June 4, 2024 • 45 mins
Bloating can range from mildly annoying to downright painful, can happen for a multitude of reasons and you've likely experienced it! Expert and world-renowned gastroenterologist, Dr. Brian Lacy from Mayo Clinic Jacksonville joins Kate and Dr. Riehl to explore the science behind bloating and abdominal distention. Dr. Lacy breaks down the details of when extraintestinal gas may not be your bloating culprit and how stress and diet can mess with your gut.
Join us as we explore the brain-gut connection and uncover how our mental state can influence digestive symptoms. Discover how stress can turn a sensitive gut into a full-blown uproar of discomfort. By highlighting that these symptoms are not "all in your head," Dr. Lacy helps us navigate the intersection of emotional well-being and physical health. He also emphasizes the importance of diet to manage bloating and why sometimes, eating the healthiest foods can bloat the belly.
Finally, we focus on the often-neglected discussion connecting constipation and bloating. It's time to get acquainted with our pelvic floor muscles and learn why sometimes the best remedy is not another pill but a new understanding of our body's inner workings. Dr. Lacy sheds light on the relief pelvic floor physical therapy can offer and shares actionable tips — from diaphragmatic breathing to abdominal massages — that might just offer the release you've been seeking. So, if you're ready to banish bloating and calm your gut for good, this is an episode not to be missed.
This episode is sponsored by Ardelyx
References to check out:
- Lacy, Brian E. PhD, MD, FACG1; Cangemi, David J. MD1. A Pragmatic Approach to the Evaluation and Treatment of Abdominal Bloating. The American Journal of Gastroenterology 117(5):p 701-705, May 2022. | DOI: 10.14309/ajg.0000000000001665
- Lacy BE, Cangemi D, Vazquez-Roque M. Management of Chronic Abdominal Distension and Bloating. Clin Gastroenterol Hepatol. 2021;19(2):219-231.e1. doi:10.1016/j.cgh.2020.03.056
- Moshiree B, Drossman D, Shaukat A. AGA Clinical Practice Update on Evaluation and Management of Belching, Abdominal Bloating, and Distention: Expert Review. Gastroenterology. 2023;165(3):791-800.e3. doi:10.1053/j.gastro.2023.04.039
Learn more about Kate and Dr. Riehl:
Website: www.katescarlata.com and www.drriehl.com
Instagram: @katescarlata @drriehl and @theguthealthpodcast
Order Kate and Dr. Riehl's book, Mind Your Gut: The Science-Based, Whole-body Guide to Living Well with IBS.
The information included in this podcast is not a substitute for professional medical advice, examination, diagnosis or treatment. Always seek the advice of your physician or other qualified health care provider before starting any new treatment or making changes to existing treatment.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Kate Scarlata (00:00):
This podcast has been sponsored by Ardelyx.
Maintaining a healthy gut iskey for overall physical and
mental well-being.
Whether you're ahealth-conscious advocate, an
individual navigating thecomplexities of living with GI
issues, or a healthcare provider, you are in the right place.
(00:22):
The Gut Health Podcast willempower you with a fascinating
scientific connection betweenyour brain, food and the gut.
Come join us.
We welcome you.
Dr. Megan Riehl (00:37):
Hello friends, and welcome to the Gut Health
Podcast, where we talk about allthings related to your gut and
well-being.
We are your hosts.
I'm Dr Megan Riehl, a GIpsychologist.
Kate Scarlata (00:49):
And hello, I'm Kate Scarlata.
We have an exciting podcast foryou.
Today.
We're talking all aboutbloating.
We'll get into the complexitiesof this troublesome symptom
that every one of us deals withfrom time to time.
We'll learn about what causesbloating and how to treat it.
Today's guest is world-renownedgastroenterologist, Dr Brian
(01:12):
Lacy from Mayo ClinicJacksonville, Florida.
Dr Lacy focuses his research inclinical interests in disorders
of gastrointestinal motility.
His scientific articles onbloating are my personal go-tos,
especially for clinical tipswith my patients.
He is the author of nearly 200peer-reviewed articles on GI
(01:32):
motility disorders.
As well, he is the pastco-editor-in-chief of the
American Journal ofGastroenterology.
Welcome, Dr Lacy.
Dr. Brian Lacy (01:42):
Well, thank you so much for being here.
I'm just as excited as you guys.
This is great.
Dr. Megan Riehl (01:47):
Yes.
So as we kick off today'spodcast, we want to start with
some myth-busting.
So what is a commonmisconception about gut health
that you would like to dispelwith our audience?
Dr. Brian Lacy (01:58):
I think that's a great question.
I think there are a lot ofmyths and misconceptions about
gas and bloating, but one of theones I hear most commonly from
my patients is that they firmlybelieve that they produce much
more intestinal gas than anybodyelse and that's the root cause
of all their symptoms of gas andbloating.
But that's really amisconception.
Dr. Megan Riehl (02:20):
All right, so we're going to get into the
details here.
So let's dive in.
What is bloating and how doesit differ from abdominal
distension?
Tell us a little bit more aboutthis.
Dr. Brian Lacy (02:30):
Yeah, and I think that's a really important
point for all of your listenersbecause it makes us think about
the symptoms differently and itmakes us think about the
underlying pathophysiologydifferently and therefore likely
thinking about the treatmentdifferently.
So bloating, which isincredibly common, as you've
(02:51):
already mentioned, is a sense ofbeing gassy.
It's that sense of gas on theinside, bloating, and it's very
prevalent and we talk about, youknow, 14% of adult Americans
having symptoms of bloatingwithin the last week.
Distention is the physicalmanifestation and patients may
(03:13):
come in saying I look threemonths pregnant, I look six or
nine months pregnant.
When they're not, I look likeI've got a basketball in my
belly.
Frequently they overlap andpeople may have symptoms of gas
and bloating, but they may alsothen describe periods of
significant distension.
Pathophysiologically they mayexist on a bit of a spectrum,
(03:35):
but to some degreepathophysiologically they may
also be a little bit different.
So it's good to kind of teasethat out with your patients.
Dr. Megan Riehl (03:44):
So you're saying you know this is a pretty
common symptom in the generalpopulation and how common in IBS
or in SIBO small intestinalbacterial overgrowth- yeah,
great question.
Dr. Brian Lacy (03:59):
So there's a recent nice study from
Cedars-Sinai published about ayear ago.
There's a recent nice studyfrom Cedars-Sinai, published
about a year ago, surveyingnearly 90,000 patients across
the United States.
Thought to kind of capture thegeneral US population and in
that sample size one of thequestions they asked about was
gas and bloating and one inseven 14% said within the last
(04:19):
week they had symptoms of gasand bloating.
And, as you mentioned, this isvery prevalent in people with
IBS symptoms, whether IBS andconstipation or IBS and diarrhea
or those who go back and forth,and some studies have shown
that 60 to 70% of patients withIBS have overlapping symptoms of
(04:42):
gas and bloating.
It's not part of the formaldefinition but it's so common.
I always ask about it and Ithink most healthcare providers
and psychologists and dieticiansask about it as well.
SIBO (small intestinal bacterialovergrowth) is interesting.
The definition is that you havetoo many bacteria in your small
(05:02):
intestine where they don'treally belong.
We have a lot of bacteria inthe colon.
As everybody knows right, wehave four pounds of bacteria in
your colon.
We don't have a lot in thesmall intestine, but the
definition of SIBO is reallyjust more bacteria than usual.
They don't talk about symptomsat all as part of the definition
, probably a mistake.
That said, most patients withSIBO small intestinal bacterial
(05:26):
liver come in because they havesymptoms of gas and bloating.
The vast majority theoccasional SIBO patient comes in
just with chronic diarrhea, butmost have symptoms of gas and
bloating.
You're right.
Kate Scarlata (05:38):
So everyone gets bloated once in a while and I
think people think I'm bloated.
It's terrible.
You eat a large meal, overdobeans, whatever you can feel a
little bloating, but as agastroenterologist, when do you
escalate a workup based on anindividual's symptoms of
bloating?
What are some red flags?
Dr. Brian Lacy (05:59):
Yeah, that's a great question because you're so
well aware of healthcareefforts, especially for
something like ovarian cancer,and they mentioned that bloating
could be a sign of ovariancancer, and they're really
trying to help the public andmake young and middle-aged women
aware of this potentiallydisastrous fatal disease.
(06:19):
The problem is bloating is soprevalent.
It extends across all differentdisease states, whether
constipation or diarrhea,gastroparesis, functional
dyspepsia, ibs, as we talkedabout.
It is so prevalent it overlapsalmost everything, and so you
have to be very careful about anon-specific symptom such as
(06:41):
bloating, feeling gassy You'reright, people have it all the
time, obviously.
Symptoms such as bloating,feeling gassy.
You're right, people have itall the time, obviously, and
then thinking, wow, that symptommust represent something bad or
dangerous, because rarely doesit represent something dangerous
.
So your question really is howdo you tease out that
nonspecific symptom and makesense for all of our listeners
who are worried it couldrepresent something bad?
(07:01):
So then, what I want to focuson is what are some other
warning signs, maybe paired upwith it, that would make me want
to investigate further, such asare you losing weight
unintentionally, more than 10%of your ideal body weight?
Is there a family history of aGI malignancy or ovarian or
uterine cancer?
Are you anemic?
(07:22):
Is your blood count too low?
Do you have significant otherwarning signs, such as maybe
sweats at night, or you havesignificant abdominal pain that
doesn't be relieved by having abowel movement or urination?
Then I might want toinvestigate, and certainly a
simple investigation might be anabdominal ultrasound or pelvic
ultrasound to get the ballrolling.
Kate Scarlata (07:42):
Perfect In your practice.
What are some of the commonsort of related disorders that
you see that are associated withbloating just every day?
As a gastroenterologist, Right.
Dr. Brian Lacy (07:56):
So if we were to make up a list of common causes
of gas and bloating, we couldprobably quickly list 25 or 30
between the three of us in thenext minute.
But to help our patients and tohelp other healthcare providers
, I try to really focus on fivebig areas and I think that
encompasses about 90 to 95%.
So I start thinking about dietand dietary causes of gas and
(08:20):
bloating.
Fortunately we have an expertright here on the call, Kate
Scarlata, who can educate usabout diet and dietary causes of
gas and bloating.
Fortunately we have an expertright here on the call, Kate
Scarlata, who can educate usabout diet and dietary causes of
gas and bloating.
I think about constipation andbowel habits.
Again, some patients withdiarrhea have bloating, but it's
much more common withconstipation and, as I explain
to patients, if you're havingdifficulty evacuating stool,
(08:41):
don't be surprised.
You have difficulty evacuatinggas as well.
They're handled similarly inmany ways.
As you've already mentioned, Ithink about small intestinal
bacterial overgrowth and,depending on which study you
read, the prevalence may be onein 25 people or one in five
people.
So it may be much more commonthan we think.
(09:01):
We have a wonderfulpsychologist on the phone call,
Dr Megan Riehl.
And then I start talking aboutvisceral hypersensitivity.
As I mentioned, most patientsdon't make more gas than other
patients.
One to two liters per day onaverage, by the way, is what the
average American produces interms of intestinal gas.
But some patients sense normalamounts differently.
(09:25):
They sense that little bit ofgas differently and they sense
it as pain, bloating, discomfort.
Lastly, there's a smaller groupof people who have kind of this
funny reflex and I actuallytell them they have a wiring
problem.
We call it abdominophrenicdyssinergia, phrenic, referring
(09:45):
to both the phrenic nerve andthe diaphragm.
And to briefly explain thatnormally if you get some gas in
your GI tract, whether the colonor the small intestine, you
sense that gas.
Normally what happens is yourdiaphragm ascends.
That makes your belly cavitybigger.
Your diaphragm goes up higherinto your chest, makes your
(10:27):
belly cavity bigger, as you bothknow, and subconsciously your
external obliques and abdominalwall muscles contract.
And now they've got thisimmediately protuberant abdomen,
they're very distended expert,I'm going to pick your brain a
little bit.
Dr. Megan Riehl (10:46):
Sometimes I'll teach patients diaphragmatic
breathing to help with theirbloating, what you're just
describing.
Can diaphragmatic breathingreset some of that, do you think
, or maybe make it worse?
Dr. Brian Lacy (10:56):
I think it can definitely help reset it,
however.
So for all you listeners outthere, this is the problem
talking to somebody who knowsthe field so well.
If you were to challenge me,what I'm talking about is
actually Dr Megan Reel, not me.
If you challenge me and saywhere's the data, we don't have
the data.
This is routinely practiced bya lot of healthcare providers
and generally the clinicalexperience is good.
(11:18):
That diaphragmatic breathing,which can be tricky to teach, as
you know, Dr Riehl, but whentaught appropriately and when
performed at home we recommendbefore meals, so at least three
times a day can be veryeffective at treating gas and
bloating.
But we don't have greatclinical data.
However, if you ask me the samequestion in one year, we just
(11:38):
started a pilot study here,prospective, randomized.
We're going to give you thedata in one year's time.
Dr. Megan Riehl (11:44):
Perfect, awesome, thank you.
Dr. Brian Lacy (11:47):
How's that for a shameless plug?
Oh no, that's not shameless.
Kate Scarlata (11:51):
We like to let our listeners know what's coming
down the pipeline, that'sawesome.
Dr. Megan Riehl (11:55):
Yeah, I think this is.
We know that there are lots ofevidence-based strategies for
IBS and we also know thatbloating is a very common
symptom of IBS.
But when people are looking toexpand with their dream team, we
call it.
You know, working with adietician, working with a
psychologist, I do tell mypatients, you know that I've got
(12:17):
a lot of evidence to suggestthat gut-directed hypnosis or
diaphragmatic breathing is veryhelpful for bowel symptoms,
including your diarrhea,constipation, reducing that
visceral hypersensitivity.
But I find and I think some ofmy colleagues feel this way,
when somebody is presentingspecifically with their bloating
, we all kind of are like okay,like buckle in, we can help you,
(12:40):
we definitely have strategiesfor you.
It's just the evidence isn't asstrong.
So we're really going topersonalize things.
So that's what I think you'rejust highlighting that bloating
can be tricky, but there aredifferent strategies out there
that can be helpful.
And then you're going toproduce the evidence-based
literature that we really needto back up what we're doing in
clinical practice.
Dr. Brian Lacy (13:00):
You know I like, Megan, so much of what you said
, because I think all of us, atheart, we're scientists.
We want to understand howthings work, why symptoms
develop.
I think, at heart, we're alleducators, because what do we
really want to do every day?
We want to educate our patientsright, we want to reassure them
, we want to make them feelbetter and we try to use the
(13:21):
best data from the literature.
And at least in this space wedon't have as much data as we
would like.
When you think about it, it'ssuch a common problem, but it's
actually understudied and so youknow, hopefully in the next
year or so we'll get a lot ofreally good data and you can say
now, based on this study, wecan tell you with very strong
feelings that this is what'sgoing to work for you very
(13:44):
strong feelings that this iswhat's going to work for you.
Dr. Megan Riehl (13:50):
Yeah, so can you tell me a little bit about
how you describe how stress mayimpact bloating ?
Dr. Brian Lacy (13:53):
Yeah, that's complicated, isn't it?
Dr. Megan Riehl (13:55):
Right.
Dr. Brian Lacy (13:55):
So let's, can we set the stage for 30 seconds
and talk about the brain-gutaxis?
Dr. Megan Riehl (14:00):
Yes, please.
Dr. Brian Lacy (14:01):
I'm sure you've had other speakers on this
wonderful show talking about thebrain-gut axis, but for maybe
listeners who weren't therebefore or aren't quite as up to
date, think about this brain-gutaxis, and what I mean by axis
is this bidirectional pathwaybetween the brain and the gut,
and what I tell my patients isthat this brain-gut axis, this
(14:22):
bidirectional pathway, signalsfrom the brain to the gut and
the gut to the brain.
You have more nerves in your GItract than the spinal cord.
In fact, you have five times asmany nerves in the GI tract
than in your spinal cord.
The GI tract is a sensory organand 90% of the nerves in the GI
tract are sensory in nature.
So you could imagine that ifyou're having gut symptoms, it
(14:44):
sends signals to the brain.
Brain is affected.
Similarly, if you have brainsignals and stress or emotion,
it can affect your brain, whichcan affect your gut.
So you could imagine we'vealready discussed the fact that
with these disorders ofgut-brain interaction, such as
IBS, your gut is sensitive.
Your gut is wired differentlyand patients feel things
(15:05):
differently than other patients,and so you could imagine, with
this brain-gut interaction, ifyou are getting some stress on
the outside emotion, there's afight with a boyfriend, there's
financial issues, there areproblems with your spouse or
children.
It affects your brain and it'sgoing to affect your gut, and if
you already have a sensitivegut, it's going to make it even
more sensitive.
Dr. Megan Riehl (15:29):
Yeah, so we love talking about how impactful
the brain is on the gut, butthat it's bi-directional,
because certainly, you know,unfortunately, people have heard
that some of these symptoms are, oh, they're in your head, you
know, and that's like the lastthing that we want people to
experience, and so that'sanother thing that we dispel
often that your head is heavilyinvolved in these symptoms, but
(15:52):
in a really impactful waythrough the brain-gut axis, and
so you do a beautiful jobdescribing that and, again, I
think, helping people tounderstand that these symptoms
are very, very real.
They're just complex andimpacted by things that you
never would have thought wouldcause bloating or cause bowel
problems, but they can and theydo.
Dr. Brian Lacy (16:14):
Absolutely, absolutely well said.
You know, I think too just asan aside, you know, sometimes
patients will say, oh, I've justtold it's stress.
Everybody blames it on stress,and I think I always try to take
a step back and say, yeah, it'seasy to say stress, but when
you think about it, this is whystress can do it, and if you go
that extra step, as you do, asKate does, it just makes sense
(16:34):
to patients.
Dr. Megan Riehl (16:35):
Right when you label what stress hormones are
and that stress certainly can beemotional, but that stress has
very profound physiologicalimpacts on the body too.
That, I think, also is whatyou're talking about in terms of
connecting and again validatingthat patient's experience.
Dr. Brian Lacy (16:56):
Agreed.
Kate Scarlata (16:57):
Yeah, and I just I love the way you described the
gut as such a sensory organ insuch clear description, because
I don't think people realize howthe gut and brain are connected
, but also just so much sensoryability it can really take in.
You know, is very affected bywhether it's food or gas,
(17:18):
depending on how heightened thatbrain-gut access is, especially
like in something like IBS, howstress can really exacerbate
those symptoms.
Dr. Brian Lacy (17:28):
Absolutely, absolutely.
I mean, as I tell the medicalstudents what's the smartest
organ in the body?
Well, it's the stomach, right,you know?
It's not your brain, it's notyour heart, it's the stomach,
because it's telling you, reallyon a second-by-second basis,
what its functional status is.
Am I a little queasy?
Am I full?
Am I overly stuffed?
Am I too hungry?
Do I have butterflies in mystomach?
A brain-gut problem, right,because everybody's had some
(17:50):
butterflies before.
So, on a second-by-second basis, it's telling you its sensory
status.
Dr. Megan Riehl (17:56):
I love that (Kate).
Those of us that can lean intothat gut instinct.
It's real.
That's another thing thatyou're teeing me up to talk
about, that that there is a gutinstinct and your thoughts are
connected to that, and sosometimes giving pause when your
stomach is giving you somesignals and then sifting through
some of the cognitions and theemotions that go along with that
(18:17):
, leaning into that and learninghow to lean into that, can
really help guide you in termsof all the things that we
navigate in the world,absolutely.
Kate Scarlata (18:28):
So let's segue a little bit into nutrition, and
this is obviously working withIBS patients that experience a
lot of bloating.
I'm making diet modificationson a regular basis, but I'd love
you to just talk a little bitabout your practice and what are
some of the dietary culpritsthat you find frequently in your
(18:48):
patients, and I'd love you totalk a little bit about just the
notion that fiber andplant-based diets are really hot
right now, and I can see whyeating plant-based diets are
good for us from a gutmicrobiome, gut health
standpoint, but I think for somepeople they might be overdoing
(19:09):
it and whether it's too fast toramp up or just too much fiber
all at one time, what are yourbeen asked a diet question from
an internationally recognizedexpert in diet and nutrition, so
(19:41):
she's just setting me up tofail.
Dr. Brian Lacy (19:43):
But let me tell you how I do it in my I'm
teasing.
Let me tell you how I do it inmy practice.
I take time with every patientand I try to be very efficient,
but this is the way I approachit, knowing that this is not the
way a dietitian would approachit during a 45-minute visit.
So when I think about commondietary offenders, I ask about
(20:03):
dairy.
So don't forget that lactoseintolerance is present in 35% of
adult Americans and up to 95%in African-Americans and Asians,
and it happens slowly over time.
I ask about fructose.
Remember we don't have anenzyme that breaks down fructose
.
It's absorbed very slowlythrough co-transporters.
There's a lot of fructose outthere.
(20:25):
The average American takes in40 pounds a year of high
fructose corn syrup.
Yeah, I see Megan closing hereyes, thinking this is terrible,
and it is terrible because itcauses gas, bloating and, of
course, obesity.
I think about healthy foodsthat can backfire.
So cruciferous vegetables arehealthy, but too much broccoli,
(20:45):
cauliflower, brussel sprouts canbackfire gas and bloating.
And I think about legumes,which can be very healthy.
You know we're talking aboutgalactans now.
It can be very healthy, reducecholesterol, good source of
protein, but they can cause gasand bloating because many
Caucasians don't have the enzymeto break it down.
I ask about sugar-free candies,gums and mints, because
(21:07):
anything that ends in O L,sorbitol, lactitol, erythritol,
mannitol can cause horrible gasand bloating.
And I ask about artificialsweeteners as well.
Your point is a great one.
I think many of your listenersare trying to become healthier,
trying to shift more to aplant-based diet, which is great
, and incorporating morefiber-rich foods.
The problem there is sometimeseating healthfully great for
(21:30):
your overall health backfiresfor your gut, because if you do
add things in too fast you cancause gas and bloating.
But also fiber, if it goesthrough the GI tract and gets to
the colon, ferments and a scaryfact or maybe not so scary, but
maybe a surprising fact is ateaspoon of fiber can produce
(21:51):
200 cc's of gas A teaspoon offiber.
So your teaching point, kate,was perfect.
If you start that plant-baseddiet, start that higher fiber
diet, do it slowly, let thosegut bacteria get used to it.
Don't overwhelm them all atonce, because if you add a huge
fiber load you're going to looklike the Pillsbury Doughboy the
(22:11):
next day.
Kate Scarlata (22:13):
I love that and you know it is so true.
I think people like it's all ornothing and I'm going to be on
a high fiber diet tomorrow andeat 50 grams at breakfast.
I was just looking I think it'sthe cereal poop like a champion
.
I don't know if you're familiarwith that cereal, but it's like
23 grams of fiber and a half acup and I thought, oh boy, this
(22:36):
is like a sprinkle on top ofyour lactose-free yogurt, but
not a half a cup at one shot.
I think yes, I'm so gratefulthat you agree with me.
Go slow, let that colonicenvironment adjust the little
microbes residing there so thatyou'll tolerate things better.
I am so grateful you talk aboutsugar-free gum and mints and
(22:59):
ask that question because I havehad so many patients come into
my office chewing gum, poppingthe mints and thinking to myself
okay, I got my firstrecommendation here.
Dr. Megan Riehl (23:12):
Drinking the carbonated soda.
Kate Scarlata (23:15):
Right, exactly, or even the bubbly waters.
Dr. Megan Riehl (23:18):
Right.
We think that that's ahealthier choice, which in a lot
of ways it can be.
But all that carbonationsometimes can be really a killer
on the gut.
Dr. Brian Lacy (23:28):
Yes, absolutely.
Dr. Megan Riehl (23:30):
I was smiling as you're describing the sugar,
because you know, in the realhousehold we try to take a
liberalization, moderationapproach.
So you know, just like we mayeat an entire head of broccoli
all together at the dinner table, you know, then we go get our
ice cream in the summer.
And so the approach ofmoderation, but also then
(23:51):
knowing that I live a prettyhealthy lifestyle and I'm not
immune to bloating just like thenext person.
But I think that knowing that,like when you can step back and
take a little bit of aself-assessment of, huh, I've
been more bloated recently, isit that summer's around the
corner here in Michigan, whereit's not warm down in Florida
all the time, so we're morelikely to have ice cream and
(24:12):
we're eating more of those freshfibrous vegetables as we get
them a little easier, and so youmight see this kind of uptick
in bloating.
And there may be some gentleways that you can approach that
through some changes.
And I think that notcatastrophizing around the why
right away can be really helpful, especially when it comes from
a stress management perspective.
Dr. Brian Lacy (24:35):
I agree with all that yeah.
Kate Scarlata (24:39):
IBS-C, or irritable bowel syndrome with
constipation, is a commoncondition in which people
experience constipation alongwith other belly symptoms like
pain, bloating and discomfort.
Sound familiar like pain,bloating and discomfort Sound
familiar.
Many people with IBS-C arewilling to give up key parts of
their lives in exchange forsymptom relief.
(25:00):
And because the causes of IBS-Cmay differ for each person,
there is no one-size-fits-alltreatment approach.
If you're suffering from IBS-C,you may have to try a number of
different medications beforeyou find the right one for you.
So don't be okay with justfeeling okay.
If you have IBS symptoms thatcontinue to bother you, talk to
(25:23):
your healthcare provider to findout if your current medication
is right for you or if it's timeto try something different.
The more you know about IBS-C,the better prepared you will be
to speak with your doctor aboutthe right treatment option for
you.
Dr. Megan Riehl (25:40):
As a psychologist in this area, I
feel pretty comfortable givingpatients some guidance around
the breathing techniques, sowe'll link our diaphragmatic
breathing video that's availableon YouTube in the show notes.
Today I also will talk withpatients about exercise and
gentle movement of their body.
(26:01):
But what about some of thoseholistic over-the-counter
remedies that I'm sure peopleare asking you about?
The simethicone activatedcharcoal is one I hear about
probiotics.
Do these work and also what arethe risks to using some of them
?
Dr. Brian Lacy (26:18):
At heart I'm kind of a scientist, so let's
preface this whole conversationsaying that for most of what I'm
going to say, we don't havegreat data, so we'll have to
rely.
I've done this job for about 30years, so I've seen a lot of
patients with gas and bloatingand I try to keep up with the
literature.
What do we really know?
So activated charcoal can binddifferent chemicals and can bind
(26:42):
medications and may helpprevent a poisoning overdose,
but the data supporting its usefor gas and bloating is
essentially zero.
And then you take activatedcharcoal, your stool is really
dark and you get everybody allexcited because they think
you're bleeding on the inside.
Kate Scarlata (26:57):
So don't use activated charcoal.
Dr. Brian Lacy (26:59):
Exactly.
Just stay away from that.
What about simethicone?
So we know that we give that tobabies for colic, biliary colic
, which is really gas bubblesstretching the colon and small
intestine cramps and spasms.
What does simethicone really do?
What it really does is take abig gas bubble and breaks it
into little gas bubbles.
It doesn't get rid of your gas,but it may help a little bit.
(27:23):
So could you add a little bitof simethicone Can't hurt, but
we don't have great data at all.
Some people use probiotics and aconcept again we kind of
started almost a conversationwith that is that probiotics may
change your gut microbiome, maychange that gut flora, that
delicate balance of good and badbacteria.
But the data supportingbloating is very weak at best.
(27:47):
Matter of fact, if we looked atIBS and looked at 53 published
studies in IBS, probiotics arebarely better than placebo and
don't do much for pain orbloating.
So I don't usually recommendthem and sometimes it makes
bloating worse.
I think watching your diet, Ithink exercising, I think taking
(28:08):
control of your constipationAgain, if it's hard to evacuate
stool, it's hard to evacuate gasand thinking about some of
those other common offenderswe've already discussed.
Dr. Megan Riehl (28:17):
And what about the pharmaceutical treatments?
So there's more rigorousresearch around this.
Antibiotics, the prokineticagents, tricyclic
antidepressants, antispasmodicsare probably the things that if
people were Googling, they wouldfind and bring to their doctor.
What do you use and what mightyou suggest for patients?
Dr. Brian Lacy (28:42):
Now we actually have some data.
So let's talk about data.
So let's think aboutantispasmodics first, with
smooth muscle antispasmodics.
The theory there is that theycan relax the gut and there is
some data showing that smoothmuscle antispasmodics I'll use a
generic name, hyosiamine ordicyclamine as an example might
improve some symptoms of gas andbloating.
And there's one product sold inCentral America that's a smooth
(29:04):
muscle antispasmodic withsimethicone, as you know,
showing that was better thanplacebo.
So there's a little bit of data.
Some people translate that tousing warm peppermint tea.
Peppermint oil helps spasms andcramps, but remember it's not
changing the gas content.
It's really changing how yourespond to the gas.
Could you use antibiotics?
(29:24):
So we use antibiotics forpeople with documented small
intestinal bacterial overgrowth.
I don't recommend it just forbloating in general because
antibiotics have risk and Iwould feel terrible giving
somebody horrible diarrhea likeC difficile clostridium
difficile diarrhea, somebodyhorrible diarrhea like C
difficile clostridium difficilediarrhea.
But antibiotics can definitelychange gut flora and treat small
(29:46):
intestinal bacterial overgrowthand therefore improve symptoms
of gas and bloating.
But I want to have thatdocumented.
The best data for medicationsmight come in the IBS with
constipation field.
We have five FDA approved drugsfor this disorder I'm sure your
listeners are very familiarwith them such as linaclotide or
(30:08):
plecanatide or lubiprostone.
Those are the generic drugs andthe data shows that in all the
studies performed to date, as weimprove IBS and constipation
symptoms, those agentsprokinetic agents, as you
mentioned, Megan also improvesymptoms of gas and bloating.
Is one necessarily much better?
Dr. Megan Riehl (30:30):
Yeah, and we're going to shift in I'm going to
let Kate bring this up but Ithink the constipation so often.
Sometimes patients get stuck ontheir bloating.
But then I'll ask them when'sthe last time you've had a bowel
movement and they're bloating?
But then I'll ask them when'sthe last time you've had a bowel
movement and they're like yeah,I go, I don't know, every five
or six days.
They oftentimes don't evenrecognize.
That's not normal, and so I'lllet Kate take it away from here.
Kate Scarlata (30:52):
Yeah, I mean I would say, and I'm a 30-year
veteran too, Dr Lacy.
And most of my patients areconstipated and it's just.
I don't know if this is anincreasing problem in America,
but I see constipation sofrequently and I wanted to
mention the condition as well,which I'd love you to just
(31:16):
quickly define.
But I am really seeing this asa big driver of bloating the
constipation and maybe evenwhich I think we're seeing in a
lot of constipated patients.
So I'd love you to describe andjust the relationship.
How significant is constipationin this bloating picture from
(31:36):
your clinical experience?
Dr. Brian Lacy (31:38):
Okay, great question.
So a couple of points here.
One is, as you've highlighted,constipation is common we talk
about 15% of US adults atminimum and if you imagine
trouble evacuating stool gas ishandled to some degree the same
way.
So it may be difficult toevacuate gas.
(31:59):
The anal rectal area is verysmart and if the muscles aren't
working properly you may havetrouble evacuating gas.
Your point about dyssynergicdefecation comes to that pelvic
floor.
So what I tell my patients isgoing to the bathroom should be
really easy, right?
What's the big deal?
People go to the bathroom everyday.
It's incredibly complicated,right.
(32:21):
So what I tell my patients isone it has to be an appropriate
time.
So if you're outside of NewYork and you're on 95, that's
probably not the best time, soit has to be appropriate setting
.
Number two, stool has to movethrough the colon normally, and
in most people it does.
Number three you have to beable to sense it normally.
So maybe think about alongstanding diabetic who has
(32:42):
now lost some sensory functionand actually can't sense that
pressure in the rectum.
It's time to go to the bathroom.
They've lost that sensation.
Number four, and this is thekey point in split-second
sequences, certain muscles haveto relax and certain muscles
have to contract.
And if they are a split-secondoff sync, patients think they're
(33:02):
pushing to evacuate, butinstead the muscles are clamping
down, they're holding back andthat's what's dyssynergic
defecation, it's out of sync,it's synergy, so it's out of
sync, dyssynergic.
And a key teaching point hereis that those patients, as you
well know, don't get better withmedications.
Usually it's physical therapy.
(33:23):
But when their physical therapygoes well and their
constipation gets better, theirbloating always gets better as
well, hand in hand.
Dr. Megan Riehl (33:32):
Another team member, the pelvic floor
physical therapist.
They get another shout out andyou know I just had a patient
today actually, that I wasdescribing how, you know, pelvic
floor dysfunction could be apart of the puzzle.
This is a patient that hasconstipation and she hadn't yet
met a doctor that had done arectal exam.
(33:55):
She's coming up on a firstcolonoscopy and we really gave a
playbook today around conceptsto talk with her doctor about,
because she hadn't even thoughtabout pelvic floor dysfunction.
Nobody had ever mentioned thatbefore and it really can be a
big part of the picture,especially for women that have
(34:17):
had babies or a variety offactors that can impact the
pelvic floor.
Dr. Brian Lacy (34:23):
Absolutely so.
I think it is overlooked.
I think some people don't wantto open Pandora's box and start
talking about this, because it'sa little bit of a longer
discussion.
So you just did your patient agreat service today.
That's wonderful, right.
Very lucky.
They met you Well there we go.
Kate Scarlata (34:38):
I love that.
Just to go back toabdominophrenic dysnergia, did I
say that right?
Dr. Brian Lacy (34:44):
Absolutely.
Kate Scarlata (34:45):
Okay, outside of maybe trying diaphragmatic
breathing, are there any otherevidence-based therapies for
this?
I should have asked you earlier, but before I wrap up anything,
the simple answer is no.
Dr. Brian Lacy (35:00):
So we do think about this as being this wiring
problem where subconsciouslysomething has happened, and that
gas that stretches the smallintestine or colon again.
Normally your diaphragm goeshigher in your chest, your belly
cavity gets bigger and yourabdominal wall muscles contract
to keep your belly flat.
(35:20):
It's the exact opposite.
Why that occurs, we don'treally know.
Some prior infection, someinsult, some learned behavior?
We really don't know why itoccurs.
The best data we have but wedon't have much data, as we
already discussed is probablydiaphragmatic breathing.
It seems to make sense and atleast in clinical practice by a
lot of smart providers it works.
(35:41):
Some people have triedelectrical stimulation to the
abdominal wall.
That doesn't seem to work verywell.
Some people have triedmedications to fix that, but the
medications really don't work.
So I think we really need tofocus on behavioral strategies
for this.
Kate Scarlata (35:56):
There you go, Megan.
Let's go, let's go.
You're the valued team memberin this case.
So real quickly for ourlisteners.
Dr Lacy brought up some reallykey factors from the diet that
may be a player for bloating,lactose malabsorption.
We drink a lot of milk.
We love our ice cream.
There's lots of lactose-freeoptions, but if you're
(36:19):
experiencing bloating, thatmight be the first thing you
might want to look at.
There are some fibers that aresmall fibers that are fast food
for our gut microbes.
Dr Lacy brought these upgalactans or
galactoaligosaccharide.
These are common in legumes.
We also have another type offiber called fructans, and
(36:39):
they're common in garlic, onionand wheat in the American diet.
Those are also fast food forour gut bacteria, so those two
types of fibers can beproblematic for bloating.
The other consideration isramping up fiber and your goal
to have the best gut, healthiestmicrobiome in the whole entire
(37:00):
universe.
Go slow, make sure you'readding water and then be careful
of those sugar-free mints andadditives that you might find in
various granola bars andsupplements, because those are
poorly absorbed too, and thosetypes of sugars that are poorly
absorbed can be food for yourgut microbes, and what they do
(37:23):
is they make gas, and gas makesyou feel bloated.
And there you go.
A couple other lifestyle tipsthat I bring up with my patients
is walking, you know.
Go for a nice evening walkafter dinner.
That can stimulate colonicmotility and may move through
some of that gas.
And another tip that I oftenencourage and we did include it
(37:44):
in the Mind Your Gut book is agentle abdominal massage which
sometimes can help move the gasfurther down into the rectum for
easier passage.
So, Megan, what about you?
Dr. Megan Riehl (38:03):
Ye s and I love that Dr behavioral himself a
simple gastroenterologist.
Kate Scarlata (38:07):
It's about the furthest thing from that, hello.
Dr. Megan Riehl (38:12):
And another equally simple
gastroenterologist, Dr BahaMoshiree, she and I.
She's another motilityspecialist.
You know, back in April the NewYork Times just ran this
article on gas and bloatingwhile traveling and she was
featured.
She's a fabulous Atrium Healthgastroenterologist who explained
(38:33):
more of the physiology aroundit.
So the high altitude of beingon an airplane might slow down
the muscle contractions that areneeded to kind of push the
digestive process through.
So I had the privilege of beinga part of this New York Times
article as well, because of thebehavioral sides of gas and
bloating while traveling, and Igot to normalize that.
(38:53):
You know, if you're somebodythat feels these symptoms while
traveling or you've wondered wow, when I travel I get
constipated, I'm more gassy, I'mbloaty, and I got to be quoted
saying trust me, you're not theonly one farting on an airplane.
Never in my life did I thinkthat would be the quote that
came out.
But the reality is, if you'veever seen a chip bag on an
airplane and it expands, that'swhat can happen to all of us,
(39:23):
and especially those that areprobably more prone to IBS or
other digestive symptoms.
And I really think that thenormalization that even if
you're not traveling but you'rein class.
Now you don't want to be theperson that's just letting your
fart fly in class.
But standing up, leaving theroom, excusing yourself to go to
the bathroom, sucking in,holding your stomach, excusing
yourself to go to the bathroom,sucking in, holding your stomach
(39:44):
, holding your gas when you'reout and about, it's not good.
And you're not alone.
Other people are experiencingthis.
Dr Lacy highlighted thestatistics of people that are
experiencing these symptoms andif you're doing that, you're
more likely to just worsenbloating, worsen your
constipation.
So in the real household wehave normalized that everyone
poops, everyone toots.
(40:04):
My two-year-old says it to meall the time Mama, I tooted and
I'll say that's great.
And I want everybody to kind offeel destigmatized in their
normal bowel habits and theirpatterns and this can go a long
way.
So you know, if you're seatedaround the dinner table talking
about things, normalize ourbodily processes, make sure that
we're having conversationsabout, especially with your kids
(40:26):
.
Are they pooping at school?
Are they going to the bathroom?
Do they feel uncomfortable atschool, so that we can get them
the help that they deserve at ayoung age instead of what I'm
sure the three of us experiencewhere we're seated with.
You know 50, 60-year-olds thatare just starting their pathway
of addressing these symptoms.
So, as we've kind of mentioned,gentle yoga, going for walks,
(40:50):
thinking about the foods thatyou're eating, but if your belly
is bothering, you don't ignoreit.
Get help it might not be with agastroenterologist, it might be
with a dietitian or abehavioral health specialist and
just know that it's okay to letit go when you need to, and you
know that we all support that.
As we wrap up this incrediblyinformative podcast today with
(41:15):
Dr Lacy, we like to wrap up byasking each of our guests the
following questions.
So, Dr Lacy, what is somethingthat you prioritize when it
comes to your overall health andyour wellness?
Dr. Brian Lacy (41:29):
So first of all, thank you.
This has been a wonderfuldiscussion.
Your listeners are very luckyto have you both.
I learned a lot.
So what do I do?
I guess can I say three or fourlittle things.
Dr. Megan Riehl (41:41):
Please.
Dr. Brian Lacy (41:43):
So some seem.
I'm sure your listeners haveheard all this before.
So one I do prioritize sleep,and the reason being is that
poor sleep changes sensorythresholds in your gut and if
(42:03):
you don't sleep well your gutfeels worse.
So try to prioritize sleep.
I try to exercise, so I dosomething six or seven days out
of the week and it could just bethat wonderful half-hour walk
with your family after supper.
It doesn't mean three hours atthe gym.
Exercise comes in differentforms.
It could be playing ping pongwith your family, it could be
any number of things, but dosomething physically active.
Number three I turn devices off.
People laugh at me.
(42:23):
I think I have four apps on mycell phone.
Sorry, guys, but turn yourdevice off on vacation and at
night at home.
Don't stay connected.
You need to focus on yourfriends and your family and
yourself.
And number four I guess what Iwould say, other than try to eat
healthily you'd be prod, Kateis I try to express gratitude.
(42:43):
You know, all of us are solucky in so many different ways
and even if you're having a badday, if you do one nice thing to
somebody every day, expressgratitude to that checkout clerk
, to the person who helped youat the pharmacy.
That one minute interaction,that 30 second interaction of
expressing gratitude to somebodyelse completely changes that
(43:04):
person's day and my day as well.
Right, we have so manywonderful things around us.
So, at 30 seconds, that oneminute of gratitude each day can
be just a life changer.
Dr. Megan Riehl (43:14):
And this is why he's such a gem.
Kate Scarlata (43:17):
I know it's amazing.
I'm like geez Louise the nicestguest, the nicest person and
everyone that knows you saysthat about you, just so you know
like the nicest, kindestindividual on the planet.
So I love what you do forwell-being.
I'm going to take those, everysingle one of your tips, and
(43:40):
incorporate them into my life.
I do get my sleep, but I'm badwith the device, but that was
excellent, thank you.
Thank you so much for being ourguest today.
You shared so much around thistopic that is confusing for
people and worrisome for people.
Just leading us down ascientific path, which is really
(44:01):
the goal of this podcast, is toprovide the real truth, the
real science as we know it today.
So thank you again for spendingtime with us on our podcast.
Dr. Brian Lacy (44:12):
Absolute pleasure and thank you for
having me.
Delighted to do it, and bestwishes to all your listeners.
Dr. Megan Riehl (44:18):
So next up we are talking with Dr Darren
Brenner, gastroenterologist andprofessor of medicine at
Northwestern University inChicago, Illinois, and it really
features you know it's going toswing right in from bloating to
constipation, so we're going totalk about everything you need
to know about constipation.
Thank you for joining us as wegrow this gut health community.
(44:40):
We hope you enjoyed thisepisode and don't forget to
subscribe, rate and leave us acomment.
You can also follow us onsocial media @TheGut Health
Podcast, where we'd love for youto share your thoughts,
questions and experiences.
Thanks for tuning in, friends.
This podcast has been sponsored by Ardelyx.
Maintaining a healthy gut iskey for overall physical and
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Whether you're ahealth-conscious advocate, an
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issues, or a healthcare provider, you are in the right place.
(00:22):
The Gut Health Podcast willempower you with a fascinating
scientific connection betweenyour brain, food and the gut.
Come join us.
We welcome you.
Dr. Megan Riehl (00:37):
Hello friends, and welcome to the Gut Health
Podcast, where we talk about allthings related to your gut and
well-being.
We are your hosts.
I'm Dr Megan Riehl, a GIpsychologist.
Kate Scarlata (00:49):
And hello, I'm Kate Scarlata.
We have an exciting podcast foryou.
Today.
We're talking all aboutbloating.
We'll get into the complexitiesof this troublesome symptom
that every one of us deals withfrom time to time.
We'll learn about what causesbloating and how to treat it.
Today's guest is world-renownedgastroenterologist, Dr Brian
(01:12):
Lacy from Mayo ClinicJacksonville, Florida.
Dr Lacy focuses his research inclinical interests in disorders
of gastrointestinal motility.
His scientific articles onbloating are my personal go-tos,
especially for clinical tipswith my patients.
He is the author of nearly 200peer-reviewed articles on GI
(01:32):
motility disorders.
As well, he is the pastco-editor-in-chief of the
American Journal ofGastroenterology.
Welcome, Dr Lacy.
Dr. Brian Lacy (01:42):
Well, thank you so much for being here.
I'm just as excited as you guys.
This is great.
Dr. Megan Riehl (01:47):
Yes.
So as we kick off today'spodcast, we want to start with
some myth-busting.
So what is a commonmisconception about gut health
that you would like to dispelwith our audience?
Dr. Brian Lacy (01:58):
I think that's a great question.
I think there are a lot ofmyths and misconceptions about
gas and bloating, but one of theones I hear most commonly from
my patients is that they firmlybelieve that they produce much
more intestinal gas than anybodyelse and that's the root cause
of all their symptoms of gas andbloating.
But that's really amisconception.
Dr. Megan Riehl (02:20):
All right, so we're going to get into the
details here.
So let's dive in.
What is bloating and how doesit differ from abdominal
distension?
Tell us a little bit more aboutthis.
Dr. Brian Lacy (02:30):
Yeah, and I think that's a really important
point for all of your listenersbecause it makes us think about
the symptoms differently and itmakes us think about the
underlying pathophysiologydifferently and therefore likely
thinking about the treatmentdifferently.
So bloating, which isincredibly common, as you've
(02:51):
already mentioned, is a sense ofbeing gassy.
It's that sense of gas on theinside, bloating, and it's very
prevalent and we talk about, youknow, 14% of adult Americans
having symptoms of bloatingwithin the last week.
Distention is the physicalmanifestation and patients may
(03:13):
come in saying I look threemonths pregnant, I look six or
nine months pregnant.
When they're not, I look likeI've got a basketball in my
belly.
Frequently they overlap andpeople may have symptoms of gas
and bloating, but they may alsothen describe periods of
significant distension.
Pathophysiologically they mayexist on a bit of a spectrum,
(03:35):
but to some degreepathophysiologically they may
also be a little bit different.
So it's good to kind of teasethat out with your patients.
Dr. Megan Riehl (03:44):
So you're saying you know this is a pretty
common symptom in the generalpopulation and how common in IBS
or in SIBO small intestinalbacterial overgrowth- yeah,
great question.
Dr. Brian Lacy (03:59):
So there's a recent nice study from
Cedars-Sinai published about ayear ago.
There's a recent nice studyfrom Cedars-Sinai, published
about a year ago, surveyingnearly 90,000 patients across
the United States.
Thought to kind of capture thegeneral US population and in
that sample size one of thequestions they asked about was
gas and bloating and one inseven 14% said within the last
(04:19):
week they had symptoms of gasand bloating.
And, as you mentioned, this isvery prevalent in people with
IBS symptoms, whether IBS andconstipation or IBS and diarrhea
or those who go back and forth,and some studies have shown
that 60 to 70% of patients withIBS have overlapping symptoms of
(04:42):
gas and bloating.
It's not part of the formaldefinition but it's so common.
I always ask about it and Ithink most healthcare providers
and psychologists and dieticiansask about it as well.
SIBO (small intestinal bacterialovergrowth) is interesting.
The definition is that you havetoo many bacteria in your small
(05:02):
intestine where they don'treally belong.
We have a lot of bacteria inthe colon.
As everybody knows right, wehave four pounds of bacteria in
your colon.
We don't have a lot in thesmall intestine, but the
definition of SIBO is reallyjust more bacteria than usual.
They don't talk about symptomsat all as part of the definition
, probably a mistake.
That said, most patients withSIBO small intestinal bacterial
(05:26):
liver come in because they havesymptoms of gas and bloating.
The vast majority theoccasional SIBO patient comes in
just with chronic diarrhea, butmost have symptoms of gas and
bloating.
You're right.
Kate Scarlata (05:38):
So everyone gets bloated once in a while and I
think people think I'm bloated.
It's terrible.
You eat a large meal, overdobeans, whatever you can feel a
little bloating, but as agastroenterologist, when do you
escalate a workup based on anindividual's symptoms of
bloating?
What are some red flags?
Dr. Brian Lacy (05:59):
Yeah, that's a great question because you're so
well aware of healthcareefforts, especially for
something like ovarian cancer,and they mentioned that bloating
could be a sign of ovariancancer, and they're really
trying to help the public andmake young and middle-aged women
aware of this potentiallydisastrous fatal disease.
(06:19):
The problem is bloating is soprevalent.
It extends across all differentdisease states, whether
constipation or diarrhea,gastroparesis, functional
dyspepsia, ibs, as we talkedabout.
It is so prevalent it overlapsalmost everything, and so you
have to be very careful about anon-specific symptom such as
(06:41):
bloating, feeling gassy You'reright, people have it all the
time, obviously.
Symptoms such as bloating,feeling gassy.
You're right, people have itall the time, obviously, and
then thinking, wow, that symptommust represent something bad or
dangerous, because rarely doesit represent something dangerous
.
So your question really is howdo you tease out that
nonspecific symptom and makesense for all of our listeners
who are worried it couldrepresent something bad?
(07:01):
So then, what I want to focuson is what are some other
warning signs, maybe paired upwith it, that would make me want
to investigate further, such asare you losing weight
unintentionally, more than 10%of your ideal body weight?
Is there a family history of aGI malignancy or ovarian or
uterine cancer?
Are you anemic?
(07:22):
Is your blood count too low?
Do you have significant otherwarning signs, such as maybe
sweats at night, or you havesignificant abdominal pain that
doesn't be relieved by having abowel movement or urination?
Then I might want toinvestigate, and certainly a
simple investigation might be anabdominal ultrasound or pelvic
ultrasound to get the ballrolling.
Kate Scarlata (07:42):
Perfect In your practice.
What are some of the commonsort of related disorders that
you see that are associated withbloating just every day?
As a gastroenterologist, Right.
Dr. Brian Lacy (07:56):
So if we were to make up a list of common causes
of gas and bloating, we couldprobably quickly list 25 or 30
between the three of us in thenext minute.
But to help our patients and tohelp other healthcare providers
, I try to really focus on fivebig areas and I think that
encompasses about 90 to 95%.
So I start thinking about dietand dietary causes of gas and
(08:20):
bloating.
Fortunately we have an expertright here on the call, Kate
Scarlata, who can educate usabout diet and dietary causes of
gas and bloating.
Fortunately we have an expertright here on the call, Kate
Scarlata, who can educate usabout diet and dietary causes of
gas and bloating.
I think about constipation andbowel habits.
Again, some patients withdiarrhea have bloating, but it's
much more common withconstipation and, as I explain
to patients, if you're havingdifficulty evacuating stool,
(08:41):
don't be surprised.
You have difficulty evacuatinggas as well.
They're handled similarly inmany ways.
As you've already mentioned, Ithink about small intestinal
bacterial overgrowth and,depending on which study you
read, the prevalence may be onein 25 people or one in five
people.
So it may be much more commonthan we think.
(09:01):
We have a wonderfulpsychologist on the phone call,
Dr Megan Riehl.
And then I start talking aboutvisceral hypersensitivity.
As I mentioned, most patientsdon't make more gas than other
patients.
One to two liters per day onaverage, by the way, is what the
average American produces interms of intestinal gas.
But some patients sense normalamounts differently.
(09:25):
They sense that little bit ofgas differently and they sense
it as pain, bloating, discomfort.
Lastly, there's a smaller groupof people who have kind of this
funny reflex and I actuallytell them they have a wiring
problem.
We call it abdominophrenicdyssinergia, phrenic, referring
(09:45):
to both the phrenic nerve andthe diaphragm.
And to briefly explain thatnormally if you get some gas in
your GI tract, whether the colonor the small intestine, you
sense that gas.
Normally what happens is yourdiaphragm ascends.
That makes your belly cavitybigger.
Your diaphragm goes up higherinto your chest, makes your
(10:27):
belly cavity bigger, as you bothknow, and subconsciously your
external obliques and abdominalwall muscles contract.
And now they've got thisimmediately protuberant abdomen,
they're very distended expert,I'm going to pick your brain a
little bit.
Dr. Megan Riehl (10:46):
Sometimes I'll teach patients diaphragmatic
breathing to help with theirbloating, what you're just
describing.
Can diaphragmatic breathingreset some of that, do you think
, or maybe make it worse?
Dr. Brian Lacy (10:56):
I think it can definitely help reset it,
however.
So for all you listeners outthere, this is the problem
talking to somebody who knowsthe field so well.
If you were to challenge me,what I'm talking about is
actually Dr Megan Reel, not me.
If you challenge me and saywhere's the data, we don't have
the data.
This is routinely practiced bya lot of healthcare providers
and generally the clinicalexperience is good.
(11:18):
That diaphragmatic breathing,which can be tricky to teach, as
you know, Dr Riehl, but whentaught appropriately and when
performed at home we recommendbefore meals, so at least three
times a day can be veryeffective at treating gas and
bloating.
But we don't have greatclinical data.
However, if you ask me the samequestion in one year, we just
(11:38):
started a pilot study here,prospective, randomized.
We're going to give you thedata in one year's time.
Dr. Megan Riehl (11:44):
Perfect, awesome, thank you.
Dr. Brian Lacy (11:47):
How's that for a shameless plug?
Oh no, that's not shameless.
Kate Scarlata (11:51):
We like to let our listeners know what's coming
down the pipeline, that'sawesome.
Dr. Megan Riehl (11:55):
Yeah, I think this is.
We know that there are lots ofevidence-based strategies for
IBS and we also know thatbloating is a very common
symptom of IBS.
But when people are looking toexpand with their dream team, we
call it.
You know, working with adietician, working with a
psychologist, I do tell mypatients, you know that I've got
(12:17):
a lot of evidence to suggestthat gut-directed hypnosis or
diaphragmatic breathing is veryhelpful for bowel symptoms,
including your diarrhea,constipation, reducing that
visceral hypersensitivity.
But I find and I think some ofmy colleagues feel this way,
when somebody is presentingspecifically with their bloating
, we all kind of are like okay,like buckle in, we can help you,
(12:40):
we definitely have strategiesfor you.
It's just the evidence isn't asstrong.
So we're really going topersonalize things.
So that's what I think you'rejust highlighting that bloating
can be tricky, but there aredifferent strategies out there
that can be helpful.
And then you're going toproduce the evidence-based
literature that we really needto back up what we're doing in
clinical practice.
Dr. Brian Lacy (13:00):
You know I like, Megan, so much of what you said
, because I think all of us, atheart, we're scientists.
We want to understand howthings work, why symptoms
develop.
I think, at heart, we're alleducators, because what do we
really want to do every day?
We want to educate our patientsright, we want to reassure them
, we want to make them feelbetter and we try to use the
(13:21):
best data from the literature.
And at least in this space wedon't have as much data as we
would like.
When you think about it, it'ssuch a common problem, but it's
actually understudied and so youknow, hopefully in the next
year or so we'll get a lot ofreally good data and you can say
now, based on this study, wecan tell you with very strong
feelings that this is what'sgoing to work for you very
(13:44):
strong feelings that this iswhat's going to work for you.
Dr. Megan Riehl (13:50):
Yeah, so can you tell me a little bit about
how you describe how stress mayimpact bloating ?
Dr. Brian Lacy (13:53):
Yeah, that's complicated, isn't it?
Dr. Megan Riehl (13:55):
Right.
Dr. Brian Lacy (13:55):
So let's, can we set the stage for 30 seconds
and talk about the brain-gutaxis?
Dr. Megan Riehl (14:00):
Yes, please.
Dr. Brian Lacy (14:01):
I'm sure you've had other speakers on this
wonderful show talking about thebrain-gut axis, but for maybe
listeners who weren't therebefore or aren't quite as up to
date, think about this brain-gutaxis, and what I mean by axis
is this bidirectional pathwaybetween the brain and the gut,
and what I tell my patients isthat this brain-gut axis, this
(14:22):
bidirectional pathway, signalsfrom the brain to the gut and
the gut to the brain.
You have more nerves in your GItract than the spinal cord.
In fact, you have five times asmany nerves in the GI tract
than in your spinal cord.
The GI tract is a sensory organand 90% of the nerves in the GI
tract are sensory in nature.
So you could imagine that ifyou're having gut symptoms, it
(14:44):
sends signals to the brain.
Brain is affected.
Similarly, if you have brainsignals and stress or emotion,
it can affect your brain, whichcan affect your gut.
So you could imagine we'vealready discussed the fact that
with these disorders ofgut-brain interaction, such as
IBS, your gut is sensitive.
Your gut is wired differentlyand patients feel things
(15:05):
differently than other patients,and so you could imagine, with
this brain-gut interaction, ifyou are getting some stress on
the outside emotion, there's afight with a boyfriend, there's
financial issues, there areproblems with your spouse or
children.
It affects your brain and it'sgoing to affect your gut, and if
you already have a sensitivegut, it's going to make it even
more sensitive.
Dr. Megan Riehl (15:29):
Yeah, so we love talking about how impactful
the brain is on the gut, butthat it's bi-directional,
because certainly, you know,unfortunately, people have heard
that some of these symptoms are, oh, they're in your head, you
know, and that's like the lastthing that we want people to
experience, and so that'sanother thing that we dispel
often that your head is heavilyinvolved in these symptoms, but
(15:52):
in a really impactful waythrough the brain-gut axis, and
so you do a beautiful jobdescribing that and, again, I
think, helping people tounderstand that these symptoms
are very, very real.
They're just complex andimpacted by things that you
never would have thought wouldcause bloating or cause bowel
problems, but they can and theydo.
Dr. Brian Lacy (16:14):
Absolutely, absolutely well said.
You know, I think too just asan aside, you know, sometimes
patients will say, oh, I've justtold it's stress.
Everybody blames it on stress,and I think I always try to take
a step back and say, yeah, it'seasy to say stress, but when
you think about it, this is whystress can do it, and if you go
that extra step, as you do, asKate does, it just makes sense
(16:34):
to patients.
Dr. Megan Riehl (16:35):
Right when you label what stress hormones are
and that stress certainly can beemotional, but that stress has
very profound physiologicalimpacts on the body too.
That, I think, also is whatyou're talking about in terms of
connecting and again validatingthat patient's experience.
Dr. Brian Lacy (16:56):
Agreed.
Kate Scarlata (16:57):
Yeah, and I just I love the way you described the
gut as such a sensory organ insuch clear description, because
I don't think people realize howthe gut and brain are connected
, but also just so much sensoryability it can really take in.
You know, is very affected bywhether it's food or gas,
(17:18):
depending on how heightened thatbrain-gut access is, especially
like in something like IBS, howstress can really exacerbate
those symptoms.
Dr. Brian Lacy (17:28):
Absolutely, absolutely.
I mean, as I tell the medicalstudents what's the smartest
organ in the body?
Well, it's the stomach, right,you know?
It's not your brain, it's notyour heart, it's the stomach,
because it's telling you, reallyon a second-by-second basis,
what its functional status is.
Am I a little queasy?
Am I full?
Am I overly stuffed?
Am I too hungry?
Do I have butterflies in mystomach?
A brain-gut problem, right,because everybody's had some
(17:50):
butterflies before.
So, on a second-by-second basis, it's telling you its sensory
status.
Dr. Megan Riehl (17:56):
I love that (Kate).
Those of us that can lean intothat gut instinct.
It's real.
That's another thing thatyou're teeing me up to talk
about, that that there is a gutinstinct and your thoughts are
connected to that, and sosometimes giving pause when your
stomach is giving you somesignals and then sifting through
some of the cognitions and theemotions that go along with that
(18:17):
, leaning into that and learninghow to lean into that, can
really help guide you in termsof all the things that we
navigate in the world,absolutely.
Kate Scarlata (18:28):
So let's segue a little bit into nutrition, and
this is obviously working withIBS patients that experience a
lot of bloating.
I'm making diet modificationson a regular basis, but I'd love
you to just talk a little bitabout your practice and what are
some of the dietary culpritsthat you find frequently in your
(18:48):
patients, and I'd love you totalk a little bit about just the
notion that fiber andplant-based diets are really hot
right now, and I can see whyeating plant-based diets are
good for us from a gutmicrobiome, gut health
standpoint, but I think for somepeople they might be overdoing
(19:09):
it and whether it's too fast toramp up or just too much fiber
all at one time, what are yourbeen asked a diet question from
an internationally recognizedexpert in diet and nutrition, so
(19:41):
she's just setting me up tofail.
Dr. Brian Lacy (19:43):
But let me tell you how I do it in my I'm
teasing.
Let me tell you how I do it inmy practice.
I take time with every patientand I try to be very efficient,
but this is the way I approachit, knowing that this is not the
way a dietitian would approachit during a 45-minute visit.
So when I think about commondietary offenders, I ask about
(20:03):
dairy.
So don't forget that lactoseintolerance is present in 35% of
adult Americans and up to 95%in African-Americans and Asians,
and it happens slowly over time.
I ask about fructose.
Remember we don't have anenzyme that breaks down fructose
.
It's absorbed very slowlythrough co-transporters.
There's a lot of fructose outthere.
(20:25):
The average American takes in40 pounds a year of high
fructose corn syrup.
Yeah, I see Megan closing hereyes, thinking this is terrible,
and it is terrible because itcauses gas, bloating and, of
course, obesity.
I think about healthy foodsthat can backfire.
So cruciferous vegetables arehealthy, but too much broccoli,
(20:45):
cauliflower, brussel sprouts canbackfire gas and bloating.
And I think about legumes,which can be very healthy.
You know we're talking aboutgalactans now.
It can be very healthy, reducecholesterol, good source of
protein, but they can cause gasand bloating because many
Caucasians don't have the enzymeto break it down.
I ask about sugar-free candies,gums and mints, because
(21:07):
anything that ends in O L,sorbitol, lactitol, erythritol,
mannitol can cause horrible gasand bloating.
And I ask about artificialsweeteners as well.
Your point is a great one.
I think many of your listenersare trying to become healthier,
trying to shift more to aplant-based diet, which is great
, and incorporating morefiber-rich foods.
The problem there is sometimeseating healthfully great for
(21:30):
your overall health backfiresfor your gut, because if you do
add things in too fast you cancause gas and bloating.
But also fiber, if it goesthrough the GI tract and gets to
the colon, ferments and a scaryfact or maybe not so scary, but
maybe a surprising fact is ateaspoon of fiber can produce
(21:51):
200 cc's of gas A teaspoon offiber.
So your teaching point, kate,was perfect.
If you start that plant-baseddiet, start that higher fiber
diet, do it slowly, let thosegut bacteria get used to it.
Don't overwhelm them all atonce, because if you add a huge
fiber load you're going to looklike the Pillsbury Doughboy the
(22:11):
next day.
Kate Scarlata (22:13):
I love that and you know it is so true.
I think people like it's all ornothing and I'm going to be on
a high fiber diet tomorrow andeat 50 grams at breakfast.
I was just looking I think it'sthe cereal poop like a champion
.
I don't know if you're familiarwith that cereal, but it's like
23 grams of fiber and a half acup and I thought, oh boy, this
(22:36):
is like a sprinkle on top ofyour lactose-free yogurt, but
not a half a cup at one shot.
I think yes, I'm so gratefulthat you agree with me.
Go slow, let that colonicenvironment adjust the little
microbes residing there so thatyou'll tolerate things better.
I am so grateful you talk aboutsugar-free gum and mints and
(22:59):
ask that question because I havehad so many patients come into
my office chewing gum, poppingthe mints and thinking to myself
okay, I got my firstrecommendation here.
Dr. Megan Riehl (23:12):
Drinking the carbonated soda.
Kate Scarlata (23:15):
Right, exactly, or even the bubbly waters.
Dr. Megan Riehl (23:18):
Right.
We think that that's ahealthier choice, which in a lot
of ways it can be.
But all that carbonationsometimes can be really a killer
on the gut.
Dr. Brian Lacy (23:28):
Yes, absolutely.
Dr. Megan Riehl (23:30):
I was smiling as you're describing the sugar,
because you know, in the realhousehold we try to take a
liberalization, moderationapproach.
So you know, just like we mayeat an entire head of broccoli
all together at the dinner table, you know, then we go get our
ice cream in the summer.
And so the approach ofmoderation, but also then
(23:51):
knowing that I live a prettyhealthy lifestyle and I'm not
immune to bloating just like thenext person.
But I think that knowing that,like when you can step back and
take a little bit of aself-assessment of, huh, I've
been more bloated recently, isit that summer's around the
corner here in Michigan, whereit's not warm down in Florida
all the time, so we're morelikely to have ice cream and
(24:12):
we're eating more of those freshfibrous vegetables as we get
them a little easier, and so youmight see this kind of uptick
in bloating.
And there may be some gentleways that you can approach that
through some changes.
And I think that notcatastrophizing around the why
right away can be really helpful, especially when it comes from
a stress management perspective.
Dr. Brian Lacy (24:35):
I agree with all that yeah.
Kate Scarlata (24:39):
IBS-C, or irritable bowel syndrome with
constipation, is a commoncondition in which people
experience constipation alongwith other belly symptoms like
pain, bloating and discomfort.
Sound familiar like pain,bloating and discomfort Sound
familiar.
Many people with IBS-C arewilling to give up key parts of
their lives in exchange forsymptom relief.
(25:00):
And because the causes of IBS-Cmay differ for each person,
there is no one-size-fits-alltreatment approach.
If you're suffering from IBS-C,you may have to try a number of
different medications beforeyou find the right one for you.
So don't be okay with justfeeling okay.
If you have IBS symptoms thatcontinue to bother you, talk to
(25:23):
your healthcare provider to findout if your current medication
is right for you or if it's timeto try something different.
The more you know about IBS-C,the better prepared you will be
to speak with your doctor aboutthe right treatment option for
you.
Dr. Megan Riehl (25:40):
As a psychologist in this area, I
feel pretty comfortable givingpatients some guidance around
the breathing techniques, sowe'll link our diaphragmatic
breathing video that's availableon YouTube in the show notes.
Today I also will talk withpatients about exercise and
gentle movement of their body.
(26:01):
But what about some of thoseholistic over-the-counter
remedies that I'm sure peopleare asking you about?
The simethicone activatedcharcoal is one I hear about
probiotics.
Do these work and also what arethe risks to using some of them
?
Dr. Brian Lacy (26:18):
At heart I'm kind of a scientist, so let's
preface this whole conversationsaying that for most of what I'm
going to say, we don't havegreat data, so we'll have to
rely.
I've done this job for about 30years, so I've seen a lot of
patients with gas and bloatingand I try to keep up with the
literature.
What do we really know?
So activated charcoal can binddifferent chemicals and can bind
(26:42):
medications and may helpprevent a poisoning overdose,
but the data supporting its usefor gas and bloating is
essentially zero.
And then you take activatedcharcoal, your stool is really
dark and you get everybody allexcited because they think
you're bleeding on the inside.
Kate Scarlata (26:57):
So don't use activated charcoal.
Dr. Brian Lacy (26:59):
Exactly.
Just stay away from that.
What about simethicone?
So we know that we give that tobabies for colic, biliary colic
, which is really gas bubblesstretching the colon and small
intestine cramps and spasms.
What does simethicone really do?
What it really does is take abig gas bubble and breaks it
into little gas bubbles.
It doesn't get rid of your gas,but it may help a little bit.
(27:23):
So could you add a little bitof simethicone Can't hurt, but
we don't have great data at all.
Some people use probiotics and aconcept again we kind of
started almost a conversationwith that is that probiotics may
change your gut microbiome, maychange that gut flora, that
delicate balance of good and badbacteria.
But the data supportingbloating is very weak at best.
(27:47):
Matter of fact, if we looked atIBS and looked at 53 published
studies in IBS, probiotics arebarely better than placebo and
don't do much for pain orbloating.
So I don't usually recommendthem and sometimes it makes
bloating worse.
I think watching your diet, Ithink exercising, I think taking
(28:08):
control of your constipationAgain, if it's hard to evacuate
stool, it's hard to evacuate gasand thinking about some of
those other common offenderswe've already discussed.
Dr. Megan Riehl (28:17):
And what about the pharmaceutical treatments?
So there's more rigorousresearch around this.
Antibiotics, the prokineticagents, tricyclic
antidepressants, antispasmodicsare probably the things that if
people were Googling, they wouldfind and bring to their doctor.
What do you use and what mightyou suggest for patients?
Dr. Brian Lacy (28:42):
Now we actually have some data.
So let's talk about data.
So let's think aboutantispasmodics first, with
smooth muscle antispasmodics.
The theory there is that theycan relax the gut and there is
some data showing that smoothmuscle antispasmodics I'll use a
generic name, hyosiamine ordicyclamine as an example might
improve some symptoms of gas andbloating.
And there's one product sold inCentral America that's a smooth
(29:04):
muscle antispasmodic withsimethicone, as you know,
showing that was better thanplacebo.
So there's a little bit of data.
Some people translate that tousing warm peppermint tea.
Peppermint oil helps spasms andcramps, but remember it's not
changing the gas content.
It's really changing how yourespond to the gas.
Could you use antibiotics?
(29:24):
So we use antibiotics forpeople with documented small
intestinal bacterial overgrowth.
I don't recommend it just forbloating in general because
antibiotics have risk and Iwould feel terrible giving
somebody horrible diarrhea likeC difficile clostridium
difficile diarrhea, somebodyhorrible diarrhea like C
difficile clostridium difficilediarrhea.
But antibiotics can definitelychange gut flora and treat small
(29:46):
intestinal bacterial overgrowthand therefore improve symptoms
of gas and bloating.
But I want to have thatdocumented.
The best data for medicationsmight come in the IBS with
constipation field.
We have five FDA approved drugsfor this disorder I'm sure your
listeners are very familiarwith them such as linaclotide or
(30:08):
plecanatide or lubiprostone.
Those are the generic drugs andthe data shows that in all the
studies performed to date, as weimprove IBS and constipation
symptoms, those agentsprokinetic agents, as you
mentioned, Megan also improvesymptoms of gas and bloating.
Is one necessarily much better?
Dr. Megan Riehl (30:30):
Yeah, and we're going to shift in I'm going to
let Kate bring this up but Ithink the constipation so often.
Sometimes patients get stuck ontheir bloating.
But then I'll ask them when'sthe last time you've had a bowel
movement and they're bloating?
But then I'll ask them when'sthe last time you've had a bowel
movement and they're like yeah,I go, I don't know, every five
or six days.
They oftentimes don't evenrecognize.
That's not normal, and so I'lllet Kate take it away from here.
Kate Scarlata (30:52):
Yeah, I mean I would say, and I'm a 30-year
veteran too, Dr Lacy.
And most of my patients areconstipated and it's just.
I don't know if this is anincreasing problem in America,
but I see constipation sofrequently and I wanted to
mention the condition as well,which I'd love you to just
(31:16):
quickly define.
But I am really seeing this asa big driver of bloating the
constipation and maybe evenwhich I think we're seeing in a
lot of constipated patients.
So I'd love you to describe andjust the relationship.
How significant is constipationin this bloating picture from
(31:36):
your clinical experience?
Dr. Brian Lacy (31:38):
Okay, great question.
So a couple of points here.
One is, as you've highlighted,constipation is common we talk
about 15% of US adults atminimum and if you imagine
trouble evacuating stool gas ishandled to some degree the same
way.
So it may be difficult toevacuate gas.
(31:59):
The anal rectal area is verysmart and if the muscles aren't
working properly you may havetrouble evacuating gas.
Your point about dyssynergicdefecation comes to that pelvic
floor.
So what I tell my patients isgoing to the bathroom should be
really easy, right?
What's the big deal?
People go to the bathroom everyday.
It's incredibly complicated,right.
(32:21):
So what I tell my patients isone it has to be an appropriate
time.
So if you're outside of NewYork and you're on 95, that's
probably not the best time, soit has to be appropriate setting
.
Number two, stool has to movethrough the colon normally, and
in most people it does.
Number three you have to beable to sense it normally.
So maybe think about alongstanding diabetic who has
(32:42):
now lost some sensory functionand actually can't sense that
pressure in the rectum.
It's time to go to the bathroom.
They've lost that sensation.
Number four, and this is thekey point in split-second
sequences, certain muscles haveto relax and certain muscles
have to contract.
And if they are a split-secondoff sync, patients think they're
(33:02):
pushing to evacuate, butinstead the muscles are clamping
down, they're holding back andthat's what's dyssynergic
defecation, it's out of sync,it's synergy, so it's out of
sync, dyssynergic.
And a key teaching point hereis that those patients, as you
well know, don't get better withmedications.
Usually it's physical therapy.
(33:23):
But when their physical therapygoes well and their
constipation gets better, theirbloating always gets better as
well, hand in hand.
Dr. Megan Riehl (33:32):
Another team member, the pelvic floor
physical therapist.
They get another shout out andyou know I just had a patient
today actually, that I wasdescribing how, you know, pelvic
floor dysfunction could be apart of the puzzle.
This is a patient that hasconstipation and she hadn't yet
met a doctor that had done arectal exam.
(33:55):
She's coming up on a firstcolonoscopy and we really gave a
playbook today around conceptsto talk with her doctor about,
because she hadn't even thoughtabout pelvic floor dysfunction.
Nobody had ever mentioned thatbefore and it really can be a
big part of the picture,especially for women that have
(34:17):
had babies or a variety offactors that can impact the
pelvic floor.
Dr. Brian Lacy (34:23):
Absolutely so.
I think it is overlooked.
I think some people don't wantto open Pandora's box and start
talking about this, because it'sa little bit of a longer
discussion.
So you just did your patient agreat service today.
That's wonderful, right.
Very lucky.
They met you Well there we go.
Kate Scarlata (34:38):
I love that.
Just to go back toabdominophrenic dysnergia, did I
say that right?
Dr. Brian Lacy (34:44):
Absolutely.
Kate Scarlata (34:45):
Okay, outside of maybe trying diaphragmatic
breathing, are there any otherevidence-based therapies for
this?
I should have asked you earlier, but before I wrap up anything,
the simple answer is no.
Dr. Brian Lacy (35:00):
So we do think about this as being this wiring
problem where subconsciouslysomething has happened, and that
gas that stretches the smallintestine or colon again.
Normally your diaphragm goeshigher in your chest, your belly
cavity gets bigger and yourabdominal wall muscles contract
to keep your belly flat.
(35:20):
It's the exact opposite.
Why that occurs, we don'treally know.
Some prior infection, someinsult, some learned behavior?
We really don't know why itoccurs.
The best data we have but wedon't have much data, as we
already discussed is probablydiaphragmatic breathing.
It seems to make sense and atleast in clinical practice by a
lot of smart providers it works.
(35:41):
Some people have triedelectrical stimulation to the
abdominal wall.
That doesn't seem to work verywell.
Some people have triedmedications to fix that, but the
medications really don't work.
So I think we really need tofocus on behavioral strategies
for this.
Kate Scarlata (35:56):
There you go, Megan.
Let's go, let's go.
You're the valued team memberin this case.
So real quickly for ourlisteners.
Dr Lacy brought up some reallykey factors from the diet that
may be a player for bloating,lactose malabsorption.
We drink a lot of milk.
We love our ice cream.
There's lots of lactose-freeoptions, but if you're
(36:19):
experiencing bloating, thatmight be the first thing you
might want to look at.
There are some fibers that aresmall fibers that are fast food
for our gut microbes.
Dr Lacy brought these upgalactans or
galactoaligosaccharide.
These are common in legumes.
We also have another type offiber called fructans, and
(36:39):
they're common in garlic, onionand wheat in the American diet.
Those are also fast food forour gut bacteria, so those two
types of fibers can beproblematic for bloating.
The other consideration isramping up fiber and your goal
to have the best gut, healthiestmicrobiome in the whole entire
(37:00):
universe.
Go slow, make sure you'readding water and then be careful
of those sugar-free mints andadditives that you might find in
various granola bars andsupplements, because those are
poorly absorbed too, and thosetypes of sugars that are poorly
absorbed can be food for yourgut microbes, and what they do
(37:23):
is they make gas, and gas makesyou feel bloated.
And there you go.
A couple other lifestyle tipsthat I bring up with my patients
is walking, you know.
Go for a nice evening walkafter dinner.
That can stimulate colonicmotility and may move through
some of that gas.
And another tip that I oftenencourage and we did include it
(37:44):
in the Mind Your Gut book is agentle abdominal massage which
sometimes can help move the gasfurther down into the rectum for
easier passage.
So, Megan, what about you?
Dr. Megan Riehl (38:03):
Ye s and I love that Dr behavioral himself a
simple gastroenterologist.
Kate Scarlata (38:07):
It's about the furthest thing from that, hello.
Dr. Megan Riehl (38:12):
And another equally simple
gastroenterologist, Dr BahaMoshiree, she and I.
She's another motilityspecialist.
You know, back in April the NewYork Times just ran this
article on gas and bloatingwhile traveling and she was
featured.
She's a fabulous Atrium Healthgastroenterologist who explained
(38:33):
more of the physiology aroundit.
So the high altitude of beingon an airplane might slow down
the muscle contractions that areneeded to kind of push the
digestive process through.
So I had the privilege of beinga part of this New York Times
article as well, because of thebehavioral sides of gas and
bloating while traveling, and Igot to normalize that.
(38:53):
You know, if you're somebodythat feels these symptoms while
traveling or you've wondered wow, when I travel I get
constipated, I'm more gassy, I'mbloaty, and I got to be quoted
saying trust me, you're not theonly one farting on an airplane.
Never in my life did I thinkthat would be the quote that
came out.
But the reality is, if you'veever seen a chip bag on an
airplane and it expands, that'swhat can happen to all of us,
(39:23):
and especially those that areprobably more prone to IBS or
other digestive symptoms.
And I really think that thenormalization that even if
you're not traveling but you'rein class.
Now you don't want to be theperson that's just letting your
fart fly in class.
But standing up, leaving theroom, excusing yourself to go to
the bathroom, sucking in,holding your stomach, excusing
yourself to go to the bathroom,sucking in, holding your stomach
(39:44):
, holding your gas when you'reout and about, it's not good.
And you're not alone.
Other people are experiencingthis.
Dr Lacy highlighted thestatistics of people that are
experiencing these symptoms andif you're doing that, you're
more likely to just worsenbloating, worsen your
constipation.
So in the real household wehave normalized that everyone
poops, everyone toots.
(40:04):
My two-year-old says it to meall the time Mama, I tooted and
I'll say that's great.
And I want everybody to kind offeel destigmatized in their
normal bowel habits and theirpatterns and this can go a long
way.
So you know, if you're seatedaround the dinner table talking
about things, normalize ourbodily processes, make sure that
we're having conversationsabout, especially with your kids
(40:26):
.
Are they pooping at school?
Are they going to the bathroom?
Do they feel uncomfortable atschool, so that we can get them
the help that they deserve at ayoung age instead of what I'm
sure the three of us experiencewhere we're seated with.
You know 50, 60-year-olds thatare just starting their pathway
of addressing these symptoms.
So, as we've kind of mentioned,gentle yoga, going for walks,
(40:50):
thinking about the foods thatyou're eating, but if your belly
is bothering, you don't ignoreit.
Get help it might not be with agastroenterologist, it might be
with a dietitian or abehavioral health specialist and
just know that it's okay to letit go when you need to, and you
know that we all support that.
As we wrap up this incrediblyinformative podcast today with
(41:15):
Dr Lacy, we like to wrap up byasking each of our guests the
following questions.
So, Dr Lacy, what is somethingthat you prioritize when it
comes to your overall health andyour wellness?
Dr. Brian Lacy (41:29):
So first of all, thank you.
This has been a wonderfuldiscussion.
Your listeners are very luckyto have you both.
I learned a lot.
So what do I do?
I guess can I say three or fourlittle things.
Dr. Megan Riehl (41:41):
Please.
Dr. Brian Lacy (41:43):
So some seem.
I'm sure your listeners haveheard all this before.
So one I do prioritize sleep,and the reason being is that
poor sleep changes sensorythresholds in your gut and if
(42:03):
you don't sleep well your gutfeels worse.
So try to prioritize sleep.
I try to exercise, so I dosomething six or seven days out
of the week and it could just bethat wonderful half-hour walk
with your family after supper.
It doesn't mean three hours atthe gym.
Exercise comes in differentforms.
It could be playing ping pongwith your family, it could be
any number of things, but dosomething physically active.
Number three I turn devices off.
People laugh at me.
(42:23):
I think I have four apps on mycell phone.
Sorry, guys, but turn yourdevice off on vacation and at
night at home.
Don't stay connected.
You need to focus on yourfriends and your family and
yourself.
And number four I guess what Iwould say, other than try to eat
healthily you'd be prod, Kateis I try to express gratitude.
(42:43):
You know, all of us are solucky in so many different ways
and even if you're having a badday, if you do one nice thing to
somebody every day, expressgratitude to that checkout clerk
, to the person who helped youat the pharmacy.
That one minute interaction,that 30 second interaction of
expressing gratitude to somebodyelse completely changes that
(43:04):
person's day and my day as well.
Right, we have so manywonderful things around us.
So, at 30 seconds, that oneminute of gratitude each day can
be just a life changer.
Dr. Megan Riehl (43:14):
And this is why he's such a gem.
Kate Scarlata (43:17):
I know it's amazing.
I'm like geez Louise the nicestguest, the nicest person and
everyone that knows you saysthat about you, just so you know
like the nicest, kindestindividual on the planet.
So I love what you do forwell-being.
I'm going to take those, everysingle one of your tips, and
(43:40):
incorporate them into my life.
I do get my sleep, but I'm badwith the device, but that was
excellent, thank you.
Thank you so much for being ourguest today.
You shared so much around thistopic that is confusing for
people and worrisome for people.
Just leading us down ascientific path, which is really
(44:01):
the goal of this podcast, is toprovide the real truth, the
real science as we know it today.
So thank you again for spendingtime with us on our podcast.
Dr. Brian Lacy (44:12):
Absolute pleasure and thank you for
having me.
Delighted to do it, and bestwishes to all your listeners.
Dr. Megan Riehl (44:18):
So next up we are talking with Dr Darren
Brenner, gastroenterologist andprofessor of medicine at
Northwestern University inChicago, Illinois, and it really
features you know it's going toswing right in from bloating to
constipation, so we're going totalk about everything you need
to know about constipation.
Thank you for joining us as wegrow this gut health community.
(44:40):
We hope you enjoyed thisepisode and don't forget to
subscribe, rate and leave us acomment.
You can also follow us onsocial media @TheGut Health
Podcast, where we'd love for youto share your thoughts,
questions and experiences.
Thanks for tuning in, friends.
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