Is Endometriosis Behind Your Bloating, Constipation, and “Gut Issues”? – with Dr. Iris Kerin Orbuch

 

Endometriosis is a painful gynecological condition that affects at least 200 million women worldwide. Unfortunately, many women, and sometimes even physicians, can mistake the symptoms of endometriosis for other gut related disorders, like IBS. Do you know the difference?

 

Today we are bringing you the answers you need about endometriosis, what it is, who it affects, how to diagnose and treat endometriosis, and much more with special guest Dr. Iris Kerin Orbuch! 

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We answer these questions:

– How many women are being misdiagnosed when they actually have endometriosis?

– How do you diagnose endometriosis?

– How do you treat endometriosis?

– What factors affect the severity of endometriosis?

– Is endometriosis an auto-immune disease?

– How is the gut linked to the female reproductive system?

– And more!

Links mentioned in the podcast:

Book: 

https://www.amazon.com/Beating-Endo-audiobook/dp/B07S5FGMP2/ref=sr_1_1?gclid=Cj0KCQiAnaeNBhCUARIsABEee8V2vOSn0fCgT5vuExCU4o1qCW2ecleBPpcyk5H894yqe3PSE6G04vIaAl1MEALw_wcB&hvadid=345549840646&hvdev=c&hvlocphy=9028778&hvnetw=g&hvqmt=e&hvrand=61260887102779474&hvtargid=kwd-745368339005&hydadcr=22531_10353738&keywords=beating+endo&qid=1638568119&sr=8-1 

Practice information: https://www.lagyndr.com/ 

Endometriosis resources: 

https://www.theendo.co/

https://www.endowhat.org/

https://nancysnookendo.com/about-endometriosis/ 

Stool testing mentioned on the podcast can be found at this practice: https://altfammed.com 

Schedule a consultation with Alexis: www.altfammed.com 

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About Dr. Iris Kerin Orbuch:

Dr. Iris Orbuch is the Director of the Advanced Gynecologic Laparoscopy Center in Los Angeles and New York City. Her practice is limited to Laparoscopic and Robotic Gynecologic Surgery, and is primarily a referral practice. She is one of a handful of physicians across the country trained to perform advanced minimally invasive procedures. Dr. Orbuch is a board certified in OB/GYN and provides both compassionate and individualized care. 

Subscribe for more gut health content and share this podcast with a friend! Take a screenshot of this episode and tag Dr. Ann-Marie Barter:

http://instagram.com/drannmariebarter

Dr. Ann-Marie Barter is a Functional Medicine and Chiropractic Doctor at Alternative Family Medicine & Chiropractic. She is the clinic founder of Alternative Family Medicine & Chiropractic that has two offices: one in Longmont and one in Denver. They treat an array of health conditions overlooked or under-treated by conventional medicine, called the “grey zone”. https://altfammed.com/

https://drannmariebarter.com/

 

Transcription:

Dr. Iris Kerin Orbuch: I view it as an autoimmune disease. The consensus is not out, but we do know those within non-metro Treos have a higher likelihood of Hashimoto’s, which is autoimmune. Higher likelihood of celiac, which is autoimmune. Higher likelihood of showgrounds, which is autoimmune. Higher likelihood of really all autoimmune disorders. And I do believe that there is an inflammatory effect to enemy troops. I think it behaves like an autoimmune disease. I don’t think we have data to say yes, it is or it isn’t, but that’s how I treat my patients.

Intro: Are you struggling with bloating, gas constipation and fatigue, but don’t know what’s causing these problems? The Gut Health Reset Podcast with Dr. Ann-Marie Barter dives deep into the root causes behind these issues that start in the gut. This podcast will give you the knowledge you need to heal your gut and reset your health.

Dr. Ann-Marie Barter: Today on the Gut Health Reset Podcast, we are diving into how gut problems and female reproductive problems are very linked. How many women are misdiagnosed with having that problem when they actually have endometriosis? We talk about the questions that you can ask. We talk about what endometriosis is, how we get it, treatment options, how to set yourself up for success, how sibo and endometriosis are linked. And also, we cover if endometriosis is an autoimmune disease. So stay tuned to see if endometriosis could be causing your bloating, your constipation, your stools or your stomach pain. Thank you so much for joining us here today on the Gut Health Reset Podcast. I’m your host Dr. Ann-Marie Barter, and we are so grateful for your support. So thank you so much for doing that. And we have brought on an amazing guest today that will not disappoint and give you lots of amazing, usable information. My special guest is Dr. Iris Kerin Orbuch. She is the director of Advanced Gynecologic Laparoscopy Center in Los Angeles and in New York City. Dr. Iris Karen Warbucks practice is limited to laparoscopic and robotic gynecologic surgery and is primarily a referral based practice. She performs advanced techniques at St. John’s Hospital in Santa Monica, California, Lenox Hill Hospital, Mount Sinai, and Beth Israel Hospital in New York City. Dr. Iris Karen Orbach is a board certified OB-GYN. She offers gentle, compassionate care and a personal touch. Dr. Karen Orbach, I’m so excited to have you on the podcast today. Thank you so much for being here today.

Dr. Iris Kerin Orbuch: Oh, it’s my absolute pleasure, I’m thrilled to be here, truly.

Dr. Ann-Marie Barter: I’ve been excited about this episode. We have to reschedule it a couple of times, but I’ve been really looking forward to this episode because you bring a lot of different pieces to the table where we can link some of the female reproductive and gut symptoms. So I just want to dove right in. So how many women do you think are misdiagnosed with a gut issue? And this is hypothetical because it’s really going to be hard to have that number that are diagnosed with a gut issue that actually have endometriosis.

Dr. Iris Kerin Orbuch: It is such a good question, and it’s probably such a high number because if I’m having a quote unquote stomach ache or constipation or diarrhea, alternating constipation or diarrhea or bloating or painful bowel movement, I’m going to go straight to the GI, the gastroenterologist, rather than going to the gynecologist. So what happens when one visits the GI? They maybe do an upper endoscopy, a lower endoscopy, maybe maybe some bloodwork and they say everything’s normal and then they diagnose them with irritable bowel syndrome. I try and give grand rounds to gastroenterologists, and I tell them if after you’ve done your full workup, you diagnose someone with IBS. If you can ask three questions, it’ll take literally 40 seconds to the patient. Number one, do you have painful periods? Number two, do you have pelvic pain? Number three, do you have any painful sex? Deep penetration pain or heavy periods, let’s say four questions if they answer yes to even one of them. If you can just say to that patient, Hey, I wonder if you have an DIMITRIUS? Go see a specialist like I try and educate all the time. And I think only if guys were trained about endo would they that would we actually have that? No. But I suspect most of most patients are diagnosed with IBS when in fact it is endometriosis or some other autoimmune disease that is causing inflammation, which is then flaring with that.

Dr. Ann-Marie Barter: Hmm. And what is endometriosis?

Dr. Iris Kerin Orbuch: So endometriosis? This is a really common disease process, which affects way too many women roughly about 10 percent of women, which translates to about 200 million women worldwide, which is just like the nuttiest number when we think about it and it can cause symptoms of painful periods, it can be pain preceding a period. Pain after a period of pain with ambulation could be pain all month long, heavy menses, heavy bleeding, deep penetration pain. It can cause GI issues such as constipation or diarrhea, or alternating constipation and diarrhea painful bowel movements bloating. It can cause urological symptoms, such as getting up at night time to urinate urinary urgency like I got to go to the bathroom. Urinary frequency feeling like one has a urinary tract infection and burning with urination.

Dr. Iris Kerin Orbuch: It can cause infertility. In fact, unexplained infertility when the sperm is normal and the tubes are open. When someone has unexplained infertility and accounts for 40 percent of unexplained infertility. But scientifically, what I know is is when you have cells that are similar to the endometrium, not identical, but similar. So the enemy trims that lining that gets thicker and thicker each month. And then if we don’t get pregnant, we shed that lining. So when we have cells that are similar to that lining, but they’re found external or outside of the uterus, that’s what enemy Treos says. So what happens every month? Our lining linings getting sicker and sicker because the hormones from our ovaries are telling our uterine lining to get sicker and sicker. Those same hormones are targeting the inflammatory implants of endometriosis, so too telling them, Hey, you get sicker and sicker. The problem is, there’s no exit point in the pelvis. So month after month after month, those implants are getting deeper and deeper and deeper, and they start pulling or distorting the anatomy to the left, or to the right or to the back, and causing scarring adjacent to the nearby organs such as the bowel and inflammation. And it’s it’s just it’s such a devastating disease because it’s invisible, meaning the patient looks perfectly quote unquote normal, meaning if someone has a slingshot in their arm, you’re like, Oh my gosh, what happened to you? That must be painful. But someone with endometriosis, they physically look perfectly normal and we’re not picking it up on bloodwork. We’re not picking it up on imaging. And in the US, there’s a 10 year diagnostic delay where women see an average of eight physicians over a course of a decade. Can you imagine, like every time I say that statistic, I just literally I box this morning. I just I want to hit the bag so hard every time I hear that.

Dr. Ann-Marie Barter: Yeah, absolutely, that’s so many. So how do you diagnose endometriosis?

Dr. Iris Kerin Orbuch: So we need to so that the accurate way to diagnose sendo is a surgical diagnosis. So we do a laparoscopy, which is like little keyhole surgery, same surgery. If you had your gallbladder out or your appendix out and we need to exercise or remove the cells, send them off to the pathologist that doc who looks at them under the microscope and they say, Yeah, these cells are pretty similar to the lining of the uterus. Hence they have the diagnosis of enemy neurosis.

Dr. Iris Kerin Orbuch: But the way that I can tell with a very high suspicion is in my initial consultation with my patients, I read all the records that preceded their appointment. I listen to my patients. I spend about an hour and a half or two hours with my initial counsels, and I query them on gynecological issues, GI issues, urological issues, inflammatory issues, fatigue, just all of like from head to toe approach. And then my physical exam.

Dr. Iris Kerin Orbuch: I combine that with those other two modalities the records. I’m listening to a patient and I can tell with 90 percent certainty, it’s probably higher than that, but at least 90 percent certainty whether I would find endometriosis at the time of surgery, my physical exam that I learned from one of my two amazing mentors in my fellowship, Dr. Harry reJ. It took me years to get this physical exam down, but for me, it’s it’s it’s better than any imaging modality to to tell someone, Hey, I think you’ve got.

Dr. Ann-Marie Barter: And the first course of treatment for endo is generally birth control. Is that correct?

Dr. Iris Kerin Orbuch: Well, that’s if we we’re talking and we’re following the American College of OB-GYN guidelines. Now what’s so important is that medical treatment, birth control being one of them does not stop progression of endometriosis. The purpose of birth control is just to treat symptoms. So if someone has really heavy periods, then we can prescribe a birth control pills because it’ll lessen the heaviness of their periods, assuming they can tolerate the side effects. For some people, if they have really painful periods and we put them on the birth control pill, perhaps it can lessen the intensity or the pain of their periods. Again, assuming that they can tolerate the side effects, but all the while while someone’s on the pill, it may mask some of their symptoms. But the disease is progressing. And that’s the problem is that so many people go on the birth control pill as a teenager, right? They just don’t want to get pregnant. They start to become sexually active.

Dr. Iris Kerin Orbuch: They go on the pill. Not necessarily for a painful period, reasons or pelvic pain reasons, but to prevent pregnancy. And then they end up on in college because they’re sexually active, then they just don’t want to get pregnant when they’re in grad school or whatever, where whatever course or path or trajectory their life takes them. And then when they’re finally ready to get pregnant, they go off the pill and then all of a sudden they’re like, Oh my gosh, I can’t get pregnant. And a lot of people then blame the pill. I’m not getting pregnant when in fact, it was just masking the symptoms of endometrium. Is this? Why do we get endometriosis, so we definitely know that there’s a genetic component to the disease? So meaning if the mom has endo or on the dad’s side, it could be the grandmother, the and cousins and maternal or paternal side that fetus or that young girl has a seven to 10 fold higher likelihood of getting endo if there is a genetic link to it, particularly aunt, grandmother, sibling, mother who has.

Dr. Iris Kerin Orbuch: And also if we talk about the baseline likelihood of getting and it is about 10 percent. So seven to 10 fold increases of 70 to 100 percent increase. And we also know when the mom’s pregnant with the fetus, exposures to dioxins, which are byproducts of bleaching to that fetus while she’s in her mom’s uterus, cause endometriosis. There’s probably tons of other chemicals that we don’t know of that do cause endometriosis. And really interestingly, there was a study that was done where they looked at female fetuses, so who unfortunately passed away. Let’s say there was blunt trauma to the mom or a car accident in the fetus passed away.

Dr. Iris Kerin Orbuch: And they did autopsies on those female fetuses that passed away. And you’d never guess what percentage of endometrium DCIS was found in those female fetuses. This is not. This study blew my mind. Nine percent.

Dr. Ann-Marie Barter: Wow.

Dr. Iris Kerin Orbuch: Which isn’t too dissimilar than the 10 percent we quote in the general population. So people are born with endometriosis. Again, whether it’s genetic link or exposure is better than altering. The either expressions of genes or weather are bad, how our bodies are clearing things in the peritoneal cavity, the perineal cavity meaning like the Saran wrap covering of the pelvis and abdomen. We haven’t figured it out quite yet, which is mind blowing. But you know, we don’t we don’t. We don’t have like a genetic sequence to diagnose and treat DCIS. So it’s it’s pretty amazing that so many amazing, amazingly sad that so many people are suffering for so many years with this disease. To me, it’s just it’s devastating. I share my patients pain. I feel it. That’s why I have to box. That’s why I have to like, do yoga before I go to the office or go for a walk because I need to clear my head because I feel my patients pain, because it so painful. So absolutely no question. So you you’ve kind of blown the lid off a lot of different things. I want to go back to the chemicals, not are you seeing the rate of endometriosis increase as chemicals seem to be increasing, so it’s hard to answer that question. I’m a very scientific mind. I’m not an anecdotal human being. Like the way that my brain works is it’s like I’m a really crazy outside the box thinker and I and I’m always thinking about stuff like this. But we have to take in effect one social media, right?

Dr. Iris Kerin Orbuch: There’s so much more awareness. There’s so much more. People are more comfortable talking about endo now than they were even two years ago or four years ago or eight years ago. So the more someone talks about something, the more awareness is raised, the more people are like, Oh, maybe I have endometriosis. So. So it’s hard to know what is the link that is? Kind of shortening the that 10 year delay in diagnosis. But what I am seeing in my office a lot is the I have a lot of mother daughters or siblings in my office, and I can speak from that correlation and I’ll tell you what I see all the time. I have the mom bringing the teen because teenage knows one of my passions and specialties. I love getting a teenager in my office because even if they’re in pain for six months, it’s six months too long. Right? But at least not 10 years too long, or 20 or 30 years too long, which I do see every day in my office and. The mom will say to me, I was like that, but then the mom will say it so much worse for her. Like the mom will say, Oh, it was bad for me, but it’s so much worse for her. I do think that all of the chemicals in the glyphosate and all the crap that we’re spraying on our foods and our produce and our air fresheners and our the crap we’re putting in our lotions and shampoos and our external environment has a huge impact on the expression of the disease. And I think there’s also so many more… I’m more eastern.

Dr. Iris Kerin Orbuch: I should like I probably was a natural path in another life or an acupuncturist. And I do think we have a lot more heavy metals in our body. We have a lot more things that are not allowing our body to detoxify and clear things in our body. And then we also have this crazy world where information like we don’t have a minute to let our minds rest. So we’re constantly multitasking, which is never good. We’re concerned. We never letting our body rest and restore, which is so important for healing. So I think there’s so many factors I would love to know the answer to your question, but I don’t know how we would even ascertain that.

Dr. Ann-Marie Barter: It’s tough, right, it’s just it’s I think this one’s all personal experience, I think that maybe you’re on the front lines of that, to be honest. So one last question kind of getting comfortable with endometriosis and then I want to get back to the gut. But a question I have gotten a lot is is endometriosis an autoimmune disease?

Dr. Iris Kerin Orbuch: Such a good question. I view it as an autoimmune disease. The consensus is not out, but we do know those within non-metro Treos have a higher likelihood of Hashimoto’s, which is autoimmune. Higher likelihood of celiac, which is autoimmune. Higher likelihood of showgrounds, which is autoimmune. Higher likelihood of really all autoimmune disorders. And I do believe that there is an inflammatory effect to enemy troops. I think it behaves like an autoimmune disease. I don’t think we have data to say yes, it is or it isn’t, but that’s how I treat my patients by decreasing in the same way someone would treat the gut if someone has Hashimoto’s or any autoimmune disease, because I really do believe a lot of autoimmune diseases are born from the gut. I treat my patients by shutting down as much information as we can throughout the body.

Dr. Ann-Marie Barter: So many people struggle with bloating, bowel issues, brain fog, fatigue. You might not even have any gut issues, but did you know the cause of it could be food sensitivities or gut infections? What I have done is I have brought a talented functional nutritionist into my practice. We have very similar training in the nutritional world. And her name is Alexis Appleberry. She is awesome. So you can head on over to our website AltFamMed.com and have a consultation with her and schedule so that she can help you get to the root cause of your problems.

Dr. Ann-Marie Barter: We have really covered the female reproductive system, but how is our gut linked to our female reproductive system?

Dr. Iris Kerin Orbuch: So those implants that I was talking about, those implants. External or outside of the uterus, so not only are they literally structurally pulling our uterus or whatever they’re attached to, to the right or the left or the back, and then tethering the adjacent organs to it. But those implants are pro-inflammatory. They set off all of these interleukins. Interleukins are inflammatory mediators, like with COVID, we talk about a cytokine storm. Cytokines also be inflammatory mediators, but endometriosis, as we know it’s more like interleukins and all these inflammatory mediators, those inflammatory mediators don’t just rest. Well, first of all, a no can be found from head to toe in the diaphragm, in the lungs. It’s been found in just about every organ in the body. We have a patient in our practice who had nosebleeds every month with her period because she had ectopic and Dimitrios implants in her nose. It’s been found everywhere, but what happens? There are those implants. Let’s just say for ease of the conversation that those implants are found in what we call like the cul de sac that’s the area behind the uterus in front of the rectum. And we know that those implants are releasing tons of interleukins, tons of inflammatory mediators.

Dr. Iris Kerin Orbuch: That inflammation goes everywhere. It goes head to toe, it goes to the gut, causes inflammation. And there was such a cool study that looked at those with endometriosis who have GI symptoms, gastrointestinal symptoms. What percentage of those patients actually had endo on the bowel? I a large portion, huge. Eight percent, eight, only eight percent,

Dr. Iris Kerin Orbuch: I think it was like eight point three or eight points something, and that’s enough to remember the point, whatever it was.

Dr. Iris Kerin Orbuch: But the whole idea and reading this paper totally blew my mind. And every time I read something, it makes me think and try and better understand this disease. Then I did like the day or the moments before I read these paper. Some very academic in my approach, but I’m very outside the box and how I’m treating endo. So what it is is it’s the inflammatory effect of those implants that is causing inflammation, let’s say, because we’re talking about the gut today, inflammation of the gut. And that’s why I find with my patients, I’m finding and I haven’t done a study on this, but I’m finding roughly about 70 percent of my patients have cibo small intestinal bacterial overgrowth. Huge, huge, huge percentage. Some are methane. Some are hydrogen elevations. Some are both. But what I do first with all of my patients, they come to me and want surgery tomorrow, and I’m like, Well, no, we’ve got to figure out all the reasons why you have symptoms. One of the first things I always do is I. I send them off for a gut evaluation.

Dr. Iris Kerin Orbuch: Do they have small intestinal bacterial overgrowth? Like what is the state of their gut? I have a work with integrative nutritionist to boost and rebuild the gut and its its or acupuncturist with herbs like just an eastern approach to a western disease. And it’s unbelievable. The thing is, I don’t have a roadmap when I operate on a patient. What am I going to find, right? Because I said that there’s no imaging or there’s blood work. My physical exam is going to tell me what stuck to what to the best of the best, the best indicator before I literally put the laparoscopy in a patient and I’m ready to attack bowel, you know, like to cut or exercise and go off the bowel excision surgery being the cornerstone of treatment friend. But it’s not always there. It’s it’s eight percent of the time. I’m finding a note on the bowel and even when I exercise and no adjacent to the bowel. Meaning that on the bowel, it’s just like in the pelvic cavity, very often they’re constipation gets better or their diarrhea gets better or their bloating. All these GI symptoms do get better now. We can’t simplify it that much because if someone is so overstressed and they have transit issues because they’re in sympathetic overdrive, we’ve got to undo the that’s sympathetic overdrive to help improve transit. And, you know, like that whole mind got mind body connection. Me cutting our nose, not going to improve transit. Right? Of things, but it will relieve like a lot, a lot, a lot of the symptoms.

Dr. Ann-Marie Barter: Do you…Have you ever found that after you have gotten somebody set with a gut evaluation, you’ve lowered their stress? Do you find that you always need to do surgery for endometriosis? Or do you find that a lot of the symptoms will resolve some of the time?

Dr. Iris Kerin Orbuch: I love that question. So, so that’s like my total approach is and the way that I explain it, because I played a lot of dominoes as a kid and I love the game of dominoes and it’s awesome. I had this great slide when I like. When I give lectures, there’s not many words on my slides. They’re all pictures because I’m a visual human being. Everything for me is colors and pictures and not words. It’s like. Anyways, so like, we have our first domino, which is Endo. Endo causes the tight muscle like the muscles of the pelvis to tighten and the muscles of the abdomen all over our body to tighten. Then that kind of flares the gut like inflammatory effect of the gut. Then then that can flare the central nervous system. Then that can flare the the nerves to the bladder.

Dr. Iris Kerin Orbuch: Then that you know where one can become more anxious or depressed if they’ve gone to eight doctors over a course of a decade. Now I’m telling them, there’s nothing wrong with you. So what I do is I work backwards. I start to get the mind body connection better. I talk about meditation, mindfulness, breath work, raising the parasympathetic state over a sympathetic strait because most patients who come in to me, it’s like a bear is chasing them. Like literally the bear is right behind their shoulder, and I explain to them, I’m trying to increase the distance of that bear, meaning decrease the sympathetic overdrive and raise the parasympathetic overdrive. We work on getting them evaluated for Siebold, like I said, working with an integrative nutritionist, getting them into pelvic floor physical therapy, whatever those things are. And then. I operate if they need it, however, so I usually will will do that initial email, I’ll give them suggestions of what to do based on. It’s very personalized and individualized how I approach each patient because everyone has multiple pain generators by the time they come into my office and I have to figure out what’s their primary pain generator. But either way, I’ve got to lift and undo all of these dominoes. The problem is just like the game of dominoes. If the first domino keeps knocking down the second one, it’s going to then knock down the third and knocked on the fourth. Because if the enemy tries this, let’s say it’s anatomically pulling to the right side. It’s going to pull on the underlying muscles. The muscles are then going to be tight, then that’s going to cause pain, and that’s going to flow the central nervous system that’s going to knock down all of the stuff. And also that inflammation still going to be hanging out, which is going to keep flaring the gut, which is going to keep causing ciba, which is going to keep causing all of these things.

Dr. Iris Kerin Orbuch: So in general, like I had a patient yesterday who I operated on and in the pre-op holding area, I was asking her and I asked my patients this all the time and I had been working with this patient. I’m trying to remember maybe three or four months and prior to surgery to just tune her up. And I asked her What percentage better is your pain from the first time we met to now, this is prior to my surgery. I was about to take her back to the O.R., and she’s like 60 to 70 percent. I can get my patients pain. Sometimes it’s 10 percent, sometimes it’s 30, but the number I hear often is like 40 50 to 60 70 percent better because those secondary things that are accruing over a course of a decade are so significant that I need to undo them. However, if I don’t cut out or excised that endo, that’s pulling everything to one side, I need to restore the anatomy so I’m not pulling on the underlying muscles and also cut out all that inflammatory stuff. So typically, I do end up operating on most people, but although I’m a surgeon, I’m never quick to operate on someone like, does does that make sense?

Dr. Ann-Marie Barter: I think that’s a great approach.

Dr. Iris Kerin Orbuch: Yeah. And by the time I see them for their pre-surgery visit, which I do about a week to two weeks before surgery and all we’re doing is talking about the surgery. Like, what if I find this? What do you want me to do? Or what if I sign that just about every patient says to me, I’m excited for surgery, I’m ready for surgery, and I say to them, that means you’re in the exact right place to have surgery, meaning we’ve lifted off a lot of those pain generators or started to make a huge dent on them. So now they’re in a good place for surgery and we continue all of those things. It’s not like, then I operate, they stop meditating and they stop pelvic floor. I tell them my surgery cuts out that and it doesn’t fix the tight muscles. It doesn’t fix the sympathetic overdrive. It doesn’t fix a lot of things. It cuts out that stuff that keeps causing all of those things. So we still need to address all those other components for pain.

Dr. Ann-Marie Barter: Have you seen so you’ve seen the changes in the microbiota in the gut with Sibo? Have you seen any other changes in the gut with bacteria as it relates to endometriosis?

Dr. Iris Kerin Orbuch: Hard to tell. I work with a lot of integrative nutritionists all over from Connecticut, all the way to California, and it’s hard to know a lot of the integrative or the naturopaths really do like a GI map or different type of testing, which I which I think are so fascinating. I there’s not many because it’s an out of pocket cost to do that GI map. I don’t know many physicians or naturopath or nutritionist who will send a second one off over time.

Dr. Ann-Marie Barter: I do it a lot, so know I do a lot. I want to see if their symptoms are still there. I still want to see that. Yeah, but most people, if they’re fine, they do not want to run a second one.

Dr. Iris Kerin Orbuch: If they feel great, they don’t cry.

Dr. Iris Kerin Orbuch: Exactly, exactly. So that’s the big thing is if we just, I don’t know. And the question is, why do the patients also have all these other abnormalities? I really think it’s the inflammatory effect of endo. It honestly, I really do. I really do.

Dr. Ann-Marie Barter: It sounds. It sounds about right. Yes. OK. So I think like we’ve we’ve kind of ascertained if you’re bloated, if you’re constipated, if you are basically given a diagnosis of IBS, but you still feel terrible. And then you also have the other four questions that you discussed earlier that there’s a likelihood that you need to go get checked for endo. So here’s here’s the problem with the podcast or here. The emails that I get is we’ll have guests on. They’ll get this great information and they will go to their OB-GYN, their M.D., and they get totally written off. And so it never gets looked at. So do you have any advice for somebody out there that’s like, Yes, this is 100 percent me. I’m scared, I’m frustrated. I’ve been to 12 docs. I am very upset. What would your advice be to talk to their physician or potentially who to goes

Dr. Iris Kerin Orbuch: Right? Before I answer that, can I just clarify something that I had said at the beginning?

Dr. Ann-Marie Barter: Absolutely.

Dr. Iris Kerin Orbuch: All patients experience symptoms of enemy trios is differently, some meaning some people just have Gwinn symptoms. I have like a pair of sisters where one just has neurological symptoms and no gut issues. She did have cibo, but she wasn’t. That wasn’t her predominant symptom. It was more urological, and the other sibling was more GI manifestations. Some people don’t have any GI or neurological symptoms, and they just have painful periods. Other people don’t have painful periods. They have pain preceding a period, or they have pain after periods. Some patients have no pain at all. They just experience infertility. So I have so many people come to my office and say, I can’t have endo because I have girlfriends or I have friends who have. It’s so much worse than me. So I want to just like, throw it out there that everyone’s symptoms of and are totally different. And some people are asymptomatic and there’s no correlation between quantity of &0 and severity of symptoms, either. Meaning someone can have one spot of endo and have debilitating pain while someone else can have a belly full of &0. And no pain in the converse is true. OK, so to answer your question? Going to a general OB-GYN is not going to be a fruitful place to go, and I’ll tell you why I tell my patients that I learned more in my first week of fellowship than I learned in eight years, meaning in the four years of my residency and four years of medical school. So, General OB-GYNs, God bless them, their breadth of knowledge, they’re an OBE, obstetrics and gynecology, and most residency programs are so heavy in obstetrics and gyn gets like slighted and also OB-GYN is considered a quote unquote primary care specialty. So tons of our four years is how do we deal with and treat diabetes, high blood pressure like stuff, that thyroid stuff, stuff that internal medicine doctors are treating, and there’s less and less of an emphasis on? Endometriosis is just like you can’t learn that all. So everything that I learned about Endo was wrong, that I learned and glands are just armed with misinformation. It’s not like they’re bad people. They’re amazing. God bless someone who can have such a breadth of knowledge. I’m in awe and admiration for them.

Dr. Iris Kerin Orbuch: I do one thing. I just have a really deep depth and I can’t keep up with one topic, right? Like just end. So they really need to find an end specialist. Can I give you on this podcast? Can I give names of where they can find needs?

Dr. Ann-Marie Barter: That would be very helpful to people? Yeah, go ahead.

Dr. Iris Kerin Orbuch: So in the back of my book, I wrote a book called Beating and How to Reclaim Your Life from Endometriosis, which you can get on Amazon or through HarperCollins or wherever. There’s a whole what is it called like resource in the back of my book that lists tons of places to get good information because you have to understand there’s so much misinformation on the internet. Even the definition of endometriosis is wrong in most articles that we read in, like different articles. So the back of my book has tons of resources, but my two three favorite places to get good quality information no one and no whatcom or endo what dot org I can’t remember there were switching out their website, and there’s a nice documentary that you can download. I think it’s like ten or twelve dollars to download the documentary, but 100 percent of the proceeds go to put a copy of that DVD in every school nurse’s office across the country, and there’s posters that we have that have been created to put in school nurse’s office. So if a young teen keeps going to the nurse with like period cramps, we’re hoping that Nurse will be armed with information to say, Hey, I think you may have endometriosis or picking up endo early.

Dr. Iris Kerin Orbuch: So EndoWhat.com is a great place. Nancy’s Nook is an online self-directed educational resource on Facebook. There’s over 100000 members. I don’t know how many there are now, but it’s just self-directed and there’s a list of physicians. I would say you just definitely need to do your own research with that list, but it does. It’s a great starting point, and it lists doctors across the country who specialize in endo and who do excision of endometriosis. And then the coalition and doco is another great resource. So those are my favorite. Three resources to get great good information about endometriosis is there’s tons more. I mean, there’s so many other ones. The back of my book lists tons of other resources, but just to give you a couple for to get people started.

Dr. Ann-Marie Barter: This is great. Is is there anything that I ask that you feel like is really important that we bring up before we close today?

Dr. Iris Kerin Orbuch: I think can I just talk about like a couple of myths then, though, that that’s great.

Dr. Ann-Marie Barter: I love that.

Dr. Iris Kerin Orbuch: Yeah, that I feel like such a disservice to those who are suffering so much being told by a physician. It’s in your head. Have a glass of wine before sex. It won’t hurt. I want to tell all those who are suffering and pain. I believe you. But I know this is like a podcast on the gut, but trust your gut. Trust your instinct. There is something. And find an enemy Treos a specialist. Another myth is that pregnancy cures unholy trio cis or menopause cures endometriosis. Neither of those are true. Symptoms of endometriosis may get better during pregnancy or may get better during menopause, but it doesn’t cure either. And a third one would be a hysterectomy. Is the treatment for zendo hysterectomy? Just I’d like to break down words because I’m like a little nerd histamines uterus actively means to remove. They used to call women who were hysterical when they had their periods because it was like their menses.

Dr. Iris Kerin Orbuch: But hysterectomy is not the cure or the treatment of endo, as I mentioned, and Nomi Treos is found outside of or external to the uterus. So excision of endometriosis is the treatment of endo, the only time where we utilize a hysterectomy, meaning removing someone’s uterus in addition to excision of endometrium if they have endometriosis implants in the muscle of the uterus. So that’s known as adenomyosis. So if someone’s complete a childbearing or they don’t want children and the uterus is a source of their pain, then they should have a discussion about adding hysterectomy in addition to excision. And then the last myth is that ablation of &0 is the same as excision of Vendome. So those are surgical treatments. Excision of endo is the cornerstone of treatment of endometriosis. That literally means, as I mentioned earlier in the podcast, cutting out those inflammatory implants that are like distorting the anatomy ablation of Endo is a superficial removal of the disease, and I like to explain it. Like if endometriosis is involving my entire fingernail excision will remove the fingernail. I know that’s gross, but it’s just like a really tangible understanding where ablation is just going to get at the white part of my fingernail, leaving the whole inflammatory aspect of endo behind. So you can’t even put those words in the same sentence. And typically, one ablation begets another. Ablation begets another one. And the way that I look at it like I’m not the best cook and I’ve left Saran wrap by my stove when I’m cooking in at shrivels up, right? Okay, maybe I can admit that maybe no one else has done that, but you can imagine if the end was already pulled to the right and then you cauterize it, or you oblate it or you burn it. What’s going to happen? It’s going to be sucked in even more to the right. It’s going to bury that inflammation even deeper. So it’s just like pain gets worse and worse and patients keep saying, Oh my endo came back, I got to go in for another surgery and it’s this like revolving door. It’s trauma. It’s awful, it’s awful. So excision of end is we have prospective, randomized, randomized, placebo controlled five year data to show that excision is the correct modality.

Dr. Ann-Marie Barter: Wonderful. Awesome. Where can people find you if they want to get in touch with you?

Dr. Iris Kerin Orbuch: So I’m based out of L.A., my office is in Beverly Hills and my website is L.A. White and our dot com lagi indeed.com and my book reading and how to reclaim your life from endometriosis on Amazon. It’s a real, holistic, multidisciplinary approach. And it’s like a guidebook that even someone in the middle of the country and I’m Midwestern, so I’m not talking about where someone’s from. But if they’re in a place that doesn’t even have an end of excision as they can navigate and start healing. And that’s why I wrote it, because because I want people to be able to have a resource or a guidebook. Yeah. And I just I want all those to know who are suffering. I hear you. I feel you. And there is help out there. There’s 200 million other patients out there who are suffering, and there’s a second endometriosis movie that’s coming out sometime in twenty twenty two. It’s done waiting for release. And I think once that one comes out, there’s going to be even more of a unification of patients who are really driving. The physicians to do two, to learn how to diagnose endometriosis earlier, like and I’ll close with a lot of my lectures when I talk to people who don’t know about endometriosis, all entitle it endometriosis hidden in plain sight. And I’m trying to arm pediatricians, internists, family docs how to reclaim their life. That’s how to reclaim lives, right, by asking the right questions. And so we don’t suffer.

Dr. Ann-Marie Barter: This has been amazing, you can tell that you just have a very huge heart for your patients and a heart to get this out to let people know. So this has been so informative. Thank you so much for being here today.

Dr. Iris Kerin Orbuch: Thank you for asking. I love, I like, so enjoy doing these and getting the word out and thank you for what you do because the gut is like, trust me, it’s just I’m like, It’s amazing. And I think all all health comes from the gut and all healing comes from the gut. And unfortunately, there’s no quick fixes and getting us healthy. But if we fix the gut, I think that’s that’s the basis for for for health. It’s a good starting place, down and starting place.

Dr. Ann-Marie Barter: Well, thank you all our listeners for being here today. We really appreciate you and you want to hear more of something. Please put that in the comment section. We will do our best to get that on. And thank you so much.

Outro: Thank you for listening to the Gut Health Reset Podcast. Please make sure you subscribe, leave a rating and a review. More people can hear about the podcast and hey, take a screenshot of this episode and tagged Dr. Anne Marie on Instagram or Facebook at Dr. Ann-Marie Barter. And for more resources, just visit Dr. Ann-Marie Barter.com.

 

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