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Season 3, Episode 6: Treating Endometriosis and Pelvic Pain with Functional Medicine with Dr. Jessica Drummond

Show Notes

Dr. Jessica Drummond, DCN, CNS, PT, NBC-HWC, is the founder and CEO of The Integrative Women’s Health Institute, The Outsmart Endo Health Coaching Program, and the creator of the Women’s Health Coach Certification.  She is passionate about caring for and empowering people who struggle with women’s and pelvic health concerns. She is equally passionate about educating and supporting clinicians and wellness professionals in confidently and safely using integrative tools to transform women’s and pelvic healthcare.  Dr. Drummond has two decades of clinical experience as a licensed physical therapist, licensed clinical nutritionist, and board-certified health coach working with women with pelvic pain, including endometriosis, vulvodynia, and bladder pain syndrome.  She brings a unique, conservative, and integrative approach to supporting women to overcome hormonal imbalances and chronic pain conditions. She is a sought-after international speaker on topics such as integrative pelvic pain management, natural fertility options, optimal hormone health, menopause, and female athlete nutrition.  Dr. Drummond was educated at the University of Virginia, Emory University, Duke Integrative Medicine, and Maryland University of Integrative Health.

Together Dr. Jessica and I discuss pelvic pain conditions, including endometriosis, and her journey with long COVID. She highlights the signs that indicate pelvic pain is more serious than period pain and shares what screening steps to take next to achieve optimal women’s health from the earliest stage. She shares resources for supporting women’s health and increasing endometriosis education from school age, defines the relationship of endometriosis, hysterectomies, and fertility, and underscores the importance of starting with the nervous system in healing pelvic pain. She also shares her experience with long COVID as a practitioner and details how her own journey has changed her approach to helping patients heal.

I’m your host, Evelyne Lambrecht, thank you for designing a well world with us.

Episode Resources:

Dr. Jessica Drummond

Endo What?

Below the Belt Film

Designs for Health

Nutrition Blog: Clinical Studies Investigate the Role of Micronutrients to Support Menstrual Comfort

Science Update: Review Explores Role of Micronutrients, Antioxidative Status, and Endometrial Health

Science Update: Recent Review Explores Relationship Between Pain Perception and the Gut Microbiome

Visit the Designs for Health Research and Education Library which houses medical journals, protocols, webinars, and our blog.

Chapters:

00:00 Intro.

02:16 How common is pelvic pain and what does it encompass?

07:14 Jessica’s background and the career milestones that led her to work with women’s pelvic health.

10:15 Signs that pelvic pain is more serious than period pain and what screening steps to take next.

16:00 Resources for supporting women’s health and increasing endometriosis education from school age.

20:55 The ‘terrible triplets’ of common syndromes that can be addressed by a functional nutrition practitioner can assess for.

22:48 Diagnosing endometriosis at every age of a woman’s life, and the relationship of endometriosis, hysterectomies, and fertility.

28:35 The importance of starting with the nervous system in healing pelvic pain.

32:52 Symptoms and causes of endometriosis, genetic SNPs, and optimizing valve functions.

35:24 Endometriosis surgery requirements, preparations, effectiveness, and recovery.

39:55 Nervous system regulation through effective supplements and physical practices.

44:19 Digestive support and supplements to assist endometriosis healing.

46:05 Jessica’s experience and lessons learned from long COVID as a practitioner.

54:36 Lifestyle and supplement tools that proved helpful to Jessica through long COVID.

1:06:45 Demographics of long COVID risks and sufferers.

1:07:45 Jessica’s supplement list, favorite health practices, and the approach to patients that she has changed her mind about over the years.

Transcript

Voiceover: Conversations for Health, dedicated to engaging discussions with industry experts exploring evidence-based cutting-edge research and practical tips. Our mission is to empower you with knowledge, debunk myths, and provide you with clinical insights. This podcast is provided as an educational resource for healthcare practitioners only. This podcast represents the views and opinions of the host and their guests, and does not represent the views or opinions of Designs for Health Inc. This podcast does not constitute medical advice. The statements contained in this podcast have not been evaluated by the Food and Drug Administration. Any products mentioned are not intended to diagnose, treat, cure, or prevent any disease. Now, let’s embark on a journey towards optimal well-being one conversation at a time. Here’s your host, Evelyne Lambrecht.

Evelyne: Welcome to Conversations for Health. I’m your host, Evelyne Lambrecht, and today I’m excited to have a conversation with Jessica Drummond. Welcome Jessica.

Jessica Drummond: Thanks so much for having me, Evelyne. I’m excited to be here.

Evelyne: Me too. I’m excited you’re here. Today we’ll be talking about pelvic pain conditions, including endometriosis and also talk about Jessica’s personal journey with long COVID. Dr. Jessica Drummond is the founder and CEO of the Integrative Women’s Health Institute, the OutSmart Endo Health Coaching Program, and the creator of the Women’s Health Coach Certification. She has two decades of clinical experience as a licensed physical therapist, licensed clinical nutritionist and board-certified health coach, working with women with pelvic pain including endometriosis, vulvodynia, and bladder pain syndrome. She’s a sought-after international speaker on topics such as integrative pelvic pain management, natural fertility options, optimal hormone health, menopause and female athlete nutrition. She was educated at the University of Virginia, Emory University, Duke Integrative Medicine and Maryland University of Integrative Health, and Jessica also just launched her own podcast called the Integrative Women’s Health Podcast. Congratulations, Jessica.

Jessica Drummond: Thank you. It’s a lot of fun actually.

Evelyne: Yeah, it is a lot of fun. To set this stage, how common is pelvic pain and what does that encompass?

Jessica Drummond: Well, about 80% or more of women will experience some form of pelvic or period pain or sexual pain in their lives. It’s very common because it does encompass quite a number of things. Endometriosis for example, is 1 in 9 to 1 in 10 women, so roughly 10% of women globally, and that number has been increasing just a bit to more like 1 in 9 in the last decade. There are potentially some reasons for that. We also have just other forms of period pain that have not necessarily been diagnosed as endometriosis or some other clear diagnosis. Endometriosis at this time is really a surgical diagnosis. There is some imaging that can be done to look for endometriosis, but it can’t be ruled out by imaging. Sometimes if it’s seen on imaging, of course it’s there, but if it’s not seen, it doesn’t necessarily mean it’s not there, so not everyone has the capacity to get that surgical diagnosis or chooses to have that surgery.

Then there are other forms of period pain driven by things like gut microbiome, dysbiosis or musculoskeletal pain, things like pelvic floor-related tension, tightness, low testosterone, low estrogen, low estrogen-related things like vaginal pain syndrome, bladder pain syndrome, which can be related to the bladder microbiome and/or the gut microbiome, chronic bladder infections. Can also be related to hormone changes of perimenopause and menopause, vulvodynia, which is autoimmune condition that is related to the tissues inside the very opening of the vaginal canal. And that can also be related to pelvic floor dysfunction. From a musculoskeletal standpoint, I walk around with this pelvis because a lot of people are unaware of all the layers of muscle that are… If we’re looking at the pelvis, here are your two sitting bones and your hip bones, and so the muscles around the vaginal and rectal opening, there are several layers of depth of muscles there.

The external anal sphincter can be irritated, the smaller muscles around the vulva vaginal opening, just the fragile tissues of the vulva can be irritated related to hormones or immune dysfunction, or musculoskeletal, and then there’s this whole kind of hammock of layers of deep muscle just deep to that, that hold up all of the organ systems. The bladder, the rectum, the cervix and uterus is above that of course. The thing is that there are many structures in the pelvis that are very close together, bladder, vaginal canal, rectal canal, and then all of the different nerve compression that could be at risk if someone’s sitting on those bony protrusions, like if you’re sitting on your sit bones or they’re called ischial tuberosities in science anatomy language, all day long.

And we’re seeing more and more of that as people do this remote work 24 hours a day, or things like riding. Cyclists get that kind of nerve compression. And there is also vascular tissue that can be compressed as well in the area, so there are lots of delicate structures and layers of structure that are organs, that are musculoskeletal tissues and that are vascular and neural tissues, and then the immune system can be irritated, the microbiota locally or more globally of the gut microbiome can be irritated, so there’s so many things in the pelvis that can be irritated that it’s very, very common for women to have pelvic pain. Particularly because one of the most common irritants is something as simple as constipation, which is so common that we always have to consider the digestive system when we’re thinking about pelvic health.

Evelyne: Yeah, you’ve just given us such a great overview and so much to dive into. And for anyone listening to this, if you did want to see what Jessica was showing us, you can always watch it on our website, podcast.designsforhealth.com or on YouTube. Can you share a little bit about your background and what led you to become so fascinated in this area and become an expert on pelvic pain?

Jessica Drummond: Sure. Well, I graduated from graduate school in physical therapy in 1999, and I started my career in sports medicine. I was an athlete as a kid, I really liked orthopedics, sports medicine, but I pretty quickly began to specialize in women’s health, which at the time was mostly around pelvic health, pregnancy, postpartum, pelvic pain. I actually got into it via a patient of mine who had had breast cancer surgery and then we were working on her shoulder recovery post-surgically, so women’s health from a physical therapy perspective is really kind of specialized orthopedics related to women’s health concerns, breast cancer, pregnancy, postpartum. We’re talking a lot more about perimenopause and menopause now. And then the challenges of pelvic health, like pelvic organ prolapse, which of course is a relatively orthopedic condition just inside of the pelvic bowl, and all of the other common conditions of pelvic health like incontinence and chronic pelvic or sexual pain, which again is so common and can be common for different reasons across the lifespan.

I specialized pretty quickly and then I focused my physical therapy practice in the world of women’s health for the first decade or so of my practice, but chronic pelvic pain was always a challenge, so I felt like physical therapy tools were not enough. Around 2006, after the birth of my first daughter where I did have some experience of pelvic pain at that time and just really even understanding what kind of recovery women were not getting postpartum, even with everything I knew and even delivering my baby in a woman’s hospital that I worked in, there was still a lot to be understood from that personal experience.

And then I went back eventually and got my doctorate in clinical nutrition and began to bring in more of the functional nutrition perspective, which allowed us to address… I think really allowed me to address the immune and hormonal and microbiota aspects, the more biochemical, if you will, aspects of these pelvic pain conditions that it’s just not something that we have the tools to address in physical therapy. And I’ve at this point worked with tens of thousands of patients with endometriosis and other pelvic health conditions, and we just learn more and more over time.

Evelyne: What are some of the signs when somebody would come to see you or any practitioner that it’s not just period pain and you need to actually dive deeper and it’s something more serious, and then how do you go about determining where to go from there?

Jessica Drummond: Well, I really think we should be screening for period pain right from the get go, like age 8, 9, 10, 11, 12, 13. We should be looking at as school nurses, as pediatricians, as pelvic physical therapists who work with children, as orthopedic physical therapists who work with children or occupational therapists because the thing is pelvic, I mean period pain is not normal. Now, it’s not always endometriosis, but it’s always not normal. Now, a mild one day of cramping that you occasionally need to take an Advil for a few times a year, that’s within the range of normal, but if someone’s missing school or work even in just a few days every month or in serious enough pain that they would take a medication, an anti-inflammatory or something every single month, then it’s a red light that again, it’s not necessarily endometriosis, but it’s not normal.

Women should be able to have healthy cycles without this pain, and so that’s a little yellow warning light, if you will, that we need to start looking at the basic foundations of health for teenage and young teenage, teen, tween women in their early 20s around the real fundamental lifestyle health basics. The menstrual cycle can be a really helpful kind of red flag, warning sign that something’s a little off in her optimal health, so that’s when we do start looking at the gut. How’s her digestion? Any constipation, any bloating? How’s her nervous system? Because if someone’s living in a chronic state of fight or flight, or freeze, they’re always upregulated, always under a little bit of stress, anxiety or on the other end of the spectrum stuck in depression, overwhelm, then the nervous system is that could actually be driving the immune and digestive systems to be putting pressure on the hormone systems which are founded… Their foundation is the stress resilience.

I think two things need to be screened for early on with any kind of period or pelvic pain, is digestive function, gut microbiome health, and how is this woman generally living, or this girl? In our endometriosis programs for example, and even actually all of our programs, every single one of our programs, we start our professionals and our clients using wearable technology, either an Oura Ring or a Garmin. We actually use the Garmin vívosmart 4 most commonly in our client level programs because it gives us direct real-time data in a way that’s pretty simple and passive to collect about people’s heart rate variability, which shows if the moment they woke up in the morning, and I see this all the time with my high school and college girls, put their feet on the floor and they’re like, “Boom, in the orange stress zone.”

They haven’t learned the tools to live in a way that helps them modulate their nervous system regulation, which is so key to their immune gut and hormone health that that’s really always going to be the first step and then we can layer in the other tools of healing those other systems. But I really think it’s something that we need to screen for at the get-go because sometimes women don’t look at their pelvic health until they’re trying to get pregnant, and maybe 15 years ago when they were 14, 15 years old, they were put on hormonal birth control pills to mask those symptoms, which can work in certain cases and is not always a bad idea, but it has to be put into context.

If we’re going to mask the symptoms, we also want to be doing the things we can do to optimize the system underneath that hormonal support, which may help quiet the symptoms and help girls and women live a healthier life, but we don’t want them to wake up at 32, 35 and be like, “Oh my gosh, now I can’t get pregnant because I didn’t address this problem when I was 15, 16, I just masked it.”

Evelyne: Is it common to get screening? I’m just thinking, did I ever go to a doctor as a teenager? I know I went to the dermatologist for acne, and I think I went to the school nurse, but it was if I didn’t study for a test and I’d stayed up too late the night before and I didn’t go to class. But I’m just thinking, I guess if you do have period pain, I assume that your parent probably would take you to get an evaluation, but I don’t think it’s common at all to get evaluated for any of this unless you go to a naturopathic doctor or a functional medicine provider. And you said a pelvic floor therapist. I think that’s so rare for especially a teenager to go to, right? Usually that’s not covered by insurance. I’ve gone to one when I had SI joint issues and I thought, “Okay, who would know that anatomy best? I think a pelvic floor therapist.”

Jessica Drummond: Yeah, yeah.

Evelyne: What are your thoughts on that? Am I missing something, like I just don’t know that people do go to the doctors for that, and it’s not being addressed or where can they go?

Jessica Drummond: Well, okay, so I think there’s a couple answers to that question. One, we’ve been working, our institute, the Integrative Women’s Health Institute has been working with many other organizations to support Shannon Cohn is a woman who has created a nonprofit called Endo What? She’s also a producer and filmmaker who’s created two movies. One is called Endo What? It’s basically like, “What the heck is endo?” Explains it to people. And the other follow-up to that movie is Below the Belt, which we’ll actually be screening for our community in a few weeks in June. And that movie follows people who have endometriosis on their journey, what’s the experience of gas lighting, and I think getting to your question of at the end of day, who cares about this? And one of the things that they do have, which we support every month, and I strongly encourage people to support, you can support it financially or you can just reach out to Endo What? and say, in my town there are three middle schools and a high school, can you please send the school nurse at these three schools a screening kit for endometriosis?

That program has been going on at least five years, and so if that’s not something that exists in your community, that nonprofit is doing that work to try to get school nurses and middle schools and high schools to screen girls for endo because at the end of the day, if you have a class with 10 girls in it, one of them’s going to have endo, so that’s the place to start looking. Then the other common thing that happens is girls do have this pain and it’s severe enough that their mothers are not able to, or their parents are not able to help control it, so they take them to their gynecologist or their pediatrician, and normally the response is, “Okay, we’ll just put you on birth control.” Now again, I don’t see that necessarily as a bad thing, but that’s where parents do need to step in and then take their child to someone else too.

And those people are going to be functional nutritionists like our clinic, we do functional nutrition and functional medicine. We now have a nurse practitioner in our system, or functional medicine clinicians in their local area or pelvic health physical therapists where they can at least evaluate the pelvic floor. Pelvic health physical therapists do see teenagers for sure, and while they may not do an internal intravaginal exam necessarily on teenagers, depending on the circumstances, there’s a lot they can do to teach them about things like breath work and breathing and doing all the work to optimize the nervous system piece that we’ve talked about, connected directly with essentially learning to relax all of these muscles of the pelvic floor coordinated with breath and diaphragm. And they can also do visceral mobilization to the abdomen. There’s a lot of things they could do to see if the pelvic floor is driving some of the symptoms or at least irritating what’s going on more biochemically.

I think the ideal team for anyone, no matter how old they are with period pain or pelvic pain of any kind is to work with a pelvic physical therapist, and some of them absolutely do take insurance, and if they don’t, they often provide really good care that doesn’t require as many sessions maybe as people who could take insurance because they’re really able to give an hour of attention. I’m sure you had that experience when you saw pelvic PT. It’s a lot. You may only need to see them three, four or five times because it’s like they really can teach a lot in a focused amount of time. And then same thing with us, we can work with you for something like 6 months and really resolve this from the root and teach you so many things that that person doesn’t need to see me for 10 years.

I see them for 6 ix months… The earlier we get it, the better. And then sometimes a longer-term follow-up if there are other things going on. With endometriosis there’s the terrible triplets, which is bladder pain, syndromes as well, and vulvodynia, so if they also have vulvar pain, bladder pain, and increasingly I’m seeing with my clients with endometriosis, a combination of dysautonomia, which is their dizziness, fainting out of nowhere, it might’ve been something they had their whole lives or it might’ve been irritated by some kind of stressor or triggered by some kind of stressor. The new terrible triplets that can go with this is that dizziness, dysautonomia, hypermobility. Again, a lot of these girls are really high-achieving, dancers, gymnasts, they go in that direction, but then they may not have full Ehlers-Danlos syndrome or other hypermobility diagnoses, but they have a genetic tendency in that direction.

And then histamine issues or Mast Cell activation where they’re always allergic, they tend to break out in hives periodically, they have increasing food sensitivities. These cluster of syndromes is one of those things that a functional nutrition practitioner can assess for, and a lot of times by just dealing with all of those systems, we talked about nervous system, immune system, hormone system, digestive system and musculoskeletal system, all of those issues can be resolved without having to go to a specialist for each one, which I think can be helpful when it feels really overwhelming.

Evelyne: Yeah. Yeah, absolutely. I want to back up a little bit, and thank you so much for sharing about that school nurse program, that is amazing, incredible, and I hope that our practitioners who are listening will take advantage of contacting Endo What? and increasing the reach in our communities. That’s amazing. Backing up a little bit to the statistics on endometriosis and how you know that it’s endometriosis, because you said that it’s just diagnosed by surgery, so you said 1 in 10 girls will have it. Is that the same in older women, like 10% of women?

Jessica Drummond: Yeah, roughly it’s 10%. And what’s interesting is that there has been found endometriosis lesions, endometriosis cells… Endometriosis, first of all, what the heck is that, right? It’s basically growth of abnormal cells that are similar to, but not exactly the same, as the lining of the uterus, which is also called the endometrium. These cells can be displaced cells. I think of it as a non-cancerous cancer, so it’s similar to cancer in that you have these abnormal cells growing anywhere. There are certain areas of the body where it’s more common, but they have been shown, endometriotic lesions have been found in the nose, in the knee, in the lung, in the diaphragm, all over the pelvis. It’s actually not in the uterus. That’s a separate condition called adenomyosis, so hysterectomy is absolutely not a cure. It’s not even a good treatment for endometriosis because by definition, endometriosis is not in the uterus, it’s outside of the uterus.

Could be on the ovary, fallopian tube, it’s often on the bowel, it’s often on ligaments in the pelvis and other soft tissues in and around the pelvic abdominal cavity, but it could be anywhere in the body. That’s called extrapelvic endo, so for women that have shortness of breath and things like that, they could also have diaphragmatic or lung-related endo. It’s highly variable, so about one in nine female fetuses and a study that was done quite a while ago were found to have these aberrant cells even in utero. It’s at least at some percentage a… It’s definitely got a genetic underpinning, but it’s not always expressed. I have a client right now who has an identical twin sister who doesn’t have endometriosis, so it’s possible for a person to have the genetic predisposition without it being expressed. And then there’s some new research that I was just talking about yesterday on our podcast that scientists or clinicians are looking more for endometriosis.

We used to think it was cured. Well, I didn’t use to think this, but there was this myth out there that endometriosis was cured by menopause because some of the data 20 years ago showed that endometriosis lesions could be driven by estrogen in the same way, for example, that some breast cancers are driven and fed by estrogens. That’s sort of true, so in 2018 there was a study done in Belgium that found some lesions had an upregulation of estrogen receptors, some had an upper regulation of progesterone receptors, some none, neither of those, some both. And these four different kinds of endometriotic lesions, and they only studied deep infiltrating endometriosis, which is one phenotype of endometriosis, but all four of those different kinds of lesions could have even been in the same woman, so just suppressing estrogen or even pushing the quote unquote detox of estrogen is not a cure for endometriosis. It’s not even really an appropriate way to address it, and thus natural menopause is also not a cure for endometriosis.

In this population of perimenopausal and menopausal women, about 14% of the perimenopausal women were found to have endometriosis, and about 4% of the post-menopausal women were found to have endometriosis. So it could be that the diagnosis was just delayed because this is a complicated diagnosis. Sometimes it’s confused with gut issues, so 80% of people with endometriosis also have digestive issues. It might even be more like 90, 95%, so they may have never been… If they didn’t have infertility, if they were just masking their period pain for years with birth control or ibuprofen or whatever, and then finally at perimenopause there was enough of a symptom shift that they… Or they went off birth control because they were not trying to have a baby or something like that, they could be newly diagnosed in perimenopause because I think there is a potential…

One of the things I’m seeing in my practice is in perimenopause because of the new hormonal shifts, I do think it’s possible that women who didn’t really have expressed endometriosis younger, they didn’t really have any symptoms at all, there was a trigger in perimenopause. That’s possible. Same thing could be post menopausally, but it seems to be more common in perimenopause and post, so that group could be just delayed diagnosis or it could be a trigger at that time. And I’ve seen clinically lots and lots of different triggers for the expression of endometriosis, everything from a virus, a stressor, just starting your period, just moving into perimenopause, postpartum. Any big change, a viral issue, even a vaccine injury in some cases, so any kind of irritation or stressor could be that trigger for that individual that kicks off the disease expression is what I’ve seen.

Evelyne: And you mentioned already that… Well, the connection with the gut health, you mentioned the connection to the nervous system, immune system, so where do you start usually?

Jessica Drummond: We always start with the nervous system because I think with any chronic condition, there’s always got to be a safe space of I feel comfortable. Healing physiology is activated in parasympathetic ventral vagus activation, so if someone is always living in a sympathetic upregulation or a parasympathetic free state, it’s just much, much harder to heal. It’s not impossible, but it’s certainly much easier, because we always say, I say to my clients, “Look, if all of us could just go to whatever, Bali or a Caribbean island for six months and just chill, we had no work, someone was taking care of our kids, someone was cooking all the perfect food, people would just heal and pretty quickly.” But the problem is then they’d have to go back to their lives, and it would just come back, so there has to be a level of learning how to regulate the nervous system in general.

And I think that’s key for any chronic condition, but really hard because feeling all these symptoms and not really knowing where they’re coming from and being gaslit by your practitioners, and there’s so much on the internet and it’s very confusing, it can be triggering to someone to just try to understand this condition. The first step is really hope around the possibility for sure of getting much, much better to completely healing from this, and I think that has to be part of it. And then we have to have some practices of safety. Then the next step a little bit depends on the client, so nervous system regulation is step one. Step two is what is the client’s real vision, goals? What does health look like to her? And then the third piece is we’re… Because there are all these different potential symptoms of endometriosis and other pelvic pain syndromes, what’s bothering her the most? What does she care the most about quieting?

Let’s say it’s the fatigue. Endometriosis can come with a lot of fatigue, so we might then start with optimizing her circadian rhythm, getting her sleep hygiene dialed in, working on a morning routine to support her adrenal function, her hypothalamic pituitary adrenal function, daylight exposure, a morning grounding meal, letting go of alcohol and sugar, things like that, and then maybe doing some supplemental support for her mitochondria. That might be where we would start for someone whose fatigue is the most bothersome symptom. For someone who’s bloating, and constipation is the most bothersome symptom, we would absolutely start there because we can’t metabolize if we’re not day in and day out detoxifying, so constipation is a really important one, and hydration, two sides of the same coin.

Is she sweating? Is she pooping? As we always say, are the windows and doors open? Doing that can be really important to optimizing the gut microbiome and can really help with her menstrual flow and consistency, so then we would do more with potentially nutrition, pre and probiotic foods, hydration, rotational movement, visceral physical therapy, things that get the lymph and the bowel and the sweat and the hydration all moving. That’s really the first step when things are stagnant, puffy, bloated, stuff like that because endo belly is a real thing. It’s a lot of bloating and SIBO or SIFO-related dysbiosis.

Evelyne: I was just going to ask about SIBO. I know there’s a big connection with endometriosis, and is SIBO the symptom or is it one of the causes?

Jessica Drummond: Well, I would say it’s like a part of the syndrome because a lot of times there’s endometriosis actually growing on the intestines, and so motility often gets messed up because you either have a lesion there or you may have an adhesion, so there’s also a genetic snip that’s really common in people with endometriosis that leads to more fibrotic activity, and so they have local inflammation about the lesions. Let’s say there are a number of lesions on the small intestine. Even if those lesions are removed by surgery, which will be helpful quite a bit, it still means that the small intestinal motility, there’s going to be little pockets of sluggishness, if that makes sense, so for my clients with endo-related SIBO or endo belly, there’s a structural challenge that even post-surgically is a lot better, but is still potentially an area of a little bit of slowness where bad bugs can thrive.

And so, I think of the SIBO and SIFO management as being more chronic. We’re not just going to quote unquote cure the SIBO with one bout of antibiotics or even antimicrobial herbs, it’s something we’re going to manage over time with fascial mobility support, with things like ginger and artichoke and other things that help motility, but also probably once a quarter, two, three times a year, we’ll do a burst of antimicrobial herbs just to keep things going. And it’s really important in those cases to optimize bowel function. And sometimes that’s as simple as toileting posture, squatty potties, so many things we can do to make sure things keep moving, even if there are pockets of structural vulnerability. Some of my clients with endometriosis surgically have to have parts of their intestines removed because of where the endo is and how much it’s damaged the intestines, so there’s a lot of structural challenges that actually underlie the SIBO, but there also could be just the general inflammation and the peritoneal fluid that can contribute to that overgrowth, that dysbiotic overgrowth.

Evelyne: I have some questions about the surgery and then I want to go back to the mind-body connection and the HRV piece. With surgery, does everybody with endometriosis need to have surgery? What are your thoughts on that? I’ve definitely heard some success stories from people who had it and that it was very helpful, so I’m curious about that.

Jessica Drummond: It very often can be very helpful, and I think we always ideally… I talked about the team of your functional nutritionist and your pelvic physical therapist. Ideally anyone with pelvic pain will have those two people in their team for at least three to six months pre-op, so we want to do pre-op preparation. We want to get your nutrition dialed in, your tissues moving, your pelvic floor relaxed, your mind-body integrated, your immune system optimized, lower your toxin load. Just get you in really good shape before going into surgery because even though the surgery can be really, really helpful, any surgery to your mind-body is a sort of literal attack, if that makes sense. You’re literally being cut, and so the more nervous system regulation there is, the less the body takes it as an attack, if that makes sense.

And then post-op, same kind of thing. We want to really optimize the lining of the small intestine, we want to optimize motility, we want to make sure your nervous system isn’t panicking. There has to be this deep recovery in the same way we would do with any major orthopedic surgery. I think it’s just that we think when it’s a women’s surgery that they just go in, they’re there for a couple days and they come out. No, I really want three to six months of pre-op, depending on how severe the situation is. Good excision surgery is done by a surgeon who specializes in endometriosis excision. That’s really important because it’s as complicated as cancer surgery, as we were just talking about. They’ve got to get to the roots of these lesions and fully take them out. And those surgical techniques have really evolved a lot in the course of my career. 15 years ago, all of my patients had a lot of problems.

They had 15, 20 surgeries by the time I would see them. They would have surgery every year, every other year because the technique was just burning off the endo. You could see an ablation, but now they actually think of it as similar to a cancer surgery. They cut out the lesion, which is much more effective, and we only see people needing one to three maybe surgeries in a whole lifetime. It’s a complicated surgery, sometimes they have to do some things and they have to also involve a bowel surgeon a lot of times. There’s a lot going on depending on the severity, which is why we want to deal with that as early as possible, but surgery, the surgical techniques, work with a surgeon who’s been very well-trained in robotic excision. And then post-op, we do about six weeks of acute recovery, so that’s where you’re just recovering from the surgery. Then people can go back to work generally and slowly starting to exercise and things like that.

But I suggest to people who’ve had endometriosis surgery, the full recovery is about 6 to 24 months, so it takes a while to get the best possible results from that surgery, so don’t panic if 8 months later you’re like, “Oh, I still have some symptoms.” And you might actually have different symptoms, and that’s okay. There’s a kind of resetting that happens after the surgery. Now, surgery is not required because it’s not a lethal disease in most cases, so in most cases it’s an elective surgery, but it can be really, really helpful and it can be very helpful for fertility sparing. Women in roughly their… Well, any age of fertility, but relatively early in their 20s would be the optimal time to have it if their goal is fertility. Not all of my clients have a fertility goal, but if they do, the earlier, the better in terms of fertility preservation.

Evelyne: Interesting. Thank you. And going back to the nervous system regulation piece, what are some of your favorite ways both through supplements and through different practices that you recommend? Because I do think there are so many things out there and different things work for different people, and there’s the trauma piece too, which we really haven’t even talked about on this podcast, so tell us more about that.

Jessica Drummond: Yeah. Well, I definitely work with my colleagues in mental health and trauma health and somatic healing and EMDR. All of that is really, really valuable. And then what I do from a coaching perspective is a lot of breath work, a lot of HRV tracking, using wearable devices and helping people understand what are their unique contributors to having a higher baseline heart rate variability or HRV. A lot of nature exposure. I’ve tried 100 different vagus nerve stimulators and PMF mats and all this stuff, and they’re lovely, but honestly, I have found that just having people spend more time outside is way more effective than any of those other things. It just is. Just sit outside. If they can walk outside, that’s great. If they can just be outside more, it makes a huge difference, so breath work, outdoor exposure, visceral mobilization and craniosacral work, the manual therapy work that some specialize, like where all trained, for example, physical therapists can do, can be really, really helpful.

It’s one of my favorite tools. And I love 528 hertz music, so for those of us who are a little bit chained to our computers for our work, our Zoom work or whatever, having the 528 hertz music, you can get it free on YouTube or Spotify, that’s really valuable tool for nervous system balancing. I also like contrast showers, I like sauna, I like meditation. Cold plunging can be good. For women we have to be careful with that and go a little bit slow because women have a higher risk of vascular spasm, heart attacks, so we don’t want to just go from zero to jumping in a cold ice tub or whatever, but cool, end of shower, a minute cool on the feet or legs and then slowly progressing can be really valuable. And then really from a mind-body perspective, it’s also valuable from that body mind perspective to regulate the nervous system through any tools that calm neuro inflammation.

Things like turmeric, things like… Well, the other thing that can be helpful and just generally anti-inflammatory for the whole body for this condition that does have a lot of fibrotic adhesions is using proteolytic enzymes. That can be helpful for both pain management and for I think nervous system regulation because the person’s not kind of gripping in pain all the time. And things like L-theanine, GABA, neurotransmitter support, but I really… Proteolytic enzymes, about 13% of people with endometriosis… We don’t have any data on the mechanism for this, but 13% of women with endometriosis choose to use proteolytic enzymes such as serrapeptase and report that it’s helpful. And also CBD. I really like CBD tinctures. That can be valuable as well. And there is data on THC as well, so there’s many, many tools. Even things like using vibrators to relax the pelvic floor, that vibration, heating, things like that, because don’t forget, the vagus nerve has a branch to the clitoris, so anything that kind of relaxes the pelvic floor or stimulates orgasm can be really helpful to the mind-body balance.

Evelyne: Thank you for that. And talking a little bit more about other supplements, because you just mentioned some, but related to the mind-body part, what about generally for endometriosis to address all of the different aspects?

Jessica Drummond: Well, again, you would kind of have to go system by system and see what we’re dealing with, but digestive support for sure. Mindful eating, digestive enzymes, super valuable. Sometimes betaine HCL, motility support, supplements, prebiotics, probiotics, antimicrobials for the SIBO and or SIFO, binders. Someone women with endometriosis are also irritated by mold toxins, mycotoxins, so binders for yeast, for dysbiotic die off and for mycotoxins, so charcoals and chlorella and things like that. And then from an immune system standpoint, depending on if they have any chronic infections, things like monolaurin or L-lysine, and then still the things that break up biofilm, so the proteolytic enzymes are really, I think, the most valuable tool for that and doing it really slowly, because otherwise there can be a lot of symptom flares related to the metabolism and detoxification of any chronic infections.

Evelyne: Thank you for sharing all that, and thank you also for what you shared about the vagus nerve. We are interviewing a vagus nerve expert also on the show this season-

Jessica Drummond: Oh, good.

Evelyne: … but I always think of it with the gut and brain, so very interesting. Jessica, I kind of want to switch gears here. I’d love to talk more about endometriosis, but I’d also love to talk about your personal experience with long COVID and how that journey was and has been for you, especially as a practitioner. Broad overview, what are all the things that you’ve learned? Or maybe not all of them, BC that could be a whole hour TOO.

Jessica Drummond: So many things, yeah.

Evelyne: Yeah.

Jessica Drummond: Interestingly, the biggest thing I learned was how ableist I was and most of my colleagues. It was very challenging for me to be that sick, and even now, and even in the last… I got COVID in December of 2020 and had a pretty bad case, but I wasn’t hospitalized. I was in the ER twice. I had fluids and some basic support like that. There was one other medication they gave me early on that I’m blanking on right now, but basically I was having trouble maintaining my oxygen saturation, and then I had a ton of chest pain, shortness of breath, ended up with pericarditis. It was rough acutely, but I run a company, I see patients, I have employees, I have a lot going on, and really I didn’t have the capacity. I took time off as needed, I worked from home, but I never really stopped working for any sustained period of time.

I expected myself to recover… First of all, I had absolutely no fear of COVID, which was dumb, and looking back at it, I was like, “Oh, this is a virus. I have 1,000 tools for viruses.” My team, I was working with a functional medicine practice at the time, I was going into the office occasionally, and I was also working a lot from home, but I was also seeing patients one day a week just because I was wanting to get my hand back in it, and I’d been doing that maybe a year and a half. And that team had a physician, naturopath, and we were pulling together all the tools that would probably work for this and everything from Chinese medicine herbs to Western medicine herbs, and I was just like, “It’s a virus.” Sick people are getting sicker, but my family and I should be fine.

And my daughter had it first, she was 16 at the time, and she had a rough go, but she fully recovered in that two weeks. It was a rough virus and I was like, “Okay.” But I was really sick and I was in fantastic shape going into that. I was probably in among the best shape of my entire life. I was like 46 years old, I was fine, but I was really sick really fast to the point where I didn’t really know how it was going to go. And then after I got through the acuteness where I was mostly able to maintain my SATs, my oxygen saturation, my heart rate was all over the place, I was like, “There’s something wrong with my heart.” I would wake up in the middle of the night with 150 heart rate out of the blue, and that happened for months, and I was taking Colchicine and 800 milligrams of ibuprofen. I had a ton of chest pain. I could barely walk down my driveway, never mind down my street.

And I had been doing four times a week strength training and HIIT classes two weeks before that. I couldn’t shower, I couldn’t stand up to take a shower. I was just trashed, so it was fascinating because early in that time, I did a few interviews with some colleagues in the space of functional medicine to be like, “Hey, we were wrong. This is bad.” And pretty much everyone was like, “What did you do wrong?” They weren’t like, “Oh, we should learn from you.” It was a lot of like, “Oh, well, it’s really not that bad. It’s going to be fine.” And I was like, “Okay.” Then I just went into my own focus to work on my own healing. And I was lucky because I did know a lot actually from my work with complex chronic illness with endometriosis, so I started immediately on…

I was already eating 85% paleo, so I went 100% paleo, no grains, no sugar, tons of phytochemicals, tons of nitric oxide, moderate protein, cleanest diet I could do from day one really, really consistently for three years at least. And that I think was very, very, very helpful to the initial recovery, but I was still very sick for years and… The phytonutrient… But it was interesting to see how frustrating it was for me. I don’t know that I was so much scared of being sick because I was like, “Well, we’ll have all the tools.” Like, “Well, if some people can figure this out, I can figure this out,” but it was very hard from, like I said, an ableist perspective to accept being that sick and then to also know that my colleagues were like, “Well, what are you doing wrong?” And it made me really see that we have a lot of expectation in this world of integrative and functional medicine that individuals have the capacity to do the work, and if they don’t, they’re lazy.

And it was eye-opening to me because I certainly wasn’t. Did I have some of that thought with some of my patients in the past? Probably. And so it was a really difficult time for me to adjust to that because they were also… I certainly also worked with a lot of colleagues who were very, very helpful and very, very… It wasn’t everyone for sure, there were a lot… Especially my colleagues who work with patients, so I think it’s interesting. We’ve got colleagues in this field who do a lot of marketing, and we have a lot of colleagues in this field who work with patients and have done so for 5, 10, 20, 30 years. There was a wide divergence in their insights. The people that had been working with complex chronic illness for decades really did understand, and that was the benefit that I had. I had been working with people with complex chronic illness for a really long time and knew that there were a lot of layers to it, and then my colleagues and I could figure out, all right, what is this really? What are the different layers that we’re dealing with?

I think that was really, really valuable, and I think my functional medicine training is what has gotten me this healthy when many of my colleagues who got COVID, especially in 2020, but even now, most of the people I knew who had COVID in 2020 were clinical colleagues who got it at work, because the people on the front lines, if you will. And many, many of them are still bedridden, cannot work, are very, very sick, or get a little better for a while and then fall back down. It’s a really frustrating disease from that standpoint, but it can express in a lot of different ways. And the reality is that new people are getting long COVID with every infectious wave, about 10% of every infection, so you could have COVID two, three, four times never get long COVID and then get it on your fifth time. It absolutely could come at any point, and the expectation is that about 50% of the US population will be disabled with long COVID by 2030, so it’s a huge problem. Yeah. Yeah.

Evelyne: Thank you for sharing all that. And I was reading your posts as you were sharing about what you were going through, and you were doing everything so much more than people would do, so to think that it’s something that you were or weren’t doing, that’s interesting. I’d love to learn more too about what you found was the most helpful in terms of broad categories. You’ve written about treating long COVID as a brain injury, written about the mitochondrial component, so if you wouldn’t mind just sharing some insights that have really helped you in those areas, and especially with lifestyle and supplements.

Jessica Drummond: The good news is that in the last even six months, we’re getting a lot more research coming out, which is really helpful to what are the underlying mechanisms of long COVID, and I really believe that it’s a lot of different things. Probably in most cases there’s some level of viral persistence, so kind of like how Epstein-Barr, once you get it, you have it and it’s just hiding and it’s not always reactivated. I think we’re going to see… We absolutely know, there’s science that shows there’s viral persistence, that it’s worse for people with long COVID, that it lasts at least a year based on the data, and the virus could hide in any organ. Brain, ovaries, all over the place. That’s helpful because once we know that, okay, this is still virally… You’re constantly dealing with this virus, then what’s happening, so one is that the initial acute infection and possibly even later on as the virus reactivates or you get another variant of it or something like that, there can be acute organ damage.

There can be brain organ injury, there can be kidney organ injury, there can be heart organ injury, so for some people, they’re… And sometimes those things can be measured in the way that we would normally measure, like heart failure or kidney damage, or brain injury, MRI, things like that, so that’s the first acute irritation. Then we look at, well, what does a regular post-viral syndrome look like, or an autoimmune activation by a virus? We know, for example, that Epstein… I mean that MS is probably triggered at least in some cases by Epstein-Barr, and maybe herpes, maybe a combination of those, so it’s not necessarily that the immune system is just activated towards nothing, it’s just activated towards the nervous system for no reason. But maybe because these viruses and other pathogens that could be reactivated, because Lyme can also be reactivated in there, there’s a lot of complexity, but we definitely know that COVID can activate Epstein Barr.

That triggers where the immune system is targeting and kind of perpetuating that damage, so on a cellular level, mitochondrial for sure, I think fatigue is still the number one symptom of long COVID. I was lucky in that because the reason I even got into functional medicine 10, 15 years ago was after my first daughter was born, I had a chronic fatigue related to hypothalamic pituitary adrenal issue, suppression. Stress, basically. And I probably even had an Epstein-Barr reactivation. I know I had mono as a teenager, and I probably even had an Epstein-Barr reactivation when I was postpartum with my first daughter, so that’s how I got into functional medicine, so I knew from a fatigue standpoint that supporting the mitochondria is key, so I used Urolithin A, I used mitochondrial NRG with Designs for health and other forms of CoQ10, I used NMN. Really, really valuable. I found that the most valuable of all the tools, a combination of NMN with resveratrol even better than NAD injections or NAD directly.

Evelyne: Interesting.

Jessica Drummond: I found NMN better. And so that’s been really helpful, and then also senolytics, because the Quercetin, the Phycetin, I haven’t used Dasatinib, but some people do because you not only have to build up the mitochondria, but you’ve got to kill off the zombie ones, so that was super valuable. And that’s part of why I was doing such a clean paleo diet, very plant-based, very polyphenol-based to nourish the mitochondria. That’s still the number one symptom, but it’s like, “Well, why…” You can support the mitochondria, but you also have to keep fighting off the virus because we don’t really know exactly how to do that yet because there’s just a lot of layers to it in terms of the research, but what’s helped me the most, there’s a supplement that unfortunately, I think the company just went out of business, but it’s called Tollovid. It was made of Gromwell root, and that is a… I think it’s called PCL-3 inhibitor. The goal of that Gromwell root was to block the enzyme that COVID uses to activate itself.

Evelyne: Interesting.

Jessica Drummond: It’s the same mechanism that’s used in Ivermectin, actually, but it’s much less in Ivermectin, and in Paxlovid where it’s much more in Paxlovid. And I will tell you, I have had one infection since, much more recently in November where Paxlovid existed. None of the medical tools existed when I first had COVID, so it wasn’t a vaccine injury, there was no vaccines, I had no vaccines, it was actual COVID that triggered all this for me. But this time back in November, I did take Paxlovid given my first experience with COVID, and it’s the only time in the last three and a half, four years that I felt perfectly normal.

Evelyne: Wow.

Jessica Drummond: For me, there’s a clear viral persistence. Tollovid helps, but it’s like I only can take it periodically. Monotherapy doesn’t really work for viruses, you can’t just use one thing, so even if it is Paxlovid, I could probably take Paxlovid all the time and probably the virus would just mutate around it, so that’s not really a solution either, but it is interesting to see that an antiviral strategy is still really helpful for me. The other thing that’s really helpful is I’ve used low dose immunotherapy to be less reactive to all the other stuff that seems to have been awakened by COVID, so yeast, mold, Lyme, COVID and COVID vaccine itself, so there are low dose immunotherapy, which is a homeopathic strategy that I actually work with my colleague, Dr. Ginger Nash, to do the particular dosing, but it’s kind of like the same idea as allergy shots.

You get a small homeopathic dose just under the tongue every six weeks of anything your immune system might be hyper-reacting to, and that helped a lot. The other thing that really helped me get much, much more functional about a year ago, so April of 2023, I did an intense 40-day session of hard chamber hyperbaric oxygen therapy. And before that, I had been losing my vision in my right eye, which I could feel like was a brain thing more than an eye thing. And I had an MRI, which was basically normal, although it did show some signs of inflammation, but after doing the hyperbaric oxygen, I really think it healed the brain injury, if you will, that I was dealing with.

Because other things definitely helped, like all the neuroinflammation supplements were really valuable. Like I said, we’ll get to the vascular in a minute, but for the brain and the visual stuff, hyperbaric oxygen helped a bit and the… A lot, actually. And the thing that it helped me do most importantly was finally be able to consistently exercise without crashing every time. I’m still much lower than I was before I got COVID in terms of my physical fitness, but I luckily was wearing an Oura Ring pre-COVID the first time, so I’ve seen that I’m getting closer, and in some ways actually even better than my pre-COVID cardiovascular and strength fitness. It’s coming along because COVID also put me into menopause, so that makes things a little bit complicated, overnight, so that wasn’t so fun.

I’ve been supporting that. And then finally, we also learned, there’s way more research I can get into, but the other major thing that was really, really helpful for me was probably in early 2023, maybe late 2022, Harvard finally did a really good study that showed that COVID is ultimately a vascular disease. It’s not just a respiratory infection. And that was something I knew intuitively in 2000, days after I got COVID, because the moment I got COVID I had intense vascular pain. As a physical therapist, we kind of have a little x-ray vision about where all the structures are, and I just woke up one morning and every vessel was burning. And that continued for 8 months until every day, all the time, 24/7, 9 out of 10 burning until I had a COVID vaccination. And then overnight, it completely went away.

And so for me, vaccination was helpful at some level in resetting the immune system to not attack my vessels as much, but it’s still even here and there, I’ll get a little flare of that, so if I over push it, I’ll feel some kind of vascular inflammation. Any tools that help nourish the vessels, so things like nitric oxide, all the polyphenols, everything we do to prevent atherosclerosis and optimize cardiovascular health, vitamin C IVs, glutathione, all the things we can do to nourish the vessels really is helpful for me, because that’s of one of the Achilles heels that I had from the start. And then finally, it did seem to trigger a mold activation or mold irritation that I didn’t experience before that, and the two most helpful things for me with that regards are the LDI with some of the binders, kind of just a regular mold detox protocol, if you will, and IV ozone.

There’s not just one silver bullet, but I think if you just look at it with your functional nutrition, functional medicine brain, we have a lot of tools that maybe… I still feel like there’s… If I could get some kind of deep medication around this virus and I could get it out, that would be fantastic, but until then, it’s like a lot of other autoimmune diseases that are triggered by viruses, and that the more we can clean up the system, clean the tank, as we always talk about and reduce risk of reinfection… I do think it’s very important for, honestly, everyone, if they’re in an at risk situation, to be doing the simple basic things like masking and nasal sprays and stuff like that. Meet with people outside. All the basics are really, really valuable because the less infections you get, the less likely you are to trigger long COVID, and it’s most likely to be triggered in women ages 40 to 54.

And I also have seen it’s most likely to be triggered in women during a low estrogen state, so several times I’ve seen this for women who maybe they’re in their 30s, they’re cycling normally. On their third COVID infection they get long COVID, because they happen to be in the luteal phase just before their menstrual cycle started, so that’s a trigger. Low estrogen is a time when we have to be careful, so same thing if you’re perimenopausal, menopausal, postpartum. There seems to be something protective about estrogen and women who are on estrogen replacement therapy are at less risk. Same with women on hormonal birth control.

Evelyne: Wow, that’s fascinating. I had not heard that. Thank you, Jessica, for everything you just shared. Lots of amazing clinical pearls and I really just appreciate you sharing your personal experience around all this. I do have three more just rapid fire questions for you, and the first one you’ve probably already answered, so if it’s the same answer, we can go to the next one. But I always ask every guest, what is something you’ve changed your mind about through all of your years in clinical practice?

Jessica Drummond: I’ve just changed my mind about just the fact that I’m grateful that we have a lot of tools and I’m much more patient with people. This stuff is challenging and it’s not all… Individual responsibility is not enough in the challenging environment that we live in, that’s increasingly more challenging, so I’m just patient with myself and everyone else a lot more than I might have been before as a type A person.

Evelyne: Yeah, that’s beautiful. I appreciate that. And I feel like a common thread that I see through all of the conversations that I have is stress management is the most important thing, and yet I think it’s the hardest for everybody, right?

Jessica Drummond: Yeah, for sure.

Evelyne: The next question is, what are your three favorite supplements just for yourself in general?

Jessica Drummond: Oh gosh. I’m taking a lot of supplements these days, but I really… NMN, I really love my NMN with resveratrol. That’s a big positive. I also like my probiotics. That seems to be helping quite a bit. And all my vascular nourishing supplements, so all the polyphenols and the nitric oxide increasers and all those anti-inflammatories.

Evelyne: Great. And then final question for you, what are your favorite health practices that keep you resilient and balanced?

Jessica Drummond: Early bedtime honestly is the most important one, and then a few times a week in my hyperbaric chamber. Those are my two keys.

Evelyne: Awesome. Well, Jessica, thank you again so much. Really have appreciated this conversation and your expertise. And what’s your website where people can learn more about you?

Jessica Drummond: They can find us at integrativewomenshealthinstitute.com and on Instagram at integrativewomenshealth, and of course, the podcast, the Integrative Women’s Health Podcast.

Evelyne: Awesome. Thank you. Thank you for tuning into Conversations for Health. Check out the show notes for resources from today’s conversation. Please share this podcast with your colleagues. Follow, rate or leave a review wherever you listen or watch, and thank you for designing a well world with us.

Voiceover: This is Conversations for Health with Evelyne Lambrecht, dedicated to engaging discussions with industry experts exploring evidence-based, cutting-edge research and practical tips.


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