EP.321/ endo management vs. endo maintenance
This week we’re taking a pause from the dairy series to give those who don’t want to learn about diary or who feel distressed by the topic for ethical reasons, a bit of a break, as I appreciate it might be a bit much to go back to back with this topic.
So today, I want to answer a question that was asked of me on a call the other day.
And that’s when you’re starting to manage endo, and you put in place various protocols to get your symptoms under control, do you then have to do those strategies forever?
And the answer is no.
Let’s think of it as endo management and endo maintenance.
So, let’s say you’re my client - and you come to me with really bad endo pain, PMS like painful breasts every month and low moods, and gut problems like bloating and SIBO.
We will work to get these acute symptoms down, and the root causes solved. This is normally a period of three months to a year, depending on how much there is to work on - and so you know, the strategies are staggered slowly across this time, rather than all at once.
So, depending on the individual, I would probably want to consider working across areas such as blood sugar, inflammation, supplements, nervous system strategies and pain relief tools for the endo pain (we may not need all of them), but I’ll also be looking at how we can shrink and slow down endo growth within this context too. And that’ll involve minimising inflammatory processes and chemicals like oxidation and prostaglandins through the methods I’ve just mentioned, so diet, blood sugar, supplements, etc. I’ll also use specific supplements shown in the research to reduce endo lesions/cysts and slow down growth.
For the PMS, I would look at hormone balancing. Supporting oestrogen clearance by investigating any risk factors that could be slowing down or impairing her oestrogen metabolism pathways that occur in the liver and gut, and I would address these and resolve them. I would also work on general support for the liver and gut through nutrition, some simple lifestyle changes and perhaps supplements if needed. For things like sore breasts and water retention, we may want to add in some lymph drainage support to clear excess fluids or things like dandelion tea, which aids water retention. And for the low moods, we would want to ensure healthy levels of progesterone, so I would be looking at blood sugar, nutrition and lifestyle factors to support that, like adequate zinc, b6, magnesium, stress support, etc.
Now keep in mind, this would all vary from person to person. So for example, as this person has SIBO, it might be that she’s not absorbing much iron, because SIBO impairs iron intake, so this person may be struggling with low moods because her iron is low, and it’s not just her progesterone alone that’s the problem. So you can see how we would need to investigate the root cause with each person.
Okay so let’s say we resolve the SIBO and we bring the gut microbiome back into balance, so now this client’s endo belly problems are by and large resolved. This would allow her to eat more foods to support progesterone and oestrogen clearance, but also actually absorb the nutrients from them too.
Same with the endo pain - this client has found an approach for healthy eating and blood sugar that keeps inflammation levels low which improves pain, and has found one or two supplements that make a real difference too. And she has adapted this approach to the foods she likes and to her lifestyle, rather than the other way around.
And with the hormones, let’s say one of the issues was that this client had high levels of beta glucuronidase in her gut, and this was circulating oestrogen levels back into the body instead of allowing them to be removed in bowel movements. Well, that’s now resolved because we can treat and lower that, so that’s made a big difference to things like sore boobs, which is caused by high oestrogen or oestrogen dominance. She’s also discovered from our work that she just wasn’t eating enough of the nutrients needed for proper progesterone production, and that was affecting her moods every month and so now she knows to eat more of foods like chickpeas, bananas, turkey, etc. for B6, and beef, lentils and nuts for zinc - and these have just become a normal part of her every day diet.
Okay - so the acute symptoms have passed. All of these symptoms are now under control. So does that mean she has to constantly practice every single strategy we used to get her to this place - like dry brushing, taking digestive enzymes and drinking dandelion tea day and so on?
No, once your endo symptoms are under control, it’s really about keeping your foundations solid. Once those every day changes are in place, those foundations are set, all the extras can go. So what I mean is, most of us will want to lean towards a healthy, anti-inflammatory diet most of the time, so closer to an 80%-20% approach. And really that’s for everyone, not just those with endo, right? All of us need to keep inflammation levels low with a healthy diet - a good intake of nutrients, whole foods and less processed foods.
Does this mean you have to be 100% whole foods only? Never have any sugar? Never have any gluten? No - once your foundational nutrition is in place, your inflammation levels will calm down, your nutrient levels will be restored and your body’s resilience to things like some sugar or some gluten - as long as you don’t actually have let’s say a wheat allergy - will be much stronger. Whereas before, you may have been more reactive because your inflammation levels were already high, and then eating some sugar or bread just took them to levels that trigger a flare up. Do you see what I mean? Having good foundations basically evens the playing field. Your boat is steady, and if a wave comes, it rocks a little, but it doesn’t topple over. The other thing is, you become a bit more wise about how much of something you can tolerate without causing yourself issues. So for example, I know I can have some sourdough at the weekend and be fine, but if I’m eating it every day, I start to feel a change in my gut, my inflammation levels, etc.
The same goes for blood sugar. Pretty much everyone should be eating in a way that supports blood sugar, to prevent diabetes and chronic diseases - that’s just again, pretty much a healthy diet with a plate that contains healthy fats, protein, complex carbs and veggies and minimising sugar and refined carbs. The extras we put in place to get blood sugar down in the beginning, may be a supplement, movement after meals, apple cider vinegar, lowering carbs levels a bit, etc. but these aren’t always required forever and ever. Some people may like to keep in a 10 minute walk after dinner, and that’s a great addition, but you don’t have to be militant about it.
And let’s look at gut health. Once the SIBO and dysbiosis is cleared, you no longer have to be taking lots of gut supplements, probiotics or doing things like gut directed vagus nerve support or gut massages at night before bed. You now just need to move into general every day gut maintenance of chewing enough, not rushing your food, eating foods that support gut health like enough fibre.
Now of course, all of these foundations will be tailored to the individual, but generally, maintenance is really about a healthy lifestyle that’s more common sense than anything, with perhaps some extras on top because we of course, still have underlying endo that we need to keep in check.
What do I mean by extras? Well, I typically recommend keeping at least one supplement in that is always targeting the endo - so a supplement that has actually been shown to shrink or slow down growth. I personally think it’s worth keeping something in and just rotating through them to get the best out of them, so for example, the studies on NAC show reduction of cyst size at three months, so you could do NAC for three months, then move onto pycnogenol, which was shown to lower endo severity after 48 weeks.
And you may also want to have something to help keep pain and inflammation low, so for example, ginger. Now the good news is, some supplements, like curcumin or pycnogenol, do both - literally help to reduce pain, endo and inflammation.
And then with hormones, let’s say this client, perhaps she found magnesium really helpful for her moods, so decides to keep magnesium in her supplement regime, but she no longer needs any extra supplements that we were using to clear oestrogen and she no longer needs lots of lymph work because her swelling and sore breasts have gone. She also knows to make sure she’s eating cruciferous veg regularly and a generally healthy diet, will help to support her liver to clear oestrogen and that has just become standard to include these every day veggies into her shopping cart.
Of course, there may be things that still get to us - we may be one of those endo people who can’t tolerate dairy, even if we resolve gut issues. We may be jealous that our friends can eat an entire tub of Ben and Jerrys but for us, that high level of sugar triggers pain. For those things, it’s about creating adaptations that help us to still enjoy those things or at least similar things. For example, we may find a coconut yoghurt we love, or discover we can eat low lactose cheeses such as parmesan or that we can tolerate A2 types of dairy from sheep or goat, just not cow’s dairy. You might be like me and get really into making low sugar treats such as ice cream, or you may discover ways to eat that Ben and Jerrys occasionally without such a blood sugar spike, such as eating it after taking apple cider vinegar or some chia or peanut butter (yes, all of those slow down blood sugar release). And do you know what, sometimes you won’t want to do any of that, and you’ll just want to eat the ice cream and just take pain killers or pain relieving supplements. And that’s fine too.
My point is, the management is getting you out of the red, getting your body out of emergency mode, and then it’s about keeping you there in maintenance, with every day healthy foundations that aren’t that different from general healthy lifestyles, with a couple of extras thrown in that you know work for you and your unique endo symptoms.
Now, I know it can be more complicated than that for some of us. Some of us, like myself, have chronic SIBO, POTS, IC, MAS - so there are more things to manage and more nuances. But the theory is still the same, it just might look different. For example, for someone with MCAS, they will start of very reactive, but the idea is to resolve the various root causes that worsens MCAS (and is consequently worsening endo), and get the mast cells - which are releasing all that histamine - stable, so that they can move out of the red. Moving forward, they may need a supplement that doubles up as an endo one and something that stabilises mast cells, such as pycnogenol or quercetin. They may have some high histamine foods that they can only tolerate every now and then, but the aim would be for them to be eating as normally as possible, because we’ve calmed down that reactivity. They may always have to be mindful of their condition, but not ruled by it.
And for those of you thinking - “but I eat healthy, I exercise, I balance my blood sugar” and I’m still struggling, this is exactly the reason why we investigate root causes and resolve them in the endo management stage, because often at this stage, it’s not enough to just follow a healthy lifestyle. It’s once we have resolved your root causes, that we can move into maintenance, and a healthy lifestyle is able to keep us in a good place (with some carefully chosen extra endo-specific strategies thrown in, as we discussed).
Okay, so I hope that helps reassure some of you, who worry you’ll be juggling 20 endo management strategies for the rest of your life. It’s about resolving root causes first, getting your body calm and then allowing you to live your life with some good foundations and a few strategies that you know work for you.
Show notes
Blood sugar resources
https://endometriosis.net/living/how-to-balance-your-blood-sugar-levels-to-reduce-endo-symptoms
https://endometriosis.net/living/diet-sugar
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Produced by Chris Robson