Hello everyone and welcome back. We have been having a good laugh. I still have like laughs in me to get out before we get started, but you’re in for a great conversation today. I have a very special guest who I’ve known for some time and always just flipping admired her work and her trailblazing and just basically everything that she does. So welcome Dr. Jessica Drummond.

Jessica Drummond (00:08)

You know.

Thank you so much for having me. It’s my pleasure to be here and same right back at you.

Ginger Garner PT, DPT (00:35)

my gosh, okay, so y’all know I always brag on a bio. So I’m gonna do this first and then we have a lot to cover on the topic of endometriosis and all kinds of things today related to endo. So Dr. Jessica Drummond is a leading expert in women’s health, the founder and CEO of the Integrative Women’s Health Institute with 25 years of clinical experience in her minochronic.

program, she specializes in supporting women in that fun age range. And it is, it is a fun age range, you guys. 35 to 55, through the perimenopause and menopause transitions, who struggle with underlying chronic conditions, because let’s face it, by the time you get to that age, you’ve been on the planet enough, something else has happened to you. It’s not just perimenopause and menopause. So that could be your standard garden variety pelvic pain.

It could be endometriosis like what we’re talking about today, post-viral syndrome such as long COVID, other autoimmune issues. And she uses health coaching and integrative and functional medicine to tackle those things. Dr. Drummond is a licensed clinical nutritionist and physical therapist, a board certified women’s health coach. She is the bestselling author of Outsmart Endometriosis and clinician to coach secrets to building your successful health coaching practice.

offering practical strategies for health and wellness practitioners. Then you’ve also got the Integrative Women’s Health Institute, which under her leadership has really is thriving. They provide innovative training for healthcare providers, focusing on lifestyle medicine, functional nutrition, movement therapies, all the things that I’m jazzed about. Dr. Drummond’s work has transformed women’s healthcare and education globally and

provides and promotes a collaborative holistic approach to treatment. So welcome back. Yeah, and I say welcome back. So if y’all haven’t listened to the first time she was here, go back and listen to that one and then jump in on this one. So let’s talk about functional medicine and endometriosis, the lens through which we both are highly focused on, highly passionate about and practice.

Jessica Drummond (02:28)

Thanks so much.

Ginger Garner PT, DPT (02:50)

but for everyone listening, maybe this is their first drop into the podcast. Can you tell us a little bit about what got you interested in functional medicine and women’s health?

Jessica Drummond (03:00)

So back around 2003, just after my oldest daughter was born, I was sick, but in the vague way that sometimes you are postpartum. And so I was having more like panic issues. Now I understand it’s kind of, it was probably the first iteration in my experience of dysautonomia, which we can talk about a little bit later. A lot of fatigue, getting sick all the time, chronic sinus infections, things like that.

Ginger Garner PT, DPT (03:11)

gosh, yeah.

Jessica Drummond (03:30)

And I wasn’t really sure what was going on because of course, you know, everyone says to a new mom, especially a first time new mom, like, you know, you’re just tired. Like this is normal. And but it lasted about two years. And so and then my oldest daughter also wasn’t helpful because she slept never like she didn’t sleep through the night till she was like six. So

Ginger Garner PT, DPT (03:57)

my

God.

Jessica Drummond (03:58)

Like I literally, at one point we moved when she was about one and a half and I thought about going back to work in a physical therapy clinic. I had been kind of off because I really couldn’t, I had gone back to work and kind of come back but I was just so tired and so sick all the time. And I actually signed her up for childcare with the hospital before I took a job and then I just never took the job. It just would bring her there in the morning.

Ginger Garner PT, DPT (04:23)

Yeah.

Jessica Drummond (04:24)

when we would get there, the reason I loved it so much is because it was a hospital childcare and open at six, six AM. So like she would wake up at like three for the day and they knew if I dropped her off at six, it was cause I needed to like go back and take a nap. So, so it was a really exhausting time. And then that

Ginger Garner PT, DPT (04:39)

Yeah, it was a 3 a.m. night.

Jessica Drummond (04:47)

was a bit of a journey that took about three years, four years. And in 2006, we moved back to Houston, where I had worked years before. And there was a physician there who we sent sort of all of our difficult cases, like back in the early 2000s. And her name was Dr. Nellie Gross. She’s still alive, as far as I’m aware, and she’s wonderful, but she is retired. And she was a very early functional medicine doctor who was influenced by Chinese medicine.

And so she started doing gut testing on me and cortisol testing, HPA access testing. Her son was an acupuncturist and he worked with her. And essentially, I probably had some deeper things, but the expression at the time of what we understood was, quote unquote, adrenal fatigue or hypothalamic pituitary adrenal axis dysregulation. Meaning that my stress buffering

my stress response system was burned out. And that’s when I understood. So I made some nutritional changes. Before that, I was an athlete, super healthy, you know, was never overweight, never had any health issues. I kind of had a lifetime of allergies. Like I was the kid who was always on allergy medicine and had kind of like a congested nose and things like that chronically. But I more or less

was healthy. I had mono a couple of times in high school that knocked me down a little bit, but mostly I considered myself healthy. But I didn’t really think about what I ate. I worked out a lot because as a kid, I was a pretty high level gymnast. So I was used to training 20 hours a week and worked out all through college and then also drank a lot through college like everyone else does.

Ginger Garner PT, DPT (06:42)

Yep.

Jessica Drummond (06:42)

And

graduate school, being in physical therapy school is like peer pressure for starting to do triathlons. You would drink and then get up in the morning and do a triathlon. But I never really thought about food. My dad’s Italian, my mom’s Irish. She would cook, but not really that into it. And I loved food, but I was like…

Ginger Garner PT, DPT (06:49)

Yeah, I imagine.

Jessica Drummond (07:06)

I could eat anything because I never really… In that time, the only thing you would ever think about when it came to food was like, are you fat? The 80s and 90s was all about fat shaming and what’s your weight. That was never an issue for me, mostly because I was exercising like a crazy person all the time, but that felt normal to me. I didn’t know how to cook. In fact, my friends later when I became a nutritionist, my physical therapy school friends,

Ginger Garner PT, DPT (07:13)

Mm-hmm.

Mm-hmm.

Jessica Drummond (07:35)

like, wait, you’re a nutritionist? Because my thing to bring to any potluck was slice and bake cookies. But I did learn how to cook and I began to eat in a very nutrient dense way. And, you know, it took a few supplements. It wasn’t a very supplement heavy protocol. There was some acupuncture, but it was really about two key things at that time.

Ginger Garner PT, DPT (07:49)

Yeah.

Jessica Drummond (08:03)

learning how to nourish my system and reevaluating my source, my relationship with stress and exercise and recovery. And it was just a journey I kind of had to go on. And then at the time I was working as a pelvic health physical therapist and our most challenging clients in the practice back then were people that had chronic pelvic pain. And at the time the only real treatment

they were given was sometimes ablation surgery for endo, a lot of opioid addiction, a lot of Lupron, some birth control would be helpful, but none of those tools, we had people with implanted stimulators in the spine, those tools generally made things worse, not better. And so I just started…

sort of testing on people, because I figure it couldn’t hurt, like, let’s try a nutrition protocol without dairy and gluten. Like, it was pretty simple, just that, like very simple elimination diets. And people would have complete resolution to the point that they would cancel surgeries. Now, unfortunately, the environment has gotten a lot more complex since then. There’s more environmental toxins, there’s more pathogens that we have to deal with.

Ginger Garner PT, DPT (09:23)

Mm-hmm.

Yep.

Jessica Drummond (09:26)

So

it’s usually not as simple anymore as a simple elimination diet. And then kind of re-healing of the gut microbiome and the lining of the small intestine. Because at the time, again, we were thinking about things like leaky gut and gut dysbiosis, leaky gut otherwise known in the literature as increased intestinal permeability. All of that was seen as kind of voodoo at the time. We didn’t have a lot of research.

Ginger Garner PT, DPT (09:48)

Thank you.

Jessica Drummond (09:56)

But there was some research on this connection between the immune system, the gut microbiome, and things like chronic pain. So I’ve really looked at endometriosis through a lens of neuro-immunoendocrinology and gut microbiome for almost two decades now. And luckily in the last five years or so, the research is catching up. And

So when I think, when I see someone with endometriosis or chronic pelvic pain, my first question is how healthy is their neuroimmune system and the interface between the immune system and the gut microbiome, which about 80 % of our immune system is in and within the gut. So I start there kind of from an inside out approach and

I really find that we can get some deeper root cause healing. It doesn’t mean people don’t need other therapies or don’t benefit from surgery, they absolutely do. But it’s kind of where I start versus when I was coming purely as a pelvic rehab approach, I would think about the neuromusculoskeletal system tension, which exists for sure. But now I think about it as sort of starting in the nervous system and the immune system.

And so the motto for our organization for the last 16, 17 years that it’s existed is don’t chase symptoms, optimize systems. And I think about all the physiologic systems and instead of kind of trying to quiet the pain, I think about optimizing those systems and then the symptoms, all of the different systems, whether they’re pain, fatigue, burning,

urinary issues, et cetera, et cetera, start to melt away.

Ginger Garner PT, DPT (11:58)

Yeah, I think that it’s a tenet of the integrative approach. And if you look at systems of indigenous medicine, and we just think back to what existed before us, they were always looking at that whole person and that whole body experience, including the spirituality, know, belief systems, and part of, because that is how our nervous system decides whether or not it’s going to detect risk or threat. And then it’s up to us to then figure that out. So it’s…

Jessica Drummond (12:27)

Yeah.

Ginger Garner PT, DPT (12:28)

You know, your origin story just resonates back to, it reminded me of so many early patients that I had where using that integrated model helped them. It wasn’t my PT skills, you know? So I think that is, you know, if you’re listening to this and you’re a pelvic health provider or you’re thinking about going into it, I just really want to encourage you to look at

pelvic health and whatever healthcare field you’re going into from this approach, rather than falling into the silo, whatever silo that medical education is gonna plug you into and say, you’re PT, you look at movement. Well, okay, yeah, fine. Yeah, you look at movement, but really, when you’re looking at endometriosis from a systems-based perspective, we have to take…

three, four, five, seven, however many steps you want back and look at the bigger picture and look at this from a systems-based point of view. And I think that is really what serves the patient the best, especially when we’re talking about endometriosis.

Jessica Drummond (13:38)

Well,

and I think the must like kind of if you think about the neuromusculoskeletal system, the myofascial system, it’s not to say that the rehab skill set is not necessary. think integrating, and I know you’re not saying that obviously, you do that all the time, but I think it’s important to consider that it’s a piece of the puzzle in which there’s sort of multi-directional conversation within the body. So let’s say someone’s walking around with tight,

Ginger Garner PT, DPT (13:51)

Right. Yeah. Yeah.

Jessica Drummond (14:07)

pelvic floor or tight hips or tight lower abdomen or dysfunctional movement patterns in the pelvis. That is often related to, it’s more of a response to the immune or the nervous system, the neuroimmune system, inflammation and stress as a place of holding tension or holding a dysfunctional movement pattern. And the good news is that we can actually impact that neuroimmune system.

by starting peripherally and relaxing the myofascial and neuromuscular systems and retraining them to move differently. So we might both think about anti-inflammatory diet, mindfulness practice, targeted neuroinflammation reducing supplementation, even antivirals or antimicrobials that if you have say,

an infection at the level of chronic infection at the level of the nervous system or the autonomic nervous system and pelvic floor myofascial work, movement retraining, somatic trauma release. So we can work more from the inside and more from the outside concurrently. And then you get this, what I always say to my students, because a lot of what I do now is teach professionals.

is we want to get our clients on this upward spiral of healing because then things get better and better and better. It’s not an upward straight line because it’s messy, it is like these two things can work together. So if someone’s having like visceral mobilization release and they’re taking neuroinflammation supplementation, the process is more elevated and faster.

Ginger Garner PT, DPT (15:44)

We wish.

And that is why that systems-based approach is so important. So when you’re interviewing your provider, whomever that might be, you need to ask those questions because just treating, let’s just say something like a tight pelvic floor, that’s great, but it’s not the root cause of endometriosis. There are primary drivers and…

you know, of what’s going on there and our job is to mitigate those. It’s immune, it’s gastrointestinal, it’s mitigated by estrogen and what the body is doing with estrogen, not just what’s happening musculoskeletally. I think sometimes of the musculoskeletal issues that arise, the pelvic pain and things like that is like a flare. The body’s like sending up a flare. Not a flare as in pain, but it could literally be pain. But like,

you know, like shooting up a flare if you were stranded or something. It’s like, my gosh, help. But that’s always, always, always an underlying, you know, clarion call to evaluate all of the things that we’re about to talk about and look at those things so that you can have that, you said, that upward spiral of healing and take them to a better place so they can be back in control of their lives again, instead of feeling.

Jessica Drummond (17:16)

Mm-hmm.

Ginger Garner PT, DPT (17:19)

out of control because I think you and I both have felt what that feels like and it drives the passion that we have to be talking about this today.

Jessica Drummond (17:28)

Yeah, I think that is one of the things that’s really helpful because when you have a chronic illness like endometriosis, there’s a lot of uncertainty about how the day to day is going to be. It’s much harder to predict your kind of day to day, how you’re to feel and even kind of hour to hour. Once you have a better understanding of that and you have tools. I think symptom management is also really important because let’s say you wake up in the morning, it’s

Ginger Garner PT, DPT (17:44)

Mm-hmm.

Jessica Drummond (17:57)

the day before your cycle is about to start, you’re feeling that little bit of naggy, like right lower quadrant ovarian pain, and you’re like, uh-oh, what’s today going to be? Am I going to be nauseous? Am I going to have intense fatigue? Am I going to have brain fog? Is my digestion going to be slow? And what that can trigger when you don’t have the tools to kind of understand how all of these things can be mitigated and managed.

is a lot of fear. And so it really limits people from, know, can I go to work today? Can I go take that test? Can I, you know, try out for the softball team? Can I get a new job? And I think the benefit of understanding the systems approach is that because the symptoms are a full system, when you understand it more and you understand what these different tools do, you can use them. Because I think

Ginger Garner PT, DPT (18:33)

Right.

Jessica Drummond (18:55)

At the root cause, at the end of the day, endometriosis is a disease of the immune system and it’s genetic. So we don’t know for sure exactly how to quote unquote cure endometriosis such that it never bothers you. A stressor, might flare it, perimenopause might flare it, postpartum might flare it, lots of things.

Ginger Garner PT, DPT (19:13)

Mm-hmm.

Jessica Drummond (19:23)

Remind it, it exists in your body. so while excision surgery is fantastic because it takes away some of the root cause lesions which drive their own hormones, which drive their own inflammatory cytokines, you’re still just kind of like lowering the impact of endometriosis. But the good news is that utilizing other tools and technologies, we can also do that

Ginger Garner PT, DPT (19:45)

Yeah, there’s.

Jessica Drummond (19:52)

pre-surgically, post-surgically, even if someone never is able to have surgery or decides not to for some reason, these other tools can be applied. And there’s definitely a range of outcomes of how much endometriosis might affect your day-to-day life, but there is a way to kind of, and I think about that in general, I think our conversations around health are too focused on

health being a binary. Like you’re either healthy or you’re sick. But if you have endometriosis or a thousand other Achilles heels, if you will.

Ginger Garner PT, DPT (20:31)

We often go with it and we’ll get to that one in just a second.

Jessica Drummond (20:35)

that

either go with it or just something else. Like you have Crohn’s disease or whatever, Epstein-Parr or something else. Even cancer, cardiovascular disease, metabolic issues, like 90 % of people have something along that continuum. And I don’t think it’s actually that this is necessarily new, although I do think our environment is making this worse, our environment on many levels. Yeah.

Ginger Garner PT, DPT (21:02)

making harder, definitely harder.

Jessica Drummond (21:05)

But I think it’s just never been a binary that someone is like 100 % healthy because I know people who are like super, super fit and yet to the level of addiction and danger and mental health strain or because of mental health strain. you know, there’s almost no one who’s like perfectly healthy. I don’t even really know what that means because you could have some physical mitigations and yet

be really at peace, be really engaged in your community, be really engaged with your family. Like you can be very mentally healthy and yet have some physical limitations. So I think we need to generally start thinking about health as more of a continuum. So it will release some of our own internalized ableism, which actually can make this worse. Because then you get a lot of guilt and shame if like, can’t go to work today or, you know.

I don’t know how to navigate this. I’m in a lot of pain. I might be in a lot of pain for the next couple of weeks. How do I talk about that with people? When, you know, I’ve met a lot of people in my practice, and I’m sure you have too, who look perfectly fine. They show up, they’re made up, they’re wearing clothes, you know, and they’re an intense amount of discomfort. So think about the number of people who are just walking around in your world today who have a migraine, who have, you know,

stage one cancer, we just never know. And so I think if we can reduce that sigma, everyone will feel less alone when they’re struggling with things like this.

Ginger Garner PT, DPT (22:43)

Yeah, and to circle back to what it means for endometriosis, because it is essentially an invisible disease, and compound that with the fact that it’s a woman’s disease, primarily, men can have it, but it’d be extremely, extremely rare. So chiefly, women’s health issue that,

Jessica Drummond (22:59)

Primarily, yeah.

Ginger Garner PT, DPT (23:10)

is misconstrued and misunderstood as a reproductive issue, which it isn’t. It can include it, but it doesn’t have to. It can include any other system in the body or tissue in the body. And the fact that it’s invisible, you have kind of a double whammy since it’s harder for women to access that healthcare. It’s harder for women to access endometriosis-driven healthcare. There are far less experts on endometriosis in the world today. Oftentimes, surgical

solutions that actually will help, like excision surgery, are going to be out of network for people, again, making it harder to access. You end up with this crippling level of invisible stress and strain on women when they deserve to have relief for their chronic disease just as much as someone who might have diabetes.

which is a chronic disease, it’s much more well-funded and everyone knows about it. And there are protocols for treatment and treatment is paid for, that kind of thing. So I think it’s a really heavy, heavy burden on women. And you also have to think about then what happens when you can’t go to work, right? Is that a missed day of pay? Do you actually have sick leave? Are there kids that…

you’re raising that you still have to be up for. Like we were just talking just before we pressed record about, you your oldest who’s like awake at 3 a.m. my gosh, what if it’s a bad day and you’re having trouble walking and the kid is in their crib, you know, screaming their head off and you don’t have a support system. All of a sudden it feels impossible, like unmanageable. So.

Jessica Drummond (24:45)

Yeah.

Ginger Garner PT, DPT (24:57)

to that end of ditching that stigma and being compassionate to ourselves, our patients, because the things that we’re describing here is like every patient that I talk to with endometriosis is feeling these things, this heaviness, not just that invisible pain. There are so many things that can go with it. So what we wanted to elucidate today was

Jessica Drummond (25:13)

Yeah.

Ginger Garner PT, DPT (25:25)

what are some of these, what we call comorbid conditions, which sounds like such a dark term. So let’s like strip that away for a second and go, there’s stuff you can have that come along, comes along and loves to like be in tow with endometriosis that can be missed. And then that means your care system, you your team that you have set up, cause it does take a village, you guys, y’all to really truly get relief. You may be missing some things.

Jessica Drummond (25:30)

Okay.

Ginger Garner PT, DPT (25:54)

So let’s talk about that. Let’s talk about dysautonomia. Let’s talk about mast cell activation, et cetera. What are some of these things? And then we’re gonna talk about some of the treatments and things that, what it may look like, things to consider, things to ask your healthcare provider about in terms of enzymes, peptides, like all of these things that are out there that are very hopeful. All right, Jess, I’m gonna turn it over to you. Take it away on dysautonomia and…

Jessica Drummond (25:54)

Yeah.

Ginger Garner PT, DPT (26:22)

defining what those things are like POTS and INCAS and all these acronyms that are floating out there in the world.

Jessica Drummond (26:28)

Yeah. Well, increasingly, we’re seeing that autoimmune disease and other immune related diseases, and even actually there was a paper that just came out last week about Alzheimer’s, are actually triggered by underlying viruses or other infections, microbial infections. So, you know, one of the things I think we have to think about in the current environment that we have kind of exploding kind of random

transmittable acute infections in the world is mitigating our exposures to those because the data in the last three years has shown that Epstein-Barr virus, for example, can trigger MS. so endometriosis, we don’t have a direct trigger. There is some evidence that fusobacterium in the gut microbiome can trigger

Ginger Garner PT, DPT (27:13)

Mm-hmm.

Jessica Drummond (27:25)

endometriosis and in the vulva vaginal microbiome. We do know there’s a genetic predisposition. And so a lot of these kind of secondary or collaborative challenges that can go along with endo, the quote unquote comorbidities, collaborative challenges. So are because there’s this sort of genetic constellation. Now this has not been fully elucidated, but there’s more and more conversation in the literature about

Ginger Garner PT, DPT (27:40)

I like that word, collaborative challenges. That’s great. Yes.

Jessica Drummond (27:55)

People who have the genetics related to hypermobility, whether or not you’re fully expressing Ehlers-Stanlos syndrome or other forms of kind of diagnosable hypermobility, or you just have some degree of hypermobility, which again can be made worse by an infection. COVID, for example, can make the…

the hypermobility of the upper cervical spine worse or can trigger it. So if you kind of were a kid, and this is one of the things really interesting about the fact that I was an athlete as a kid, is that I was a gymnast, but I wasn’t particularly aware of hypermobility because since I was seven years old and then certainly when I was like 10, 11, 12, I was like doing strength training.

I was lifting weights, I was doing body weight, string turning, I was very strong. So until I lost some of that with my more recent illness, I was underlying hypermobile. And this can show up in the vascular system, it can show up with people who have slow digestion. And it’s interesting because now knowing part of the graduate school work I had to do was look at some of my own genetics. So I’ve got all of my genetics.

out there. So anytime I want to look something, I’m like, Oh, I wonder if I have that. And while again, I don’t have a full expression of, of Elostanolose, I do have some, um, heterozygous snips of hypermobility. And I tested my mom too during the, that class, cause I needed to do two people in my family and kind of relate some things for the work I did. That was back in my doctoral program in like 2016, 2017, but the genetics don’t change. And what’s really interesting was

COVID and or COVID vaccination triggered dysautonomia in my mom of the cardiovascular system. And she also has those underlying genetics. And I look at my youngest daughter who’s now a dancer and just looking at her hands, I’m like, you’re hypermobile, you know. So it’s interesting to see. So hypermobility often goes along with this. And there are some…

Ginger Garner PT, DPT (30:01)

Yeah.

Jessica Drummond (30:08)

of physical therapy related things that we can look at to see, know, like can you touch your finger to your wrist? I don’t have a lot of those things, but my daughter now does, which is really interesting. And even just like the skin is more pliable, you know, they’ll have constipation, slow motility, but can also have arrhythmias. So then getting to your and or dysautonomia or both. So dysautonomia, so the constellation of things that often go with

Ginger Garner PT, DPT (30:18)

Yeah.

you

Jessica Drummond (30:38)

these genetic vulnerabilities. And again, this is kind of my theory based on having this multidisciplinary perspective. We don’t have a piece of data that says like viral trigger of people with these genetics is what causes this. But here’s what I think, given the tens of thousands of patients I’ve worked with. If you have these predisposing genetics to endo to hypermobility,

And then you are exposed to a gut dysbiosis or a bad bacterial or I guess an imbalanced bacterial environment in the gut and or other parts of the body, the vulva vaginal, the placental, there’s lots of microbiota and or a viral infection. And that can be anything from various herpes viruses to COVID to other viruses.

then you may express more of these kind of diagnoses. And dysautonomia means your autonomic nervous system. The way I describe it, having had experience with this, is it’s like you go from having a manual car where like when you stand up, your blood pressure just adjusts, your temperature adjusts when you take a blanket off, you know, things like that, to everything is kind of, sorry, you go from having an automatic car.

Ginger Garner PT, DPT (32:05)

to manual, yeah, yeah.

Jessica Drummond (32:06)

To manual. Yeah. So when

you stand, you have to make sure you drink enough water. Do you have enough salt? Are you pumping your ankles a little bit? When you step outside and it’s really hot, okay, you got to adapt to that for a second versus if you’re coming out of air conditioning or vice versa. Your temperature regulation, your heart rate, your blood pressure, all of these kinds of things that ideally you don’t think about.

Ginger Garner PT, DPT (32:13)

Yeah, ankles, yeah.

We take for granted.

Jessica Drummond (32:35)

Yeah.

Ginger Garner PT, DPT (32:35)

Yeah.

Jessica Drummond (32:36)

You have to then slow down for a minute and let those things adjust because if you don’t, you’re going to feel all kinds of things. Anything from blacking out to panic attack because you don’t know what’s going on with your body. You can’t tolerate showers. You can’t tolerate heat. You can’t tolerate standing up. You can’t tolerate standing weightlifting, things like that. You’re dizzy a lot. You have a lot of migraines, a lot of headaches. You don’t get good blood flow up into your brain, so you feel fatigued and

Brain foggy. So POTS, is postural orthostatic tachycardia syndrome, stand up. So postural orthostatic, it’s like your blood pressure tanks. And then because your vessels didn’t quickly respond to that, it took them a minute. Then because of that, your heart rate speeds up. That’s tachycardia syndrome. So just describing what’s happening. It’s not really that helpful of a label, but.

That is one version of dysautonomia. Some people have similar things, but their blood pressure is actually too high or their blood pressure changes. Some people have more temperature symptoms. Some people have more brain fog symptoms. The other thing that often happens, and again, this is a constellation of things that can happen together. We don’t exactly know the chicken or the egg. Like is the dysautonomia triggering the immune system to go out of whack or vice versa? We don’t really know. But another

Another thing that tends to go along with this hypermobility dysautonomia is mast cell activation syndrome, which is otherwise known as MCAS. And the mast cells are some of the cells in the immune system that release inflammation. Generally a good thing if you’re having an infection that’s targeted to clean up the infection, but people with mast cell activation syndrome can have these mast cells kind of be activated to anything.

Again, heat, pressure, exercise, different foods, stress is another big one. So we do know that one of the tools we can then use, actually I’ll walk through the tools in a minute. So that makes the mast cells kind of constantly shaky. They also can be irritated by changes in estrogen levels, which makes this super rocky during perimenopause.

So if you kind of have a diagnosis of endometriosis where you suspect that you have endometriosis.

and you’re feeling a lot of other system symptoms, the fatigue, the migraines, the dizziness, the heat, cold, hot flashes, there’s a lot of burning, hives, things like this, because you’re sort of allergic to more things as well. What’s likely happening is that may not be directly driven by the endometriosis, but all of these things have a very similar genetic

Vulnerability too. Is that clear?

Ginger Garner PT, DPT (35:45)

Yeah, I hope that has landed with some of you in terms of what you may have been feeling that feels strange or maybe you’ve been dismissed because if your heart rate goes high and you get a little dizzy, what can people tell you that is? you’re just anxious. Just drink a glass of water. Just stop being so female because those things have historically been associated with hysteria, right?

And so it could be that you have had these symptoms before and you’ve been completely blown off. And so we’re just here to say, it’s real. The symptoms that you’re having are real and they are worth getting tested and checked out. And the good thing is there are solutions for it and there is treatment and it’s real. It’s not just you getting miscategorized with some kind of mental health diagnosis that actually was just medical gaslighting.

Jessica Drummond (36:35)

Absolutely. And so I think what’s great about this. So once you understand, so hypermobility, dysautonomia, mast cell activation syndrome, endometriosis, post viral related chronic fatigue, those are probably the biggest, is also called, chronic fatigue is also called myalgic encephalomyelitis, which is probably a better term for it. It’s like really.

tired muscles and brain inflammation. So these things are real physiologic expressions and they go in this bucket that tends to concentrate in people that have the genetic vulnerability. So what I like to say when I get frustrated about the fact that these issues are primarily present in women and so they are often ignored is that, well,

Men die more often of this stuff. So they die more often of viruses and things like that. Not that that’s funny, but like we suffer more longer term, but men’s immune systems at some level are weaker. And that’s why they tend to die rather than deal with long-term post-viral challenges.

Ginger Garner PT, DPT (37:49)

That’s a good point.

We have

developed some level of epigenetic resilience in all of this.

Jessica Drummond (37:59)

Yeah, so

we have this like hyper, we have an imbalanced immune system, a little bit hyperactive at some level, but it’s better than dying, I guess. So I don’t know. Yeah.

Ginger Garner PT, DPT (38:13)

Better than the alternative.

It’s not good that we have to suffer for longer, wait longer for treatment, or be ignored, or gaslit, or anything like that. But I do think that if you look at, and here’s a shout out to all women, right, if you do look at what we have to go through and what we have to suffer with that biology, it inherently does, whether or not we want to be stronger because of that pain, it inherently does create a resilience and a strength that…

that should give you hope, you know, that you can endure and get through this.

Jessica Drummond (38:45)

Yeah.

One quick thing I want to say on people who are transgender men, there is also a particular vulnerability in the same way, because of course there are some sort of female characteristics genetically and hormonally. And so there was a really interesting study done post around long COVID, which again can exacerbate all of these things. So if you had endo and you were

transitioning into becoming male, so female to male transitioning, where your estrogen was being suppressed versus if you were male to female transitioning and adding estrogen, the risk of having long COVID is something like six times higher. I may not be exactly right on the number. It might’ve even been higher, but it’s something like six times higher. So it’s interesting to me that also people have this vulnerability

when they remain, when they are female and express as women during times where their estrogen is either inconsistent or transiently lower. Does that make sense? So that suppression of estrogen to transition from female to male is a vulnerable time in all of this. And so I think for our colleagues in particular, or if you happen to be a trans male,

this applies to you as well and possibly even more because you’re having this active estrogen suppression. Just a little clinical pearl. So, okay, so estrogen matters too. And so let’s talk about some of the things we can do because again, when I think about this constellation of things, endo, dysautonomia, MCAS, chronic fatigue, hypermobility,

Ginger Garner PT, DPT (40:24)

Mm-hmm.

Yeah, absolutely.

Jessica Drummond (40:47)

and post-viral irritation of this, it’s all kind of in the same bucket. So instead of trying to figure out like, is this a dysautonomia issue or is this a histamine issue today or is this an endoflare? Let’s try to take that systems approach. So we don’t have to be so hyper vigilant about what’s going on with our system. And so…

Then if you wake up in the morning and you don’t feel good or you haven’t felt good for a little bit and you’re trying to like get some control back, I really like to start with the nervous system because the reality is the nervous system drives a lot of this because anyone who’s experienced this knows that stress tends to make it worse, right? So the first thing I would think about is it’s really helpful to get yourself in a rhythm.

Ginger Garner PT, DPT (41:32)

Mm-hmm.

Jessica Drummond (41:40)

I always say to my patients, the brain and the bowel love a rhythm, and especially a circadian rhythm. And even a little bit of menstrual rhythm, especially if you’re like right smack dab in just your menstruating years, like if you’re, I don’t know, 18 to 35, like you can also think about your menstrual rhythm. But day-to-day rhythms really help the brain and the gut. And that’s

drives kind of getting the systems working together again. So when you get up in the morning, create a morning routine. Something like step outside, drink a full glass of water. If dysautonomia is really an issue for you, that dizziness and your blood pressure tends to be low, adding like a salty electrolyte to that or even just some salt to that can be very helpful. Check your blood pressure over time to make sure it doesn’t start to creep up. But salty water,

greens powder or vitamin C, something like that, and outdoor sunlight exposure. It is really important to have a mindfulness practice. Some people find that that’s easiest to do for that first thing in the morning. Maybe it’s a literal nature walk through your neighborhood. Maybe it’s just sitting in your back porch doing some breath work.

but some kind of mindfulness practice is really helpful because it trains your autonomic nervous system to create space between stressful irritation and response so you can respond rather than react. So, but you have to practice that as many of my earliest meditation teachers said to me, if you’re not practicing mindfulness, you’re actually practicing distraction.

But that was about 20 years ago that I learned this. Now what we’re actually usually practicing is literally like scrolling. It’s like dopamine hitting. And so if you’re as old as I am in your 40s or 50s, you might remember a time where there were many little moments in the day where you were like doing nothing. You were sitting on a bus or you were taking a walk.

Ginger Garner PT, DPT (43:43)

Mm-hmm.

Jessica Drummond (44:00)

We have very few times where we’re not kind of like picking up our phone and checking on whatever. And so be careful of that. So if you can practice being in one place at a time, doing one thing at a time, and even having just a 10 minute a day mindfulness practice, it changes how your vagus nerve reacts to things. And 80 % of the vagus nerve afferents, so the part of the nerve that senses the environment, is in your gut microbiome.

So how you eat can also be a part of that morning routine to set yourself up for success. And basically you want to think about how can you feed your gut microbiome so that it will calm the internal physiologic stress. And that is primarily some form of quality protein, vegetables, and a little bit of healthy fat. So it could be like a vegetable omelet with some avocado. It can be like even a

you know, sausage kind of bowl or burger. think, I always think dinner for breakfast, not breakfast for dinner. You know, we don’t want sugar in the morning. We want nutrients that really feed the gut microbiome. And to keep this really simple when you’re starting out and you don’t feel good and you’re really fatigued, I very often say to my clients, have soup, three meals a day for like three or four weeks.

Ginger Garner PT, DPT (45:07)

Yeah.

Jessica Drummond (45:26)

almost any kind of soup, like we’re talking any kind of protein and vegetable soup. can be beef chili with veggies, it can be chicken soup with any kind of veggies, like there’s thousands of paleo soup recipes. It’s a really nice, easy way to start because then you can prep it in advance, all of that. People with really severe histamine issues can often struggle with reheating food, but even still, it’s going to move you in the right direction.

if your mast cells are that shaky, we’re eventually probably going to need some medications to really help you anyway, but this will still help you get started in the right direction. So that morning routine and then an evening routine of a wind down routine, again, often we’re going from working on our computer, emailing the teacher or whatever, 11 PM to just go to bed. No, create some space, try to stop eating, stop working.

by six, seven, eight p.m. Have a couple of hours before you go to sleep.

Ginger Garner PT, DPT (46:29)

And just said, wind down, not whine down.

Jessica Drummond (46:35)

Yes, yes, yes, yes.

Ginger Garner PT, DPT (46:38)

Although we love a good glass of resveratrol, unfortunately, as you hit after 35, your liver decides it’s not going to metabolize it quite as well. And it is challenging. So that might be a good point to stop and say, part of that separation is, if you’re going to have that glass of wine, you’re going to have to space that out and separate it and make sure that it’s kind of well metabolized before you try to get, normalize your circadian rhythm.

Jessica Drummond (47:03)

Yeah. know, alcohol is tricky, caffeine, even sugar. Whenever I work with clients, know, what I’m telling you right now is sort of an ideal vision of what you might get to three, four, six months, you know, maybe right away. It depends on where you are. But I had a student yesterday who was like, okay, have this client and all she drinks. Every morning she starts with like a coffee and a, was like a pastry or something like that, and like a chocolate croissant or something. And I was like, you know, but she said, but she really…

Ginger Garner PT, DPT (47:06)

Mm-hmm. Yeah.

Yeah.

my.

Jessica Drummond (47:31)

liked that. was like the only thing that was regulating her nervous system in this world of stress she was having. Like it was a little pop of joy to get her out of bed. And I said, you know, I really understand that. What we do as humans, whether it’s the wine, whether it’s a cupcake or whatever, is we’re just all trying to regulate our nervous systems. And so we don’t want to like change that until we’ve built other

Ginger Garner PT, DPT (47:34)

Yeah.

Yeah.

Yep.

Mm-hmm.

Jessica Drummond (47:59)

systems for regulating our nervous system. And sometimes we can change that as a part of it, but then maybe we first like move the coffee break to a different time of day where it’s less irritating, even alcohol, generally not good for anyone. I mean, we know alcohol causes cancer. Like if you’re worried about taking estrogen because of cancer risk, you absolutely should not be drinking alcohol at all. Yeah.

Ginger Garner PT, DPT (48:16)

Mm-hmm.

Yeah, alcohol at all. You

know, one of the things that I, just from a practical standpoint, because women are generally going to be the caregivers and kind of the gatekeeper caregiver of the families and the family system, which is an added stress. And when we talk about habits, sometimes it creates anxiety because they’re like, how am I supposed to fit this in? I’m up at 6 a.m., I’m packing three lunches and making three breakfasts and the kitchen’s a bomb and then I gotta get dressed and run.

How am I supposed to do these things? And I often don’t pull, and I’m just gonna be flatly upfront about this, I often don’t pull advice on time management from men. Because they do not have the biological burden that we do, frankly. Have they ever been pregnant and chronically sick for 12 weeks throwing up while you have a toddler still in diapers and you’re running a company?

Jessica Drummond (49:04)

No, absolutely do not do that.

Ginger Garner PT, DPT (49:18)

Okay, if you haven’t done all that, you probably can’t give time management advice. Yeah. Yeah, but there is a rare little gem. And what you mentioned really reminded me, and I think it was James Clear, but again, I don’t take advice from men very often on time management or stress relief either.

Jessica Drummond (49:23)

That’s a really valid point, 100%.

Ginger Garner PT, DPT (49:40)

So all these gurus sitting on the side of a mountain that are male giving advice and like, no, you come live in my house, you know, with all the things going on. And then, you you talk to me about stress management was the habit stacking thing where if you’re gonna have the coffee, let’s replace the pastry with something also yummy and fantastic, or you do the coffee and the pastry, but then you’re gonna do mindfulness because you’ve like squeezed in

Jessica Drummond (49:54)

Mmm.

Ginger Garner PT, DPT (50:07)

mindfulness while you’re having your coffee. Okay, there’s a stacked habit. You didn’t change anything. Now you just get to be mindful with your coffee.

Jessica Drummond (50:16)

100%. And I think we have to just work with people where they are because I think one of the challenges for women, you you and I are both working moms, is that there’s so many expectations and there is just a lot to do. And sometimes we have to stop for a minute and be like, what do we actually want out of the system? You know, when my kids were

Ginger Garner PT, DPT (50:34)

Yes. Yeah.

Want, yes.

Jessica Drummond (50:43)

of that young elementary age, they’re seven years apart. my husband for about six or seven years was never home during the week. He was only home on the weekends because he had a consulting job. And yeah, and I also had a full-time business and I worked a lot in Asia at that time and I was on night calls. so I was very, like, I really got my kids

Ginger Garner PT, DPT (50:56)

So you were like a single married mom. Yeah.

Jessica Drummond (51:11)

active in their own responsibility super early and not in a way that I feel like was, hopefully, mean, who knows, damaging to them. Mine are, you know, they’re 21 and 14 now. And so, but I do actually think that was good for me and good for them. Like there was a lot of really like, we would sit at dinner and be like, okay, you guys are going to clean the kitchen, Claire, you’re going to read to Kate, put her to bed.

Ginger Garner PT, DPT (51:18)

All our kids are gonna get therapy, so it’s okay. It’s okay.

Jessica Drummond (51:37)

I’m in the office, I was on site all the time, but I was not always supervising and I’m like, if nothing’s on fire, please don’t knock on the door. But if it is.

Ginger Garner PT, DPT (51:43)

That sounded so healthcare provider like

I was on site that I wasn’t like, yeah. Yeah, exactly.

Jessica Drummond (51:48)

I wasn’t supervising. was just hoping for the best.

you know, anyway, and then, you know, so I do think sometimes we can do a couple of things. We can really boundary, especially when we need to take care of our own physical body. Because at the end of the day, the unfortunate thing is we are not robots. Well, fortunate or unfortunate, I don’t actually want to be a robot, but we are not robots. And so…

If we do not take care of this, we are going to get sicker or die. We’re not gonna just like, you can’t just ignore this. You can for a while, but when you’re sick, when you have a chronic illness like endometriosis and it’s progressed to the point where you are having a lot of symptoms,

It is a severe situation that needs to be taken care of because you are a vulnerable animal. You’re not a robot.

Ginger Garner PT, DPT (52:54)

Yeah, and you are a human being that deserves to feel well.

Jessica Drummond (52:59)

Yeah. And so you

have to start shifting some time resources, boundaries, and it’s going to require that you have conversations that most of us don’t like to, which is asking for help, asking for space, asking for boundaries, saying no to things. Like, you know, maybe at that time my kids might’ve wanted to like play afterschool soccer or something. And it’s like, no, you’ve got to watch your sister.

Ginger Garner PT, DPT (53:27)

Mm-hmm.

Jessica Drummond (53:29)

Maybe it’s we sell our house and move into a smaller house because you can’t work as much, and your family is used to two incomes or something like that. So there are hard decisions to be made that through my journey, I personally also had to do that. But I think when you do that, you realize that if you make those decisions very actively versus feeling like you’re backed into a corner and you have no choices, but you stop for a minute and you really think about, what do I…

actually want versus what other people think I should want or I think I should want versus what I actually want. It helps you create the space to start gently habit stacking because the reality is a lot of these habits stacking changes how you eat, what time you go to bed, the rhythm of life, less time on your phone, saying no to your kids more, saying no to other people more.

saying no to your mother-in-law sometimes, things like that, right? That’s uncomfortable, but when you get good at it, you begin to really change how you live in a way that’s more authentic to you. Because I think one of the things that doesn’t happen for anyone really, but particularly women, is especially if you have a chronic health issue like endo that probably started when you were younger,

but you may or may not have been aware of it fully, because a lot of times women aren’t even diagnosed till they’re the perimenopausal years, is no one sat down with you and said, okay, let’s talk about the kind of whole life that you want, not just career, not just how many kids, but like, what do you want your regular Tuesdays to look like? And when we start there, then it becomes more meaningful for you about when you change your morning routine or things like that, because

Ginger Garner PT, DPT (55:10)

Mm-hmm.

Yeah.

Jessica Drummond (55:23)

The good news about this is when you start implementing these changes, you feel better and better and you have more energy and you have more tools and this can just continue to expand.

Ginger Garner PT, DPT (55:36)

And the literature on health coaching really underscores that point because when you talk about, let’s just say about ending smoking, right? We know no one needs to smoke. That’s easy, nobody can argue about that. So when you look at the literature on tobacco cessation, the interventions that mattered the most were brief. So think about this as if you, okay, the listener are now your own practitioner. You’re your own healthcare provider.

you’re gonna give yourself brief interventional counseling of five minutes or less. The literature said that was the most effective at getting people to stop smoking. So think about what your bad habits are, what you think is a bad habit, or the good habit that you wanna pick up and go, I’m going to positively self-talk to myself for five minutes or less about this new habit that I’m going to pick up on.

The other thing that really helped, and it was a two-part piece, you had to first do the brief counseling, and then the second thing you had to do was come up with your own reasons why it was important for you to do this. It wasn’t Dr. Jess or Dr. Ginger telling you, you should do this because the literature says this, that doesn’t work. Nobody cares about that. If you come up with the reasons why it’s important for you to make this change, that’s when the real change happens.

Jessica Drummond (56:55)

It’s so true and and just seeing yourself in the way you want to see yourself makes a dramatic difference So I have a client who has endometriosis. She has some other post-viral issues. She was really fatigued had a lot of pain a lot of histamine issues and She was really she was a business owner. She had two kind of middle elementary school kids. She was used to seeing herself as an active mom She was a cross fitter athlete and she really got knocked down

by COVID on top of the endo and had endosurgery not long before she got COVID, like six weeks, something like that. So it really was a problem. And she was starting to get depressed because she was really withdrawing from her own life because she wasn’t feeling very well. And I said, okay, let’s talk about like when, how you see yourself, what would you like to be doing?

Ginger Garner PT, DPT (57:30)

my word. Wow.

Jessica Drummond (57:46)

I’d like to be out in the backyard. have a pool, we have a basketball court. I’d like to be out in the backyard playing with my kids in the afternoon. That was our time. I said, all right, fine. Tomorrow, tonight, whatever, when your kids are swimming in the pool, just get in the pool. What do you think of that? And she was like, okay. Because that already starts to change your perspective of yourself. It’s not that things are getting worse and worse. I’m starting to get better.

Then three, four weeks later, she could swim a little bit in the pool. Then she could stay in half an hour and play with them. And so how you implement that is so personal to what’s important to you. And that does really matter because then you’re going to make these changes over the long term and feel really good about it. Because if I just tell you like, hey, stop drinking, never again touch sugar, like…

Ginger Garner PT, DPT (58:28)

Mm-hmm.

Jessica Drummond (58:43)

you know, take these 15 supplements, red light every week, like you’re just not going to do it. And you also won’t even understand why to do it. And so it’s not going to help you when you have a flare. Meanwhile, with this client, she’s like, okay, I’m not feeling that great in the afternoon, but you know what, I’m going to go outside, I’m going to put my bathing suit on, I’m going to sit in my pool and let my kids talk at me and just chill.

Ginger Garner PT, DPT (58:48)

Yeah. Yeah.

Yeah,

I think we often, I mean, this feels very personal. I think often as clinicians, once you reach this third decade of practice, you speak from a very personal place because you have lived many of these things. so when you talk about just getting into the pool or just taking your shoes off and walking through the grass, it seems like, yeah, that’s easy, no problem.

Well, when you’re coming from a place of severe pain and fatigue, we will often all or nothing ourselves. We’ve all heard of the don’t should yourself kind of thing, stop shoulding yourself. And so it’s really a profound thing to say, it’s okay, I’m not gonna get in the pool and swim 17 laps. I’m gonna get in the pool and sit down or just walk to the other end, let my kids splash me. It’s all fun, everybody’s laughing and then go rest.

It doesn’t have to, you don’t have to go from sitting on the sofa to your triathlon or whatever, which is what we were joking about in the beginning. But hey, we lived through all of that crap. We did that stuff to ourselves in order to get to this point and go, hey, younger generation, you don’t have to do that. You can just, just like you said, you can just get in the pool or put your feet in the grass. It’s okay. You’re not gonna lose all of your fitness in that afternoon if you don’t work out or.

eat perfectly or whatever it may be. my gosh, so I wanted to get nerdy and we might have to do a part two if you’re willing to come back because I wanted to bend into the nerdy realm. We’ve already been doing that the whole time. But we didn’t get to talk about the gut microbiome and endometriosis, enzymes and peptides and endometriosis. So.

Jessica Drummond (1:00:29)

Yeah. Yeah.

Ginger Garner PT, DPT (1:00:53)

You know, we could start a little bit of a 40,000 foot view, but I wanna put on our listener’s radar how important it is to regulate and optimize the gut microbiome with endometriosis. So giving the listener just a brief, you know, overview of, what’s the relationship between gut dysbiosis and systemic inflammation? Are there certain probiotics that impact hormonal regulation in immunomodulation in endo?

Jessica Drummond (1:01:21)

Yes. So I think the thing to think about with the gut microbiome is that it’s a whole system and community. It’s not like one species, particularly in the gut. In the vulva vaginal area, it is more lactobacillus dominant, especially lactobacillus crispitus. But in the gut microbiome, what you want is diversity. You want strength and diversity. And so normally I’ve run dozens, no, hundreds.

Ginger Garner PT, DPT (1:01:30)

Yeah.

Hey Jess, can you say

that louder for everyone in the back row? We need diversity, there’s strength in diversity, that part. Let’s just put that out there one more time to the universe. Yeah.

Jessica Drummond (1:01:54)

Yes, that’s… Yeah, that is 100 % true. In

the gut microbiome, there’s strength in diverse species. Diversity is key. And what… I’ve run hundreds of stool tests now on clients and with students for people with endometriosis. And usually the dominant challenge is not enough beneficial bacteria.

Ginger Garner PT, DPT (1:02:21)

I

have seen the same thing.

Jessica Drummond (1:02:23)

Now what’s interesting

is we don’t know what a perfect gut microbiome looks like. And there’s probably some variety there and it probably could be genetically dependent. There’s a lot of reasons. But so there’s two ways that I approach gut microbiome optimization and kind of a gentle supplement approach, if you will. One is I do sometimes use anti-microbials if the sort of quote unquote

bad bacteria, pathogenic bacteria are a little too high, maybe a little too much certain kinds of E. coli or strep or things like that. Then three tools have been found to be useful. I like biocidin products, which is kind of a generalized antimicrobial because it’s very gentle for people that have these more histamine or MCAS-like reactions. But there was a really good study done a long time ago, like 2005.

that compared supplements to rifaximin or xifaxin, which is the antibiotic used to kill off the bacteria that tends to trigger SIBO. So you can also use a combination of this is one set of products, candy-backed in AR and BR or F-C-Cytol and dysbiocide. You choose one group of those and you take them twice a day between meals.

Ginger Garner PT, DPT (1:03:32)

Mm-hmm.

Mm-hmm.

Jessica Drummond (1:03:50)

that or biocide. And those are different kinds of protocols for killing off the quote unquote bad bacteria. And when you do that, you also make sure people are having great bowel movements, that they’re doing visceral mobilization, that their toileting is optimal, that sometimes we use binders with that, which are things like charcoal or other fibers, or there’s even some medication prescription binders.

Ginger Garner PT, DPT (1:04:04)

Mm-hmm.

Jessica Drummond (1:04:16)

zeolite clays, things like that, that kind of bind up the junkie bacteria, if you will. And then, so sometimes we’ll start there if people have a lot of bloating. I always say you have to start by opening the windows and the doors. We don’t want to layer on complicated detox protocols if people are not peeing and pooping and sweating. So you have to do that first.

Ginger Garner PT, DPT (1:04:33)

Yeah.

Yeah. Yeah.

I like the naturopath, Dr. Carrie Jones. She talks about the bathtub analogy for hormone metabolism. Yeah, that’s great. So I love the opening the windows and the doors and the drains kind of thing because I think that’s overlooked a lot. And that’s perfectly where pelvic health fits into all that too.

Jessica Drummond (1:04:52)

Yeah.

Yeah, for sure. So you have to deal with pelvic floor dysfunction if you’re having it. Visceral mobilization, especially if someone has endo, because often there’s endo on the bowel or there’s old adhesions or someone had a C-section or anything like that. We want to get everything moving. And I even think about the fascia and the lymphatic system and the glymphatic system. So sleep is really important for that kind of nightly brain cleaning. We got to

Ginger Garner PT, DPT (1:05:07)

Mm-hmm.

Mm-hmm.

Yeah.

Jessica Drummond (1:05:25)

open and clean up stuff first and before we do any detox protocols. I’m really, really careful with detox protocols with people with mast cell activation because they’re sensitive to everything. There may be a room, a space for antimicrobials. We also want to stop feeding the bad bacteria. What do bad bacteria love? They love sugar and they love grains. Those are tasty.

but the chocolate croissant is unfortunately, you know, creating a party in your gut bacteria. Now it’s not to say you never eat chocolate croissants, but even eating them, if you’re in France, I mean, go for it, unless you live there, then not every day. But the key is to be, you know, not feeding the pathogenic bacteria, but positively feeding the, you know, quote unquote,

Ginger Garner PT, DPT (1:05:58)

Not helping. Yeah.

Especially if you’re in France,

Jessica Drummond (1:06:22)

good bacteria, the commensal, the beneficial supportive bacteria. Yeah, so when people with endo, especially people with endo and vulvodynia and there’s all these other fun comorbidities, know, painful bladder syndrome, which is also a histamine issue, vulvodynia is also an autoimmune and histamine issue. So if you’ve been not eating a lot of foods because you’re afraid they’re flaring you,

Ginger Garner PT, DPT (1:06:25)

that are also so deficient, as you’re mentioning. Yeah.

Mm-hmm.

Jessica Drummond (1:06:48)

sometimes you’ve gone too far too tight without working on the resilience of the digestive system. So that’s the nerdiness I want to be careful of because if you follow a lot of influencers, they have you eat really, really restrictive, quote unquote, endo diets. There’s no research for that. But it does kind of help, especially initially. The problem is unless you really build the resilience of

Ginger Garner PT, DPT (1:06:56)

Yeah.

Mm-hmm.

Jessica Drummond (1:07:15)

the digestive juices, the stomach acid, the lining of the small intestine, that all comes from robust mitochondria, otherwise known as energy. And so if you’re barely eating, you’re going to feel better temporarily, but you’re going to deplete your good bacteria. And that’s one of the risks of going fully gluten or grain free. We’ve got to make sure we replace that with lots of other good fibers.

because otherwise you damage your gut microbiome and you start getting really fatigued, really tired, you’ll have more mitochondrial dysfunction. So we want to, the kind of step-by-step is regulate the nervous system, circadian rhythm, menstrual rhythm, open the windows and doors, add beneficial nutrients, so that’s all the, really every vegetable, broths.

proteins, sometimes nuts and seeds, beans, depends a little bit on the person when we add those in. And then some support, I call it crutches for the digestive system. Usually we have some benefit with some digestive enzyme support, sometimes betaine, HCl or apple cider vinegar, which will help increase the acidity of the stomach where you want acidity and even chewing.

Ginger Garner PT, DPT (1:08:31)

Mm-hmm.

Jessica Drummond (1:08:43)

You know, 40 times per bite of chewing is the evidence-based number. Most of us are eating way too fast or way too distractedly, and you don’t have any teeth in your stomach. So you gotta break down the stuff in your mouth. Yeah. So thinking about that system, the digestive system being nourished, rather than being like, I can’t eat this and you can’t eat that and don’t have this and da, da, da.

Ginger Garner PT, DPT (1:08:56)

There’s a thing you don’t think about every day, but we should.

Jessica Drummond (1:09:11)

think about what are we doing with each bite of food? And the more we understand that as a positive, it begins to also actually help regulate the nervous system. Because now you’re eating and you’re not eating in this intense fear of like, is this blueberry gonna flare me? Is this salmon gonna flare me? Is this one piece of dark chocolate gonna flare me? Instead you’re like, yeah, this soup is like healing the lining of my gut microbiome and it’s so delicious and I’m chewing.

every bite of it and I’m eating with people I enjoy. And now you’re actually building up the resilience of your gut microbiome as you heal the fullness of the digestive system. And when you do that, you also start supporting the immune system to function better because your overall inflammation comes down. And if you do all that mindfully, even just eating one meal a day, really calmly and mindfully,

then you’re training your nervous system to be in a more regulated, balanced place. And then also you’re having better bowel movements, so your pelvic floor is not as flared, your lower abdomen is not as tense and uncomfortable, you’re not as bloated. So it’s really a whole process of becoming more and more and more well. So there isn’t one probiotic, there are some…

common antimicrobials that I’ll use. I don’t, there are certain probiotic species that I do like in general, because I think endometriosis is not necessarily different, other than bifidobacterium tends to be low. There are a couple of products. Bifidomaximus is by the Gut Institute, and they have another product called Microbiomojo. And so there’s a company called, Kieran, what is the name of it?

But they have a lot of spore, Megaspore is their kind of core product. It’s like microbiome labs, I think. Those are spore-based bacteria that are kind of, they’re more keystone species that help support the other species. And we were talking about peptides. There’s a lot of conversation about GLP-1 and GIP peptides, the injectables that are for

Ginger Garner PT, DPT (1:11:12)

Mm-hmm.

I’ve used that one before.

Jessica Drummond (1:11:34)

quote unquote, weight loss. And they do work for that, but they also are strongly anti-inflammatory and may help balance the immune system from being so allergic to everything. What we’re talking about when we’re talking about food sensitivities is more like a mild allergy, if you will, not an IgE allergy where you’re going to anaphylaxis, but an intolerance.

Ginger Garner PT, DPT (1:11:36)

Mm-hmm.

Mm-hmm.

Jessica Drummond (1:12:03)

In endometriosis, the research shows that GLP-1 level, which is a peptide, it’s like insulin, is low in people with endometriosis. So there are some species of bacteria, including acrimansia and a couple of others that help bring up the levels of GLP more naturally. Pendulum has a probiotic product that has all the different species in it that help bring up GLP.

I’m really hopeful that we see some research pretty soon on GLP-1 agonists, the medications at low doses, very low doses so that we don’t incite the slow motility because that’s a problem in this population. But very low doses, at least to start, some people may need more in the endometriosis and MCAS populations because

Ginger Garner PT, DPT (1:12:47)

Mm-hmm.

Mm-hmm.

Jessica Drummond (1:13:02)

I’m seeing some really interesting things clinically. People who have gone on GLP-1 agonists for weight loss or metabolic dysfunction and their symptoms nearly disappear. So I think there’s a lot of hope. I think how we use those medications is going to be important. And I think because they can deplete muscle…

Ginger Garner PT, DPT (1:13:12)

That’s yeah.

Jessica Drummond (1:13:24)

We have to make sure that people who are on GLP-1s are eating enough and eating enough of the most beneficial foods, proteins, and strength training for both bone and muscle, which can be impacted by this other kind of constellation of things that we were talking about before. So when you’re thinking really nerdy, open the windows and doors and build up your gut microbiome so that it can support

Ginger Garner PT, DPT (1:13:32)

Yeah.

Jessica Drummond (1:13:54)

a healthier immune function and a healthier nervous system function.

Ginger Garner PT, DPT (1:13:59)

Yeah, absolutely. All right, one more geeky question, and then we will have to sign it off. So the question is, because I’m thinking about some recent GI maps that came back, and I’m looking at these, when do you, because of the patterns that I’ve seen lately,

When do you decide to use more of a broad spectrum probiotic, but then add something in like acromansia if that is so profoundly impacted for that individual? When do you make that decision? Do you go like a trial and then go, gosh, they’re still having symptoms, it’s still low, should we do kind of a compound approach?

Jessica Drummond (1:14:40)

Yeah, that’s a good question. I don’t think we have a really strong evidence-based answer for that. I think that’s the art of medicine a bit. Acromansia is a keystone species, but there is some evidence that acromansia is elevated in people with MS. And again, we’re kind of thinking about this viral activation of an immune long-term syndrome, which may also be at play here. MS is kind of the model that I’m…

Ginger Garner PT, DPT (1:14:49)

Yeah.

Mm-hmm.

Jessica Drummond (1:15:09)

thinking about when I’m thinking about it in this way, I’m a little careful. And it’s the same thing. There’s a probiotic called Vinella that is really helpful for people with chronic fatigue, kind of PEM, post-exertional malaise, because it calms muscle soreness and it of eats up lactic acid. But too much Vinella actually puts people at more risk for long COVID. So a lot of these people already have long COVID. I think…

Ginger Garner PT, DPT (1:15:37)

Yeah.

Jessica Drummond (1:15:38)

It’s the same kind of question. So with acrimansia, if it’s super, super low and we add it and people feel better and their gut is stronger and more resilient. So I kind of think of all of these things as like crutches or stepping stones. Like if when we add them, we can do other better things and maybe we don’t have to be on it forever. Maybe it’s for a year or six months or two years or whatever.

Ginger Garner PT, DPT (1:15:51)

Yeah.

Mm-hmm.

Jessica Drummond (1:16:04)

test it. And then sometimes with anti- almost always with antimicrobial herbs, for people with endometriosis, I’ll probably do a three month course and then I will pulse it almost forever. Forever. Because the problem is if you have endometriosis and you had any bowel lesions, even if you’ve had them removed, there’s always like a sticky part of your digestive tract.

Ginger Garner PT, DPT (1:16:21)

Yeah. Yeah.

Yeah.

Jessica Drummond (1:16:32)

And it’s a place where just things are going to thrive, you know, that we don’t want to. And so I think you’re always going to have to pulse an antimicrobial protocol. And for some people that’s once a quarter, for some people that’s a couple of weeks a month, like just depends. Some people twice a year. So I think those are the kinds of things that are a little more collaborative with your client to see how they respond. And when it comes to the probiotics, I really think about adding

Ginger Garner PT, DPT (1:16:36)

Unfortunately.

Yeah.

Jessica Drummond (1:17:02)

prebiotic foods and fibers and things that feed the good bacteria. particularly, for example, I did have my gut microbiome tested when I initially had post-COVID to see what’s going on there. Maybe we can fix this. And my acrimonious, it was like zero. And adding it back in has really been helpful. So I think we have to test it. Sometimes you can just bring things up with feeding it if you have any.

Ginger Garner PT, DPT (1:17:04)

Mm-hmm.

Hmm.

Wow, yeah.

Jessica Drummond (1:17:31)

know, if I had any acromantia, you could just eat a ton more like berries and pomegranates and things like that. But if you’re starting from zero, you may need to boost it for a little bit. Yeah.

Ginger Garner PT, DPT (1:17:40)

Give it a boost. Yeah.

And I think that’s a good point to make because every patient is going to have different budgetary allowances, time, accessibility, those type of things. And if you can get things through food, of course, that’s always great, but in the environment we live in now, it’s increasingly harder to get that. So it is a case-by-case issue.

These final points are also great research questions for the future and things that we can look forward to in terms of where endometriosis research goes. Yeah.

Jessica Drummond (1:18:17)

Yeah, yeah, for

sure. One other thing I want to say quickly about endometriosis research, there is some benefit to treating, if you will, fusobacterium. And so that’s something that people can maybe test for. Evy, I believe, tests for it in the vulva vaginal canal. And so there are some antibiotic options. I think optimizing the gut microbiome to the best of our ability at this point is really helpful in endometriosis and may even

stabilize and reduce the lesions. It’s not 100 % the case that endometriosis is progressive. Sometimes it is stable. Sometimes you can even reduce some of the smaller lesions. And we’ve seen that in studies on N-acetylcysteine, on pycnogonal, on HOCAT, which includes like transdermal ozone, which is another antiviral approach. So I definitely think there are interactions between

bacterial overgrows or viral infections and endo that if we can mitigate those, we have less endo expression, possibly to the point of reversal. We just don’t have the data to show that yet.

Ginger Garner PT, DPT (1:19:31)

Yeah.

Well, as a person with, part of my endometriosis was bowel. I think that on the one hand, it delayed diagnosis because I was addressing all of those things. And so it did tamp down the growth and the spread of that to a point where I finally reached having applied functional medicine to it, then still here’s what I was left with, right?

Jessica Drummond (1:19:37)

Mm-hmm.

Ginger Garner PT, DPT (1:20:00)

I was left with this handful of stuff where they went in and got, there it is. Okay, let’s clean that out. And so I think that there can be a lot of hope for people. That’s why, you know, tell and share that story at all that you can, I think you’re exactly right. You can mitigate so much about endometriosis by using the tools and the evidence-based in integrative, functional, and lifestyle medicine.

So that, yeah, in some cases, maybe you wouldn’t need surgery. In my case, I finally did. It’s when I finally got that diagnosis, but it was seeking out a healthy gut microbiome that actually led me on that whole adventure and track. And so I am definitely hands in the air and fist bumping all about the gut microbiome in endo. And so that’s why I’m so glad you were here today. Thank you so much for being with us. Dr. Jessica Drummond.

Jessica Drummond (1:20:51)

Thank you so much.