with them as they come up, that can be a contributor to chronic HPA activation, nervous system dysregulation, and inflammation. People pleasing, over-functioning, That's a really big contributor to chronic stress.
But we don't always realize it because it's like, especially for women, it's kind of expected of us. So it's not something that we pay attention to. We know that a history of trauma, a high ACE score, so adverse childhood experiences, a high ACE score can increase the likelihood of chronic illness. There's some suggestion in the research to link high ACE score with endometriosis, which is not surprising because we know it can impact the nervous system, HPA axis, the inflammatory signaling and immune system. So like, not a huge shock there. And when I say all of this, I want to be super crystal clear that I am not saying that trauma or chronic stress causes endometriosis or any chronic inflammatory disorders, but it can for sure amplify symptom expression. So it's just something to be aware of. It does this primarily through nervous system activation, inflammatory signaling, neuroimmune connection.
And I was thinking about this in preparation for today's show. I was thinking about an endo client that I had who was just in a really bad home situation. And it makes me think of the quote, you cannot heal in the same environment in which you got sick. And so for her in particular, she really had to leave that home environment in order to heal. And so, again, not going to necessarily be true for every single endometriosis patient, So we do want to speak into that in case it is part of your story. It is something that you would want to address as part of your healing path. So when we're thinking about a whole body approach to health, we want to be thinking about your mental health and your emotional health as well. And this is part of the reason that we give all of our clients access to Manifest Your Health, which is our brain-body healing membership.
It really is supportive of all of these things that I'm talking about. It is supportive of nervous system healing as well. We know that that is just a crucial part of an endometriosis healing path. So what about— we wanted to save this one for the last, so not to overemphasize the importance of supplements, but what about supplements?
Rachel Heintz:
So supplements are very individualized. That's my big disclaimer. They really should be based on your test results and your personalized goals as well. The goal is not for you to walk away from today's episode ordering all of the 10 things I'm about to mention. One of the most researched supplements when it does come to endometriosis is NAC, or N-acetylcysteine. A lot of research does support the use of NAC as it relates to reduced endometriosis-related pain, and there's actually some really cool studies that show that regular NAC supplementation can reduce the size of endometriomas. We love NAC. We use it in practice for acne.
It supports glutathione. It It supports fertility and cervical mucus. And so I get a lot of my endo patients on N-acetylcysteine, but not everyone.
Erin Holt:
Do you take it personally?
Rachel Heintz:
Yeah, yeah, I take it personally. There is some research that suggests the perfect ideal dosing schedule for NAC is 600 milligrams 3 times a day, 3 days a row in a week. I was like, I could not. I work from home.
Erin Holt:
I was gonna ask you if you did.
Rachel Heintz:
I could not get into a routine with that. I could have a bottle on my desk and, you know, take it in the middle of the day. I take it once a day daily, sometimes twice a day. It's just on my nightstand. I was— it's also like I'm a routine gal. 3 days a week on, 4 days a week off is just hard. It's one more thing I did not want to keep track of. It's also one of those supplements that's better when taken away from food.
If it was something to take with food, I would just pop it in my little supplement container for 3 days, but it's best away from food.
Erin Holt:
So I know, I feel like as soon as a supplement says take away from food, I'm like, I'm out.
Rachel Heintz:
Oh yeah, bedtime. Yeah, antioxidants. There's so many antioxidants that could be impactful. There is research that shows that antioxidant supplementation can be therapeutic with endometriosis. You know, some of the antioxidants we might be thinking about bringing in with endo might be vitamin E, C, and/or CoQ10. CoQ10 is great for mitochondrial support and fertility as well. So So, if I'm working with an endo patient who's also trying to get pregnant, that's when I might be recommending the CoQ10 for inflammation control but also egg quality fertility. I love magnesium.
I've been taking it for years before I knew I had endo. And magnesium does support methylation, estrogen metabolism. We can check for methylation issues on a DUTCH, but we also check red blood cell magnesium on blood work. And I rarely see normal levels in someone who is not supplementing. So, that's a consideration. DIM is not a supplement that you should take without getting tested. We use DIM a lot, but only if estrogen dominance is present. A lot of supplement blends out there include DIM, and I really advise against it if you're not doing lab testing.
And then, omega-3s to combat inflammation. You know, of course, I want to encourage fish consumption a few times per week. If you are not eating fish, you should get on an omega-3.
Erin Holt:
Probably.
Rachel Heintz:
And then PEA. I'm not even going to pretend like I know how to pronounce the full name of PEA. PEA is great to stabilize mast cells. They reduce inflammation, and then PEA can also help to reduce pelvic pain. We'll get into this in 2 episodes from now where we're going to talk about the endo-mast cell connection, but PEA is a biggie for the, like, mast cell endo gals. I actually was sent a sample of a supplement that has PEA in it and ginger, and I actually used it my first few periods after excision surgery. It worked really well. It worked really quickly, so I like it.
Erin Holt:
What was the supplement you used? Do you remember the brand?
Rachel Heintz:
It's called Relevade by Trelli, T-R-E-L-L-I, and it's PEA and ginger, and then there's 50 milligrams of caffeine in it to enhance its absorption. But yeah, my first couple of periods, they were different after excision surgery, more of dull pain, ache. And I was very impressed with how quickly it worked. I'm like, I'll try anything. And yeah, it's worth checking out. And then I still—
Erin Holt:
Pycnogenol.
Rachel Heintz:
Pycnogenol.
Erin Holt:
I like have like a weird infatuation with pycnogenol. Yeah, I was really excited to say it out loud.
Rachel Heintz:
It's another supportive option for pelvic pain. So again, I don't recommend getting started on Yeah. All of this at once, but these are some considerations. A lot of these, you know, we'd want to use some lab testing to drive some of this strategic supplementation too. But everything we talked about today, from the labs, the nutrition, the lifestyle pieces, to the supplements, they all work towards the same goal. We're wanting to reduce inflammation, regulate the immune system, support ovulation and detoxification, and ultimately regulate estrogen levels and metabolism. So when these pieces come together, they don't just support your overall health, they also help enhance your fertility along the way. And you don't have to navigate your endo journey with just anyone.
Find practitioners who understand this process firsthand, not just clinically. And I say that as someone with endometriosis myself. That's why I do the work that I do, helping women get the kind of support I wish I'd had sooner. And I want to encourage you guys to tune into our next episode where we're going to chat about what to consider when you're looking for a surgeon and then how to support your body prior to surgery.
Erin Holt:
We'll be back next week.
Erin Holt:
Thanks for joining me for this episode of the Functional 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. Bye.