5: IBS & Anxiety: Navigating This Common Connection With FODMAP Everyday

Episode Transcript
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(00:00):
So we still don't know exactly why there's such a strong link
between anxiety and IBS, but onethought is that it may be
related to changes in the microbiome that can occur with
anxiety and stress, and then also the overlap of that
dysbiosis that's quite commonly present in those with IBS.
So we know that people with IBS tend to exhibit the lower
diversity in their gut microbiome and a bit more of a

(00:21):
fragile gut microbiome. So it tends to have like lower
diversity of species and typically like a lower
population of beneficial or healthy bacteria.
And there's some thought that just that imbalance in the gut
microbiome could contribute to maybe imbalances in
neurotransmitters and the regulation of different like
hormones and chemicals that playa role in our mood.

(00:42):
Welcome to the Gut Fit NutritionPodcast, the show where we dive
deep into the world of gut health, nutrition, and fitness
to help you unlock your best cell from the inside out.
I'm your host, Lee Morado, a registered dietitian, gut health
expert, long distance runner, and movement enthusiast on a
mission to empower you with science backed whole body
strategies to fuel your body, heal your gut, and thrive in

(01:03):
your active life. Whether you're here to finally
break free from IBS and digestive symptoms, optimize
your fitness performance, or learn how to support your gut
health with natural strategies, you're in the right place.
Each week, we'll explore topics like conquering digestive
symptoms, building a gut friendly lifestyle, enhancing
endurance and strength performance, and more.
So grab a cup of your favorite gut friendly tea and settle in

(01:27):
because we're about to get gut fit together.
Today's episode is actually recording from a live webinar
are recorded with Da Da Wilson, Co founder of FODMAP Everyday as
well as The Queen Zone. If you're not familiar with
them, FODMAP Everyday is a amazing resource to help you
thrive on the low FODMAP side with IBS.
Thank you to FODMAP Everyday forthis awesome information packed

(01:50):
interview. If you experience both irritable
bowel syndrome, IBS and anxiety,you're not alone.
These two conditions occur together more often than you may
realized. AUS based study actually looked
at over 1,000,000 IBS patient hospitalizations from 4000
hospitals over a three-year period.

(02:10):
The findings? More than 38% of those had
anxiety and 27% had depression, More than double the rate of
anxiety and depression found in those without IBS.
If you'd like to know how IBS and anxiety interact, as well as
how to manage anxiety when you have FODMAP intolerances and or
IBS, you'll want to listen to this interview with myself and

(02:31):
Dade Wilson from FODMAP Everyday.
Be sure to check out FODMAP Everyday for evidence based
comprehensive guides, recipes and resources for your low
FODMAP diet journey. They're on Instagram at FODMAP
Everyday and you can find lots of evidence based blogs written
by various Monash trained dietitians, including several
from yours truly, as well as lowFODMAP recipes, product guides

(02:54):
and more at fodmapeveryday.com. Enjoy this in depth interview
all about IBS and anxiety. Welcome everybody.

(03:19):
I'm Dede Wilson of FODMAP Everyday.
I'm here with Lee Morado, our wonderful dietitian who has
written so many amazing articlesfor us at FODMAP Everyday and
today we are going to discuss the overlap of IBS and anxiety.
Many of you told us that this was the topic that you wanted to
to discuss and so that's why we're bringing it to you today.

(03:43):
For those of you who are just coming in, you will be able to
add questions to the chat which we will address at the end and
we are going to get started. I wanted to begin by touching on
a quote from our article that Lee wrote, which hopefully

(04:06):
you've all seen. And this is that AUS based study
from 2023 looked over 1,000,000 IBS patient hospitalizations
from 4000 hospitals over a three-year period.
So that's a very, a really well done study with a broad outlook.
And the findings were more than 38% of those that had anxiety

(04:31):
and 27% who had depression. This was more than double the
rate of anxiety and depression for those have found for people
with IBS. So it's, it's prevalent, you
know, that's more than 1/3. And that's why we're here today.
So I thought we would start if Lee and welcome, Lee, thank you

(04:53):
so much for your greatness with us and your expertise is greatly
needed. So could you first define for us
what anxiety is? Yeah.
So in reference the American Psychological Association
definition, but it's defined as an emotion characterized by
feelings of tension, worried thoughts, and physical changes

(05:15):
like increased blood pressure. So it's thought to be sort of a
response to maybe like a broad or a vague threat rather than a
specific external trigger. Essentially.
And how does stress, you know, Ithink laypeople, we use the term
anxiety, stress, depression, nervousness, like sometimes we

(05:38):
use all of these terms to, we think they mean the same thing
or really similar thing. So can you just sort of take us
through the the differences between these things and why
we're talking about IBS and anxiety in particular?
Yes, they definitely are used interchangeably.
I think depending on who you talk to, you may get like a
slightly different definition, but they are thought to be

(06:01):
different. So like I mentioned, anxiety is
more of like a a response to something that may happen.
It's more future oriented and itcan go over like a long period
of time and it's more vague or broad versus stress is in
response to an actual external trigger.
So something like a work deadline or you know, being in

(06:23):
the presence of something that'sgoing to harm you, like there's
a Mountain Lion on your hiking, hiking trail route and you know
that there is a real, real danger there versus anxiety.
It's more something that that may happen, but may not
necessarily. Happen.
I thought when I use those examples, it's like that
anticipatory thing, the fact that anxiety is something that

(06:45):
could happen in the future that really help me understand the
difference between the two. And, and the example you gave of
something like a Mountain Lion, that's like here, you know, you
have a stress response, which isvery different than worrying
about you. Like, how am I going to eat when
I go to my sister's wedding three months now and doing in

(07:06):
that in that anticipatory anxious state?
Yeah, exactly. I think they still can occur
together, like even the example of a work deadline like you may,
that is the real stressor and you may be stressed about that.
But then you may also have anxious feelings of all the
things that may go wrong or could, you know, go badly in

(07:27):
that episode. That may not necessarily happen.
So I think they can still exist together, but there is a
difference there for sure. And so the gut brain connection,
I mean, this is the perfect segue right into talking about
that. I think that, you know, most of
us who have been on the diet fora while or a low fiber diet or
have IBS have read about the gutbrain access or maybe just heard

(07:49):
about the gut brain access, aren't quite sure what that
means. So if we could talk a little bit
about that now, I think that would be great.
Yeah, yeah. So definitely, I think more
people are learning about it andunderstanding it.
There's still a lot we don't know, but the gut brain access
is considered that like two way cross or bi directional

(08:09):
communication between our gut, our gastrointestinal tract and
our our brain. So it's thought to be in sort of
constant communication through primarily like different
neurotransmitters, the bacteria and the microbes that reside in
our our gut. And then communication between
nerve endings and the primary nerve that's sort of responsible

(08:30):
for that connection is the the vagus nerve.
So quite an interesting. Someone so you know, I'm
assuming that you know most or all of the people here have IBS,
maybe they've experienced anxiousness or anxiety and
they're wondering, you know now we we are starting to understand

(08:53):
what the connection is right so our gut brain have this actual
connection, but what can we do about it right That's.
The big. Question and how the low FODMAP
diet might feed into it or just take us through that a little
bit? Yeah, I think even to just sort

(09:14):
of understanding why there's that overlap can help us to sort
of address it. So we still don't know exactly
why there's such a strong link between anxiety and IBS, but one
thought is that it may be related to like changes in the
microbiome that can occur with anxiety and stress, and then
also the overlap of that dysbiosis that's quite commonly

(09:36):
present in those with IBS. So we know that people with IBS
tend to exhibit like a sort of alower diversity in their gut
microbiome and a bit more of a fragile gut microbiome.
So it tends to have like lower diversity of species and
typically like a lower population of beneficial or
healthy bacteria. Bacteria.
And there's some thought that just that imbalance in the gut

(09:57):
microbiome could contribute to maybe imbalances in
neurotransmitters and the regulation of different like
hormones and chemicals that playa role in our mood.
So interesting. One of the things that I've
always thought was really interesting is reading about how
the microbiome can be altered and changed pretty quickly.

(10:19):
I mean, it's a very, it's a very, it's not static, right?
Yeah, exactly. We, we, it's, it's this ever
evolving thing. And I, I think that's a really
interesting point that within this anxiety discussion, but
also in a general discussion of IBS that I'm often talking about
in our groups, which is that people who speak up in our

(10:42):
groups often speak up because there's an issue, right?
They're having a flare right nowor they don't understand why
this pain or all of a sudden like diarrhea, there's something
that's happening. And my observation is that a lot
of times people fear that, Oh myGod, this, what I'm experiencing
now is always going to be this way.

(11:05):
Like they they're stuck in this moment, right?
And so. One of the things I'm always
trying to remind people is that your guts not a static place,
right? And your reaction to Fodmaps
aren't static and the FODMAP content in food is not static.
And so, well, that can be crazy making because then we feel like

(11:27):
everything's a moving target. I, I'd like to think about it as
well, but it means there's possibility for, in change,
there's possibility for improvement, right?
So when it comes to the microbiome, if, OK, if we're on
the elimination phase of the lowFODMAP diet, and hopefully
everybody here understands that the low FODMAP diet is a three

(11:51):
phase diet. So the whole diet is 3 phases,
right? So when people say you shouldn't
be on the low FODMAP diet for very long, they're just talking
about that first phase. You're just talking about the
elimination phase. And so in the late elimination
phase, we have a very restricteddiet.
And so, you know, the point is to restrict Fodmaps, right?

(12:11):
So we can calm our system. And if we are reactive to
Fodmaps, our system will be calmed.
But dietitians, you know, all ofyou have educated us to
understand that the reason why the elimination phase is not for
long term is because of that restriction.
We're not as as positively feeding our microbiome as we

(12:36):
could be because we want to eat broadly, right.
We want to bring diversity of those microbio, of those
bacteria into our microbiome andthat's going to be best
addressed by a broad diet. And so my segue here, my
connection to the topic today isthat we hear all the time from

(12:58):
people who have started the low FODMAP diet.
It's been really successful for them.
They're going through elimination.
They've eliminated all these triggers.
They're not having their explosive diarrhea, They're not
having their extreme Constipation, they're not having
their extreme visceral hypersensitivity.
And they're like, you know what,I'm going to stay right here.

(13:20):
I, I'm, I'm too afraid and I hear that word all the time.
I'm too afraid. I'm too anxious of starting any
kind of reintroduction or challenge because I don't know
what's going to happen. I don't want to trigger anything
again. So can you talk about that, like
that intersection of anxiety andmoving through the diet into the
challenge phase and why it's really important that people

(13:43):
move through that? Yeah, really good, really good
point. So when it comes to the low
FODMAP diet and as we mentioned it's a three phase diet, what
it's really meant to do is help you to 1 like help better
control and manage the symptoms of IBS and then also understand
like specific tolerance levels for different carbohydrate

(14:04):
intolerances or those Fodmaps. What it doesn't really get to
is, as I mentioned, at the heartof IBS is that sort of dysbiosis
or potentially lower resilience or imbalance in the gut
microbiome. So I always tell my clients, I'm
always talking about this, But if we really want to help to
manage IBS and help even improveour tolerance to foods and

(14:27):
really help find like more lasting relief for lasting
freedom is we also need to pay attention to the health of our
gut microbiome. So that's where the issue lies
of just following the low FODMAPdiet.
And I've seen many people who have been following it even for
5-10 years, the elimination phase on such a restricted even

(14:48):
amount of food. So they may be following low
FODMAP, but it's really only like 10 foods that are low
FODMAP or that sort of like really small safe list, eating
the same thing day-to-day. So for a while that can help to
control symptoms. But we know that when your diet
is, as you mentioned, there's restricted diversity, especially
in what's called like microbiotaaccessible carbohydrates or like

(15:09):
the food that our our gut bacteria feed on is that we can
continue to sort of lose the diversity of the different types
of microbes in species in our gut microbiome over time.
So we can actually make that dysbiosis worse by eating a
restricted diet for too long or or extending it for too long.
So going back to the low FODMAP,even how we do it.

(15:31):
So when we're following that elimination phase, I'm sure you
see this too, but a lot of people will even just follow
like their own very restricted version of it.
So even only eating like FODMAP free foods, they may not even go
to the foods that actually have yellow or red servings and only
eat the green. So it's a very, very small,
small, narrow list of foods. And then some things they will

(15:52):
just continue to stay on that for too long.
So even thinking about it from that approach, there's lots of
diversity that we can add when we're following the elimination
phase, like just trying to get as many different plant foods as
you can within the low FODMAP realm.
And then of course, moving towards the reintroduction
phase, where then we can strategically challenge back in
the different FODMAP groups, assess what our tolerance levels

(16:14):
are. It's good to know too.
Like there's a strategic way to do it.
We don't just like kind of randomly, you know, add a clove
of garlic one day and then a piece of onion the next.
So that's also why it's important to work with
dietitian. But then we can sort of assess
like, you know, what is my tolerance level to fructins,
Maybe I can tolerate a yellow serving, you know, assessing

(16:35):
sort of that tolerance level. So sort of a tall maybe then you
need to stick within the grid. So then we can move on to the
third phase, which is the personalization phase where
there are some, you know, FODMAPgroups that we can be more
liberal with and then maybe others that we need to be more
mindful with and essentially be able to further extend like the
diversity of our diet and get back in more of those Fodmaps,

(16:57):
which are essentially most of them are prebiotics anyways.
So they help to feed the the gutmicrobiome and act as fuel
source for the microbiome. So yeah, so that's unpack there.
I see the same trend in a lot oflike new clients as well, just
that anxiety to add more diversity of foods as well as to
like challenge bottom UPS. But my overarching message here

(17:19):
is that it actually in the long term will do you more harm than
it will do good. So we need to really think about
the microbiome. You know, I'm glad that you
mentioned working with a dietitian because I think this
is a good moment just to talk about that.
Yeah. I, you know, before I've been
working full time on pod map every day for eight years going

(17:41):
on. Oh my goodness, it's gonna be 9
years. Oh, at this point I know.
Happy birthday to us. So for.
Those of you who don't know my stories, so I have IBS.
I've been living with IBS for 25years.
I had a real health crisis to discover the diet and it
completely changed and saved my life.
And I I was a professional recipe developer and I took a

(18:04):
right hand turn and, and starteddeveloping food for people like
me who have IBS and who are following the diet.
And when I started all of this, I was not aware really of what a
registered dietitian was. I envisioned a dietitian in a
hospital helping people with, you know, tube feeding or

(18:25):
whatever. And of course, there are
dietitians who specialize in that.
But what it's really important for everyone here to understand
is that while we always suggest that you get an accurate
diagnosis and it's it's really great to get to be able to get
one from a Doctor Who specializes in the gut, like a
gastroenterologist. The gastroenterologist's job is

(18:48):
not to hold your hand on a day-to-day basis and help you
figure out, OK, so let's say whatever, you're a mom, you're
the only one that has IBS. You have a certain budget.
You've got three kids, One of them also has IBS with you.
The others don't you, you know, you cook three times a week, but
you like to eat out. You know, each of us has our own

(19:10):
picture, right? And the GI is not going to sit
down with you and talk to you about those needs that you have
that are specific to your personal and home picture.
And this is exactly what the registered dietitians do, in
addition to helping you maintainor maybe attain for the first

(19:34):
time, a positive relationship with food.
And for any of you who are wondering if it's worth working
with a dietitian or whether you really need to work with a
registered dietitian, I'm telling you that, you know,
we're talking about anxiety today.
The dietitian is going to hold your hand and help figure out a

(19:56):
tailored program that's gonna work for you, which is gonna be
different than what I would get you need, different than your
cousin who also has IBS would need.
This is a highly IBS is highly individual.
The approach to the low fodvap diet is highly individual and

(20:17):
it's the dietitian that's going to help you do that and is it's
going to go a long way to assuaging those those anxious
fears that you might have. So you know, I always say
dietitians are the rock stars. If you're not working with a
registered dietitian, we have a list.
We can help you find one. So, OK, so let's go back to the

(20:39):
article for a moment because this is all based on an article,
folks. If you don't know already, Lee
has written an article for us called Understanding the Overlap
Between IBS and Anxiety. And so you can always use that
article as a touchstone to the information we're talking about
here today. And we will have this video
recorded and it will be accessible in several places,

(21:02):
including within the article when all is said and done.
So we talked about how anxiety can impact the microbiome.
So let's talk about, you know, gut inflammation and dysbiosis.
And I think this is really, thisis a complicated topic for me

(21:23):
because a lot of times dietitians and doctors talk
about IBS as not having any structural effect.
On. On our digestive tract, but here
we do have this inflammation aspect.

(21:44):
So could you talk about that a little bit?
Yeah. So the, yeah, the inflammation
pieces is interesting. So essentially we have seen in
more recent research as well that those with IBS tend to have
for this more like chronic low grade inflammation in the
intestinal tract. And it typically is related to

(22:08):
that dysbiosis. Because we know when we have
potentially less of beneficial species of bacteria,
specifically like Bifidobacterium, which help to
maintain like a healthy lining of the intestinal tract, then we
can get some sort of like weakening or degradation in the
layer of the intestinal, like epithelium or that sort of like
protective barrier. So the information that's

(22:31):
present in IBS, like it doesn't tend to show up sort of on
standard testing. Like we often can't even see it
in like a colonoscopy or scope or in like standard blood work.
But yeah, that's something that we're sort of learning a little
bit more about. And again, we don't have like
the best way to to test for it, but essentially in our
intestinal lining, there's sort of like a few protective

(22:54):
mechanisms that we have to kind of prevent like what essentially
things that are moving through our intestinal tract like food
and waste to prevent them from getting into like the
bloodstream. So one of them is like our mucus
layer sort of plays a protectivebarrier.
And then also between like the cells of our intestinal tract,
we have these things called likecell junctions or tight

(23:16):
junctions. So we see that when there's sort
of like a decrease in certain types of beneficial species of
bacteria and then potentially like an increase in certain
types of more pathogenic, there can actually be sort of
weakening of the mucosal layer and sort of like openings
between those tight junctions. And what this can lead to is
even like byproducts of some of those like pathogenic bacteria,

(23:39):
we call them sort of more inflammatory byproducts or even
different chemicals from the food that we eat can actually
start to pass through that barrier and make its way into
the bloodstream where it shouldn't necessarily be.
So sometimes we can sort of evensee like extra intestinals,
effects of inflammation, things like migraines, headaches, joint

(23:59):
pain, things like skin issues, acne, eczema that may flare up
even when digestive symptoms flare up as well.
So I know there's a lot of people that tend to see both
like, you know, may get the digestive issues, but also we'll
see sort of other signs of inflammation in the body as
well. So it's an interesting, yeah,

(24:20):
interesting connection. We're learning more about it,
but sort of how I would explain like the inflammation piece and
how it relates to that dysbiosis.
So we're, you know, we're talking about how to, you know,
why anxiety exists, how they overlap with IBS, how to improve
our guts. So maybe we can improve our

(24:41):
mental state as well. You mentioned, you mentioned
healthful bacteria. So let's talk about probiotics
for a moment. So it comes up a lot people want
to they read about probiotics, they read about how wonderful
they are. They want to take them.
They come into the groups, they say, is this a good product?
Or they say, you know, what should I take?

(25:03):
And I think it's really important to to point out that
if you're following the low FODMAP diet, the elimination
phase and the challenge phase are diagnostic phases, right?
We're moving through these two phases to help us individually
learn our tolerances and intolerances to Fodmaps.

(25:25):
And Monash researchers who developed the diet specifically
tell us not to take probiotics during these phases because they
can alter our digestion of Fodmaps.
And that's exactly what you're trying to assess at that time.
So if you take probiotics duringthese early phases, you're going

(25:48):
to be skewing the data that you're, you're trying to gather
on yourself. And I think this is a, a perfect
example of where AGI might say to you, you know, well, why
don't you take, you know, why don't you try some probiotics?
Because they're not a dietitian and they're not trained in the
diet and they don't understand that actually we don't want you

(26:09):
taking probiotics during the first two phases of the diet.
But let's say you're or you know, let's say you're post
challenge and now you're at thispoint where you're really trying
to build as healthy a microbiomeas possible.
You know what is someone's best approach in terms of food and or
supplements? Yeah.

(26:31):
So I think we, we also tend to always focus on like, what is it
that we're eating that's causingthe issue?
But then also maybe not want to work on expanding our diet, but
focus more on supplements. So I think we always want to
know like, what can I take in terms of supplements to help me
feel better rather than what canI add to my diet?
So I will say to like the probiotic fact.

(26:53):
That's yeah, probiotic supplements, I would say they
are very commonly, I guess like talked about online, there's a
lot of like influencers that promote them.
Even doctors who don't know likea lot about IBS may just kind of
throw them out and tell you to take one.
But say with probiotics, like itreally has to be a very specific

(27:14):
strain for the right person at the right time.
So I myself like working in GI health and working with IBS
clients. Like I actually don't tend to
recommend them very often. I don't find they typically have
like, yeah, the the best use fora lot of my patients.
That said, there are like specific strains that could

(27:34):
potentially be used for IBSD forConstipation, but it, it really
just depends. But my focus is really like,
let's work on actually looking at your food, your diet, getting
in more sources of those microbiotic accessible carbs so
that we can like feed your gut bacteria and the good ones like
Bifidobacterium with actual foodrather than just relying on a

(27:57):
supplement. Right.
And, and for those who are, who are here today, it, it might
surprise you that Lee is this isthe same that we hear from the
rest of our success team in general, our registered
dietitians are not promoting probiotics, you know, they're
looking for. And like you said, there's a lot

(28:17):
of influence out there. There's a lot if, you know, all
of us here have gut issues. And so if you're on Facebook,
you're getting slammed with ads every single.
Day they're very. All kinds of tests and
supplements that are going to cure everything.
And unfortunately that's not thecase.
So right now this is this is a great segue into so you're

(28:39):
saying we're we're going to lookat the diet, we're going to look
at the actual food to help buildthe best microbiome as possible,
which is going to affect our mood and that sense of anxiety.
So we're we're starting from sort of the ground up, but it is
two way, as we said, though, just as you like to look at
whole food, which is, you know, a more holistic way to approach

(29:02):
things as opposed to a supplement.
Let's talk about non food triggers, right?
Because there's so much like yousaid, people when people have a
flare up, they immediately think, Oh my God, what did they
eat? They go to the food or when
they're anxious, they're often anxious about the food.

(29:27):
Like, you know, my friends are going out for pizza.
What am I gonna do? And they, they don't realize
that the emotions, the anxiety that you're bringing to that
might even have a greater effecton you eating that pizza then
eating the pizza. So you know, the, the, the non
food triggers like sleep hormones, stress, the anxiety

(29:54):
is, is huge. So could you talk a little bit
about that, about all the non food triggers, how that like how
that is part of anxiety and how it can really affect our
digestion? Yeah, yeah.
So it's always good to highlightthat there's a lot more to your
gut health than just the food that you eat.

(30:14):
So even the, I know it's still related to like food, but even
like the timing of meals and thinking about spacing your
meals and supporting stable blood sugars can be a really
good place to look. So I actually worked in earlier
on in my career as a dietitian, I worked in like an inpatient
treatment clinic for clients coming off substances.

(30:37):
So it was a substance recovery clinic.
And in the nutrition lesson thatwe used to teach like new
patients, we'd always talk aboutthe importance of like blood
sugar management. And if any of you've heard of
like the hunger scale, thinking about where we are from fullness
to hunger. So when it comes to like
supporting staple blood sugars, that can play a role in terms of

(31:01):
like your digestion, because we know that if potentially blood
sugar levels drop like too low and then spike up, that can
actually cause changes in insulin, which can cause changes
in like motility and movement ofour gut.
But also when we get sort of blood sugar fluctuations, if
blood sugar drops too low or we go really hungry for a long

(31:21):
period of time, that also is a big trigger for like anxiety.
So that and then that anxiety can also trigger GI symptoms as
well. And then it may also cause us to
maybe eat things that are not asmaybe supportive of like
managing our IBS symptoms or supportive of our gut health and
may turn to maybe more quick convenience foods, maybe things

(31:43):
that are lower in things that help support our gut microbiome.
So even just like thinking aboutthe how we're eating and trying
to eat a little bit more regularspace meals, not letting
ourselves get like go too long between meals and sort of
supporting more stable blood sugars can be really supportive
of both mood but also digestion.Yeah, I love that you mentioned

(32:03):
that. The thing about, you know, that
if you're not prepared, you might end up reaching for
something that that really isn'tthe best food for you.
I think that a lot of people, they get very anxious when they
know they're going to be eating out.
You know, if we, when we're home, it's easier to control

(32:24):
what we're consuming. And when we go out into the
world, whether it's for a big holiday event or you're going to
someone's house for a meal, or you're going out to a restaurant
or you're going out to, you know, a cocktail party where
there's gonna be a huge buffet or, you know, whatever it is, it
can be anxiety producing becauseyou don't know what, whether

(32:45):
there's going to be anything that you can eat.
And if you get hungry, you mightstart reaching for the things
that that are not going to be beneficial for you.
So I think planning is huge. Like I, I always try to have a
snack in my handbag. You know, I, I'm, I have certain
bars that work for me. We have a great article on how

(33:08):
to choose energy bars. You know, different bars work
for different people. Some people tolerate pea
protein, some don't. Some tolerate oats, some don't.
You know, these aren't FODMAP issues, but they're IBS issues.
But once you find something thatworks for you, having something
always at hand so that you're not grabbing something from the

(33:28):
buffet that you that might tip you over the the FODMAP scale
or, you know, go to the vending machine.
So planning for me at least is agood anxiety, you know, eases
can ease the anxiety planning, planning so that I know I'm
never without. We've also been talking a lot
recently. We're doing this great project

(33:52):
with Fodzeim for those who don'tknow Fodzeim.
So it's a digestive blend that can help you digest certain
Fodmaps and you know, having they have little packets that
are perfect. You can tuck one in your jeans,
you can have one in your, your handbag, whatever.
And so if you're, if you're faced with a restaurant meal or

(34:15):
something like that where you'reout and about, you could rely on
a digestive enzyme to help you threw in a pinch, but you know,
not something that you're going to necessarily use, you know,
all the time. So talking about different ways
to approach this, there is a section in the article on gut

(34:36):
directed hypnotherapy that I thought we should talk about.
NERVA is another company that wework with and who we absolutely
love. You know, the first time it was
actually the first year. So it was nine years ago when we
started FODMAP everyday and our very first dietitian, Erica
Ilton, who started working with us, brought gut directed

(34:57):
hypnotherapy to our attention. And neither Robin nor I had
heard about this. And for those who have never,
you know, maybe when you hear the word hypnotherapy, you think
it's, you know, some tricky stage kind of thing.

(35:17):
It isn't real. People are being, you know, put
under and you know, to bark likea dog.
I mean, people have all kinds ofideas of what they think
hypnotherapy is, but there it hypnosis is.
But there is something called gut directed hypnotherapy, which
is clinically proven. And so this is an evidence based
approach to calming your cyst symptoms and it works

(35:42):
fantastically for anxiousness. So could you talk a little bit
about about that? Yeah, that directed
hypnotherapy. So sort of like, I'll be honest,
I, I think I tried a couple versions of the NERVA, but I'd
like to test out doing like the full trial myself to learn a bit

(36:02):
more about it. But essentially it involves like
discussion and education on the digestive system while also
being put into like a hypno hypnotic state.
Sorry, that's what I'm looking for in order to help like
regularize or normalize digestive functioning.
So there are actual practitioners who are trained

(36:24):
and got directed hypnotherapy and you could work with one,
like one-on-one. Otherwise a lot of like the
readers, listeners will be familiar with NERVA which is
essentially like a 12 week or their first program is like a 12
week program where you do daily sessions that are based around
gut directed hypnotherapy. So the idea is that it's sort of

(36:45):
helped to meant meant to like improve that connection between
the gut and the brain and without even like adjusting your
diet or thinking about elimination diet meant to help
improve IBS symptoms like visceral hypersensitivity,
urgency, pain, gas, etcetera. So it's quite interesting.
Like we said, there is good support for it.

(37:07):
I found that it works best, I think for clients who have a
history of disordered eating or eating disorders where we, you
know, we don't want to further restrict their diet because it
will cause more anxiety around food, which then could make
their symptoms worse. And really sort of moving away
from looking at food as the, theissue or the enemy and really

(37:28):
helping to support like that gutbrain connection and, and
reducing that anxiety and that fear around eating times and,
and food options and all that. So that's that's been quite
helpful for for a few of my patients for.
Sure, I, I did the entire, I, I did it and I found it immensely
helpful. And, and just to let all you
know, I'm very type A. I'm not someone that could ever

(37:49):
like sit and meditate. I was, I was anxious about doing
it because I didn't know how I was going to sit still for 15 or
20 minutes. But I got to tell you, I loved
it. It was, so it's basically a
guided meditation you're listening to every day is a
different little program and you're listening to this guided
meditation and there's imagery and it's incredibly calming and

(38:13):
it is clinically proven to be aseffective as the low FODMAP
diet, which is amazing when you think about that.
Now we're going to, I'm going tointegrate one of the questions
that came in because it's a perfect segue to what we were
just talking about. This person asks, can you please

(38:33):
comment on IBS and the current trend of intermittent fasting
where people can become anxious about their food management and
how that can impact the gut? OK, I need to read that question
over just together comment on the.

(38:55):
It's at 12:34. Can you please comment on IBS
and current trending of intermittent fasting?
Because this the segue for me iseither you mentioned most of us
have heard about eating disorders, right?
So most of us have heard about something, you know, bulimia or
anorexia nervosa, that sort of thing, but not necessarily they

(39:18):
haven't necessarily heard the term disordered eating.
And I know last year the great majority of continuing education
webinars that I attended touchedon disordered eating.
And for those of you who are wondering, I mean, this is
disordered and a disordered eating pattern can be any kind

(39:40):
of pattern where you are fearful.
So you're fearful of starting the the challenge phase, you're
fearful of going out to dinner, you're fearful of trying a bite
of an apple for the first time after you haven't had it for a
year. All those things might seem
incidental to you, but they're actually a disordered eating

(40:02):
pattern that can then become a greater disordered eating
pattern. So intermittent fasting, so this
person, I think what they're trying to get us.
So intermittent fasting you're having structured time frames
where it's like you're not supposed to eat and then you're
supposed to eat, You're not supposed to eat and you're
supposed to eat. So that's, it's this highly
structured approach to food. But how does that affect the

(40:26):
gut? And also, can that feed into
anxiety around food? Yeah, Yeah, that's a that's a
good question. So I think so to explain the
intermittent fasting, essentially it's sort of
structured fasting periods or times when you go off of eating
anything with calories you may consume like some water or an
herbal tea during that time. There's different types, people

(40:48):
do like 2448 hour fasts once a week or once a month, but the
most common is sort of that 16/8intermittent fasting where you
will fast for 16 hours a day andthen you will eat within an 8
hour window. So when it comes to IBS, like
there are definitely a few issues with this approach, one

(41:10):
of them being even just the impact on blood sugar levels.
So a lot of people maybe if they're delaying eating too long
in the day, that can sort of cause like dips, crashes and
then spikes in blood sugar levels, which can actually make
IBS and gut symptoms worse. But even for people who maybe
have, you know, need to eat enough calories to field their
body during the day, it may be packing in quite a lot of volume

(41:33):
of foods within like a very short eating window.
And you may even know that like changes in portion sizes can
trigger visceral hypersensitivity issues.
So for a lot of people, this canbe a concern.
And then even just the impact ofpotentially like under eating or
not consuming enough calories orenough nutrients, because maybe
you're restricting your eating window through a very short

(41:56):
period during the day, that can also impact like the functioning
of your gut. If it's not getting enough of
nutrients that you need or slowing down your metabolism,
that can lead to things like changes in motility and, and,
you know, worsening of IBS symptoms.
So as a whole, I have a lot of issues, I guess, with doing
intermittent fasting and it would not suggest it for IBS.

(42:18):
And then I think too, when we get into maybe focusing on quite
quite restrictive or maybe hard to sustain sort of like, you
know, eating patterns or even call it like trends, you know,
that can lead to sort of maybe more, more anxiety and, and even
contribute to like that disordered eating approach long
term. So there's a lot, yeah, a lot to

(42:39):
impact there. I do want to say though, like my
approach as a dietitian, I do believe in sort of that idea of
like Chrono nutrition. We also have an article on that
as well, like thinking about supporting your circadian
rhythms 'cause they play a role in your digestive rhythms.
And even trying to eat within similar times during the day,
eating more during the daytime. Like having maybe a somewhat of

(43:01):
a fasting window like we'll do like 12 hour fast, but that's a
little bit like or I'd say for most people much easier to
sustain and we know it can help versus the intermittent fasting.
I think for most people with IBSwill cause more issues than than
good. We have, we have the article on
Chrono nutrition, which is timing you're eating.
And we also do have an article on intermittent fasting on the

(43:22):
website. And most of the dietitians that
we work with feel the same way, Lee, that they do not support
intermittent fasting for those with IBS for the, you know, the
reasons that you've mentioned. And also just as a general
comment, I mean, Monash, when, when you're particularly when
you're starting the low FODMAP diet, it's, it's going to be a

(43:45):
change, you know, it's going to be a big change for people.
And so it's recommended that younot overlay any other
restrictive type of diet. And so, you know, if you're a
diabetic and you have to follow a, a dietary protocol for that,
of course you're going to continue to do that.
And you're hopefully work with adietitian so they can help you

(44:08):
both at the same time. But it's, it's strongly
suggested that you do not voluntarily start any other kind
of like system, restrictive system as as at the same time,
because it's too much. And frankly, it's it's going to
make, it's going to make pure anxiety worse.
I mean, troubling more. So now we had another question

(44:30):
that came in and this is interesting.
So according to anthropological research, our species consume
mostly meat until the agricultural revolution.
If this is true, then how would restricting one specific
carbohydrate intake cause dysbiosis if we never consumed

(44:51):
much to begin with? I think there is a confusion
here because OK, so the questionsays how would restricting one
specific carbohydrate intake 'cause dysbiosis?
Well, I mean, I don't know why don't, why don't you?
You want to feel that? Yeah, there's a lot, OK.

(45:13):
There's a lot to tease out there.
I mean, we do know that their ancestors, they did consume
different plant species, like they were on nivorous, so they
didn't just consume meat. So we'll comment on that.
But yeah, I think, yeah, there'sbeen more, more research just on
different dietary patterns and how they influence the gut

(45:34):
microbiome. So there was a really good
review that looked at compare different diets, the standards
Western diet, which we know is quite high in meat products and
low in fiber and prebiotic foodscompared with low FODMAP,
compared with the Mediterranean diet which emphasizes things
like legumes, fruits, vegetablesand whole grains.

(45:57):
And the Mediterranean diet pattern was really given like
the A+ out of all the diets and was shown to have sort of with
the people who followed it. They had the highest sort of
diversity in their gut microbiome and highest
population of sort of beneficialspecies.
So that's one to reference. There was also a really large
population based study done. It was maybe two or three years

(46:20):
ago looking at sort of the diversity of plant foods across
like the the participants that they looked at and those who ate
at least 30 or more different plant foods in their diet per
week had a much higher microbiome diversity than those
who ate less than 30. So those are sort of the two

(46:43):
key, key studies that we researched from when it comes to
like talking about the importance of plant diversity
and the health of our gut microbiome.
So. And it is, you know, it's, it's,
I think, well, diversity is key,right?
So that's the thing. We have another question here.
And this is interesting. I looked up this thing that they

(47:05):
mentioned Gamma dynacare, which apparently is a Canadian thing.
So maybe you know about this. So the question is could you
comment on food intolerance testing and they specifically
mentioned something called GammaDynacare, which I guess is out
of Ontario. Could you please comment on food
intolerance testing in relationship to IBS and the low

(47:25):
FODMAP diet? Is this testing relevant and is
it evidence based? You know, in general, you know,
none of our dietitians recommendany of the home tests.
If this is a home based test then.
You know what it's, it's actually one that you can go in
and do in a lab. Your doctor has a right
requisition for it. So either MD or MD.

(47:49):
So it's a, it's a, I'm just reading it now.
So it is one of the IgG food intolerance blood test.
So I feel like 20% of my week islike telling people not.
To do this IGA right, Right. So the issue with these tests is
that they really are not clinically significant when it
comes to like assessing food intolerances.

(48:11):
So they claim to help you understand what your food
sensitivities are, but sort of the main issue with these tests
is that they result in a high number of false positives.
So they may identify some foods that you're sensitive to, but
they will also flag a lot of foods that you actually aren't
sensitive to, but it will tell you that they're sensitivity.
So a major issue with these tests is that people will go and

(48:33):
do them. They spend a lot of money on
them. They're like $300.00 Canadian.
Get this whole list of foods that they can't eat and then
they'll go proceed to maybe cut out the foods for a few weeks
and then they really won't feel any better.
And when it comes to like the point of anxiety and disorder
eating and IBS, what I see is that a lot of people will then
become really fearful of adding those foods back in, even though

(48:56):
we know that they may not actually be issues for them.
So I have I had a client as wellwho was following both the low
fib map diet and then she was also following results from her
food sensitivity blood test for the last year and her anxiety
around food was just like through the charts.
This is so great. You know, this is a great way to

(49:19):
bring it back to the main focus of anxiety.
It's we see this all the time. People come into our groups and
they've done one of these home based tests and the list is this
long telling them they're like, Oh my God, now I don't know what
to do. I can't many different things
and their anxieties going through the roof.
And like you said, it's not necessarily even true.

(49:39):
And over restriction is we see so much over restriction of food
that doesn't need to be happening, right.
And that it's, it's again, it's,you know, the low FODMAP diet is
a clinically based diet. It's a medically based diet.

(50:00):
This is what differentiates it from a fad like, you know, whole
30 or paleo or the way the keto diet has been popularized, for
instance. And you know, we, a lot of
people will come to us. They're like, well, I, I fast
intermittently and you know, I feel great what we do at FODMAP
every day. And one of the reasons we love

(50:21):
working with you is that we we're bringing you information
that's evidence based. All of you are individuals.
You can, you're in charge of your medical health, you can do
whatever you like and you know, you're home.
But we're trying to help you understand what has been shown
to work or shown not to work because at least if you start

(50:45):
with evidence based information,you just have a stronger
foundation of where to begin Your, you know, your IBS and
your anxiety and your, you know,low FODMAP process.
If you're just cherry picking and like, oh, I'm going to do a
home based test and oh, I've heard about fasting and now I'm
going to try this and I'm going to try to overlay, I need to

(51:07):
lose weight. So I'm going to do keto and low
FODMAP at the same time. Like it's, it's, it's not going
to work and it's going to drive you even more crazy.
For sure. And things can get worse, yeah.
Maria wants to know if you couldtalk a little more about the
vagus nerve and the connection with the brain in the gut.
Yeah. So I guess, I guess we missed

(51:27):
touching on the impact of actualstress on our digestive system.
So I will say with yeah, as we mentioned, stress and anxiety
are not quite the same. Well, I think a lot of people
with IBS 2 are told to just likestress less by the doctor.
I think that's common. Yeah, you need to stress less.

(51:51):
But the thing with stress is that there actually is like
stress can be positive. Like it can get us sort of like
increases like maybe our attention and it can get to help
us to like work towards something.
Like if we do have a work deadline, it kind of put us into
action. So there's a really good book on
stress by Kelly Mcgonigal. She's a psychologist and a
researcher. It's called The Upside of

(52:12):
Stress, where she talks about how sort of like how we can use
stress to our advantage and not like how stressing about stress,
like even in the case of IBS, like, oh, I'm stressed to be
stressed because it's going to make my IBS worse.
How that can actually just stress your body more.
So using stress to our advantage, But when we sort of
react when we react to stress ina way that it's like a fight or

(52:34):
flight response, that can sort of caused changes in our
digestion. So essentially when we have
something like a stressor, like there's I mentioned the Mountain
Lion on our hiking path or you know, we run into a rattlesnake
or something like that. What our body does is like helps
to protect us by sort of like getting our our resources ready

(52:54):
to, to fight back to fight or flight.
So in that instance, it's sort of down regulates our
parasympathetic nervous system or like slows it down.
So that's part of our nervous system that's responsible for
like everyday processes recovery, like production of
hormones, as well as like our digestive system, digestive

(53:15):
functions, and then sort of heightens that sympathetic
nervous system, which raises blood sugar and gets us ready to
fight the response. So essentially what I'm trying
to say here is that stress and sort of like slow down our
digestion and maybe then that's when we see sort of heightened
IBS symptoms in response to likea stressor that fight or flight
response. One of the major regulators of

(53:38):
our parasympathetic nervous system is the vagus nerve.
So the vagus nerve is actually like 2 nerves.
Nerves, we always talk about it as one, but it's sort of the
main connector between like our gut in our brain.
And it sort of facilitates like that two way, two way
connection, the gut brain access.
And we have seen that those withIBS as well as even IBD and GERD

(54:01):
have reduced vagal nerve tone, which may potentially even
impact like hunger and fullness cues.
It can worsen symptoms of mood and anxiety and even cause
changes in like our digestive functioning.
So when it comes to managing IBSas well like supporting the
health of our vagus nerve, there's not a ton of like actual

(54:24):
evidence based information on how we can support that.
But doing things like even just yoga or taking some time off
like to downtime after a stressful event, even the gut
directed hypnotherapy meditation, I really like EFT
tapping. All of those things are thought
to potentially help support likeour our vagal nerve tone, which

(54:44):
may help us to better managing IBS and support our digestion.
Well, you just figured out your next article that you will write
for us on the tapping no, it'd be great have.
You learned. A bit or yes, No, I have, I
have. I love it.
We have less than 10 minutes left and Jared has asked a few
questions that are interrelated.So we're going to end with that.

(55:07):
So, and this is good because this is all like super high
level anxiety stuff. So Jared says he has orthorexia
nervosa. He's down to maybe eating just
six foods. He knows this is not healthy for
his brain or his gut. He's underweight.

(55:28):
He he's caught. He's caught in this cycle of
being afraid to eat, but then eating and then feeling like he
gets a reaction. So he goes back to hyper
restriction. So, you know, he wants to know
if you can talk about the rabbithole of disordered eating and
worsening food intolerances and how to escape it.

(55:49):
I will quickly say, Jared, that if you want to get in touch with
us after the fact, I mean, the, the, the big answer is getting
you connected with the right registered dietitian and we will
help you with that. But so.
So what would you say to that, Lee?
Yeah. So as I had mentioned earlier,
like the more we restrict our diet just from like reducing

(56:10):
the, the, the food that our microbes have to eat.
But also I should have mentionedtoo, just even nutrient
deficiencies, not getting enoughcalories in our diet can
actually make our digestive symptoms worse.
So keeping that in mind. But yeah, I would say in this
this instance, or for anyone who's maybe struggling with
anxiety around food and how it impacts their IBS, one thing I

(56:33):
do recommend is maybe doing a social media detox.
So I think now a lot of the likefear that we get around food
maybe comes from a lot of the stuff that we see or we read
online. So even just being really
mindful of what we're consuming,maybe you need to filter what
you're seeing on your feed or even taking some time off of
Instagram and TikTok cuz there'sa lot of fear mongering

(56:54):
information on there. And then I would say probably in
your instance, I think it would be good to seek some
professional support. So definitely when it comes to
the psychological aspects, you know, working with, with a
therapist who maybe specializes in IBS and, or just for eating
would be really helpful in, in this situation.

(57:14):
And then definitely, as I'm, as Dave has mentioned, you know,
working with a specialized dietitian so that you're able
to, you know, add back more diversity into your diet and,
and improve your relationship with food.
I think we'll be really beneficial and we want to make
sure that we we do this maybe before things get worse, because
I think sometimes that this kindof comes over time when people

(57:36):
may be kind of caught in that, you know, whole of just just
trying to fix all these things themselves, reading things
online and and then things get worse and they become more
restrictive. I think it's sometimes better to
maybe reach out for support likeearlier rather than it it it
going on for too long right? Getting worse.
So we're going to tie up here. We're at the end.

(57:58):
And I think that, you know what I would say in closing, which
is, you know, connected to what you just said nine years ago
when I started educating about this diet, we used to talk about
approaching things strictly. And I got rid of that word from
my vocabulary almost two years ago now.

(58:20):
And what we like to say is structured.
And you know, I think that that's the great thing that
dietitians can bring. Like, so if you're on social
media, if you're, you know, likeyou said, you're seeing all
these things all the time, try this, try that.
And you're, you're bouncing around and this one's working a
little, This one's actually working against this, but you

(58:40):
don't realize it because, you know, you're not a health
professional, you're not a dietitian.
And, and, and things are anxietyproducing and going crazy.
But I think that what dietitianscan do is they can provide a
structured approach that's goingto be tailored to your
particular situation. And so it's not only going to
ease your mind because there's somebody taking control, giving

(59:03):
you direction that's going to bespecific to you and your needs.
But then physically you're goingto start feeling better.
You're going to be eating the the foods that are appropriate
for for your needs. You know, maybe medications
involved, maybe supplements involved, who knows, but this is
what the registered dietitian isgoing to do.
They're going to take a look at the whole picture and just

(59:26):
knowing that there's someone there that's going to help you
is going to take a huge load offyour mind.
You don't have to do this alone.I think that's, you know, a big
take away and and something thatwill really go to helping all of
us who get anxious around food and and have it trigger.

(59:49):
So, any parting words from you, Lee?
I think just the final thing we'll mention too is just when
it comes to like managing anxiety as well, it's important
to remember that our our brain is a major organ and it needs
good nutrition just like our body.
So getting enough of certain nutrients, magnesium, B

(01:00:10):
vitamins, vitamin C, etcetera, those all are going to impact
like the structure and the functioning of our brain as well
as the production and regulationof.
Neurotransmitters like serotonin, dopamine, all those
things that play a role in good mood.
So if you haven't, I encourage you to read the article 'cause
we talked more about nutrients that support your brain health.
So I just want to put that out there too, is that sometimes we

(01:00:32):
may need medication to help withanxiety symptoms as well.
But don't discount the the impact that that good nutrition
has on your brain function and your mood.
Excellent. Thank you so much.
Well, this will be recorded. We will put it up here, there
and everywhere in our social channels.
Hopefully all of you are signed up for our newsletter at Vodmap

(01:00:54):
everyday. If you're not, please come to
our homepage and sign up becauseyou will be the first then to be
alerted of upcoming webinars, articles like this videos when
they're they're ready to be pushed out there.
And thank you so much for your time everybody.
And we will work on doing that Visceral Hypersensitivity 1 as

(01:01:16):
well. Thank you everyone.
Have a great afternoon. That's a wrap for today's
episode. Thank you so much for listening
and being a part of our community here.

(01:01:37):
If the Gut Fit Nutrition podcastis giving you value, helped your
digestion and fitness, made you rethink how you approach your
gut health, consider leaving a review on Apple, Spotify, or
wherever you're getting your podcasts.
If you have questions for my listener Q&A episodes, you can
submit them as a comment on thisepisode or send me an e-mail at
lee@leemorado.com. For more digestible IBS gut

(01:02:00):
health and fitness tips, be sureto follow me on Instagram at Lee
Morado under score Rd. and to apply for coaching, shop the
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We'll be in touch soon.

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