Love heals too: the part of the prescription nobody writes down

What endometriosis and a divorce taught me at the same time

I was living with endometriosis long before my marriage ended, and for years I did what most of us do: treated the pain as a purely physical problem to be solved with the right protocol. Better diet, better supplements, better surgeon. All of that mattered. None of it explained why my worst flares clustered so precisely around the months when I was most emotionally unsafe.

Going through a divorce while managing a chronic inflammatory disease was the first time I could no longer pretend the two systems were separate. I was eating well and sleeping badly. My cycle was chaotic. My gut stopped working properly. My pain thresholds dropped through the floor — the same amount of disease, felt far more loudly. I remember thinking: nothing about my nutrition has changed, so why does my body feel like it is under attack?

The answer, which took me years and a second diagnosis to fully understand, was that my body was under attack — just not by anything I could put on a food diary. Chronic relational stress is a physiological input. It changes cortisol rhythm, immune signalling, gut motility, sleep architecture and pain perception. My body was responding to my life accurately.

Nothing about my diet had changed. Everything about my safety had. My body was not malfunctioning — it was reporting.

Then came dysautonomia, and I could no longer ignore the nervous system

A few years later I was diagnosed with dysautonomia — dysfunction of the autonomic nervous system, the part of you that runs heart rate, blood pressure, digestion, temperature and the switch between fight-or-flight and rest-and-repair. Suddenly the invisible thing I had been sensing had a name and a mechanism.

Dysautonomia is a brutally efficient teacher, because the consequences of dysregulation are immediate and measurable. A hard conversation and my heart rate is 120 standing up. A week of conflict and my digestion stops, my temperature regulation goes, my sleep fragments. There is no lag time in which I can tell myself the stress is not affecting me. My nervous system publishes the results the same day.

It also reframed the endometriosis. Both conditions involve immune activation, both involve central sensitisation of pain, and both sit downstream of autonomic tone. Research increasingly describes autonomic dysfunction and altered heart rate variability in women with endometriosis, and central sensitisation is now recognised as a core driver of persistent pelvic pain rather than an afterthought (Zondervan et al., 2020; Woolf, 2011). In other words: the nervous system is not a soft, secondary consideration in chronic disease. It is a mechanism.

So I audited my relationships like I would audit a diet

I know how to take a food history. I had never taken a relationship history — not clinically, not on myself. So I did. I wrote down every significant relationship in my life at that point: partner, family, close friends, colleagues, clients, my boss, the friend I always felt slightly braced around. And beside each one I answered a single question: after time with this person, is my nervous system calmer or louder?

It was an uncomfortable exercise, and it was the most useful piece of health data I have ever collected. Some relationships were unambiguously regulating. I slept better after seeing those people. My gut worked. My pain was quieter. Others were reliably dysregulating — not always dramatic, sometimes just a constant low-grade vigilance, the kind where you are managing someone's mood rather than being in their company.

The evidence backs up what the audit showed me. Marital conflict measurably slows wound healing and raises inflammatory cytokines (Kiecolt-Glaser et al., 2005). Chronic relationship strain predicts worse cardiovascular and immune outcomes, while supportive relationships predict better ones (Robles et al., 2014). Loneliness and weak social connection carry a mortality risk comparable in magnitude to well-established physical risk factors (Holt-Lunstad et al., 2010; Holt-Lunstad et al., 2015). And the Harvard longitudinal work on adult development, which followed men for over eighty years, landed on relationship quality at midlife as one of the strongest predictors of health decades later (Waldinger & Schulz, 2023).

• Regulating relationships: I could exhale in them. Disagreement was possible without threat. Rest afterwards, not recovery.
• Dysregulating relationships: I performed wellness in them. I anticipated moods. I noticed I held my breath, clenched my jaw, or over-explained.
• Neutral-but-costly relationships: nothing wrong on paper, but they took energy I no longer had a surplus of.
• Work relationships counted just as much as home ones — a chronically unsafe workplace is a chronic physiological stressor, not a personality flaw in you.

Co-regulation is a physiological event, not a nice idea

The reason safe relationships change symptoms is that human nervous systems regulate each other. This is not metaphor. Being with someone who is calm, attuned and reliably kind measurably shifts autonomic tone — vagally mediated heart rate variability rises, cortisol reactivity falls, and pain perception drops. In brain imaging work, simply holding a trusted partner's hand during a painful stimulus reduces threat-related neural activation (Coan et al., 2006). Social support blunts cortisol responses to stress (Ditzen et al., 2008; Heinrichs et al., 2003).

For anyone with dysautonomia, endometriosis, an autoimmune condition or any inflammatory disease, that is not a wellness extra. Vagal tone influences the inflammatory reflex — the cholinergic pathway through which the vagus nerve dampens cytokine production (Tracey, 2002). Higher heart rate variability associates with better immune regulation and lower inflammatory markers (Thayer & Sternberg, 2006). If your relationships keep your nervous system in sympathetic dominance for years, you are living in a low-grade inflammatory state that no amount of turmeric will out-argue.

Your nervous system does not care how good your supplement protocol is if it never gets to feel safe.

The love I had not been giving myself

Here is the part I found hardest to write. The most dysregulating relationship in the audit was the one I had with myself.

I had spent years treating my body as a problem to be corrected. Every flare was a personal failure — I must have eaten something, done too much, not managed my stress well enough. That internal voice sounds like discipline and it functions like threat. Self-criticism activates the same physiological alarm systems as external criticism does: sympathetic arousal, cortisol, threat-focused attention. Self-compassion does the opposite, and this is measurable rather than sentimental — self-compassion interventions are associated with lower cortisol, higher heart rate variability, reduced inflammatory markers and better outcomes in chronic illness populations (Rockliff et al., 2008; Breines et al., 2014; Sirois et al., 2015).

What changed for me was small and unglamorous. Stopping mid-flare and asking what I actually needed rather than what I should be capable of. Cancelling without a justification paragraph. Eating properly on the days I felt least deserving of the effort. Letting rest be a treatment rather than a concession. Saying, out loud, that a body managing two chronic conditions is not a body that has failed.

It sounds soft. It produced harder outcomes than most protocols I have tried: fewer flare days, better sleep, a heart rate that behaved more predictably, and a considerably less frightening relationship with my own symptoms.

What I actually did — and what I ask my clients to do

This is not a call to blow up your life. Most of it is smaller and more repeatable than that.

• Run the audit honestly. List your key relationships — home, family, friendship, work — and mark each one regulating, dysregulating or costly. Do not edit for guilt.
• Change the dose before you change the relationship. Frequency, duration and context are all adjustable. Not every dysregulating relationship needs ending; many need boundaries and less exposure.
• Protect one reliably regulating relationship per week as if it were an appointment. Co-regulation needs repetition, not intensity.
• Watch for the physiology, not the story. Jaw, breath, gut, sleep quality that night, resting heart rate the next morning. Your body reports faster than your opinion does.
• Treat work like an exposure. If your income depends on a chronically unsafe environment, you may not be able to leave this quarter — but you can stop pretending it is neutral and build recovery around it.
• Add active vagal support: slow nasal breathing with a longer exhale, humming or singing, cold water on the face, gentle consistent movement, time outdoors, and touch from people and animals you trust.
• Speak to yourself in the voice you would use with a client. If it would be unacceptable said aloud to someone you loved, it is not acceptable internally either.
• Get the physical basics right at the same time — iron, vitamin D, thyroid, B12, blood sugar stability, protein at every meal, salt and fluids if you have dysautonomia. Nervous system work is far harder on an undernourished, anaemic, blood-sugar-crashing body.

Why this belongs in a nutrition practice

Because I cannot get a client's gut working properly if they are eating every meal in a state of threat. Digestion is parasympathetic — motility, stomach acid, enzyme release and bile flow all require the body to believe it is safe. I cannot regulate someone's hormones if they are running on four broken hours of sleep because of the dread of a Monday. I cannot lower inflammation in a body braced twelve hours a day.

So I ask. Who do you live with? What is your work like? Who can you be unwell in front of? Is anyone looking after you? What do you say to yourself when you are in pain? These are clinical questions, and the answers change what I prescribe.

Food, movement, sleep and testing remain the foundation of what I do — I am not suggesting love replaces medicine, hormone support, surgery or investigation. But I have stopped treating relational health as a lifestyle footnote. It is one of the inputs, and often the one nobody has ever measured.

References

• Holt-Lunstad, J., Smith, T.B., & Layton, J.B. (2010). Social relationships and mortality risk: a meta-analytic review. PLoS Medicine, 7(7), e1000316.
• Holt-Lunstad, J., Smith, T.B., Baker, M., Harris, T., & Stephenson, D. (2015). Loneliness and social isolation as risk factors for mortality: a meta-analytic review. Perspectives on Psychological Science, 10(2), 227–237.
• Robles, T.F., Slatcher, R.B., Trombello, J.M., & McGinn, M.M. (2014). Marital quality and health: a meta-analytic review. Psychological Bulletin, 140(1), 140–187.
• Kiecolt-Glaser, J.K., Loving, T.J., Stowell, J.R., et al. (2005). Hostile marital interactions, proinflammatory cytokine production, and wound healing. Archives of General Psychiatry, 62(12), 1377–1384.
• Coan, J.A., Schaefer, H.S., & Davidson, R.J. (2006). Lending a hand: social regulation of the neural response to threat. Psychological Science, 17(12), 1032–1039.
• Ditzen, B., Neumann, I.D., Bodenmann, G., et al. (2008). Effects of different kinds of couple interaction on cortisol and heart rate responses to stress. Psychoneuroendocrinology, 33(5), 565–574.
• Heinrichs, M., Baumgartner, T., Kirschbaum, C., & Ehlert, U. (2003). Social support and oxytocin interact to suppress cortisol and subjective responses to psychosocial stress. Biological Psychiatry, 54(12), 1389–1398.
• Tracey, K.J. (2002). The inflammatory reflex. Nature, 420(6917), 853–859.
• Thayer, J.F., & Sternberg, E. (2006). Beyond heart rate variability: vagal regulation of allostatic systems. Annals of the New York Academy of Sciences, 1088, 361–372.
• Woolf, C.J. (2011). Central sensitization: implications for the diagnosis and treatment of pain. Pain, 152(3 Suppl), S2–S15.
• Zondervan, K.T., Becker, C.M., & Missmer, S.A. (2020). Endometriosis. New England Journal of Medicine, 382(13), 1244–1256.
• Rockliff, H., Gilbert, P., McEwan, K., Lightman, S., & Glover, D. (2008). A pilot exploration of heart rate variability and salivary cortisol responses to compassion-focused imagery. Clinical Neuropsychiatry, 5(3), 132–139.
• Breines, J.G., Thoma, M.V., Gianferante, D., et al. (2014). Self-compassion as a predictor of interleukin-6 response to acute psychosocial stress. Brain, Behavior, and Immunity, 37, 109–114.
• Sirois, F.M., Molnar, D.S., & Hirsch, J.K. (2015). Self-compassion, stress, and coping in the context of chronic illness. Self and Identity, 14(3), 334–347.
• Waldinger, R.J., & Schulz, M.S. (2023). The Good Life: Lessons from the World's Longest Scientific Study of Happiness. Simon & Schuster.