Endometriosis and the Gut: we chat with Dr Bulsiewicz

AEF volunteer Charlotte interviewed with Dr Will Bulsiewicz, a gastroenterologist and expert in gut health, who founded the The Plant Fed Gut platform. Dr Bulsiewicz is the author of the bestselling book Fiber Fueled and recently founded 38TERA - a daily microbiome Nutrition designed to nourish and enhance your gut. Dr Bulsiewicz has dedicated his career to helping people improve their digestive health through diet and lifestyle changes. We asked him all about the importance of gut health, living well, and, of course, the connection between the gut and conditions like endometriosis.

1. Can you share a little about your background and what led you to focus on gut health?

My journey into gut health began in a fairly traditional medical setting – I trained in internal medicine at Northwestern and gastroenterology at the University of North Carolina. But what really ignited my passion for the microbiome was my own personal health transformation.

During my medical training, I was working incredibly demanding hours, eating poorly, stressed, and neglecting my health. I reached a tipping point where I felt chronically fatigued, depressed, anxious, overweight, and an upset gut with bloating and unpredictable bowels. Despite great training at leading American hospitals, in that moment I didn’t want my own medicine. I wanted to heal the root cause, not take a bunch of pills just to treat symptoms.

This led me on a personal journey where I changed my diet, and it changed my life. As a result, my perspective on medicine changed. I became fascinated by the microbiome – the trillions of microbes living inside us – and their remarkable influence on digestion, immunity, metabolism, mood, and more. I brought what I found into my clinic, and my patients experienced incredible transformations. Now, my mission is helping others harness the power of gut health, using science-backed approaches and practical, approachable methods. I firmly believe that optimal health begins in the gut, and my work is dedicated to sharing that empowering message with as many people as possible.

2. What fascinates you most about the connection between gut health and overall well-being?

What fascinates me most about gut health is the sheer scope of its influence on our entire body. The gut isn't just about digestion; it's deeply interconnected with virtually every aspect of our overall well-being – our immune system, mental health, metabolism, hormonal balance, and even our longevity.

Consider this: approximately 70% of our immune system resides in the gut. Our gut produces over 90% of serotonin, a neurotransmitter that significantly affects mood, sleep, and emotional health. And we now have a term specifically dedicated to how our gut microbes influence estrogen balance in our body – it’s called the estrobolome.

What I’m saying is that inflammation, your mood, and even your hormones are influenced by what’s happening in your gut.

3. Many people with endometriosis experience digestive discomfort— what are some possible reasons for this link?

Endometriosis involves the growth of endometrial-like tissue outside the uterus, often affecting organs within the pelvis, including parts of the bowel. Many women with endometriosis report digestive symptoms – bloating, constipation, diarrhea, abdominal pain, and nausea – often mistaken for conditions like irritable bowel syndrome (IBS).

There are a few key reasons for this link:

1. Chronic Gut Inflammation:

Endometriosis is inherently inflammatory, with endometrial-like implants that can directly irritate the gut lining, causing digestive discomfort.

2. Altered Gut Motility:

Inflammation and adhesions caused by endometrial implants can change how food moves through the intestines, which can cause constipation, diarrhea, and bloating.

3. Gut Sensitivity:

Persistent pain can sensitize nerves, which we call visceral hypersensitivity. This amplifies discomfort, causing the gut to feel more pain and even feel pain when it shouldn’t.

4. Damaged Gut Microbiome (Dysbiosis):

Emerging research suggests that women with endometriosis may have distinct gut microbiome profiles that are associated with inflammation and can contribute to gut symptoms.

5. Hormonal Factors:

Endometriosis is estrogen-dependent, and fluctuations in estrogen levels can significantly influence gut function, affecting motility, microbiome balance, and pain sensitivity.

For all of these reasons, I believe in a gut-focused approach for those with endometriosis. Nourishing the microbiome with a high-fiber, plant-rich diet, addressing inflammation, and leveraging stress management strategies often provide significant improvements in symptoms.

4. What are some simple ways people can support their gut health in daily life?

Gut health doesn't have to be complicated. Simple, daily choices can make a huge difference. Here are my favorite actionable strategies anyone can incorporate:

1. Prioritize Plant Diversity:

Each unique plant provides specialized fibers and nutrients that fuel diverse gut microbes, fostering a thriving microbiome. Aim for 30 different plant foods each week.

2. Incorporate Daily Microbiome Nutrition (DMN) by 38TERA:

Think of DMN as your gut’s daily "multi-vitamin." This carefully crafted blend of 7 plant-based prebiotics nourishes your gut microbiota, supports digestive regularity, reduces bloating, and helps maintain gut barrier integrity. It’s an easy, tasty way to support your gut health daily – especially on busy days when your diet might fall short.

3. Hydrate Consistently:

Staying well-hydrated is crucial for gut motility, digestion, and maintaining a healthy mucosal barrier. Aim to sip water regularly throughout the day.

4. Move Your Body Regularly:

Regular physical activity stimulates digestion, supports a balanced microbiome, and helps reduce inflammation. Even short, gentle movements like walking or stretching can make a difference for your gut.

5. Prioritize Sleep:

Getting enough sleep (7+ hours per night) and maintaining a consistent bedtime support your gut’s circadian rhythm, improving digestion, immunity, and overall gut function.

5. What’s one misconception about gut health that you’d love to clear up?

One of the biggest misconceptions I see is the idea that gut problems should be addressed with restrictive diets – cutting out food groups and narrowing your diet to "safe" foods. While restrictive diets may temporarily reduce symptoms, they don’t address the root cause, and they can actually harm your gut health in the long term.

Your gut thrives on variety. Diversity in plant-based foods is key – every unique plant food you eat supports a different community of beneficial gut microbes. Rather than limiting your diet and weakening your gut, think of eating diverse foods as exercise for your gut. Like muscles, your gut needs training and variety to become stronger and more resilient.

Just like starting a new workout routine, you may need to ease into it. Start low, go slow, and gradually add more fiber-rich, plant-based foods into your diet. This is where 38TERA DMN can help, because it is a prebiotic blend that provides a variety of powerful prebiotics, but it was uniquely formulated to be low FODMAP, which means that it’s gentler on the gut. Over time, this gentle approach helps your gut adapt, grow stronger, and become more tolerant.