Gut Health and Fertility Connection (Episode 301)

Full Transcript: Episode 301

Lisa Hendrickson-Jack: Welcome to the Fertility Friday podcast, your source for information about the Fertility Awareness Method and all things fertility. I’m your host, Lisa Hendrickson-Jack. I’m the author of The Fifth Vital Sign and the Fertility Awareness Mastery Charting Journal. I’m a certified fertility awareness educator and holistic reproductive health practitioner with nearly 20 years of experience teaching women to connect to their fifth vital sign through menstrual cycle charting, balancing hormonal health, and optimizing the menstrual cycle without hormones. I’m outspoken about hormonal birth control and its impact on fertility and overall health because you have the right to know how your body works and how artificial hormones disrupt that natural process. I host live coaching programs to help you achieve optimal fertility and health because it’s important to have healthy menstrual cycles regardless of whether or not you want to have babies. I’m also a wife and mother of two beautiful boys. I know, I know, I’m a busy girl, but I managed to fit it all in. This podcast is designed to empower you to take full control of your cycles, your fertility, and your overall health, and I’m so excited that you’re here with us today.

I’m so excited to share today’s episode with you. Today’s episode focuses specifically on the link between fertility and gut health. If you’ve been listening to the podcast for a while, you’ll know that over the years we’ve covered gut health on a number of different episodes in a number of different ways, because when you’re charting, it’s one of the things that can actually show up in your charts. If you do have issues with gut health, issues with intestinal permeability, food sensitivities, allergies, and all of those different types of scenarios — gut infections — it often shows up in your menstrual cycle charts, disrupts your normal menstrual cycle pattern, and can certainly have a negative impact on your chances of conceiving naturally. So let’s go ahead and jump right into today’s episode with Dr. Haley and Kristin.

And I’m really excited to be here today with Haylee Nye and Kristin Cornett. If you don’t know, I’ll just do a quick bio, and then I’ll let you two share a little bit about yourselves. Dr. Haylee Nye is a licensed naturopathic physician and certified nutritionist with advanced training in women’s health and infertility. Kristin Cornett is a certified nutritional therapy practitioner with expertise in functional wellness, women’s health, and fertility. And together, they run Tiny Feet, an online platform that helps educate and empower couples as they journey toward parenthood. And they also co-host a popular weekly podcast on iTunes called Mastering Your Fertility, which is how we met. So without further ado, I’ll welcome you to the show and also just share with the listeners that today we’re going to be focusing on gut health and how it impacts fertility. So I’m really excited to have you on the show.

[Note: The greeting that follows is a brief overlapping exchange; attribution below is inferred from context and should be reviewed.]

I would love just to give you both an opportunity to quickly introduce yourself and share what inspired you to focus on the area of women’s health and fertility, and also what inspired you to start Tiny Feet.

Dr. Haylee Nye: Well, I could go ahead and start, and this is Dr. Haylee Nye. I was originally inspired — I had a lot of health issues, stems back all the way to when I was 19 years old. I had an ovary that twisted due to a large cyst that was sitting on the ovary, and it had to be surgically removed, which was more of an emergency removal. And just in a matter of seconds, half of my ovaries — or half of my eggs — were gone. So that was really eye-opening for me, just trying to understand what that means for my fertility, and if I was going to be able to get pregnant. I have always been kind of a career woman, so I knew I wanted to go to college and go to graduate school, and so I knew that having children was going to be later on in my lifetime too. So that was another reason why it was like, okay, one ovary, and I want to have children probably more in my 30s, so how do I preserve my fertility going forward?

And then, fast forward to about five to six years later, I had a pretty severe kidney infection that changed my health drastically. I had a lot of issues after that, after taking a round of antibiotics. I developed irritable bowel syndrome, I had chronic UTIs, I had chronic vaginitis, and going the conventional route was very frustrating. I wasn’t getting the help that I needed, and so I sought out nutrition and naturopathic medicine, and I was able to learn a lot more about my gut health and how to balance out my flora in the vaginal canal and kind of get better in that regard. And so that’s where I got really interested in helping others do the same, and I pursued a career in naturopathic medicine. All along the way, I’ve always been really interested in women’s health, and more particularly, preconception care and fertility.

Lisa Hendrickson-Jack: Thank you for taking us through that. That’s super traumatic to lose an ovary and to have that realization — like, whoa — because when you have to, you kind of know, like, you don’t actively think of it, but you kind of know that losing one has potentially some pretty serious ramifications. And Kristin?

Kristin Cornett: Yeah, so my story kind of starts when I was a kid. I grew up really sick with a lot of chronic issues — gut health problems, immune system issues, asthma, eczema, allergies — just kind of all of the chronic childhood conditions that a lot of kids are growing up with nowadays. When I was in my 20s, I developed debilitating anxiety and panic disorder, and somehow I just didn’t think that any of these things were going to affect my ability to get pregnant. I just kind of thought, well, that’s something you’re supposed to be able to do, and I have a period every month, so I must be fine. And it just didn’t turn out that way. So my husband and I tried for a couple of years, and I really instinctively knew that there was something going on that was connecting my health issues to my fertility, but I just didn’t have the knowledge to figure that out on my own, and I didn’t know who to go to.

I started seeing a naturopathic doctor, but I still felt like we were more trying to treat my cycle and not addressing some of these underlying issues. And so that kind of drove me to just become a practitioner myself. I was working — actually, I was in business school at the time, and then started working in corporate finance, and I was like, gosh, I really need to figure out how to incorporate nutrition and do something more than what I’m doing right now. So I went back to school for nutrition when I was still working full-time as a finance analyst, and as soon as I finished that program, I was just really called to quit my job and start this work full-time.

And when I really sat down and thought about where I wanted to focus my career, there were two things that really drove me toward preconception care, fertility, and women’s health. One is that I grew up sick, and I thought, how do you prevent the types of issues that I grew up with? And the best way is to intervene before a woman conceives, because there’s so much research out there now to show how impactful both parents’ health — but especially the woman’s health — is on the future health of that child. So part of it was more of a preventative approach, just so that other kids don’t have to grow up the way that I did. And then the other piece of it was just being really passionate about helping couples avoid that pain of infertility, because I’ve been through that, and I know what that feels like.

Lisa Hendrickson-Jack: Well, thank you for sharing that as well. So important, and it’s interesting because I’m currently in this headspace of critically examining male fertility as well, because we already think that the issue is us, right? So I’ve never had a female client who didn’t think that the issue was her. Let’s get into some of the gut health questions and information, because one of the questions that came to mind, and I think this might be a good way to jump into the topic, is — as you mentioned, Kristin, you grew up sick — there’s a lot of women and men out there, but there’s a lot of women who have gut issues but don’t recognize them as such. They just kind of may think that it’s normal to only have a bowel movement every three days, or typically just feel gassy and bloated after they eat meals, or all of those types of things that you may have experienced for years. So to you it’s just a typical Thursday, and so you first of all don’t necessarily know that that’s not normal, and second of all wouldn’t necessarily know that that would have any impact on fertility. So I’d love to just hand that one over to you two.

Kristin Cornett: Yeah, you know, I think it’s definitely true that these types of symptoms — there’s a couple of reasons that they become so ingrained and we think of them as normal. One is that we just don’t talk about it unless you’re having a pretty severe, life-disrupting issue. You’re not typically going to the doctor and discussing your bowel movements, and conventional medicine doesn’t typically ask about them unless you specifically go in for a digestive concern. And then I think the other piece is exactly what you said, that we’re just sort of ignoring these issues because they happen on a daily basis. We assume that that’s just what’s normal for us, and since there’s no education about what’s actually normal or optimal for health, it becomes really difficult to assess whether or not you’re actually on that curve of normal.

Digestive health is so foundational to your overall health. Think about it — your digestive system is what turns nutrients in your food into the raw materials that build and maintain your body and all of your metabolic processes and your reproductive processes. Growing a baby especially is such a nutrient-intensive process; there’s so much that goes into that, and we really need that healthy digestive system to make that work. There’s a bunch of other things going on as well — I’m sure Dr. Haylee can continue to expand on why gut health is so important.

Dr. Haylee Nye: Yeah, well, just to touch a little bit more on what you were saying, Lisa, about patients — or my patients, at least — thinking that their digestive issues are just normal. With my own personal experience, I had that kidney infection back in 2007, and it was a very gradual onset of digestive issues where it escaped me for many years. It wasn’t until about 2010 or ’11 — three to four years later — that I actually realized that my gut health had drastically changed. My digestion slowly slowed down to where I was starting to become more and more constipated, more bloated, more gassy, and really, sitting in medical school, I would be in the afternoon having to unbutton my pants because I was so uncomfortable. Sometimes I had to just leave class because my stomach hurt and I was in pain and bloated. That was kind of when I finally realized something was wrong — I don’t think this is normal. So I just want listeners to know it’s a gradual onset, and a lot of times it can just feel normal until all of a sudden you realize this isn’t normal.

Another thing that can cause typically normal bowels to go wrong is if you’ve had food poisoning before — food poisoning can actually cause an autoimmune condition toward your nervous tissue and your small intestine, and slow down the motility. That again is a very slow, gradual onset, so it could take years before you actually realize that now you’re going to the bathroom three to four times a day and have diarrhea, or maybe you’re now constipated, and you just really don’t realize it. Another thing that’s really normalized, which we know isn’t normal, is heartburn or indigestion after you eat. A lot of people think, oh, I just have a little heartburn, I’ll take some Tums, or go on a proton pump inhibitor or some type of antacid. That might happen gradually and become worse and worse over time, and a lot of times that’s a sign of food sensitivities or low stomach acid. A lot of people think they have too much stomach acid, but it’s actually that you don’t have enough, and it’s causing this gradual onset of heartburn symptoms — one of the first signs of an ongoing change in your digestive ecology, and it’s gradually just going to get worse.

[Note: The transition into the next section is not clearly speaker-tagged in the source audio; attribution below is inferred from context.]

Once it’s addressed — I’ve had a number of conversations with clients over the years, and some of my clients who have these digestive issues can often remember when it started. Even though it’s been going on for a year, two years, or whatever, they can often remember when it happened. Sometimes it’s related to a trip, or some sort of exposure to something or someone, and from that point on, the stool was never the same. It was always running or loose, or always kind of constipated, but they kind of remember normal before that.

Lisa Hendrickson-Jack: So I think one question is — we feel like we’ve just gone through it, but are there any other signs that there could be something going on with your gut health? Something for the listeners so the light goes off, like this could be me. And then, if you do suspect it, maybe you could talk a little bit about what types of testing are appropriate and what type of practitioner to go to, because I feel like with gut health, there are many people who know they have gut issues and have sought support and haven’t been helped. There are people who hang on, they’ve done protocols, they’ve taken medication, and it doesn’t — they still have the problem and it persists. It’s really complex and can be very challenging for people.

Kristin Cornett: Yeah, it definitely can. Some of the things that might come up, when you can remember where it started, are things like antibiotic use, or some type of infection or virus, or maybe you had runny poop for three days and then your digestion was never the same after that, and you don’t really know what you had — you suspect maybe you ate something off, or food poisoning. Antibiotic use for other types of infections — say you get frequent UTIs, and you’re on antibiotics, or you get an infection and take antibiotics, and then it kind of sets off this chain of several rounds of antibiotics. That happens a lot to women for things like UTIs or upper respiratory infections. Antibiotic use is really common.

Even something like a really stressful or traumatic event — traumatic brain injury can cause digestive dysfunction because it disrupts the communication between your brain and your gut. There’s a direct communication — your vagus nerve is directly connected from your brain to your gut, and it really manages digestive function. That’s also a slow-onset type of thing, so traumatic brain injury — something like a concussion, or you got into a car accident — it might not feel like a big deal. You go to the doctor and they say you’re fine, just rest for a couple of weeks. But if your digestion changes after that, that is likely one of the causes.

Dr. Haylee Nye: Yeah, definitely, and then in terms of having it investigated — this is where most of us take the long road, and that has certainly been one of the motivating factors for me to get into this work and become a practitioner myself — taking the long road, going to a conventional medical provider and saying, I have these issues, I don’t feel right. I had one doctor palpate my stomach and say, well, you don’t feel like you have any infections, so I’m just going to do a workup for celiac disease. Okay, all of that’s negative, and he literally said to me he could refer me to a gastroenterologist to do more testing and investigation, but more than likely they’re just going to do a whole bunch of expensive and invasive testing and probably not find anything because my issues are psychosomatic. I was discouraged from conventional evaluation from a conventional medical provider. Now, I’m not saying that’s everybody’s experience, but I’m just trying to paint the picture a little bit — when you go in with these sort of nonspecific digestive issues, it can be difficult to get an appropriate workup for any type of issue that you might have.

A lot of times, if your basic evaluation is negative for any specific disease, you’re labeled with IBS, or irritable bowel syndrome, which is kind of a diagnosis of exclusion — okay, well, we’ve ruled out any of these other super serious issues, we’re just going to label you with IBS. That’s a really frustrating diagnosis, because a lot of times you’re just told, oh, if you’re constipated, exercise more, drink more water, eat more fiber. Dr. Haylee, this was your experience when you first went in with IBS-type symptoms, and that actually made the problem worse because you had small intestine bacterial overgrowth and you didn’t know it at the time, and you were actually inadvertently feeding that bacteria with the excess fiber. So really, the investigation into issues like this needs to happen from a functional perspective, and that requires seeing a practitioner who is trained to look at the digestive system from a functional perspective — meaning, are all of your organs and systems functioning properly. It starts, honestly, at the top, which is not your stomach — it’s actually your brain. Are you in a rest-and-digest, relaxed parasympathetic state when you’re eating? Then it goes to your mouth — are you chewing your food fully? It’s actually amazing how many people just kind of chomp-chomp-swallow, and they really don’t let that mechanical breakdown of food happen, so the rest of the digestive process isn’t so stressed and overwhelmed. And then, your stomach — do you have sufficient stomach acid, are you producing and excreting enough pancreatic enzymes, is the motility complex in your small intestine able to move food through on the correct transit time — not too fast, not too slow — so you can absorb your nutrients. There’s a lot of different things to look at, and it’s really important to see somebody who is familiar with how to look at that system and address it and restore that function.

Lisa Hendrickson-Jack: So for the listener who’s kind of like, okay, I want to know who to go to — I’ll just ask the question the listener might be thinking. Does this mean I don’t go to the doctor? And then the second question is, who do I go to? If I’m living in a small community and I think I have a gut issue and I think it could be affecting my fertility, am I going to a naturopath, am I finding a medical doctor with a functional background — who do I Google? Tell me, Kristin.

Kristin Cornett: I would like to just quickly answer the “should you go to the doctor” piece — yes, you should go to the doctor. Please go to the doctor. What I would say is definitely get checked out for the big baddies, as I call them — Crohn’s disease, ulcerative colitis. If you have blood in your stool, or mucus in your stool, or chronic abdominal pain, you could have gallbladder disease and might have to get your gallbladder out. There’s a lot of things that could be going on that really need to be looked at. There’s chronic appendicitis that happens, so you just want to make sure those things are ruled out — you might have a bowel obstruction, and you definitely don’t want to mess with that. So get checked out, but if your doctor is just kind of fumbling around and saying, well, you seem fine, eat more fiber, go on some runs — at that point, trust your gut, quote-unquote, to seek out somebody who can help you, because when you’re diagnosed with irritable bowel syndrome — which one out of five Americans are — that means one out of five people are going to the doctor and being told that they don’t know what’s wrong with them, that it’s kind of in their head. What we’re finding in the last five years or so is that small intestinal bacterial overgrowth causes a substantial proportion of irritable bowel syndrome — an overgrowth of bacteria in the small intestine — and all of the risk factors we talked about earlier, such as antibiotic use, a previous food poisoning episode, or a traumatic event, all make you susceptible to having that small intestinal bacterial overgrowth. And that’s treatable — you can treat that and get better, so that’s really important for people to know.

As far as where you would go, I always recommend the licensed associations — for naturopathic doctors, we have the American Association of Naturopathic Physicians, at naturopathic.org. I know in Canada they have a Canadian Association of Naturopathic Physicians as well, and these are physicians who have gone to a four-year medical school and become licensed through a board, and they all know about IBS and SIBO and digestive health — the gut is our thing. Ever since naturopathic medicine became a thing, the gut has always been an obsession of ours, so you’ll definitely find some help there. And Kristin can mention the Nutritional Therapy Association, because they’re a really great resource as well.

Lisa Hendrickson-Jack: I just want to interject for a moment — I’m glad you clarified that, because a lot of women have had negative experiences with doctors gaslighting them, basically telling them it’s all in their head, and some women wear it as a badge of honor, like, “I don’t go to doctors anymore.” It’s important to recognize we all need doctors — it’s just challenging to advocate for ourselves, because, like any profession, all physicians don’t come to you with the same degree of knowledge, bedside manner, etc. So I think the most challenging part is, if you don’t have the most wonderful experience with a doctor, it’s not to give up on doctors as a concept, but it’s harder because then you might have to go through a couple of doctors to find somebody who’s going to treat you the way that you deserve. There is something I wanted to ask you about, though — like any profession, there are some naturopaths who have a lot more experience with gut issues specifically than others, and so there are women who have gone to a naturopath for gut issues, and maybe that particular person didn’t connect, or they didn’t feel satisfied with it. So how would you recommend somebody find a naturopath or functional practitioner in her area who specifically specializes in gut health? Any tips to look for someone who’s a little bit more specialized?

Dr. Haylee Nye: I would say, as far as the naturopathic route, you can always start there — our American Association — I think the NDs who are practicing day in and day out are part of that association. And then I know there’s the SIBO Info website — Dr. Allison Siebecker’s website — which has some really great resources, listing out what testing to get done and diets to be familiar with. If you asked the potential doctor you want to see whether they’re familiar with Dr. Allison Siebecker and her protocols and suggestions on how to investigate gut health, and if they waver and say, “I don’t know,” then they’re probably not the practitioner for you. I think that would be the same with functional health, because Dr. Allison Siebecker and Dr. Steven Sandberg-Lewis are kind of the founders of functional SIBO diagnosis and treatment, and they’re up on all the most recent research, along with Dr. Pimentel and his team. If the person you’re going to isn’t familiar with any of those doctors, recommendations, or treatments, you might want to look elsewhere. Kristin might have some other suggestions as well.

Kristin Cornett: Yeah, well, I also think it’s important to note that SIBO isn’t the only thing that can be going on in your digestive system, so asking a practitioner that’s familiar with different options for testing and investigation is important. SIBO is typically diagnosed gold-standard through a lactulose breath test, but there are other investigations into functional gut health that can be done as well, such as a stool test — there are a couple of different options. We personally use a GI-MAP in our practice because we feel like we get the most accurate information from the DNA PCR technology that test uses, but what’s really important is that you see a practitioner who is used to using a particular test and is experienced interpreting it and getting results for their patients — whatever tests they’re using, knowing whether or not they run those routinely, whether they’re familiar with interpreting them, and comfortable creating a protocol that addresses the findings.

I’m kind of a website-researcher junkie, so when somebody asks me about a doctor, I say start at their website — what are they saying they do, what are they saying their wheelhouse is — and if you’re still not sure, or you don’t see your particular condition listed, call the clinic and ask the hard questions. You’re interviewing this person — this is an important job you’re hiring somebody to do for you, this is your health — and if they aren’t comfortable answering your questions about their experience treating these types of conditions, move on to the next person until you find somebody who is comfortable addressing these for you. I totally get being done with going through a couple of different practitioners, being frustrated, wanting answers yesterday, and still looking for somebody, so I really think doing your due diligence — I think we’re sort of trained to think we should be able to go down a list and randomly stop somewhere, “here’s a doctor accepting new patients, I should be able to go and get the help I need,” and with specialized issues like functional gut problems, it just isn’t quite that simple. So really doing your research is the answer.

Lisa Hendrickson-Jack: Well, thank you for that, I think it’s so important. I talk about that a lot on the podcast, as I’m sure you know, but I remember a long time ago I did an interview with Dr. Thomas Cowan, and it was interesting because — I’ll butcher the quote, but he basically said something along the lines of, you have to be really cautious with doctors, and everyone nods their heads, and he’s like, you also have to be really cautious not to — and I was like, wait a minute — what he was saying was that within every profession, you can have an amazing doctor who’s incredibly knowledgeable and supportive, so it’s kind of like, after years of working with women, you just start to realize that if you have a specialized issue, just like you said Kristin, it’s really important to find someone who specializes in that issue — someone whose thing is poop, and that’s what they do, and that’s what lights them up, and they’ve spent years researching and practicing around it, because that’s the person you need when you have issues with the poop. So, speaking of poop — I would like for us to cover what is normal. We touched on all the different things around how this could be a problem, but could you take us through a normal day or week — what should our digestive system be like if it is functioning optimally?

Kristin Cornett: I’ll start, and you can add, Haylee. First of all, you shouldn’t be uncomfortable when you’re eating food — you should be able to get through an entire meal without feeling bloated or excessively full, having any reflux, discomfort, or indigestion. You shouldn’t feel crappy or bloated an hour after eating. Excessive gas is not normal. So basically, you should be able to eat food comfortably without any symptoms, and see that reappear roughly 24 hours later in the toilet, with a nice, solid, smooth, snake-like bowel movement at least once a day being considered pretty normal. If you’re pooping less than once a day, you’re constipated. If you’re pooping more than three times a day, especially if it’s loose at all, you have diarrhea. Even if it’s not the horrible, watery, no-substance-at-all kind that people picture when they think of diarrhea — going to the bathroom very often throughout the day, even if it’s reasonably solid, is still faster transit time than we’d want, and that’s not giving your small intestine enough time to absorb nutrients from your food. So there’s some type of functional issue if you’re going that often.

Lisa Hendrickson-Jack: Okay, but what if I’m gassy — how do you know if you’re too gassy?

Kristin Cornett: Usually, if it causes abdominal pain — if the gas can’t escape — that’s usually too gassy. If it’s really rancid, that could be a sign it might be hydrogen sulfide gas, which could be an overgrowth, or what we call dysbiosis. A little bit of gas here and there is totally normal — we have a whole ecology of microbes living in our gut, feeding off of us and keeping us alive, and we have to keep them alive, so we feed them food and they make gas, and that’s what happens. But if you have rancid gas, or it’s causing a lot of abdominal pain and not escaping, or causing a lot of bloating, that’s not necessarily normal.

Dr. Haylee Nye: Yeah, if you look pregnant when you’re not, that’s definitely a sign that you have bloating or excessive gas.

[Ad break for the show sponsor removed.]

Lisa Hendrickson-Jack: Okay, I’m trying to think of how to answer that — so just to summarize, and you can tell why I do this, like you can tell I work with women — to clarify what you’re saying, is when you eat, your stomach should be fairly silent? Like, as we’re talking, I’m thinking about my gut right now, and I feel nothing — the stomach is just doing its thing, but it should be silent, and I think that might be very strange for the woman who basically poops every other day or so. She’s like, but I don’t feel constipated, I’ve always pooped every other day — you’re telling me I’m constipated? It doesn’t make sense.

Kristin Cornett: I want to say something about that too, about constipation — you can also be constipated and poop every day. There’s a chart you can look at called the Bristol Stool Chart — that’s B-R-I-S-T-O-L — and you can look it up on the internet, it’s really easy to find. It has type 1 through type 6 or 7 — one is like small little rabbit pellets, and seven is like super watery diarrhea. If you’ve ever had food poisoning, you know what that looks like. So you can be constipated and have something between a Bristol stool type one and two, or even three, and if it’s hard, if you’re straining to have that bowel movement, or you feel like you have to go but you don’t have an urge, so you’re really trying to push it out, and you only get a few pieces that go into the toilet, and then you’re like, oh, that was not satisfying, but at least I got a little bit out — that’s constipation. You might be having a few bowel movements a day, but it’s really unsatisfying, and you just feel bloated, and you’re like, can I please just have one good bowel movement — that’s constipation, and that’s not normal. We actually use the Bristol Stool Chart in our Food and Mood Journal — it should be called Food, Mood, and Poop Journal, but I feel like that’s off-putting when people see it for the first time — but we ask about bowel movements, and I actually have a link to the Bristol Stool Chart on every day, to note whether you had a bowel movement and what number on the Bristol Stool scale it was, so we can really get a sense of what people are experiencing, because that is important.

Lisa Hendrickson-Jack: I just want to make a comment that’s kind of unrelated — I was watching Red Table Talk the other day, I don’t know if you’ve ever watched it, Jada Pinkett Smith — and there was this episode where Will was sharing that he did this health intervention, and it came to mind because somewhere in the conversation he shared that he only poops every three days, and that’s been his normal for his whole life. Wow, and everyone was kind of teasing him about it, but I felt like that was just an example of how you can have this poop schedule that is not optimal, not within the range that would be considered ideal, and for years have no idea. Now, not all of us are the Smiths — he’s directly working with Dr. Mark Hyman right now — but I thought it was really interesting first of all that he said that out loud, but how many people out there are in one of these categories where their poop doesn’t fall into the normal range, but it’s been that way for years, so I’m glad that you addressed that.

Kristin Cornett: Yeah, well, and I just think this is one of the reasons that investigation in the context of fertility is so important, because we do get into these situations where — oh, this has been happening forever, it’s not relevant to my current situation with my fertility — and it’s like, wow, not quite, because we inherit our microbiomes from our parents, and so a lot of times we’ll think, oh, well, my mom’s constipated too, that’s normal, she only poops every three days, so it’s fine that I only poop every three days. But eliminating waste is one of our body’s elimination pathways for toxins, and our immune system is in our gut, and, like I said, about nutrient absorption — especially if you have fast transit and you’re not getting all of the absorption that you need because your food isn’t staying in your small intestine long enough to absorb nutrients — these are all things that have a major impact on fertility, and that’s why it’s important to investigate this in the context of fertility, as well as overall health.

Dr. Haylee Nye: Yeah, and just to add on to that, I always love analogies, so I think of it like taking your garbage out — you take your garbage out at least once or twice a week, and the garbage man comes and picks it up and takes it away, and nothing stinks, everything is clean and pristine. But when you’re constipated, the garbage man isn’t coming except for once a month, and it’s just piling up and starting to stink and get rancid, and it’s fermenting, and that’s what’s happening in your body — all that waste is being reabsorbed back into your bloodstream because it’s just sitting there. That’s where you can get headaches or migraines, or it can cause leaky gut, where you actually start getting more food sensitivities and maybe even joint pain.

Another analogy I really like — most people know this one, but we all come with a bucket. We’re born with this — I know you use the bank account analogy, Lisa, I love that one — but we use the good old-fashioned bucket analogy. Everybody is born with a certain size bucket, and some are smaller, some are bigger. The interesting thing is women’s buckets are always a little bit smaller than men’s, because we menstruate every month, and that’s a stressor on the body. What goes inside the bucket is stressors, so if our digestive system is a stressor, then we have that, plus we have menstruation, plus we have environmental toxins — for women, once again, we have another stressor because we like to put makeup on, and shampoo and conditioner and beauty products, and if those aren’t right, that’s adding to our toxic load. And of course, stress in general is a toxic load into our bucket. So, depending on the size of your bucket, yours may overflow a little bit sooner than somebody else’s, and you might be thinking, well, my mom’s fine, or my best friend is fine, she’s doing all this and had a baby and she’s fine, why can’t I do it? It’s because you have to look at the size of your bucket — it may be due to genetics or environmental toxins, or just the size you were born with. Yours might be overflowing, and your friend might have more room in her bucket.

Lisa Hendrickson-Jack: I really like that. I mean, obviously I love analogies in general — I was kind of reeling from the garbage bag analogy because I really felt that, but it’s true, and you need to use analogies because then it makes sense why it’s problematic to poop every two to three to four to five days, because that just means that stuff is sitting in your body and it should be out of your body. The bucket analogy is also really helpful to give you a sense of what your body can handle, and everybody is different. We live in this interesting world where everyone wants, if I have this issue, to know the three things I can do to solve it, and when you’re not looking at yourself and your health and your fertility in a holistic way, it’s really easy to forget that everybody is different, and there might be things your friends can handle that you can’t. So — a big topic, but I think it’s important to touch on it to our best ability in this episode — how do gut issues specifically impact fertility? Why is it — I mean, if you look at the research, there’s a lot of research showing that women who have different gut issues tend to take longer to conceive. So the evidence is there, but tell us why it is that these gut issues are connected to our ability to have babies.

Dr. Haylee Nye: Well, one major impact is that seventy to eighty percent of your immune system is in your gut, and immune system issues are common in women who struggle with fertility. So let’s look at some of the major conditions that can contribute to or even cause infertility directly — conditions like PCOS, endometriosis, hypothyroid, especially Hashimoto’s thyroiditis, which is an autoimmune condition. These three conditions make up a pretty significant portion of infertility cases, and each one is influenced by inflammation, and inflammation is influenced by gut health. The microbiome is a super important modulator of the immune system, and with conditions like endometriosis, there’s actually direct evidence that not only is leaky gut involved in endometriosis, but also dysbiosis — and not just in the gut, but also in the vaginal microbiome and the uterine microbiome. When we look at where those microbes come from and how that microbiome develops, a lot of that is happening early in life, from what we’re inoculated with in our gut, and some of that’s coming from what we’re getting from our moms — whether we’re born vaginally, or c-section birth, which is actually a risk factor for dysbiosis and gut issues later in life. But basically, that’s one of the main connections — looking at the immune system, and how the gut influences inflammation, and how inflammation influences the development of some of these other conditions. And then women who have genetic predispositions or epigenetic programming toward one condition or another are going to see dysbiosis impact them in different ways.

Kristin Cornett: I just wanted to add on to that too, and bring it back to a really common gut condition, which is small intestinal bacterial overgrowth. The reason that can actually affect fertility is because there’s bacteria in your small intestine that shouldn’t be there, and that bacteria can take your nutrients away or not allow them to be absorbed, causing this kind of functional malabsorption issue where you’re not getting iron. Women who have this bacterial overgrowth, SIBO, are chronically low in iron, which is really important for fertility — they’re chronically low in zinc, they’re low in folate, B12. So if you have this condition, not only is it causing nutrient deficiency, it’s also causing leaky gut — and then those microbes have what’s called LPS on them, which is lipopolysaccharides, and those are on gram-negative bacteria, and when that bacteria comes in contact with the gut lining and it’s leaky, then that LPS can actually get into your bloodstream. What they’ve shown is that LPS is really inflammatory — it goes into your brain, it goes into your liver, and they’re showing a lot of connections with endometriosis and LPS as well, and how that’s affecting inflammation in the uterine environment and also in the ovary environment, causing some hormonal imbalances. So it’s interesting that a lot of people don’t realize endometriosis is tightly connected to gut health in the small intestine and large intestine, and when that’s accurately treated and taken care of, the endometriosis actually gets a lot better.

I also want to mention too that you can have issues with your gut and not have any diagnosed fertility issue — like the issues can be affecting your fertility even if you don’t have endometriosis or PCOS or an autoimmune condition, or any evidence of inflammation in the body. Even things that are systemic and don’t seem to have anything to do with your gut or your reproductive system — like chronically itchy skin, hives, seasonal allergies — that’s a sign of inflammation. Being fatigued, having headaches, having acne — these are all things that are kind of intimately tied to gut health that we associate more with hormonal issues, or other types of problems, or “I’m just getting older and stressed out.” But there may be something deeper going on there that needs to be investigated. The last thing I want to mention about gut health is that it’s possible to have a pathogenic infection and not know it — my story is that I ended up having two parasitic infections without even realizing it, probably from my dogs. I had giardia and cryptosporidium, and I had no idea. I didn’t have the classic ten-times-a-day watery diarrhea, weight loss, and all those scary things that can happen with really serious infections — I didn’t have any of that, but having a chronic infection you aren’t aware of is still stressful to your body, and it’s a resources issue — your body is going to put resources toward the thing that is stressing it in that moment, and it’s going to deprioritize things like reproduction, detoxification, sleep — all of these rest-and-digest and reproductive processes that your body needs to be healthy.

Lisa Hendrickson-Jack: Well, and I just want to chime in there, because my work is always focused on the menstrual cycle, and what’s really interesting is, when we talk about these things, you’re not seeing your gut — it’s an internal situation, so we can be very disconnected from it. There are often very practical ways that it can impact your cycle. When you think about inflammation, if you have a high degree of inflammation, you may have a higher degree of cholesterol in your bloodstream, and that might have a negative effect on ovulation. I’ve seen multiple times in women who have gut issues that it’s often aggravated by — I mean, tell me if I’m wrong, but when I’m working with a woman who has issues with digestion, if I just ask her, she can list a few things that she knows aggravate it. And so if she’s consuming those things, you’re often seeing shifts and changes in the menstrual cycle. So just to point out the very physical nature of these issues, because I think for a lot of women it just feels completely out of control, and once you start becoming more in tune to your body — because I think there’s some degree of this — when you have these chronic gut issues, these chronic digestive issues, there seems to be some degree of separation from your body, where it’s important to bring that in and start to be more aware of how the different actions, different stressors, different foods, whatever the situation, can be affecting your gut health, because once you’re aware, then you can start making some shifts.

Kristin Cornett: Yeah, that’s completely true. I think a lot of the work we do with clients is about bringing them back into their bodies and helping them make connections between the things they’re feeling and experiencing and how that manifests in something like their menstrual cycle.

Lisa Hendrickson-Jack: That’s a really good point. I think it is important to restore that awareness.

Kristin Cornett: There’s this interesting phenomenon in nutritional therapy — we’re trained to use something called a Nutritional Assessment Questionnaire, which is basically a zero-through-three assessment of about 300 different symptoms, and when you add together the scores of all of those, that gives you your total symptom burden. It’s a way of trying to quantify this more subjective assessment of symptoms, and what’s really important is the change in the overall number as you continue to work with people over time. One of the things that’s interesting is sometimes you’ll talk with somebody who you feel has a lot going on, and they probably have more symptoms, but they really under-report because they’re just not in tune and really in their body, experiencing what’s really happening on a daily basis. So sometimes you work with somebody for three months and they feel better, and yet their symptom burden number goes up, because now all of a sudden they have this heightened awareness of what’s going on in their body — they’re actually able to identify the symptoms they were experiencing before, so they feel better, and yet their number is higher, and to me that’s a classic indication of just better awareness.

Dr. Haylee Nye: Yeah, I like that. I also wanted to mention, with the menstrual cycle, Lisa, when you were saying how you can be disconnected from what’s going on in your gut — but women are usually really connected to our menstrual cycle, which is really amazing, and I love that you wrote The Fifth Vital Sign, because it’s so true — we know when it’s coming, or we know when something’s off, or anything to do with our menstrual cycle. It’s really common and really cool to see the changes in the menstrual cycle as you’re working on your overall health, and specifically your gut health, because your cycle will change — your periods won’t become as heavy, the cramping is less. Really the ultimate goal is we shouldn’t have a painful cycle — we should just be able to glide right through our menstrual cycle without any major issues, and I know you’re really preaching that PMS isn’t normal — it’s a sign of inflammation. The menstrual cycle within itself, all in all, is an inflammatory process, so we’re all going through this inflammatory process — it’s a matter of what extent that inflammatory process is happening. Is it a baseline of health, and then you just have this little blip of inflammation so you don’t really feel it? Or do you already have a baseline of pretty significant inflammation, and then you have your menstrual cycle each month, and it’s like, whoa — you feel angry, you feel sad, you feel all these emotions, anxiety, depression, and on top of that you have the bloating and the cramping, and that’s just no way to be, especially when we have to go through this every single month. So that’s one way to monitor how well your health is improving — by looking at your menstrual cycle.

Lisa Hendrickson-Jack: Well, absolutely. Well, as we draw close to wrapping up, because I know I could talk to the two of you all day — what I wanted to leave the listener with is, what are a few things you can do? For the women listening who are really nodding their heads throughout this whole episode, who are identifying, okay, there’s obviously something off with my digestion, I kind of knew it because we all have our intuition, but maybe I was kind of ignoring it, and now you guys are putting it in my face — what are some simple strategies, and where do you start?

Dr. Haylee Nye: I would say for the little things, always go back to what Kristin was saying — it starts with your head, then your mouth, then your stomach. Trying to get into that parasympathetic tone, a calmer environment before you eat, spacing meals — three to four hours between big meals, less snacking, chewing your food thoroughly. And stomach acid — like I mentioned, having low stomach acid is a big driver of poor gut health, because it’s the first domino in the domino effect. It’s the thing that needs to happen for everything else to happen — it triggers the pancreatic enzymes, the bile, and the rest of the digestive process. Chronic stress reduces stomach acid, so most people are walking around without enough stomach acid, and chronic stress also makes you more susceptible to bacterial infections, because if you don’t have enough stomach acid, it’s not going to kill that bacteria, and then it gets into your small intestine and makes a nice little home there, and overgrows. So one really simple way to work on stomach acid is apple cider vinegar before meals — you can also do bitters, like gentian or orange peel bitters, little tinctures, before meals, or HCl with betaine, which is like an actual capsule, to see if that helps. But like Kristin will mention, some diagnostic testing, if none of that is helping and you really feel like you need to get some testing done, we highly recommend getting to the bottom of it. Don’t be like me — it took years of messing around and trying to fix things without actually getting an accurate diagnosis. I wasted three-plus years trying this, then juicing, then something else, and nothing ever worked, because I had this chronic bacterial overgrowth in my small intestine that needed some serious treatment.

Kristin Cornett: Yeah, I think what I would really add to that, in terms of things you can do on your own without seeking out diagnostic testing — or at least before seeking out diagnostic testing, if you suspect you have a serious issue, like Dr. Haylee mentioned earlier, blood or mucus in the stool, abdominal pain, anything like that, go get checked out, don’t wait to go to the doctor to at least rule out anything really serious. But you can try an elimination diet — this is a strategy we use frequently with clients, and there are lots of different types of elimination. The simplest one we typically start with is taking gluten, dairy, and sugar out of your diet for three to four weeks and seeing how your symptoms change. Gluten and dairy can be huge trigger foods for some people, especially if there’s an underlying immune stimulation or autoimmune condition going on, and that’s a good place to start. A couple of other eliminations we use frequently are the Whole30 diet — there’s an entire website with tons of resources and cookbooks and all the rules listed out, it’s essentially a paleo-type template — you do it for 30 days and see how you feel, then reintroduce things to see what causes symptoms. If you experience improvement in your symptoms when you take certain foods out, you can rechallenge those and see which ones are working and which aren’t, and that might give you an indication of whether some of your gut issues are coming from food triggers, because your diet is really the most important interaction between your digestive system and the inside of your body. Whole30 and AIP, autoimmune paleo, are the two we use most commonly in practice.

There’s also the option to go through food sensitivity testing if you’re really struggling and having a hard time identifying triggers, and if you feel like kind of everything you eat is bothering you, that’s an indication you might need a little bit more work. Our approach in clinical practice is typically to start with stool testing, SIBO testing if it’s indicated, but usually stool testing first, to determine what’s really going on in there from a functional perspective — what the balance is between your good and not-so-good bacteria, and whether or not there’s any infection that might need to be addressed. Food sensitivity testing at the same time can be helpful too, to make sure we’re taking food triggers out at the same time we’re addressing what we find on that testing, because doing all of that together really gives the gut a much better chance to heal, calm down, and recover from what it’s been experiencing.

Lisa Hendrickson-Jack: Well, thank you for that, that’s very helpful. Kristin, Haylee, this was such a good conversation, so much important information — I know this is going to be a favorite episode, and it’s going to be one that I refer a lot of women to as questions come up. So I really appreciate you taking the time to be here today and to share your wisdom and knowledge. Could you let the listeners know where they can go to find out more about you, about what you do, about your podcast, all the places?

Kristin Cornett: Yeah, so our website is tinyfeet.co, and so you can learn more about us there — we do free 20-minute consults if you want to jump on the phone with us — and we also do the Mastering Your Fertility podcast, and we’re almost a year in, we have some really cool episodes on gut health, and if you want to learn more about our story, we have our health stories that we shared back in the beginning of when we first started the podcast, and we have one on birth control as well, and all sorts of other stuff.

Lisa Hendrickson-Jack: And it was such a blast being on your podcast, and now I’m happy to have you on mine, so I’ll link to those episodes you mentioned for the listeners on the go. But thank you again so much for being here, I really appreciate it.

Kristin Cornett: Yeah, thanks so much for having us, this was fun.

Lisa Hendrickson-Jack: Thank you for listening. If you enjoyed today’s show, please share it with a friend. You’ll find the show notes page for today’s episode over at fertilityfriday.com/301. I hope that you enjoyed today’s interview with Dr. Haylee and Kristin — such important information about digestion and about gut health, and about how to identify if what you’re experiencing is normal. It’s really interesting to me that over the years I’ve had multiple conversations with clients who just have never really considered that it’s not normal not to have a bowel movement every day, or to go several days without a bowel movement, or to have runny stool all the time. The quality of your poop says a lot about your digestion, and I think it’s really easy for us to become really comfortable with whatever it is we’re experiencing — if you’ve been experiencing your digestion a certain way for a long time, even if it’s problematic, you may not even consider that there could be an issue. So it’s conversations like this that really bring important information to light, and this is such an important topic, especially as it relates to fertility, because issues with gut health are often related to systemic inflammation, which can interfere with fertility in one way or another. So it’s really important to get to the root issue when you have concerns about your digestion when you’re trying to conceive, because it can make an impact.

So, lots of great information in today’s episode, and if you are in that stage of trying to conceive, planning ahead, and wanting to know how you can really optimize your chances of conceiving through charting and fertility awareness, make sure to grab your copy of my free eCourse, Conceiving with Fertility Awareness — you’ll find details over at fertilityfriday.com/TTC. I just want to thank you so much for spending some time with us today, for tuning into today’s episode, for sharing these episodes with your friends, and helping to spread the word about fertility awareness and the connection between our menstrual cycles and our overall health. So thank you for being part of the Fertility Friday community, and of course, as always — until next time, be well, and happy charting.