April 1, 2025 • 47 mins
Join us as we discuss effective non-diet focused methods for IBS relief. In this episode, Kate and Dr. Riehl review key factors on how gender can influence common symptoms of IBS.
Hormones significantly influence IBS symptoms, with women being diagnosed 2.5 times more often than men, in part due to differences in gut function and pain perception.
This episode features the following key discussion areas:
• Women's fluctuating estrogen and progesterone levels affect gut motility and pain sensitivity throughout the menstrual cycle
• Visceral hypersensitivity causes normal digestive sensations to be interpreted as pain - like a car alarm going off unnecessarily
• The "microgenderome" refers to gender differences in gut microbiome that may contribute to women's higher rates of IBS and autoimmune conditions
• Gut-directed hypnotherapy helps reprogram the subconscious mind to interpret gut sensations more accurately, with 70-80% improvement rates
• Pelvic floor physical therapy can help address muscle tension that contributes to both constipation and diarrhea symptoms
• Non-diet approaches including medications, supplements like enteric-coated peppermint, and lifestyle factors are effective IBS management tools
• Regular exercise (especially in nature), adequate sleep, and stress management techniques complement other treatments
For more information on IBS-C treatments, check out our dedicated three-part series in episodes 14, 15, and 16.
This podcast has been sponsored by Ardelyx and Nerva by Mindset Health.
References:
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 and
Nerva by Mindset Health.
Maintaining a healthy gut is keyfor overall physical and mental
well-being.
Whether you're ahealth-conscious advocate, an
individual navigating thecomplexities of living with GI
(00:20):
issues, or a healthcare provider, you are in the right place.
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 (00:40):
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 (00:52):
Hello, and I'm Kate Scarlata, a GI dietitian,
and April is IBS Awareness Month.
In today's podcast we're goingto cover some non-diet related
treatments for IBS and reallyexpand on factors that
contribute to symptoms outsideof diet.
But of course, before we delveinto non-diet approaches, it's
(01:13):
important, especially as a GIdietitian, for me to acknowledge
that many people prefer dietarytherapies for IBS.
But there are occasions whenyou know a strict food
elimination diet really isn'tappropriate or may not even be
effective for certain patients.
Reducing dietary intake canreally pose risks for
(01:33):
malnutrition and, for somepeople, even amp disordered
eating, which is not ideal, sono.
So today we'll focus on othertools and factors that impact
IBS.
Dr. Megan Riehl (01:48):
Yeah, you know so many of our patients, I think
, sometimes with diet can feeloverwhelmed and, as you
mentioned, we do see a highprevalence rate of disordered
eating and eating disorders inthe IBS patient population.
So today's episode is for allof you listeners out there that
might want to think a little bitbroadly in terms of treatment
(02:09):
approaches.
But, as we said, we're going tostart by learning a little bit
more about the genderdifferences in IBS and we
haven't delved into this beforeand so the role of hormones and
symptom fluctuations and whysome people experienced
heightened pain in their gut andit may not be surprising, but
(02:30):
IBS is more common in womencompared to men, lucky us.
And research suggests that 60to 70 percent of people
diagnosed with IBS are female,or a prevalence ratio of I
always love these the 2.5 to 1,so the half of a woman.
So why is this?
Kate Scarlata (02:48):
So really there's a couple reasons.
There's probably more than acouple, but we're going to delve
a little bit into these coupleof reasons, and one of the first
big reasons is difference inprimary sex hormones.
So women have a differenthormone profile than men and
this can affect gut motility andeven pain sensations.
So women's primary hormones areestrogen and progesterone, and
(03:12):
you might know that estrogenregulates the menstrual cycle.
It also promotes breastdevelopment and supports bone
health.
It's important for mood andcognition and also our skin
elasticity, which we of coursewant to prevent those wrinkles.
We won't talk about it though,not today, not today, all right.
(03:32):
The other hormone, progesterone, is also involved in regulating
the menstrual cycle andsupporting pregnancy.
It also affects mood and has acalming effect, which we love on
the brain.
For men, testosterone is theprimary male sex hormone, and
when I say these are primary,you know, keep in mind women
have testosterone too, but theseare, you know, the more
(03:54):
prominent hormones based ongender, and so, testosterone
being the primary male sexhormone, it's responsible for
development of malecharacteristics such as a deep
voice, muscle mass, facial hair.
We don't really want that aswomen, I guess.
Well, we want the muscle.
Dr. Megan Riehl (04:10):
We want the muscle.
Muscle mass is important.
Look, that's got to lift thoseweights?
Kate Scarlata (04:15):
Exactly yes.
So women, don't forget, you'relosing about a 1% decline in
muscle mass from 35 years oldand older, so make sure you're
lifting.
That's really important.
So research indicates that themale sex hormone, testosterone,
might have a protective effectagainst IBS and maybe that
explains why men are less likelyto experience this disorder.
(04:39):
For women, progesterone andestrogen can influence how the
digestive system functions, sothey play a big role here in
motility.
They interfere with smoothmuscle contraction in the gut
and, again, may play a big rolein why women have more IBS,
particularly IBS-C, than men,and men are more, you know, at
risk for IBS-D or diarrheapredominance, so IBS-C being
(05:03):
constipation predominant men aremore at risk for IBS-D.
Dr. Megan Riehl (05:12):
So like we're not saying that, you know both
sexes can't have either one, butwe do see that constipation
predominant IBS a bit morefrequently in our female
patients.
Kate Scarlata (05:20):
Absolutely, and so I'm not going to dive deep
into the menstrual cycle.
In all the different phases itgets complicated and the hormone
fluctuations are quitesignificant.
But let's talk a little bitabout some of these changes.
So in the pre-menses phase orthe luteal phase we'll focus on,
progesterone is dominant and ifan egg is infertilized we have
(05:42):
a rapid decline in estrogen andprogesterone and this can lead
to exacerbation of bowelsymptoms.
It can be constipation ordiarrhea sort of dependent on
the hormone profile.
But we tend to notice anincrease in bloating here and
probably related to progesterone.
During menstruation, this isthe lowest levels of estrogen
(06:04):
and progesterone and this canexacerbate bowel symptoms in
susceptible people and we oftensee an increased amount in some
of these hormone interactions.
(06:24):
There are other hormones thatare related as well, with lower
progesterone levels reallyleading to bowel symptoms, often
with diarrhea alongside thepain.
In menopause there's a declinein sex hormones and this lines
up interestingly with thedecline in IBS incidence.
So less incidence of IBS in themenopause phase, but we do see
(06:50):
a higher incidence ofconstipation.
So if you are an IBS-C patientand you've gone through
menopause, you may find thatyour constipation is a little
bit exacerbated.
So we know this.
Estrogen and progesteronereally fluctuate through the
cycle and can really impact ourgut function.
Those pesky sex hormones, andprogesterone in particular,
(07:12):
slows gut motility and can leadto constipation and bloating and
worsening, as I mentioned, ofIBS symptoms.
During menstruation IBSsymptoms may worsen and cause
softer bowel movements in somepeople, more severe bloating and
abdominal pain.
Estrogen, as I mentionedearlier, can really impact that
(07:32):
gut-brain access, which is thatcommunication system between
your gut and your brain, andwhen estrogen is high it can
make people more sensitive topain.
So this might explain why somewomen feel increased discomfort
or bloating around their cycle.
And it's not just in your head,it's your hormones, right Megan
?
Dr. Megan Riehl (07:50):
That's right.
That's right, and I've had somany patients that will say what
is going on with my IBSsymptoms during my cycle.
And this, as we've justhighlighted, is exactly what's
happening.
You're having a lot of hormonefluctuations.
Your behaviors may also bechanging.
When you're in a lot of pain,you might not be moving around
(08:11):
as much, so you might foregoyour exercise a bit, and so some
of these changes can lead us toopportunities to keep going.
Maybe you don't do a heavyworkout on the first couple of
days of your cycle, but if youcan get a walk in, that's
important, certainly nourishingyour body but also give yourself
(08:32):
rest.
Taking a couple of days, acouple of times a month, to do
what's best for you emotionallyis really key here too, because
obviously we know those hormonesaren't just affecting our IBS
symptoms physically, butemotionally it can be a bit
taxing as well.
So we want to be gentle.
Kate Scarlata (08:51):
Absolutely!
Dr. Megan Riehl (08:52):
So you know, another factor where gender can
impact our IBS symptoms is ourgut sensitivity.
Hopefully we're going to giveyou some validation here in
terms of how this gutsensitivity impacts our
functioning.
So I want you to imagine thisas we start to talk about this
concept.
Think about your gut like a caralarm that's extra sensitive,
(09:16):
and for most people, a littlebump in the road doesn't set it
off.
So you're driving down, you hita pothole, car alarm doesn't go
off.
Unfortunately, though, forpeople that are living with IBS
or many other GI conditions,even a small sensation like a
gas bubble, or even the normaldigestive process, some mild
(09:37):
bloating, you're going to feelthis way more intensely.
Your gut nerves way moreintensely.
Your gut nerves, all thosenerves that line your intestinal
tract, are more reactive, andthey send stronger pain signals
up to your brain, and thereforethe alarm is going off way too
often, and this is unfortunate.
(09:59):
This is not helpful for us aswe're going through our
day-to-day activities, and womenare generally more at an
increased gut sensitivitycompared to men, and so this can
, I think, again lead to some ofthe higher likelihood of
developing IBS, and studies havesuggested that women may have
more pronounced visceralhypersensitivity.
(10:20):
So the car alarm is thisconcept, and we're going to dive
a little bit into this.
Heightened sensitivity to painor discomfort in your gut is
called visceral hypersensitivity, so these are real pain
symptoms.
This is not in your head, andso any of our listeners out
there that have ever experiencedbeing told you know it's just
(10:43):
IBS.
And with it being IBS AwarenessMonth, we want to highlight it
is never just IBS.
It is something that'shappening in your brain, but
it's because of the brain, gut,access, this bidirectional
communication pathway and a veryreal sensation called visceral
hypersensitivity.
And so, in addition to womenexperiencing this, men, you're
(11:07):
not immune either, but weexperience this typically at a
higher prevalence in women, andagain, it can contribute to all
kinds of additional IBS symptoms.
And other factors that cancontribute include our genetics
and stress, and so there are alot of factors that can
(11:27):
contribute to how one may besusceptible to visceral
hypersensitivity and how some ofthis kind of bidirectional
communication pathway betweenyour brain and your gut gets a
little bit out of whack.
And, as we've talked about,there are a lot of factors here.
Kate Scarlata (11:43):
You know, I love when you say, and I'd love you
to give our audience, ourlisteners, a little Dr Megan
Riel information, and that is,you kind of talk about the gut
and brain screaming at eachother, because that's visceral
hypersensitivity.
Dr. Megan Riehl (11:56):
That's a good example right, it's a perfect
example.
And so you know, when you'regoing through the normal
digestive process and let's sayyou and I both go out to lunch
and I have IBS but you do not,and so as we're having our lunch
, we're eating very similarthings I feel the gurgle in my
(12:18):
stomach and now my brain is intune with what's happening down
there and those sensations thatare normal, benign sensations,
are sending signals up to thebrain and in a way it's kind of
yelling hey, did you feel that?
Feel that one, feel that one.
(12:39):
And what happens with visceralhypersensitivity is the brain
has a very hard timedownregulating those signals.
So what may be a normalconversation in your body?
So you're having your lunch,you're feeling a little gurgle,
you may even toot and just passthat gas, not think about it at
(12:59):
all, and your gut is saying, hey, did you feel that?
And your brain is saying, yeah,I did, don't worry about it.
Onward we go and you don'tthink about it anymore, whereas,
poor me, I'm sitting herefeeling it, my pain is starting
to increase, the sensations arestarting to cause more
discomfort and my brain isamplifying this experience,
(13:23):
saying, yeah, this is a reallybad idea.
We shouldn't have even come tolunch.
You know, now you're reallyfeeling this.
Oh, good job, you've gottenyourself into this predicament
and that's where we seeincreased levels of anxiety and
stress.
That comes along with, you know,a good old lunch with two
friends, and so visceralhypersensitivity is a very real
(13:46):
experience.
That is happening because,you're right, my gut is
screaming up to my brain and mybrain is not turning down the
amplification of what's going ondown there.
This is a very significantfactor and goal for treatment in
working with somebody likemyself is we can utilize our
(14:07):
brain-gut behavioral therapiesto actually calm down and turn
down the volume on thatcommunication.
And that's a very unique thingthat, yes, some medications can
do.
Some of our neuromodulatorsthat we've talked about in other
episodes, certain medicationscan help with this, but
sometimes we need to also addthe behavioral therapy to maybe
(14:29):
calm down the anxiety thatassociates with these sensations
, to have you experience apleasant lunch with friends, to
not let that lunch become atrigger for anxiety which might
even ramp up that visceralhypersensitivity before you even
put an ounce of food in yourmouth.
So this is all.
Obviously I get excited aboutthis and really a true target of
(14:54):
therapy, that when peopleunderstand this concept, they
feel validated and then theyalso feel hopeful that there are
treatments that can bebeneficial to turn down that
communication pathway.
Kate Scarlata (15:10):
Absolutely.
It's just having that awarenessis so important, like my gut
and brain are screaming at eachother.
I'm always kind of talkingthrough this with patients that
it's okay if you have a gasbubble, it's okay if there's a
little gurgling.
Dr. Megan Riehl (15:19):
That happens.
Kate Scarlata (15:21):
It's normal.
Yeah, People pass up to 14 timesgas a day and so just kind of
having that barometer just likeleaning into these normal
digestive processes, especiallylike through a reintroduction
phase of a diet where you'readding back FODMAPs.
It's like FODMAPs produce gas,so be prepared, there's going to
(15:41):
be a little more gas.
Just don't get ramped about it,because that ramping can really
make a difference.
So we've talked about hormonesand visceral hypersensitivity.
As you know, these key sort ofdifferences we often see in
gender area which is so close tomy heart because I love gut
(16:07):
microbiome science is that we'relearning that men and women
have different gut microbes andthat these microbes can respond
to things like stress andhormones and nutrition
differently or in unique ways.
So men typically have a morediverse microbiome, although the
research shows that as we agethat seems to level out a little
bit.
But, very interestingly,research shows that women are
(16:32):
more likely to suffer fromautoimmune diseases and these
conditions are often linked tothe gut microbiome and gut
microbiome changes.
So there's a new term and it'scalled microgenderome and it
refers to the concept ofsex-specific differences in the
microbiome and its interactionswith hormones, our immune system
and even disease risk.
And the concept of themicrogenderome is relevant
(16:56):
because many diseases reallyshow these sex-specific
prevalences, such as IBS and, asI mentioned, many autoimmune
diseases.
So, because there's genderdifferences in the microbiome
that may contribute to diseasesusceptibility, this really can
help explain why women are moresusceptible to bloating, more
(17:18):
susceptible to pain as well, andmaybe even why women may report
their IBS-related issues morefrequently.
Dr. Megan Riehl (17:27):
And you know I get asked this all the time and
that's do you see women in yourpractice more than men?
And the honest answer is yes,but we still see a lot of men
too, and a big part of this maybe that women are a little bit
more proactive in terms ofseeking answers for their
symptoms, and I think that's anamazing thing.
(17:49):
We have to be ourself-advocates and we don't want
anybody out there suffering,and I think sometimes women
might be a little bit more opento working with a psychologist,
especially if their referringprovider has done a really good
job at explaining that thepsychologist that they are
referring the patient to is, youknow, somebody that specializes
(18:13):
in this health condition.
So all of our listeners outthere that are clinicians and
medical providers, when you makethat referral, highlight that
you know these are experts.
GI psychologists are experts inbrain- gut behavioral therapies
that are going to target thesephysical symptoms that you have,
and so that's why, then, whenwe do get men through the door,
(18:36):
we can help you too, and reallyeven the research shows that men
and women benefit just as muchfrom our treatments.
So let's take gut-directedhypnotherapy as an example, and
we're going to dive into this alittle bit more obviously close
to my heart, and the researchhas shown that gender doesn't
determine who is a goodcandidate for this type of
(18:56):
therapy.
So we just want to highlightthat to all of our fellows out
there.
If you're struggling with yourIBS, I'm talking to you too.
There's a lot that we can do tohelp.
Now, all of this talk about howus women, women who we have
babies, we have menstrual cyclesyou know we deal with so much.
(19:18):
Our human body is so remarkablyresilient and obviously,
because of the hormones thatwe're born with, it's stacked
against us a little bit more.
While, unfortunately, there'sno definitive answers on how
pain is perceived differently inthe sexes, we do know that we
(19:40):
are just more susceptible tomore severe, more frequent, more
long-lasting pain compared tomen and, as we've highlighted,
hormones is the answer here inmany ways and that that estrogen
and progesterone can actuallyamplify our pain sensitivity,
while men have higher levels ofandrogens.
(20:02):
Those are those sex hormoneslike testosterone, and we've
seen in experimental studies howtestosterone has been shown to
act as a natural painkiller.
So men actually have thesenatural born painkillers in
their bodies that are helpingthem.
So imagine if we had some ofthese, with childbirth and our
(20:23):
menstrual cycle.
Gosh, we would be ruling theworld.
I think,
Kate Scarlata (20:27):
I agree, I agree,
Dr. Megan Riehl (20:29):
and even without them, we can rule the
world.
Kate Scarlata (20:34):
That's right, that's right.
Dr. Megan Riehl (20:37):
No shortage of women empowerment here on The
Gut Health Podcast.
Kate Scarlata (20:42):
Exactly so.
We know hormones, visceralhypersensitivity, the microbiome
, really shedding the light onso many different factors that
impact the pain we feel and howour gut moves, and how these
hormones actually can reallyimpact our brain and well-being
and sense of calm even so, veryinteresting stuff here today.
Dr. Megan Riehl (21:05):
Yeah, and I hope that in understanding
visceral hypersensitivity, youreally do feel that validation
and that hope and there's reasonand you know how that is a
specific treatment target forsome of the medications that we
use, for our lifestylesuggestions, for our brain-gut
(21:25):
behavioral therapies like gutdirected hypnosis and with this
greater understanding of that,it really does then open up some
of the remedies that we maysuggest.
And certainly on our podcast wetalk about the science-based
remedies.
So everything that we'retalking about are very specific
(21:48):
to what science has shown us.
Kate Scarlata (21:51):
I think it's also really an interesting factor
that women's health reallyhasn't been studied as
significantly as men's health.
And I don't want to getpolitical here, but there are
some limitations because wereally haven't delved into the
female body as much as we havestudied the male body, and so
(22:12):
the reality is that some of thisscience really needs to be
expanded, and our hope is thatthat will be happening, you know
, sooner than later, and there'sa lot of women out there in the
scientific community reallypushing for this Gynecologists,
pelvic floor physical therapistsand reconstruction pelvic
(22:35):
surgeons and colorectal surgeonsso there is going to be a
movement here.
But I think the reality is thatthere's more research to be
done to really help women, and Ijust want to make that point.
Speaker 3 (22:51):
When it comes to irritable bowel syndrome with
constipation or IBS-C, there'sno one-size-fits-all treatment.
If you're not satisfied withyour current IBS-C medication,
it may be time to try somethingdifferent.
Ibsrela (tenapenor) is aprescription medicine used to
treat adults with IBS-C.
Ibsrela works differently tohelp relieve the constipation
and abdominal symptoms of IBS-Cand could be the right.
Works differently to helprelieve the constipation and
abdominal symptoms of IBS-C andcould be the right option for
(23:13):
you.
Ready to try somethingdifferent for your IBS-C
symptoms?
Ask your doctor about Ibsrela.
Do not give Ibsrela to childrenless than six.
You should not give Ibsrela topatients six to less than 18
years.
It may harm them.
The most common side effect isdiarrhea, sometimes severe, and
your child could get severedehydration.
Stop taking Ibsrela and callyour doctor if you develop
severe diarrhea.
(23:33):
Do not take Ibsrela if you havea bowel blockage.
Tell your doctor if you arepregnant or breastfeeding and
about the medicines you take.
Other common side effectsinclude swelling or a feeling of
fullness or pressure in yourabdomen, gas or dizziness.
Learn more at Ibsrela.
com/ PI or call 1-844-IBSRELAand press option 4.
Dr. Megan Riehl (23:51):
In my practice I see so many patients
struggling with IBS and onething is clear, managing IBS
with diet and medication alonedoesn't work for everyone.
As a GI psychologist, I knowthat the brain-gut connection
plays a crucial role in IBSsymptom management.
I refer my patients to Nerva, agut-directed hypnotherapy
(24:12):
program designed to retrain theway the brain and gut
communicate.
Many of my patients have neverheard of this approach, but once
they try it they find it's easyto incorporate into their
routine.
Most importantly, it deliverslasting results.
Nerva is easy to access via anapp on your smartphone and takes
(24:32):
just 15 minutes a day.
Beyond IBS symptom relief, theylove that Nerva helps with
stress and overall well-being,giving patients a tool they can
use for life.
With GI specialist wait timesoften long, a research-backed
and accessible tool like Nervacan provide meaningful support.
It is referred by thousands ofhealthcare practitioners and has
(24:55):
helped hundreds of thousands ofIBS patients worldwide.
If you're a patient, you candownload the Nerva app today
with a seven-day free trial.
If you're a healthcare provider, you can request free clinician
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(25:16):
Just visit nervahealth.
com/ clinicians to learn more.
Kate Scarlata (25:23):
So let's talk a little bit about some of the
evidence-based treatments wehave today.
And, of course, for IBS there'sa number of prescription drugs
that really can target thosespecific symptoms whether it be
bloating or abdominal pain ordiarrhea, constipation and
really selecting a medicationthat can help target those
(25:44):
specific symptoms.
And that's how we typically dotreat IBS.
And we've really delved intothe role of hormones and we
don't want to discount that.
So if you feel that hormonesare playing a bigger role, there
are physicians that you canspeak with.
There's a number of differenthormones.
So the sex hormones you mightsee a gynecologist.
(26:04):
You might see anendocrinologist as well.
There's thyroid hormones thatcan affect the gut as well.
Women are more prone to thyroidfluctuations and autoimmune
thyroid conditions.
So these are all differentphysicians that you can see for
the targeted IBS treatments.
Primary care doctors are greator a gastroenterologist can help
(26:27):
you select the medications totarget.
And we also want to reallyemphasize that just because you
try one medication and itdoesn't work say you have a
particular drug that's workingfor constipation or diarrhea
that's not really doing its joblet the doctor know you're not
where you want to be.
It's important that you feellike you are living your best
(26:49):
life despite having a chroniccondition right.
So work with a good team.
Expand the team if you need to,if you really think these sex
hormones are a big line item foryou, and move from there.
Other supplements that one cantry would be enteric coated
peppermint can really targetabdominal pain, relaxes the
(27:10):
smooth muscle.
Fiber supplements can work,targeting the right fiber
supplement.
In IBS.
The one with the best evidencereally is psyllium husk.
Sugarcane fiber also has gooddata but it's a little difficult
to get here in the US but forthose listeners in Australia,
sugarcane fiber has evidence aswell to work with IBS in helping
(27:32):
manage constipation.
Psyllium also works well withdiarrhea, so it can actually
soak up some of the liquids inthe gut and soften, kind of make
a more formed stool.
Laxative therapies whether theybe osmotic laxatives that pull
water into the gut or astimulant laxative that helps
kind of propel the gut inmovement those can be used along
(27:54):
with the guidance of yourhealth professional.
There's antidiarrhealmedications such as loperamide,
and that can help controldiarrhea.
Again, run these ideas throughyour health professional.
And then we also haveneuromodulator medications, and
these are prescribed againeither by your
gastroenterologist, your primarycare doctor or even a
(28:15):
psychiatrist could recommendthese.
These can be targeted to helpwith some of the anxiety and
depression, but for IBS they'rereally targeting those pain
sensations, that visceralhypersensitivity in the gut, and
so these might be tricyclicantidepressants or selective
serotonin reuptake inhibitors orSSRIs, so managing some of the
(28:39):
potential psychologicalmanifestations that often
co-occur with IBS, but oftensignificantly the pain.
Probiotics have mixed data forIBS, but certainly worth a try,
generally very safe.
Align, for instance, has someevidence to help with global IBS
symptoms, so something you canexplore with your healthcare
(29:02):
team.
And those are just some of thetreatments that you can have in
your toolbox that are non-dietrelated, because, again, we have
plenty episodes on diet.
Feel free to listen to those.
But these are really targetedto the discussion points that we
wanted to talk about today and,in line with that, we do have
(29:23):
an IBS-C Series.
So, if you're interested, checkout episode 14, 15, and 16,
where we really identify a lotof the different treatments,
from diet, behavioral tomedications, as well as
exploring really an interestingconversation with Erin Judge,
who is an IBS-C patient.
So take a listen to those aswell.
Dr. Megan Riehl (29:45):
Those episodes are great and really dive a
little deeper into what you'vementioned here.
And just to highlight that, alot of times with medication and
supplements, it's aever-evolving conversation.
Unfortunately, a lot of timesyou don't start on something at
diagnosis and remain on that forthe rest of your life, and so
(30:05):
if you are somebody that hasbeen just kind of trucking along
, getting minimal improvementsbut still suffering with some of
the other symptoms, please talkwith your team, because
oftentimes with a little bit ofwork and good communication, we
can get even better improvements, and some of that may include
working with somebody like meand incorporating some of our
(30:27):
brain gut behavioral therapies.
So let me talk a little bitabout that, and while there are
a number of brain gut behavioraltherapies that you've probably
heard of, like GI-specificcognitive behavioral therapy,
mindfulness-based interventions,I'm going to really highlight
gut-directed hypnotherapy todaybecause it tends to be the
(30:49):
treatment that I start with whensomebody is bringing up their
pain, when they are somebodythat is experiencing a lot of
physiological tension, and I'lltell you why.
Visceral hypersensitivity is abig piece of this.
But I do want to highlight thatthere was a really fascinating
study that if you've ever heardme talk, I bring this study up a
(31:10):
lot because it highlights theeffectiveness of both the low
FODMAP diet and gut-directedhypnotherapy, but I think with
benefit moving toward thegut-directed hypnotherapy piece,
because it doesn't involve anydietary restriction.
And so, Dr.
Simone Peters, any dietaryrestriction.
(31:33):
And so Dr Simone Peters, who isreally a trailblazer in the
world of GI psychology, sheconducted this study comparing
the low FODMAP diet togut-directed hypnotherapy and
found that 70 to 80% of theparticipants had improvements in
their symptoms of IBS.
But notably, the gut-directedhypnotherapy provided lasting
benefits, again without thedietary restrictions, and so
(31:57):
this is a really valuablealternative for patients,
especially those that may have ahistory of disordered eating or
who really again draw thatconnection between their stress
and their symptoms.
So when I see a patient fortreatment we do a nice long
initial consultation and I'mlearning a little bit more about
(32:17):
them.
And when I have a patient thatacknowledges I have a really
hard time relaxing.
In a lot of my patients I canpredict I bet you have IBS-C,
because when we think aboutconstipation and holding in and
the bearing down in the bathroomthat they describe and that the
(32:38):
stool is backed up and maybethey've had a recent abdominal
x-ray and they're like yeah, mystudy showed that I'm full of
beep, and I highlight that,Yeah, I bet you're living with a
level of tension that is justyour baseline.
And my other trick that I loveto do is I'll tell them drop
(32:59):
your shoulders for me right now.
Do this to listeners too,because I bet they were up.
We just kind of live in thisstate of fight or flight.
We're ready to go, and whenwe're sitting here having a
conversation there's no need forour body to be holding such
tension.
And hypnotherapy can really bebeneficial over time at helping
(33:21):
patients to get their body backto a baseline that is actually
kind of relaxed.
And so many times this is sosatisfying as a therapist to you
know, have somebody that hasnever felt deep relaxation or
has released a lot of physicaltension that they've been
(33:42):
carrying for years, to have themsay you know, now I feel
relaxed.
I can say that like I'velearned how to relax, and it is.
It is certainly a interventionthat takes time and practice and
commitment over the course of acouple months, but what you can
(34:02):
gain from it is prettyremarkable.
So I wanted to illustrate alittle bit about what hypnosis
does and how it works.
And so to do that, Kate, do youremember your childhood best
friend's phone number?
I do, Lisa P.
All right.
So when's the last time youwould have thought about that
(34:24):
phone number?
Kate Scarlata (34:25):
You know, a long, long time ago, at least 20
years.
Dr. Megan Riehl (34:28):
Okay, you know a long, long time ago, at least
20 years.
Okay, so your brain helped toretain and store that
information from the past, andthat's your subconscious mind
working.
So the subconscious mind holdsour memories, our habits, our
learned patterns, withoutconscious awareness.
(34:48):
This is why, you know, when Idrive by my elementary school
and my kids make mention of hey,did you go there?
And I say yes, and then I canstart to recite the school song
that I haven't said in 20 plusyears as well.
We are the kids from KeewahdinSchool.
I mean, I could go through thewhole thing and as I'm singing I
(35:11):
have no idea how my brain isputting these words out of my
mouth.
That's because of mysubconscious mind, and it plays
a really key role ingut-directed hypnotherapy
because our subconsciouscontrols a lot of the automatic
processes in our body, thingsthat we don't have to
consciously think about, likedigestion, pain perception,
(35:35):
muscle function.
And in IBS the subconsciousmind really becomes kind of a
misfire.
So again, that car alarm goingoff when we don't need it to,
and that misfire in IBS is howit processes the signals that
are coming from the gut.
And so, for example, when yourgut sends a signal that's
supposed to be a mild sensation,the subconscious mind may
(35:58):
interpret that as intense painand this is why in IBS we have
that visceral hypersensitivity,that heightened pain perception
and discomfort that comes withthe normal digestive process.
So a lot of people are verycurious about this type of
intervention and it used to befar more difficult to get access
(36:21):
to it and that's why I think alot of people just didn't even
know about it.
But this is a type ofintervention that's been around
since the 90s, the very early90s, and has at this point many,
many, many randomizedcontrolled trials and research
showing the effectiveness ofthis therapy.
(36:43):
So this type of therapy, youknow you're going to work with a
trained mental health providerto access that subconscious mind
and this is not like stagehypnosis, in no way are you
losing control, but we do callit a trance-like state, and in
that trance-like state you'revery deeply relaxed.
(37:04):
And then we use very targetedsuggestions and visualization
techniques to help in a way kindof reprogram.
Or I like to talk about howit's re-kind of doing that
brain-gut connection and doingso in a way where the
subconscious really starts torespond differently to the gut
(37:24):
sensations.
So that goal is to reduce thebrain's hyper alert response to
the gut and then helping tointerpret those signals more
calmly and more accurately.
And so during a hypnosissession we guide you through
this.
You know, very pleasant.
It usually takes anywherebetween 15 to 30 minutes
(37:46):
depending on what program you'reusing.
And the key here is just patientopenness.
So a lot of times patients willask me you know well I don't
truly believe that I'mhypnotizable, and that's okay.
Research has actually shownthat just being open to trying
this and going through andcompleting the program.
(38:06):
So during this program it'sabout four months and you meet
with me once every other weekand in between you get audio
recordings that you'll use athome.
And really the key here is thatyou're really getting into a
habit.
You're practicing thisintervention at home and it's
painless.
(38:26):
In fact a lot of people likethat.
They're able to tell theirfamily like, well, doctor's
orders, I have to go into myquiet space and practice my
relaxation interventions and I'dsay usually, by about two
months we're seeing improvementsin symptoms and the stats are
really remarkable that evenpatients that have not had
adequate response to medications, to diet therapy, to the other
(38:50):
things that they've tried, theystill get response from the
gut-directed hypnosis and alsoresults are very comparable
whether you're doing this with adigital program or something in
person.
There are even groups out therethat are doing group
gut-directed hypnotherapy againto increase access.
(39:12):
So talk to your doctors aboutthis as an option, especially if
you're somebody that has thoseamplified sensations of bloating
and cramping and bowelfluctuations.
I even like this a lot as anintervention to do either before
having a meal or after having ameal.
So there's a lot of ways thatwe can help you incorporate this
(39:33):
type of intervention into yourday-to-day living, but also
knowing that the actual targetis again working at that
subconscious mind.
So this is not an interventionwhere you're going to do it once
and then you're going to justbe IBS-free for the rest of your
life.
The expectation is that it'sgoing to take some time and
effort and application, butoftentimes for so many people
(39:56):
that is a huge benefit in thelong run.
Kate Scarlata (40:00):
Yeah, I love it and I think the key here, just
for our listeners, this is aspecific gut-directed hypnosis.
This is not just hypnosis.
This is a specific targetedprogram for your gut-brain
connection.
So I think, just as a reminderand you know, Megan, you
mentioned tension and I thinkabout that even for people just
(40:20):
as sort of as another non-diettherapy dimension, and that's
pelvic floor physical therapy.
So a lot of people have a lotof tension in their pelvic floor
and this can derive from anumber of different factors.
You've had a really badnorovirus with a lot of sort of
post-infectious IBS diarrheapredominant and you're
(40:41):
constantly clenching to make itto the bathroom and then you
start kind of almost learning totighten your pelvic floor.
Or it may be, you know, damagefrom a pregnancy or delivery
that has really affected yourpelvic floor.
So there's a number.
Those are just a coupledifferent factors, but really
(41:02):
having a tense and often weak.
So you're tense but you're weakand pelvic floor physical
therapy can really help.
So that's another tool in yourtoolbox to consider for both
diarrhea and constipation.
I would see mostly myconstipation patients are the
ones I'm referring, but it canalso help with diarrhea as well.
(41:22):
So I wanted to kind of wrap upwith a few more lifestyle
interventions.
And you know I did mention thatthis is a non-diet, but I was
really focusing and I'm notgonna get into diet today, I
promise, except for a couple oflittle things.
So when I say non-dietinterventions, I'm really
suggesting non-food eliminationdiets.
But there's a lot of thingsthat you can do simply to your
(41:46):
lifestyle around diet and thatis not skipping meals, eating a
balanced plate, not just eatinga big, huge piece of fish and
rice.
Where's the vegetable, where'sthe produce, where's the healthy
fat?
Looking at that balance andcolor and variety, that can also
(42:07):
really balance.
I always say balanced plate,balanced gut.
You know where is that balance?
Adding things like two greenkiwi fruit if you're prone to
constipation can be very helpful.
So diet can be beneficial, notjust with restricting but
thinking about adequate fiber,balanced diet, balanced plate,
etc.
(42:27):
Adding some positive, good,nutritious foods to your plate.
But also things like regularexercise.
And if you follow me onInstagram, you know I am a
believer of getting out innature and just getting that
really brisk walk.
I don't care if it's raining,if it's freezing, I'm out there
and I love it and it gives mecalm and there's great evidence
(42:47):
that it helps with sleeping andstress management and so many
other things.
And nature, if you get out, itactually can help boost your
immune system or add to yourability to keep a strong immune
system.
I should say.
Dr. Megan Riehl (43:01):
And your endorphins.
Kate Scarlata (43:02):
And your endorphins.
Dr. Megan Riehl (43:03):
Boosting those endorphins, those feel-good
neurotransmitters, it goes along way.
Kate Scarlata (43:09):
Absolutely so.
It doesn't have to be get on atreadmill if you need to get on
a treadmill, but it can be asimple walk, you know, in a park
.
That can really just bewonderful.
I just was in New York and wespent two days and I was in
Central Park most of the time.
I mean, that's where I findjust relaxation and beauty and
so even on vacation you can getout in nature.
(43:31):
So I encourage that.
We did an episode on sleep andboth Megan and I really focused
this, prioritized the rest whenwe can.
We both have busy lives, butit's important to get shut eye
and to let your body just relaxand regroup.
It's good for your brain, it'sgood for stress.
It's good for your brain, it'sgood for stress, it's good for
weight management.
(43:51):
Even If you don't get enoughsleep, we tend to go for the
food, the sweets, the treats totry to energize our body.
So try to get a good seven tonine hours and have a good sleep
routine.
That can be really helpful.
And then, of course, stressmanagement, and I think Dr Riehl
is the queen here.
What are your just three topstress management tips for our
(44:15):
audience today?
Dr. Megan Riehl (44:16):
Yeah, so you know, I think organization like,
don't try to put too much onyour day, pick the top priority.
Sometimes maybe it's one thingthat you know in your work day
you really need to do and begentle and kind to yourself.
A cognitive reframe that Ialways like, that I think can be
really helpful for stressmanagement, is if you are
(44:38):
putting the expectations thatyou're putting on yourself onto
a loved one, how would you talkto them?
How would you help them getthrough the stressor?
Oftentimes we are way harder onourselves than we are on
somebody that we love, and sothen you know, take that person
away and ask yourself you knowhow far away from that
(44:59):
conversation were you withyourself?
And again, have your tribe ofpeople for stress management.
Reach out, be vulnerable if youneed to, to say to your
girlfriends or your significantother you know I'm going through
a lot.
There's a lot on the proverbialplate right now.
A lot of times just talkingabout that can start to lift the
(45:22):
load a little bit You're notcarrying so much alone and that
can have a big impact on then,you know, kind of putting one
foot in front of the other againand grounding yourself back
into the present moment.
A lot of times, with stress,we're starting to think about
what's tomorrow and the next day, and the next day and two
months from now and a year.
And you know, unfortunately wecan't go up and live there.
(45:44):
We can only live in the momentthat we're in.
And trying to get yourself inthat space to then deal with
whatever that moment is can behumbling and then also
empowering.
Kate Scarlata (45:56):
Absolutely.
Stress reduction.
I think it's the fear and we'reworrying and we're in worry
land, which is things we have nocontrol over in the very moment
sometimes, and it just reallycan add such a layer of stress.
Dr. Megan Riehl (46:10):
Yep.
So you know, obviously stresscan impact those hormones and,
as we've learned today, that's abig factor here in our gut
health and we hope that you'llconsider some of our strategies
and suggestions.
For everybody listening, Kate,it's been a pleasure.
Happy IBS Awareness Month.
Let's continue to support ourfriends and patients living with
(46:33):
this condition.
I look forward to doing thatwith you
Kate Scarlata (46:36):
Absolutely!
Dr. Megan Riehl (46:37):
Our goal here is to live the best life
possible, regardless of whatelse is going on in your health.
So we hope that you willsubscribe, follow and like The
Gut Health Podcast.
Your support means the world,friends.
Thank you for joining us as wegrow this gut health community.
We hope you enjoyed thisepisode and don't forget to
(46:57):
subscribe, rate and leave us acomment.
You can also follow us onsocial media @the gut health
podcast, where we'd love for youto share your thoughts,
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Thanks for tuning in, friends.
This podcast has been sponsored by Ardelyx and
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Maintaining a healthy gut is keyfor overall physical and mental
well-being.
Whether you're ahealth-conscious advocate, an
individual navigating thecomplexities of living with GI
(00:20):
issues, or a healthcare provider, you are in the right place.
The Gut Health Podcast willempower you with a fascinating
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Come join us.
We welcome you.
Dr. Megan Riehl (00:40):
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 (00:52):
Hello, and I'm Kate Scarlata, a GI dietitian,
and April is IBS Awareness Month.
In today's podcast we're goingto cover some non-diet related
treatments for IBS and reallyexpand on factors that
contribute to symptoms outsideof diet.
But of course, before we delveinto non-diet approaches, it's
(01:13):
important, especially as a GIdietitian, for me to acknowledge
that many people prefer dietarytherapies for IBS.
But there are occasions whenyou know a strict food
elimination diet really isn'tappropriate or may not even be
effective for certain patients.
Reducing dietary intake canreally pose risks for
(01:33):
malnutrition and, for somepeople, even amp disordered
eating, which is not ideal, sono.
So today we'll focus on othertools and factors that impact
IBS.
Dr. Megan Riehl (01:48):
Yeah, you know so many of our patients, I think
, sometimes with diet can feeloverwhelmed and, as you
mentioned, we do see a highprevalence rate of disordered
eating and eating disorders inthe IBS patient population.
So today's episode is for allof you listeners out there that
might want to think a little bitbroadly in terms of treatment
(02:09):
approaches.
But, as we said, we're going tostart by learning a little bit
more about the genderdifferences in IBS and we
haven't delved into this beforeand so the role of hormones and
symptom fluctuations and whysome people experienced
heightened pain in their gut andit may not be surprising, but
(02:30):
IBS is more common in womencompared to men, lucky us.
And research suggests that 60to 70 percent of people
diagnosed with IBS are female,or a prevalence ratio of I
always love these the 2.5 to 1,so the half of a woman.
So why is this?
Kate Scarlata (02:48):
So really there's a couple reasons.
There's probably more than acouple, but we're going to delve
a little bit into these coupleof reasons, and one of the first
big reasons is difference inprimary sex hormones.
So women have a differenthormone profile than men and
this can affect gut motility andeven pain sensations.
So women's primary hormones areestrogen and progesterone, and
(03:12):
you might know that estrogenregulates the menstrual cycle.
It also promotes breastdevelopment and supports bone
health.
It's important for mood andcognition and also our skin
elasticity, which we of coursewant to prevent those wrinkles.
We won't talk about it though,not today, not today, all right.
(03:32):
The other hormone, progesterone, is also involved in regulating
the menstrual cycle andsupporting pregnancy.
It also affects mood and has acalming effect, which we love on
the brain.
For men, testosterone is theprimary male sex hormone, and
when I say these are primary,you know, keep in mind women
have testosterone too, but theseare, you know, the more
(03:54):
prominent hormones based ongender, and so, testosterone
being the primary male sexhormone, it's responsible for
development of malecharacteristics such as a deep
voice, muscle mass, facial hair.
We don't really want that aswomen, I guess.
Well, we want the muscle.
Dr. Megan Riehl (04:10):
We want the muscle.
Muscle mass is important.
Look, that's got to lift thoseweights?
Kate Scarlata (04:15):
Exactly yes.
So women, don't forget, you'relosing about a 1% decline in
muscle mass from 35 years oldand older, so make sure you're
lifting.
That's really important.
So research indicates that themale sex hormone, testosterone,
might have a protective effectagainst IBS and maybe that
explains why men are less likelyto experience this disorder.
(04:39):
For women, progesterone andestrogen can influence how the
digestive system functions, sothey play a big role here in
motility.
They interfere with smoothmuscle contraction in the gut
and, again, may play a big rolein why women have more IBS,
particularly IBS-C, than men,and men are more, you know, at
risk for IBS-D or diarrheapredominance, so IBS-C being
(05:03):
constipation predominant men aremore at risk for IBS-D.
Dr. Megan Riehl (05:12):
So like we're not saying that, you know both
sexes can't have either one, butwe do see that constipation
predominant IBS a bit morefrequently in our female
patients.
Kate Scarlata (05:20):
Absolutely, and so I'm not going to dive deep
into the menstrual cycle.
In all the different phases itgets complicated and the hormone
fluctuations are quitesignificant.
But let's talk a little bitabout some of these changes.
So in the pre-menses phase orthe luteal phase we'll focus on,
progesterone is dominant and ifan egg is infertilized we have
(05:42):
a rapid decline in estrogen andprogesterone and this can lead
to exacerbation of bowelsymptoms.
It can be constipation ordiarrhea sort of dependent on
the hormone profile.
But we tend to notice anincrease in bloating here and
probably related to progesterone.
During menstruation, this isthe lowest levels of estrogen
(06:04):
and progesterone and this canexacerbate bowel symptoms in
susceptible people and we oftensee an increased amount in some
of these hormone interactions.
(06:24):
There are other hormones thatare related as well, with lower
progesterone levels reallyleading to bowel symptoms, often
with diarrhea alongside thepain.
In menopause there's a declinein sex hormones and this lines
up interestingly with thedecline in IBS incidence.
So less incidence of IBS in themenopause phase, but we do see
(06:50):
a higher incidence ofconstipation.
So if you are an IBS-C patientand you've gone through
menopause, you may find thatyour constipation is a little
bit exacerbated.
So we know this.
Estrogen and progesteronereally fluctuate through the
cycle and can really impact ourgut function.
Those pesky sex hormones, andprogesterone in particular,
(07:12):
slows gut motility and can leadto constipation and bloating and
worsening, as I mentioned, ofIBS symptoms.
During menstruation IBSsymptoms may worsen and cause
softer bowel movements in somepeople, more severe bloating and
abdominal pain.
Estrogen, as I mentionedearlier, can really impact that
(07:32):
gut-brain access, which is thatcommunication system between
your gut and your brain, andwhen estrogen is high it can
make people more sensitive topain.
So this might explain why somewomen feel increased discomfort
or bloating around their cycle.
And it's not just in your head,it's your hormones, right Megan
?
Dr. Megan Riehl (07:50):
That's right.
That's right, and I've had somany patients that will say what
is going on with my IBSsymptoms during my cycle.
And this, as we've justhighlighted, is exactly what's
happening.
You're having a lot of hormonefluctuations.
Your behaviors may also bechanging.
When you're in a lot of pain,you might not be moving around
(08:11):
as much, so you might foregoyour exercise a bit, and so some
of these changes can lead us toopportunities to keep going.
Maybe you don't do a heavyworkout on the first couple of
days of your cycle, but if youcan get a walk in, that's
important, certainly nourishingyour body but also give yourself
(08:32):
rest.
Taking a couple of days, acouple of times a month, to do
what's best for you emotionallyis really key here too, because
obviously we know those hormonesaren't just affecting our IBS
symptoms physically, butemotionally it can be a bit
taxing as well.
So we want to be gentle.
Kate Scarlata (08:51):
Absolutely!
Dr. Megan Riehl (08:52):
So you know, another factor where gender can
impact our IBS symptoms is ourgut sensitivity.
Hopefully we're going to giveyou some validation here in
terms of how this gutsensitivity impacts our
functioning.
So I want you to imagine thisas we start to talk about this
concept.
Think about your gut like a caralarm that's extra sensitive,
(09:16):
and for most people, a littlebump in the road doesn't set it
off.
So you're driving down, you hita pothole, car alarm doesn't go
off.
Unfortunately, though, forpeople that are living with IBS
or many other GI conditions,even a small sensation like a
gas bubble, or even the normaldigestive process, some mild
(09:37):
bloating, you're going to feelthis way more intensely.
Your gut nerves way moreintensely.
Your gut nerves, all thosenerves that line your intestinal
tract, are more reactive, andthey send stronger pain signals
up to your brain, and thereforethe alarm is going off way too
often, and this is unfortunate.
(09:59):
This is not helpful for us aswe're going through our
day-to-day activities, and womenare generally more at an
increased gut sensitivitycompared to men, and so this can
, I think, again lead to some ofthe higher likelihood of
developing IBS, and studies havesuggested that women may have
more pronounced visceralhypersensitivity.
(10:20):
So the car alarm is thisconcept, and we're going to dive
a little bit into this.
Heightened sensitivity to painor discomfort in your gut is
called visceral hypersensitivity, so these are real pain
symptoms.
This is not in your head, andso any of our listeners out
there that have ever experiencedbeing told you know it's just
(10:43):
IBS.
And with it being IBS AwarenessMonth, we want to highlight it
is never just IBS.
It is something that'shappening in your brain, but
it's because of the brain, gut,access, this bidirectional
communication pathway and a veryreal sensation called visceral
hypersensitivity.
And so, in addition to womenexperiencing this, men, you're
(11:07):
not immune either, but weexperience this typically at a
higher prevalence in women, andagain, it can contribute to all
kinds of additional IBS symptoms.
And other factors that cancontribute include our genetics
and stress, and so there are alot of factors that can
(11:27):
contribute to how one may besusceptible to visceral
hypersensitivity and how some ofthis kind of bidirectional
communication pathway betweenyour brain and your gut gets a
little bit out of whack.
And, as we've talked about,there are a lot of factors here.
Kate Scarlata (11:43):
You know, I love when you say, and I'd love you
to give our audience, ourlisteners, a little Dr Megan
Riel information, and that is,you kind of talk about the gut
and brain screaming at eachother, because that's visceral
hypersensitivity.
Dr. Megan Riehl (11:56):
That's a good example right, it's a perfect
example.
And so you know, when you'regoing through the normal
digestive process and let's sayyou and I both go out to lunch
and I have IBS but you do not,and so as we're having our lunch
, we're eating very similarthings I feel the gurgle in my
(12:18):
stomach and now my brain is intune with what's happening down
there and those sensations thatare normal, benign sensations,
are sending signals up to thebrain and in a way it's kind of
yelling hey, did you feel that?
Feel that one, feel that one.
(12:39):
And what happens with visceralhypersensitivity is the brain
has a very hard timedownregulating those signals.
So what may be a normalconversation in your body?
So you're having your lunch,you're feeling a little gurgle,
you may even toot and just passthat gas, not think about it at
(12:59):
all, and your gut is saying, hey, did you feel that?
And your brain is saying, yeah,I did, don't worry about it.
Onward we go and you don'tthink about it anymore, whereas,
poor me, I'm sitting herefeeling it, my pain is starting
to increase, the sensations arestarting to cause more
discomfort and my brain isamplifying this experience,
(13:23):
saying, yeah, this is a reallybad idea.
We shouldn't have even come tolunch.
You know, now you're reallyfeeling this.
Oh, good job, you've gottenyourself into this predicament
and that's where we seeincreased levels of anxiety and
stress.
That comes along with, you know,a good old lunch with two
friends, and so visceralhypersensitivity is a very real
(13:46):
experience.
That is happening because,you're right, my gut is
screaming up to my brain and mybrain is not turning down the
amplification of what's going ondown there.
This is a very significantfactor and goal for treatment in
working with somebody likemyself is we can utilize our
(14:07):
brain-gut behavioral therapiesto actually calm down and turn
down the volume on thatcommunication.
And that's a very unique thingthat, yes, some medications can
do.
Some of our neuromodulatorsthat we've talked about in other
episodes, certain medicationscan help with this, but
sometimes we need to also addthe behavioral therapy to maybe
(14:29):
calm down the anxiety thatassociates with these sensations
, to have you experience apleasant lunch with friends, to
not let that lunch become atrigger for anxiety which might
even ramp up that visceralhypersensitivity before you even
put an ounce of food in yourmouth.
So this is all.
Obviously I get excited aboutthis and really a true target of
(14:54):
therapy, that when peopleunderstand this concept, they
feel validated and then theyalso feel hopeful that there are
treatments that can bebeneficial to turn down that
communication pathway.
Kate Scarlata (15:10):
Absolutely.
It's just having that awarenessis so important, like my gut
and brain are screaming at eachother.
I'm always kind of talkingthrough this with patients that
it's okay if you have a gasbubble, it's okay if there's a
little gurgling.
Dr. Megan Riehl (15:19):
That happens.
Kate Scarlata (15:21):
It's normal.
Yeah, People pass up to 14 timesgas a day and so just kind of
having that barometer just likeleaning into these normal
digestive processes, especiallylike through a reintroduction
phase of a diet where you'readding back FODMAPs.
It's like FODMAPs produce gas,so be prepared, there's going to
(15:41):
be a little more gas.
Just don't get ramped about it,because that ramping can really
make a difference.
So we've talked about hormonesand visceral hypersensitivity.
As you know, these key sort ofdifferences we often see in
gender area which is so close tomy heart because I love gut
(16:07):
microbiome science is that we'relearning that men and women
have different gut microbes andthat these microbes can respond
to things like stress andhormones and nutrition
differently or in unique ways.
So men typically have a morediverse microbiome, although the
research shows that as we agethat seems to level out a little
bit.
But, very interestingly,research shows that women are
(16:32):
more likely to suffer fromautoimmune diseases and these
conditions are often linked tothe gut microbiome and gut
microbiome changes.
So there's a new term and it'scalled microgenderome and it
refers to the concept ofsex-specific differences in the
microbiome and its interactionswith hormones, our immune system
and even disease risk.
And the concept of themicrogenderome is relevant
(16:56):
because many diseases reallyshow these sex-specific
prevalences, such as IBS and, asI mentioned, many autoimmune
diseases.
So, because there's genderdifferences in the microbiome
that may contribute to diseasesusceptibility, this really can
help explain why women are moresusceptible to bloating, more
(17:18):
susceptible to pain as well, andmaybe even why women may report
their IBS-related issues morefrequently.
Dr. Megan Riehl (17:27):
And you know I get asked this all the time and
that's do you see women in yourpractice more than men?
And the honest answer is yes,but we still see a lot of men
too, and a big part of this maybe that women are a little bit
more proactive in terms ofseeking answers for their
symptoms, and I think that's anamazing thing.
(17:49):
We have to be ourself-advocates and we don't want
anybody out there suffering,and I think sometimes women
might be a little bit more opento working with a psychologist,
especially if their referringprovider has done a really good
job at explaining that thepsychologist that they are
referring the patient to is, youknow, somebody that specializes
(18:13):
in this health condition.
So all of our listeners outthere that are clinicians and
medical providers, when you makethat referral, highlight that
you know these are experts.
GI psychologists are experts inbrain- gut behavioral therapies
that are going to target thesephysical symptoms that you have,
and so that's why, then, whenwe do get men through the door,
(18:36):
we can help you too, and reallyeven the research shows that men
and women benefit just as muchfrom our treatments.
So let's take gut-directedhypnotherapy as an example, and
we're going to dive into this alittle bit more obviously close
to my heart, and the researchhas shown that gender doesn't
determine who is a goodcandidate for this type of
(18:56):
therapy.
So we just want to highlightthat to all of our fellows out
there.
If you're struggling with yourIBS, I'm talking to you too.
There's a lot that we can do tohelp.
Now, all of this talk about howus women, women who we have
babies, we have menstrual cyclesyou know we deal with so much.
(19:18):
Our human body is so remarkablyresilient and obviously,
because of the hormones thatwe're born with, it's stacked
against us a little bit more.
While, unfortunately, there'sno definitive answers on how
pain is perceived differently inthe sexes, we do know that we
(19:40):
are just more susceptible tomore severe, more frequent, more
long-lasting pain compared tomen and, as we've highlighted,
hormones is the answer here inmany ways and that that estrogen
and progesterone can actuallyamplify our pain sensitivity,
while men have higher levels ofandrogens.
(20:02):
Those are those sex hormoneslike testosterone, and we've
seen in experimental studies howtestosterone has been shown to
act as a natural painkiller.
So men actually have thesenatural born painkillers in
their bodies that are helpingthem.
So imagine if we had some ofthese, with childbirth and our
(20:23):
menstrual cycle.
Gosh, we would be ruling theworld.
I think,
Kate Scarlata (20:27):
I agree, I agree,
Dr. Megan Riehl (20:29):
and even without them, we can rule the
world.
Kate Scarlata (20:34):
That's right, that's right.
Dr. Megan Riehl (20:37):
No shortage of women empowerment here on The
Gut Health Podcast.
Kate Scarlata (20:42):
Exactly so.
We know hormones, visceralhypersensitivity, the microbiome
, really shedding the light onso many different factors that
impact the pain we feel and howour gut moves, and how these
hormones actually can reallyimpact our brain and well-being
and sense of calm even so, veryinteresting stuff here today.
Dr. Megan Riehl (21:05):
Yeah, and I hope that in understanding
visceral hypersensitivity, youreally do feel that validation
and that hope and there's reasonand you know how that is a
specific treatment target forsome of the medications that we
use, for our lifestylesuggestions, for our brain-gut
(21:25):
behavioral therapies like gutdirected hypnosis and with this
greater understanding of that,it really does then open up some
of the remedies that we maysuggest.
And certainly on our podcast wetalk about the science-based
remedies.
So everything that we'retalking about are very specific
(21:48):
to what science has shown us.
Kate Scarlata (21:51):
I think it's also really an interesting factor
that women's health reallyhasn't been studied as
significantly as men's health.
And I don't want to getpolitical here, but there are
some limitations because wereally haven't delved into the
female body as much as we havestudied the male body, and so
(22:12):
the reality is that some of thisscience really needs to be
expanded, and our hope is thatthat will be happening, you know
, sooner than later, and there'sa lot of women out there in the
scientific community reallypushing for this Gynecologists,
pelvic floor physical therapistsand reconstruction pelvic
(22:35):
surgeons and colorectal surgeonsso there is going to be a
movement here.
But I think the reality is thatthere's more research to be
done to really help women, and Ijust want to make that point.
Speaker 3 (22:51):
When it comes to irritable bowel syndrome with
constipation or IBS-C, there'sno one-size-fits-all treatment.
If you're not satisfied withyour current IBS-C medication,
it may be time to try somethingdifferent.
Ibsrela (tenapenor) is aprescription medicine used to
treat adults with IBS-C.
Ibsrela works differently tohelp relieve the constipation
and abdominal symptoms of IBS-Cand could be the right.
Works differently to helprelieve the constipation and
abdominal symptoms of IBS-C andcould be the right option for
(23:13):
you.
Ready to try somethingdifferent for your IBS-C
symptoms?
Ask your doctor about Ibsrela.
Do not give Ibsrela to childrenless than six.
You should not give Ibsrela topatients six to less than 18
years.
It may harm them.
The most common side effect isdiarrhea, sometimes severe, and
your child could get severedehydration.
Stop taking Ibsrela and callyour doctor if you develop
severe diarrhea.
(23:33):
Do not take Ibsrela if you havea bowel blockage.
Tell your doctor if you arepregnant or breastfeeding and
about the medicines you take.
Other common side effectsinclude swelling or a feeling of
fullness or pressure in yourabdomen, gas or dizziness.
Learn more at Ibsrela.
com/ PI or call 1-844-IBSRELAand press option 4.
Dr. Megan Riehl (23:51):
In my practice I see so many patients
struggling with IBS and onething is clear, managing IBS
with diet and medication alonedoesn't work for everyone.
As a GI psychologist, I knowthat the brain-gut connection
plays a crucial role in IBSsymptom management.
I refer my patients to Nerva, agut-directed hypnotherapy
(24:12):
program designed to retrain theway the brain and gut
communicate.
Many of my patients have neverheard of this approach, but once
they try it they find it's easyto incorporate into their
routine.
Most importantly, it deliverslasting results.
Nerva is easy to access via anapp on your smartphone and takes
(24:32):
just 15 minutes a day.
Beyond IBS symptom relief, theylove that Nerva helps with
stress and overall well-being,giving patients a tool they can
use for life.
With GI specialist wait timesoften long, a research-backed
and accessible tool like Nervacan provide meaningful support.
It is referred by thousands ofhealthcare practitioners and has
(24:55):
helped hundreds of thousands ofIBS patients worldwide.
If you're a patient, you candownload the Nerva app today
with a seven-day free trial.
If you're a healthcare provider, you can request free clinician
access, request a lunch andlearn for your clinic, or even
offer your patients 25% off viatheir online referral form.
(25:16):
Just visit nervahealth.
com/ clinicians to learn more.
Kate Scarlata (25:23):
So let's talk a little bit about some of the
evidence-based treatments wehave today.
And, of course, for IBS there'sa number of prescription drugs
that really can target thosespecific symptoms whether it be
bloating or abdominal pain ordiarrhea, constipation and
really selecting a medicationthat can help target those
(25:44):
specific symptoms.
And that's how we typically dotreat IBS.
And we've really delved intothe role of hormones and we
don't want to discount that.
So if you feel that hormonesare playing a bigger role, there
are physicians that you canspeak with.
There's a number of differenthormones.
So the sex hormones you mightsee a gynecologist.
(26:04):
You might see anendocrinologist as well.
There's thyroid hormones thatcan affect the gut as well.
Women are more prone to thyroidfluctuations and autoimmune
thyroid conditions.
So these are all differentphysicians that you can see for
the targeted IBS treatments.
Primary care doctors are greator a gastroenterologist can help
(26:27):
you select the medications totarget.
And we also want to reallyemphasize that just because you
try one medication and itdoesn't work say you have a
particular drug that's workingfor constipation or diarrhea
that's not really doing its joblet the doctor know you're not
where you want to be.
It's important that you feellike you are living your best
(26:49):
life despite having a chroniccondition right.
So work with a good team.
Expand the team if you need to,if you really think these sex
hormones are a big line item foryou, and move from there.
Other supplements that one cantry would be enteric coated
peppermint can really targetabdominal pain, relaxes the
(27:10):
smooth muscle.
Fiber supplements can work,targeting the right fiber
supplement.
In IBS.
The one with the best evidencereally is psyllium husk.
Sugarcane fiber also has gooddata but it's a little difficult
to get here in the US but forthose listeners in Australia,
sugarcane fiber has evidence aswell to work with IBS in helping
(27:32):
manage constipation.
Psyllium also works well withdiarrhea, so it can actually
soak up some of the liquids inthe gut and soften, kind of make
a more formed stool.
Laxative therapies whether theybe osmotic laxatives that pull
water into the gut or astimulant laxative that helps
kind of propel the gut inmovement those can be used along
(27:54):
with the guidance of yourhealth professional.
There's antidiarrhealmedications such as loperamide,
and that can help controldiarrhea.
Again, run these ideas throughyour health professional.
And then we also haveneuromodulator medications, and
these are prescribed againeither by your
gastroenterologist, your primarycare doctor or even a
(28:15):
psychiatrist could recommendthese.
These can be targeted to helpwith some of the anxiety and
depression, but for IBS they'rereally targeting those pain
sensations, that visceralhypersensitivity in the gut, and
so these might be tricyclicantidepressants or selective
serotonin reuptake inhibitors orSSRIs, so managing some of the
(28:39):
potential psychologicalmanifestations that often
co-occur with IBS, but oftensignificantly the pain.
Probiotics have mixed data forIBS, but certainly worth a try,
generally very safe.
Align, for instance, has someevidence to help with global IBS
symptoms, so something you canexplore with your healthcare
(29:02):
team.
And those are just some of thetreatments that you can have in
your toolbox that are non-dietrelated, because, again, we have
plenty episodes on diet.
Feel free to listen to those.
But these are really targetedto the discussion points that we
wanted to talk about today and,in line with that, we do have
(29:23):
an IBS-C Series.
So, if you're interested, checkout episode 14, 15, and 16,
where we really identify a lotof the different treatments,
from diet, behavioral tomedications, as well as
exploring really an interestingconversation with Erin Judge,
who is an IBS-C patient.
So take a listen to those aswell.
Dr. Megan Riehl (29:45):
Those episodes are great and really dive a
little deeper into what you'vementioned here.
And just to highlight that, alot of times with medication and
supplements, it's aever-evolving conversation.
Unfortunately, a lot of timesyou don't start on something at
diagnosis and remain on that forthe rest of your life, and so
(30:05):
if you are somebody that hasbeen just kind of trucking along
, getting minimal improvementsbut still suffering with some of
the other symptoms, please talkwith your team, because
oftentimes with a little bit ofwork and good communication, we
can get even better improvements, and some of that may include
working with somebody like meand incorporating some of our
(30:27):
brain gut behavioral therapies.
So let me talk a little bitabout that, and while there are
a number of brain gut behavioraltherapies that you've probably
heard of, like GI-specificcognitive behavioral therapy,
mindfulness-based interventions,I'm going to really highlight
gut-directed hypnotherapy todaybecause it tends to be the
(30:49):
treatment that I start with whensomebody is bringing up their
pain, when they are somebodythat is experiencing a lot of
physiological tension, and I'lltell you why.
Visceral hypersensitivity is abig piece of this.
But I do want to highlight thatthere was a really fascinating
study that if you've ever heardme talk, I bring this study up a
(31:10):
lot because it highlights theeffectiveness of both the low
FODMAP diet and gut-directedhypnotherapy, but I think with
benefit moving toward thegut-directed hypnotherapy piece,
because it doesn't involve anydietary restriction.
And so, Dr.
Simone Peters, any dietaryrestriction.
(31:33):
And so Dr Simone Peters, who isreally a trailblazer in the
world of GI psychology, sheconducted this study comparing
the low FODMAP diet togut-directed hypnotherapy and
found that 70 to 80% of theparticipants had improvements in
their symptoms of IBS.
But notably, the gut-directedhypnotherapy provided lasting
benefits, again without thedietary restrictions, and so
(31:57):
this is a really valuablealternative for patients,
especially those that may have ahistory of disordered eating or
who really again draw thatconnection between their stress
and their symptoms.
So when I see a patient fortreatment we do a nice long
initial consultation and I'mlearning a little bit more about
(32:17):
them.
And when I have a patient thatacknowledges I have a really
hard time relaxing.
In a lot of my patients I canpredict I bet you have IBS-C,
because when we think aboutconstipation and holding in and
the bearing down in the bathroomthat they describe and that the
(32:38):
stool is backed up and maybethey've had a recent abdominal
x-ray and they're like yeah, mystudy showed that I'm full of
beep, and I highlight that,Yeah, I bet you're living with a
level of tension that is justyour baseline.
And my other trick that I loveto do is I'll tell them drop
(32:59):
your shoulders for me right now.
Do this to listeners too,because I bet they were up.
We just kind of live in thisstate of fight or flight.
We're ready to go, and whenwe're sitting here having a
conversation there's no need forour body to be holding such
tension.
And hypnotherapy can really bebeneficial over time at helping
(33:21):
patients to get their body backto a baseline that is actually
kind of relaxed.
And so many times this is sosatisfying as a therapist to you
know, have somebody that hasnever felt deep relaxation or
has released a lot of physicaltension that they've been
(33:42):
carrying for years, to have themsay you know, now I feel
relaxed.
I can say that like I'velearned how to relax, and it is.
It is certainly a interventionthat takes time and practice and
commitment over the course of acouple months, but what you can
(34:02):
gain from it is prettyremarkable.
So I wanted to illustrate alittle bit about what hypnosis
does and how it works.
And so to do that, Kate, do youremember your childhood best
friend's phone number?
I do, Lisa P.
All right.
So when's the last time youwould have thought about that
(34:24):
phone number?
Kate Scarlata (34:25):
You know, a long, long time ago, at least 20
years.
Dr. Megan Riehl (34:28):
Okay, you know a long, long time ago, at least
20 years.
Okay, so your brain helped toretain and store that
information from the past, andthat's your subconscious mind
working.
So the subconscious mind holdsour memories, our habits, our
learned patterns, withoutconscious awareness.
(34:48):
This is why, you know, when Idrive by my elementary school
and my kids make mention of hey,did you go there?
And I say yes, and then I canstart to recite the school song
that I haven't said in 20 plusyears as well.
We are the kids from KeewahdinSchool.
I mean, I could go through thewhole thing and as I'm singing I
(35:11):
have no idea how my brain isputting these words out of my
mouth.
That's because of mysubconscious mind, and it plays
a really key role ingut-directed hypnotherapy
because our subconsciouscontrols a lot of the automatic
processes in our body, thingsthat we don't have to
consciously think about, likedigestion, pain perception,
(35:35):
muscle function.
And in IBS the subconsciousmind really becomes kind of a
misfire.
So again, that car alarm goingoff when we don't need it to,
and that misfire in IBS is howit processes the signals that
are coming from the gut.
And so, for example, when yourgut sends a signal that's
supposed to be a mild sensation,the subconscious mind may
(35:58):
interpret that as intense painand this is why in IBS we have
that visceral hypersensitivity,that heightened pain perception
and discomfort that comes withthe normal digestive process.
So a lot of people are verycurious about this type of
intervention and it used to befar more difficult to get access
(36:21):
to it and that's why I think alot of people just didn't even
know about it.
But this is a type ofintervention that's been around
since the 90s, the very early90s, and has at this point many,
many, many randomizedcontrolled trials and research
showing the effectiveness ofthis therapy.
(36:43):
So this type of therapy, youknow you're going to work with a
trained mental health providerto access that subconscious mind
and this is not like stagehypnosis, in no way are you
losing control, but we do callit a trance-like state, and in
that trance-like state you'revery deeply relaxed.
(37:04):
And then we use very targetedsuggestions and visualization
techniques to help in a way kindof reprogram.
Or I like to talk about howit's re-kind of doing that
brain-gut connection and doingso in a way where the
subconscious really starts torespond differently to the gut
(37:24):
sensations.
So that goal is to reduce thebrain's hyper alert response to
the gut and then helping tointerpret those signals more
calmly and more accurately.
And so during a hypnosissession we guide you through
this.
You know, very pleasant.
It usually takes anywherebetween 15 to 30 minutes
(37:46):
depending on what program you'reusing.
And the key here is just patientopenness.
So a lot of times patients willask me you know well I don't
truly believe that I'mhypnotizable, and that's okay.
Research has actually shownthat just being open to trying
this and going through andcompleting the program.
(38:06):
So during this program it'sabout four months and you meet
with me once every other weekand in between you get audio
recordings that you'll use athome.
And really the key here is thatyou're really getting into a
habit.
You're practicing thisintervention at home and it's
painless.
(38:26):
In fact a lot of people likethat.
They're able to tell theirfamily like, well, doctor's
orders, I have to go into myquiet space and practice my
relaxation interventions and I'dsay usually, by about two
months we're seeing improvementsin symptoms and the stats are
really remarkable that evenpatients that have not had
adequate response to medications, to diet therapy, to the other
(38:50):
things that they've tried, theystill get response from the
gut-directed hypnosis and alsoresults are very comparable
whether you're doing this with adigital program or something in
person.
There are even groups out therethat are doing group
gut-directed hypnotherapy againto increase access.
(39:12):
So talk to your doctors aboutthis as an option, especially if
you're somebody that has thoseamplified sensations of bloating
and cramping and bowelfluctuations.
I even like this a lot as anintervention to do either before
having a meal or after having ameal.
So there's a lot of ways thatwe can help you incorporate this
(39:33):
type of intervention into yourday-to-day living, but also
knowing that the actual targetis again working at that
subconscious mind.
So this is not an interventionwhere you're going to do it once
and then you're going to justbe IBS-free for the rest of your
life.
The expectation is that it'sgoing to take some time and
effort and application, butoftentimes for so many people
(39:56):
that is a huge benefit in thelong run.
Kate Scarlata (40:00):
Yeah, I love it and I think the key here, just
for our listeners, this is aspecific gut-directed hypnosis.
This is not just hypnosis.
This is a specific targetedprogram for your gut-brain
connection.
So I think, just as a reminderand you know, Megan, you
mentioned tension and I thinkabout that even for people just
(40:20):
as sort of as another non-diettherapy dimension, and that's
pelvic floor physical therapy.
So a lot of people have a lotof tension in their pelvic floor
and this can derive from anumber of different factors.
You've had a really badnorovirus with a lot of sort of
post-infectious IBS diarrheapredominant and you're
(40:41):
constantly clenching to make itto the bathroom and then you
start kind of almost learning totighten your pelvic floor.
Or it may be, you know, damagefrom a pregnancy or delivery
that has really affected yourpelvic floor.
So there's a number.
Those are just a coupledifferent factors, but really
(41:02):
having a tense and often weak.
So you're tense but you're weakand pelvic floor physical
therapy can really help.
So that's another tool in yourtoolbox to consider for both
diarrhea and constipation.
I would see mostly myconstipation patients are the
ones I'm referring, but it canalso help with diarrhea as well.
(41:22):
So I wanted to kind of wrap upwith a few more lifestyle
interventions.
And you know I did mention thatthis is a non-diet, but I was
really focusing and I'm notgonna get into diet today, I
promise, except for a couple oflittle things.
So when I say non-dietinterventions, I'm really
suggesting non-food eliminationdiets.
But there's a lot of thingsthat you can do simply to your
(41:46):
lifestyle around diet and thatis not skipping meals, eating a
balanced plate, not just eatinga big, huge piece of fish and
rice.
Where's the vegetable, where'sthe produce, where's the healthy
fat?
Looking at that balance andcolor and variety, that can also
(42:07):
really balance.
I always say balanced plate,balanced gut.
You know where is that balance?
Adding things like two greenkiwi fruit if you're prone to
constipation can be very helpful.
So diet can be beneficial, notjust with restricting but
thinking about adequate fiber,balanced diet, balanced plate,
etc.
(42:27):
Adding some positive, good,nutritious foods to your plate.
But also things like regularexercise.
And if you follow me onInstagram, you know I am a
believer of getting out innature and just getting that
really brisk walk.
I don't care if it's raining,if it's freezing, I'm out there
and I love it and it gives mecalm and there's great evidence
(42:47):
that it helps with sleeping andstress management and so many
other things.
And nature, if you get out, itactually can help boost your
immune system or add to yourability to keep a strong immune
system.
I should say.
Dr. Megan Riehl (43:01):
And your endorphins.
Kate Scarlata (43:02):
And your endorphins.
Dr. Megan Riehl (43:03):
Boosting those endorphins, those feel-good
neurotransmitters, it goes along way.
Kate Scarlata (43:09):
Absolutely so.
It doesn't have to be get on atreadmill if you need to get on
a treadmill, but it can be asimple walk, you know, in a park
.
That can really just bewonderful.
I just was in New York and wespent two days and I was in
Central Park most of the time.
I mean, that's where I findjust relaxation and beauty and
so even on vacation you can getout in nature.
(43:31):
So I encourage that.
We did an episode on sleep andboth Megan and I really focused
this, prioritized the rest whenwe can.
We both have busy lives, butit's important to get shut eye
and to let your body just relaxand regroup.
It's good for your brain, it'sgood for stress.
It's good for your brain, it'sgood for stress, it's good for
weight management.
(43:51):
Even If you don't get enoughsleep, we tend to go for the
food, the sweets, the treats totry to energize our body.
So try to get a good seven tonine hours and have a good sleep
routine.
That can be really helpful.
And then, of course, stressmanagement, and I think Dr Riehl
is the queen here.
What are your just three topstress management tips for our
(44:15):
audience today?
Dr. Megan Riehl (44:16):
Yeah, so you know, I think organization like,
don't try to put too much onyour day, pick the top priority.
Sometimes maybe it's one thingthat you know in your work day
you really need to do and begentle and kind to yourself.
A cognitive reframe that Ialways like, that I think can be
really helpful for stressmanagement, is if you are
(44:38):
putting the expectations thatyou're putting on yourself onto
a loved one, how would you talkto them?
How would you help them getthrough the stressor?
Oftentimes we are way harder onourselves than we are on
somebody that we love, and sothen you know, take that person
away and ask yourself you knowhow far away from that
(44:59):
conversation were you withyourself?
And again, have your tribe ofpeople for stress management.
Reach out, be vulnerable if youneed to, to say to your
girlfriends or your significantother you know I'm going through
a lot.
There's a lot on the proverbialplate right now.
A lot of times just talkingabout that can start to lift the
(45:22):
load a little bit You're notcarrying so much alone and that
can have a big impact on then,you know, kind of putting one
foot in front of the other againand grounding yourself back
into the present moment.
A lot of times, with stress,we're starting to think about
what's tomorrow and the next day, and the next day and two
months from now and a year.
And you know, unfortunately wecan't go up and live there.
(45:44):
We can only live in the momentthat we're in.
And trying to get yourself inthat space to then deal with
whatever that moment is can behumbling and then also
empowering.
Kate Scarlata (45:56):
Absolutely.
Stress reduction.
I think it's the fear and we'reworrying and we're in worry
land, which is things we have nocontrol over in the very moment
sometimes, and it just reallycan add such a layer of stress.
Dr. Megan Riehl (46:10):
Yep.
So you know, obviously stresscan impact those hormones and,
as we've learned today, that's abig factor here in our gut
health and we hope that you'llconsider some of our strategies
and suggestions.
For everybody listening, Kate,it's been a pleasure.
Happy IBS Awareness Month.
Let's continue to support ourfriends and patients living with
(46:33):
this condition.
I look forward to doing thatwith you
Kate Scarlata (46:36):
Absolutely!
Dr. Megan Riehl (46:37):
Our goal here is to live the best life
possible, regardless of whatelse is going on in your health.
So we hope that you willsubscribe, follow and like The
Gut Health Podcast.
Your support means the world,friends.
Thank you for joining us as wegrow this gut health community.
We hope you enjoyed thisepisode and don't forget to
(46:57):
subscribe, rate and leave us acomment.
You can also follow us onsocial media @the gut health
podcast, where we'd love for youto share your thoughts,
questions and experiences.
Thanks for tuning in, friends.
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