Evidence Based Approach to Nutrition and Endometriosis With Registered Dietitian, Sarah Rae

Speaker 1:
0:03

Welcome to EndoBattery, where I share about my endometriosis and adenomyosis story and continue learning along the way. This podcast is not a substitute for professional medical advice or diagnosis, but a place to equip you with information and a sense of community, ensuring you never have to face this journey alone. Join me as I navigate the ups and downs and share stories of strength, resilience and hope. While navigating the world of endometriosis and adenomyosis, from personal experience to expert insights, I'm your host, Alana, and this is EndoBattery charging our lives when endometriosis drains us. Welcome back to EndoBattery. Grab your cup of coffee or your cup of tea and join me at the table as I continue my conversation with my guest, Sarah Ray, who is a registered dietitian. In case you forgot, here's where we left off and where we're going.

Speaker 2:
0:56

One thing that's gaining a lot of traction that's actually not new, it started in around 1995, is intuitive eating and a lot of dietitians are moving towards this intuitive eating approach and it's something I'm working on with my clients as well. But the whole framework is about listening to your body and kind of tuning into your health and listening to those intuitive signals for what you're needing at the time and honoring that. So it's about honoring your hunger. Body acceptance kind of accepting your genetics is a big part of it. If every woman in your family has kind of a look and maybe they're like all around 185 pounds and they have this certain build, it's unlikely that you're going to be 120 pound person and not have to severely restrict and work for it for your entire life. Pound person and not have to severely restrict and work for it for your entire life, and so kind of accepting those genetics.

Speaker 2:
1:48

And I think a part of that really is important for endo, even with excision surgery, people still have symptoms and we have to kind of accept and honor our bodies for for what they are and the card that we've been dealt. And so people who are struggling with that or who are raising kids and wanting to kind of foster that healthier relationship with food and body. I would point them towards an intuitive eating approach and there's some intuitive eating counselors out there that can be really helpful. There's some really helpful books, because kids are actually naturally born intuitive eaters. We kind of project our own insecurities and ways that we were raised onto them and they learn to ignore that too. But if you think about like an 18 month old, they'll stop eating Cheerios when they're done eating Cheerios. They don't necessarily stop when they're gone. So we learn to ignore those cues and there's some great resources out there.

Speaker 1:
2:42

Yeah, what are some good resources for intuitive eating?

Speaker 2:
2:45

Yes. So there is a book that I really like for adults. It's called Intuitive Eating A Revolutionary Approach. It's written by dieticians Evelyn Triboli and Elise Reich. There is also there are certified intuitive eating counselors that you can find online. There's actually quite a few on social media. I really like Diet Culture Rebel and Fine Food Freedom. I know Fine Food Freedom has dietitians that are out the US and accept insurance, so that's really nice. There's a book, if you're specifically wanting to focus on kids, called Raising Intuitive Eaters, and that is a really helpful one and can be helpful through, you know, those early stages, through the teenage years, kind of navigating those food relationships, and there's some really good podcasts on intuitive eating as well. I would think that for a lot of people with endo, if you can't find a dietitian that specializes in it, going towards an intuitive eating dietitian may be more beneficial than actually looking at somebody who specializes in hormones, because they're going to help you kind of tune into your body and honor those different signals that are going on.

Speaker 1:
3:57

Well, that would have been helpful when I was younger. So I'm glad that we're talking today. I think that's true. I mean, I, my husband and I actually talked about this with our, with our kids, because, you know, we've always said we're not going to restrict them and we're just going to let them kind of guide that. But when we grew up, we grew up with you need to finish everything on your plate, no matter what you need to, or you have the other side of it. It's like, well, this is just what kids eat. They don't eat what adults eat, and it's I don't know.

Speaker 1:
4:26

I think society has maybe molded us a little bit in that way too, you know, and so we've had to really fight that mold and do more of that intuitive eating.

Speaker 1:
4:37

And I would say that I have started that since I worked with someone with my nutrition, because I had, again, that really poor relationship with food and exercise, and I found that when I looked at my overall health, am I healthy? Am I thriving? Am I happy? Am I constantly thinking about what I can or cannot eat? Am I constantly thinking about is this going to make me gain weight? Is this going to make me lose weight? Is this going to help my symptoms? Is this not going to help my symptoms? I found that I was way more stressed and I had way more anxiety than when I would intuitively eat to what I felt like my body needed, like I didn't shove my face full of food all the time. And I'm not saying I'm perfect at this. What I'm saying is like I've had to heal my relationship with food in order to help my overall quality of life, and I think that's so important.

Speaker 2:
5:31

Yeah, the research really shows that dieting is more harmful than it does good. So we know that people tend to have higher levels of yo-yo weights when they've dieted. We know from research that people have higher rates of heart disease when they've been chronically dieting, that they regain the weight faster, that they tend to store more weight in their abdomens after they've lost the weight, and the younger that you diet, the higher chance you have of disordered eating in the future. So even if we're thinking about dieting for symptom relief, it's still dieting and so getting in tune with your symptoms in your body and how food makes you feel, and even if you just ate an hour ago, if you're hungry, eating is going to be more likely to prevent binge eating or overeating and that weight gain long-term.

Speaker 1:
6:24

Something that I have found helpful for me, for those that are listening to this like I snack all day, I actually going into summer with my kids and with myself being home with them, I have started making like little charcuterie boards of fresh fruits, fresh vegetables and then adding some snacks in there some salty, some sweet and it helps, like when my kids automatically want to go and just snack on everything because that's what they do and they want to rob me from anything in my bank account with all the snacks.

Speaker 1:
6:54

Like. I have found that these are things that have been helpful for not only me but for my family to have things out on the counter that are easy to grab when they're hungry, or in the fridge that's already cut up, and then I don't have to think about it as a parent, but as a person who struggles actually taking the time to eat. It makes it easier for me if I prep that ahead of time and it helps me with my anxiety of surrounding food. It helps my body feel better. It helps my body a lot. I would say. It helps me understand what's really going on with my anxiety of surrounding food. It helps my body feel better. It helps my body a lot. I would say. It helps me understand what's really going on with my body if I'm fueling it correctly by what it needs. So that's just a tip for me. I'm not the professional, I'm just saying it's helped me with snacking.

Speaker 2:
7:36

No, I think that that's a really good tip Having things ready to go, giving yourself permission to eat when you're hungry is so important. The other thing I think about in terms of like honoring your body and honoring what you're thinking about eating can also really help. So I don't know if you've ever had one of those situations where maybe you were thinking about eating like peanut butter cups. I don't know, like you have a craving for chocolate and salt and it's like, okay, whatever the reason is, I shouldn't have sugar because of endo, or I shouldn't have sugar because it's going to make me gain weight or whatever. So you maybe have like some trail mix and it just doesn't do it for you. And so then you go have like some cottage cheese and fruit because you need the protein and fiber, and then that really didn't do it for you.

Speaker 2:
8:21

So you go and have like a spoonful of peanut butter and some chocolate chips, and it's like it still wasn't the peanut butter cup, like you wanted the texture of the peanut butter cup, or like the chocolate wasn't the same. And so then in the end you like go buy a king size peanut butter cups and you eat all of them and you feel so much guilt and shame and you ate a lot of calories, kind of building yourself up to that and it just wasn't hitting the spot. And so sometimes just giving yourself permission to have those things, even if you have endo, even if you think the processed food is going to make it worse, you didn't do yourself any favor by having all of those things leading up to it and then just eating it in the end. So honoring that and also setting yourself up for success with those healthy things that are going to help you feel good throughout the day is also important. But you can have both. You can still be healthy and enjoy those things.

Speaker 1:
9:10

Yeah, I feel that 1010%, which is not even a real number, but I feel it because, as someone who has had a hysterectomy and my hormones are kind of everywhere, sometimes I have craved more sugar and I realized very early on that it was better for me to have that. Whatever I'm craving, just a little bit, like you get that taste and you're like I'm good you know, and then you kind of just move on from it, but you make decisions that fuel your body better.

Speaker 2:
9:37

Yeah, things that make you feel well most of the time, but sometimes those things that you might be craving, and maybe that's chips. Whatever it is, you may also one day crave a peach. If you can get that kind of neutrality with food and your relationship with food, then sometimes you might want a salad and sometimes you might want the sweet and salty and we can have all of those things.

Speaker 1:
9:59

Yes, and I back that. 100%. That's a real number. Yes, and I back that 100%.

Speaker 2:
10:06

That's a real number.

Speaker 2:
10:14

I think that some of the criticism or fears around intuitive eating is that there's a step in there that is allowing yourself to eat everything, and so people who have restricted for a long time will tend to eat a lot of whatever they haven't been allowing themselves to eat when they've been on a diet or an elimination diet and things like that.

Speaker 2:
10:30

And I actually I'm on an endometriosis diet group and there was some advice written by the administrator about going through your cabinets and clearing out everything and only shopping the perimeter of the grocery store to support your endo and I was just like no, this is so much diet culture and not what I would recommend for people at all.

Speaker 2:
10:52

But that's just kind of what we've been trained on and when we give ourselves permission to eat those things, most people, once they've tuned into their body, get past that sort of binging or like just eating everything, because it doesn't make you feel good to live on cinnamon toast crunch for breakfast every day. It's delicious and maybe if you haven't been allowing yourself to eat it for five years, you may like have a box or two and then you're kind of ready to move on and eat what you were eating before and so that's kind of a myth has been in the media and things like that. It's just not true and that's not what we're seeing with people who are tuning into intuitive eating. That is just so small and if we're really rejecting that dieting mentality, we'll get past it.

Speaker 1:
11:38

Yeah, and I think that if we can embrace that food is to fuel us to, I think there's something to be said about that, Like it doesn't matter what kind. You still got to function, you know, and I've definitely struggled with that. So I'm learning. I've learned a lot about this and that's why you know again I have said this before but that's why I've been so protective about this space, because I myself have struggled so much with it and, given my background and everything else, I've been really cautious. But I think that something that I appreciate so much about you is that you do talk about that. You talk about healthy relationship with food and you talk about it being a fuel, not a fear, and that's so important. Looking forward to other aspects of our lives, Food should be fuel, not fear.

Speaker 2:
12:24

Absolutely. Fuel is such a big part of our lives, I mean we have to eat it to survive. I do not believe in food addiction. We're all addicted to food because we have to have it to function Right. It's how we celebrate. It's how we can sometimes cope when we're sad. It's how we socialize with family and friends. It can be enjoyable to prepare and shop for, and my goal when working with people is that they can really find that joy in food if they don't already have it. And when we look at these really strict elimination diets being as like, a longer term solution, it's just not going to work. I haven't met somebody who's been able to stick to it longer than a year. And if you can't stick to it, no matter what the diet was whether that's full 30, what happens after that 30 days? If it's the autoimmune protocol, what happens when you're done with it? If it's low FODMAP, it doesn't work. If you couldn't stick with it long term and a lot of those things are so restrictive we wouldn't want you to.

Speaker 1:
13:29

The one thing that did help me and maybe you'll know more about this and maybe you do this, I don't know but something that did help me was understanding portion sizes and understanding like healthy amounts, because I was never really introduced to that at a small age, Because in America we supersize everything and then we feel guilty if we don't eat it all because we paid for it, and so that was super helpful for me to understand the portion size that was appropriate for me, and I think that's where working with someone you would benefit from that, when you're working with someone that understands that.

Speaker 2:
14:02

Yeah. So one of the things that I really work on with people is again focusing on that plate balance and tuning into your hunger and fullness cues. So some people don't consider that they're hungry until they're like that really low blood sugar feeling. So maybe they're hangry, they're jittery, they're nauseous, they've got a headache. A lot of people don't eat until they're at that point. What we may want to tune into for hunger is, like I'm starting to think about food, my stomach is rumbling. If you're starting to think about lunch, it's probably time to start moving towards lunch and not waiting until you're ready for a nap and then also tuning into those fullness cues. So fullness may feel just like I'm satisfied. You may feel like you have a little hiccup or a burp, or you can actually just like feel that you're at the top of your stomach. If people are frequently eating to the point that they were feeling like distended or uncomfortable, that would tell me that they've kind of lost that ability to tune into those biological signals and that's something that we may work on. So, rather than focusing on, you should eat, you know, four to six ounces of meat at a meal, in a cup of vegetables, and things like that.

Speaker 2:
15:17

I will have people work on just tuning into their hunger and fullness cues and building those plates with a variety of foods, and portions will naturally come down that way, rather than being really prescriptive about how much they should be eating. Now, if somebody has a history of an eating disorder and they're working with a dietitian specifically for that which that is not my specialty they may be looking at like you need to eat at least this much food to get enough calories, but looking at it through like the intuitive eating lens and not really prescribing weight loss. For a lot of my clients it's more about kind of looking at that plate and how can we get it so that you're feeling satisfied, because we could eat a whole bag of chips easily, but if you added a burger to it with some protein, you get full. You can't eat that many chips at the same, you know. So it's like how can we use the tools of protein and fiber to help you eat a little bit less naturally and be getting nutrients from it?

Speaker 1:
16:16

Okay, and just briefly, just kind of looking at this a little bit too, because some of us are checklist people, ADHDers, intuitive eating. What are the benefits of doing that with endometriosis patients or for endometriosis patients?

Speaker 2:
16:29

Yes. So I would say the number one benefit is it's going to help you tune into your body. So I was talking about kind of getting more familiar with what foods are going to make you bloated and things like that. So, like I mentioned, for myself, ovulation is a time where I get endo belly and a lot of gas. So intuitively, I would think to myself a latte sounds really good today, but I know, if I have latte with milk in it I'm going to feel crappy the rest of the day. So maybe I'm going to choose black coffee. I'm going to make sure that I'm eating regularly. I'm going to kind of limit some of these things. So I'm eating for pleasure, but I'm also thinking about how am I going to?

Speaker 2:
17:11

feel with that. It's going to help you kind of appreciate your body a bit more. It's going to help you honor your hunger and fullness cues. Eating more regularly and honoring that may help with some of the nausea that comes around with endo. Some people have a lot of nausea because they're not eating enough and then it can kind of be this perpetuated cycle because you also have low blood sugar so you're getting even more nauseous.

Speaker 2:
17:33

So I think that body awareness and recognizing how foods are impacting you can be really helpful.

Speaker 2:
17:39

And sometimes there's an elimination diet as a part of that if you've never really tried anything.

Speaker 2:
17:45

But then we're adding those things back and paying attention to how we feel after. Part of the intuitive eating path is also looking at gentle exercise and changing the mentality around exercising. So rather than looking at movement for getting a six pack or trying to get to a specific size or maybe trying to get like a specific mile time, we're looking at how do I feel after I move and exercising for the benefits of that. So you're more likely to get up in the morning to take a walk if you're doing it for the energizing that you feel, versus if you've been trying to walk for weight loss and you just saw really no benefit from it. It's like, well, what's the point? But there's a lot of benefits to moving your body with endo for pain relief, for, like constipation management, getting your bowels moving and so just changing the mentality around why you're eating, why you're exercising and kind of honoring who you are and honoring your body with that can be really helpful for people with endometriosis.

Speaker 1:
18:47

Yeah, I think that's important for everyone. I don't think just endometriosis. I'm like I think this is great for everyone.

Speaker 2:
18:54

Yes, yes, I absolutely. I think that it applies for everyone. I just don't think it's really made it into our community yet. There may be people with endometriosis that are doing intuitive eating already for other things, you know, for their body acceptance and things like that, but I really wanted to bring awareness to it in kind of my platform.

Speaker 1:
19:16

Yeah, something that I think that we should maybe touch on a little bit more is the hormonal aspect of this Cause. We've talked about the food, we've talked about history and everything else, but I think something that maybe a lot of us struggle with is the hormone imbalance factor. And I know for myself again, I had talked about, you know, not knowing my body after my hysterectomy, trying to find someone to help me. I've had other comorbidities kind of play a part in the way that I feel and the way that I fuel myself. But something else that I think a lot of us try to figure out is what's going on with our bodies, and sometimes it's hormones. How do we balance those hormones? Maybe our hormones are off and our food is causing it. Who knows? Something that is really prevalent is they're doing like, different tests. They're doing the Dutch test, they're doing blood work, they're doing different avenues to kind of investigate this. Can you talk to us a little bit about that?

Speaker 2:
20:14

I think that that's a really great question about the hormone testing and what we can look at for nutrition and hormone balance and kind of what considerations there are. I have seen a handful of dietitians and nutritionists online recommending the Dutch test. It's not something that I use in my practice. I am not an endocrinologist or a hormone expert. So just like full disclosure, I'm probably not the best person to talk about hormones, but I also think most dietitians are not, and so I think that that's something to really be aware of when people are considering working with somebody.

Speaker 2:
20:52

The Dutch test is a urine analysis test, so you pee on a strip four times in a day and then you send it off into the lab and they look at the different metabolites and kind of how your body is processing hormones and what those fluctuations are like during the day. So generally they're looking at like estrogen levels, progesterone. They'll be looking at cortisol, which is a stress hormone, some other things. The only validation study has been done by the creator of the test, so for me, that is one red flag in consideration to look at. Insurance doesn't pay for it, so I believe it's a few hundred dollars that you may have to pay out of pocket. I'm not sure if those providers get any financial benefit from distributing the test, but I have seen a lot of people in like the holistic, naturopath kind of space using that test. There are no medical societies or many like endocrinologists or gynecologists that are recommending the test to my knowledge, and so for me, as a dietitian who wants to work with the providers, I think if there is a dietitian or nutritionist claiming that they're going to get more information or understand your hormones better than somebody who literally went to medical school for hormones and women's health, they're stepping outside of their bounds for, like what they can be doing, and I really think that that creates an us versus them mentality and it's just not very helpful when people are dealing with this whole system disease. We need to be looking at how we can work with providers, not against them, and to claim that, like people in conventional medicine don't have the patient's best interests in mind. I just don't think that's true. I think they just don't have a lot of time and the providers don't want to have 10 minute appointments with us. It's it comes from higher than them. You know those pressures and there's just not enough of them. So sorry, that was like a side note on that.

Speaker 2:
22:51

But with the hormone balance and nutrition, I don't really need a hormone test to make a recommendation that would overall benefit somebody's hormones. So, for example, if you have estrogen dominance, one of the recommendations for eliminating estrogen is to make sure you're going poop regularly. We secrete that hormone through our feces, so if you're going three days without a bowel movement, then we should be working on getting you going to the bathroom more regularly. That's one of the best ways that you can get rid of some of that excess estrogen. There is some thought that maybe eating like a bit more cruciferous vegetables can be helpful. That's something I would just generally recommend Like eat lots of broccoli and cauliflower and Brussels sprouts. They're really good for you and we don't need to take a supplement with, like the extract of broccoli to help support that.

Speaker 2:
23:40

Sleep and reducing stress levels and relaxing are some of the best things that you can do to maintain your hormone balance. We don't need a hormone test to make that recommendation Like. That benefits most people. Getting seven to nine hours of good quality sleep and looking at your sleep hygiene that's absolutely something I would work with with somebody, but I don't need them to pee on a strip to give them that advice if they're not sleeping well, right, we talked a little bit earlier about blood sugar balance.

Speaker 2:
24:10

So making sure that you're not getting really big insulin spikes throughout the day for eating. You know, if you have just a donut and like a vanilla latte, you're going to get a really big blood sugar spike. It's going to go way up and then you've got really nothing to help keep it there, so it's going to shoot back down and then you're going to be hungry and shaky and then go for a quick source of energy and maybe eat some crackers or a piece of fruit and kind of the same thing. So trying to get that balance of protein and fats, like we've talked about with your carbohydrates, can help kind of normalize some of those hormone fluctuations. So building that overall balance plate is also really helpful. So when it comes to nutrition, if somebody has hormone labs available or they're working with their provider to get validated tests, I would absolutely look at those, but I would not necessarily recommend Dutch testing to give them some of this advice that would help Interesting.

Speaker 1:
25:06

What are some ways that you do help support hormone for those of us who have maybe struggled because of our hysterectomy?

Speaker 2:
25:11

Yeah, so if people are struggling with things like low estrogen kind of symptoms, I would make sure that they're doing all the things right, like they're eating enough food, they're eating balanced meals, they're getting a variety of nutrients in, they're sleeping well. But if those things aren't working with nutrition, I would probably send them back to their provider, their gynecologist or whoever for medical hormone management or gynecologist or whoever for medical hormone management. Especially if somebody is like perimenopausal or menopausal. There's things that they can help with, that may help with like vaginal dryness and things like that.

Speaker 2:
25:45

That you know I can make sure you're drinking enough water and you're really supported, but those things are not really in the dietician scope of practice. So it would just be identifying that, hey, this isn't really normal what you're experiencing. Maybe we should loop you back in with your provider and we can certainly look at different supplements. It's within a dietician's scope of practice to recommend supplements and kind of evaluate them, but the important thing to know with that is the supplement industry is really not regulated, and so you want to make sure that you're doing things that have had quality testing, that they actually have what is on the label inside, and so USP is a good label to be looking for and a lot of those around like hormone balance and things like that, don't have that testing done.

Speaker 1:
26:31

And as someone who struggles with like other issues, I think it's important to talk to your doctor about all the supplements that you're taking, because they can react negatively to certain medications or chronic conditions and things like that, yes, and then you know if you're seeing, like a naturopath or something like that, depending on the dietician you're working with.

Speaker 2:
26:50

Like I don't have a background in Chinese herbs, and so it's something that I'll look into with clients, but sometimes I'll have people come with a handful of things that I'm not familiar with, and so it's important that you're looping all of your providers in on all of those things, so that I'm not recommending a fiber supplement that may interact with that, or maybe you can't eat grapefruit when you're on that. You know, there's so many different things, and so it's really important that everybody knows all the things that you're taking.

Speaker 1:
27:16

Yeah, I found that highly beneficial and I actually have had my nephrologist tell me please don't take this X, y and Z supplement because your kidneys can't handle it. I'm like, okay, that makes sense. We have to be upfront and honest with our providers so that they can give us quality care as well.

Speaker 2:
27:32

Absolutely yeah, and I have like some supplements that I generally recommend to people because a lot of them have similar symptoms, for example like magnesium to help with constipation and kind of like muscle relaxation and things like that, and so we can look at those big picture things when it comes also to hormone balance. But from the nutrition side, it really comes down to that lifestyle management piece and making sure you're getting a full rounded, adequate diet with enough food in it and supporting your blood sugars throughout the day.

Speaker 1:
28:05

Yes, as we break everything down. We've talked about a lot. We've talked a lot about hormones. We've talked about eating and disordered eating and endometriosis. What are some tools for those with endometriosis when it comes to their nutrition or managing their food or ways of helping manage their endometriosis? What can we break down? Just a little bit of those tools that people can use to help navigate that better?

Speaker 2:
28:31

Yeah. So some takeaways, especially if you're kind of trying to navigate this on your own. Number one I would recommend just trying to tune into your body and your cycle. So if you're not exactly sure what's happening when, or it feels like something's happening every day, or maybe it feels like it's happening with no rhyme or reason, like, for example, endo belly, get some data to work off of with that. Track your cycle. Write down your symptoms, whether that's bloating, mucousy stools, lots of gas, diarrhea these days of the week I have a hard time getting my poop out. This time of the month it's like I'm going several times a day and it's loose. Write all of those things down and when it's happening. That would be number one.

Speaker 2:
29:15

Number two consider food journaling if you're not sure what's triggering your symptoms. The only caveat with this I would say is if you have a history of disordered eating or you're really trying to break away from dieting and your body and food relationship, you might want to work with a provider that specializes in eating disorders while you do this, or consider another method where maybe you take pictures of food. Just be really careful about hops and things like that that are counting calories if that's something that you struggle with. But starting with food logging, journaling and looking at that next to your symptoms can be a helpful tool in identifying triggers. If you've never tried an elimination diet and you just kind of feel lost, I would recommend considering the FODMAPs lower FODMAP before I recommended cutting out that's probably the one that I would recommend is the lower FODMAP diet. It is very restrictive, it's hard to follow, but I would only do it for about four to six weeks and then you want to reintroduce things about one at a time.

Speaker 2:
30:18

And then you want to reintroduce things about one at a time, and I would do that under the direction of somebody, whether that's your doctor, your dietician, somebody that's kind of looking at that to help you identify it. Because if you don't need to cut out gluten long-term, we don't want you to. We want you to live a happy, nutritious, joyful life where you get to enjoy all of the foods, right. And then, if you're taking supplements considering supplements, considering blood tests, things like that just really pay attention to any red flag words that a provider may have. If they're claiming to cure, heal, reverse, find the root cause of your endo and they're not an excision surgeon. That would be a red flag that they don't really understand the disease or they might not have your best interest in mind.

Speaker 1:
30:59

Yep, that's a big one. That's a big one I can get behind that.

Speaker 2:
31:04

I think, above all, your relationship with your food and body is more important than any dietary approach to improve endo, because we know that it doesn't cure or cause it. Your mental health and your relationship with food is most important above all. So nutrition can definitely be supportive of symptoms. It can help you with your health goals, can make you feel well overall, and I think there's a lot of benefit to working with a dietician, especially when there's potentially unlimited visits and things like that. But if that's going to be the thing that stresses you out or really impacts your mental health, there's just not a lot of evidence that that's the most important thing for this disease process.

Speaker 1:
31:48

That's, I think, a really big key takeaway for a lot of people is enjoy life in what you're eating too right.

Speaker 2:
31:55

I love working with people who have endometriosis. I think that everybody could benefit from having a dietitian even me a dietitian. There's still food relationship things that can come up or like oh, I realized I haven't had any vitamin A rich foods in like a really long time. Sometimes somebody just saying like hey, have you thought about adding this to your plate? And things like that can be really helpful. It's a really helpful tool for a lot of people, but it's not necessarily going to be like the key game changer for endo.

Speaker 1:
32:23

Yes, how can people get the support if they would like it to work with someone with intuitive eating or endometriosis, or a dietician? What are some steps that they can take to do that?

Speaker 2:
32:34

Yes. So if you're looking for somebody who specializes in endometriosis, yes. So if you're looking for somebody who specializes in endometriosis, I care better as testing and screening for dietitians. To my knowledge right now, I'm the only one listed in the United States, but there are a couple in Australia. I think there might be one in Canada and I hope, if there's any dietitians listening and you do specialize in endo and you're taking an evidence-based approach, that you might apply to be on that website, because it's a really great resource for patients.

Speaker 2:
33:03

There's physical therapists and excision surgeons also vetted on that site, checking with your insurance, especially if you're not wanting to pay out of pocket. They will have a list of dieticians in your area that they are in network with, which will make the cost lower for you. And then for intuitive eating, there is a list of certified intuitive eating counselors, so people who have completed that training. If you really want a certified intuitive eating counselor, that would be the route for that. And then there's some dietitians like myself who have not done that certification yet, that may still be practicing within that space. So you don't have to be certified to talk about intuitive eating, but there are counselors who are like the experts in intuitive eating.

Speaker 1:
33:46

Oh, that's good. Those are all really impactful things that I think that we, as endometriosis patients and just as people, can take away. One of the biggest things that I've taken away in our conversation today is to have grace with ourselves, be kind with our bodies, and I really think that it's important not to be fueled by other people's fears but to do what is going to help support your body and your lifestyle best with nutrition, with exercise, with providers. I think that it's important that we don't let the noise get to us, but we do what's going to give us a better quality of life. That has been like the biggest takeaway for me just in talking to you. I appreciate that you have such great input. Is there something that you think people need to hear as we close up?

Speaker 2:
34:35

Yeah, I think that number one is, as you said, give yourself grace. This is a really hard path to be on that we really have no control over, and so trying to honor your body when it's not feeling good and not be too hard on yourself and make sure you're still feeding it and you're not punishing it with exercise is so important. I think, looking at the evidence with kind of a critical eye and just questioning things. There's so many people who maybe want to help us with endo and they may have the absolute best intentions in mind. I really think the person who did my hysterectomy she wasn't malicious in it. I just don't think she understood.

Speaker 2:
35:13

And so going into this kind of being critical, asking the questions and being okay to move on from somebody if they don't fit, what you know is right and I think that applies to nutrition as well If you're getting any red flags, if you're having to take a lot of supplements or do a lot of tests, it should be really simple. We should be able to listen to our bodies and, you know, make sure we're fueling them and we're having a really supportive relationship and happy relationship with food. If you lost the joy in what you're doing, it's probably not the right fit for you.

Speaker 1:
35:44

Yeah, I wish I would have heard that years ago, actually. So I appreciate that input. I appreciate everything you're doing and everything you're saying and I feel like this has been so validating for some of the steps that I've taken personally, and if anything we've talked about today can be triggering to you, it's okay to seek out help, it's okay to disagree at times, but I think it is important that we have good evidence-based understanding of nutrition and endometriosis and I think that will help guide us in our next steps, whichever way that goes, and not falling prey to things that may give us false hope, you know. So this has been really good, because this is a very natural way of helping us support our bodies. So it's been really really good for me, it's been very validating. So thank you so much.

Speaker 2:
36:34

Yeah, thank you so much for having me. Yes, I absolutely feel food should be our fuel. That kind of helps us. It can also be the thing that you know supports our emotions Sometimes. It shouldn't be the thing that always supports our emotions, and if our relationship feels like it's not those things, then it could be worth examining and working with somebody on. And especially if you feel like you have a lot of red flags around talking about eating sugar and that being okay, that might be a sign that we need to examine your relationship with food and body, and there are so many wonderful registered dietitians out there who can support with that. Even if it's not me, there's a lot of really good providers, yeah.

Speaker 1:
37:11

And I think it's worth having that multidisciplinary approach as well as having a dietitian, having someone that can help with some of these traumas that you've maybe experienced in the past. So having a mental health provider assist with you as well, that might be beneficial. And then, of course, having a good healthcare provider is important. So all of these are keys and a better quality of life so amazing takeaway. Thank you, sarah, for taking your time and for breaking this down and being vulnerable with it and just having a heart and passion for good quality, evidence-based nutrition and care for endometriosis patients, so needed and so appreciated. So thank you so much for doing that.

Speaker 2:
37:57

Yeah, thank you so much for having me and taking a leap of faith to kind of understand this a bit more, and I hope that it's really helpful for listeners in kind of deciding if nutrition is a good part for them on their endometriosis journey. Yeah, absolutely.

Speaker 1:
38:12

Well, until next time, everyone continue advocating for you and for those that you love.