February 17, 2025 • 35 mins
Join Dr. Riehl and Kate as they share practical lifestyle strategies for managing IBS with constipation. Studies show that up to 84% of IBS patients experience GI distress related to eating, with most triggers linked to carbohydrate intake—particularly highly fermentable ones like FODMAPs. Learn how the low FODMAP diet, the most extensively researched dietary approach for IBS, stacks up against traditional therapies and medications. Kate also explores other researched diet options for IBS, including the Mediterranean diet and the UK NICE IBS diet guidelines.
Dr. Riehl discusses the intricate gut-brain connection and presents evidence-based therapies for managing IBS symptoms. She provides an in-depth review of a range of treatments, including mindfulness techniques, gut-directed hypnosis, and other effective interventions, offering a comprehensive approach to symptom relief.
Finally, we explore simple, holistic lifestyle changes that can complement IBS management. From the benefits of eating a wide array of colorful plants, engaging in mindful eating, to stress reduction and healthy living techniques. By the end of this episode, you'll be equipped with a variety of self-care and nurturing practices that align with your personal values, helping you find joy, reduce stress, and better manage your IBS symptoms.
Diaphragmatic breathing demonstration
References:
Nutrition:
The Association Between a Mediterranean Diet and Symptoms of Irritable Bowel Syndrome
Clinical Trial: A Mediterranean diet is feasible and improves gastrointestinal and psychological symptoms in irritable bowel syndrome
CAM & Sleep:
Complementary and Alternative Therapies for Chronic Constipation
Sleep Duration in Constipation
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, MPH, RDN (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.
(00:23):
The Gut Health Podcast willempower you with a fascinating
scientific connection betweenyour brain, food and the gut.
Come join us.
We welcome you.
Hello friends, and welcome toThe Gut Health Podcast, where we
talk all things related to yourgut and well-being.
(00:44):
I'm Kate Scarlata, a GIdietitian.
Dr. Megan Riehl (00:48):
And I'm Dr Riehl, a GI health psychologist,
and today's episode Mind YourGut: Diet and Lifestyle
Solutions for Constipation ispart two of our three-part IBS
series.
I hope that you listened topart one with Dr.
Justin Brandler, because he isa true wealth of information and
enthusiasm and we had such agreat time.
(01:10):
So please make sure you'vechecked out part one.
And now we get to dive intopart two.
Kate Scarlata, MPH, (01:16):
Absolutely , and Megan and I really love
talking about diet, behavioraltherapies, lifestyle and how
that can really play a role inIBS symptom management, and you
know we wrote Mind Your Gut forthat reason, because we know
these therapies can beextraordinarily helpful if
you're living with irritablebowel syndrome.
(01:37):
So certainly, as a GI dietitian, I'm going to delve right into
my favorite topic and that'snutrition.
I'm really grateful to see theinterest in nutrition and how it
intersects with IBS.
Finally, because I've beendoing this for over 30 years and
really for years we had nothingto say to patients other than
(01:58):
hey, try to increase your fiber.
And often that just reallyfailed and made their symptoms
worse, and often that justreally failed and made their
symptoms worse.
So now we know a lot more andpeople are interested,
researchers are interested inreally looking at this, and so,
although we're in the beginningstages of understanding
nutrition and IBS, and we allknow that individuals with IBS
(02:20):
have somewhat of a differentindividual experience, we need
to personalize nutrition, butthere are some general takeaways
that can be applied to mostpeople living with this
condition and I really wanted totalk a little bit about, just
in general, ibs and how patientsexperience eating.
(02:40):
There was a great survey studyof about 200 IBS patients and
84% said just eating any foodtriggered their symptoms.
That's quite a lot of people,and that's not surprising to me,
because I certainly hear thatfrom patients that I intersect
with on a regular basis.
Dr. Megan Riehl (02:57):
And I think even the ears that you are
listening to this podcast witheven if you don't have an IBS
diagnosis, some of us are goingto have occasional bouts of
constipation, some people aregoing to have more chronic IBS
with constipation, but Ipersonally love hearing your
wealth of information, becauseoccasionally things are going to
(03:20):
slow down a bit, and so whatare some of the foods that we
need to be thinking of when ourtummy is upset or when we're not
having complete evacuation inthe bathroom?
So I think that that's justimportant for us to be thinking
of as we move through thisconversation about food and mood
.
And you kick it off, kate.
Kate Scarlata, MPH, RDN (03:41):
Yeah, absolutely agree with you.
You know, when we think abouthow food intersects with the gut
, all of us are going to beaffected at some point, and
constipation is a hard one,because most people living with
constipation, especially withIBS, they're the ones that tend
to be a little bit moresymptomatic.
They're more likely to havebloating associated with their
(04:02):
symptoms.
So let's get into a little bitabout diet.
So the survey study that Imentioned earlier 84% felt that
eating anything triggered theirsymptoms, but the vast majority
of them pinpointed actuallyfermentable carbohydrates as
their top trigger and the lowFODMAP diet that is, a diet
specifically for reduction offermentable carbohydrates shown
(04:26):
to be the most beneficial diet,the most researched diet for IBS
.
It's really no surprise.
I mean, these patients knowwhat's bothering them, they
identified them and now we havea diet therapy that really
addresses how we can reduce someof these fermentable
carbohydrates.
So we've got the most researchon IBS.
The vast majority of studiesshow efficacy or the ability for
(04:50):
the diet to manage symptoms inabout 50 to 80% of people.
There was a recent study in TheLancet journal that suggested
efficacy around 76.
So it's in that range.
Not everyone's going to benefitfrom reducing fermentable
fibers, but at least half will.
That's pretty amazing.
(05:10):
It's better than any medicationthat's out there for IBS.
So diet is, and can be, verytherapeutic.
Dr. Megan Riehl (05:14):
It's comparable to our behavioral therapy
outcomes.
Kate Scarlata, MPH, RDN (05:18):
Yes, and we are going to dive into
those with Dr Riehl, who is theexpert in all of those
behavioral therapies, which Ican't wait to just dive into
that in just a moment.
I'm talking FODMAPs, I'mtalking about the fermentable
carbohydrates it's really anacronym and I don't want you to
get caught up in these sciencyterms, don't ask me to say this.
(05:39):
Okay, you have to.
No.
So fermentable oligosaccharides, disaccharides, monosaccharides
and polyols and in general,just so what you really need to
know.
They're small carbohydratesthat are commonly malabsorbed.
They pull water into the gutand or are rapidly fermented by
our gut microbes, creating a lotof gas.
(06:00):
That water in the gut, the gasin the gut kind of stretches the
gut, makes us feel a little bituncomfortable, makes us gassy,
right?
So all of those symptoms thatcan be problematic when
experiencing IBS, but alsosometimes just all of us, it can
be really uncomfortable.
So common FODMAP foods dairy,but it's not all dairy.
(06:24):
It's the dairy that's rich inlactose and that's the wet part
of milk.
So think of milk and ice creamsas wet, not a hard cheese
(that's dairy) or butter.
Those are very low in lactose,but those that have a lot of
like fluid consistency to themtend to be higher in lactose.
Also, big FODMAP rich foods areyour onion, your garlic, your
(06:45):
wheat.
Those are big triggers for alot of different people.
And then there's some fruitslike stone fruits, peaches,
plums, prunes.
We know we use them forconstipation a lot of times and
part of the reason we do isbecause of their FODMAP activity
, pulling a lot of water intothe gut.
It does soften the stool but itcan be a little bit gassy for
people with IBS, so sometimesthose prunes or prune juice
(07:08):
doesn't work as well in thatsensitive gut that we see in IBS
.
So additionally, when it comesto FODMAPs, there's been some
really interesting research outof UMichigan and this has been
led by Dr.
Prashant Singh, and whatthey've looked at in animal
studies and in a small subset ofhumans, that in humans,
(07:28):
particularly when they respondto the low FODMAP diet, when
they give them high FODMAP foods, a cascade of effects occur in
the gut and what happens is thatthere's more of a dysbiosis, so
more sort of pathogenicpotential microbes in the gut,
or what we call bad microbes,versus health-promoting microbes
(07:50):
, and this leads to immuneactivation as well as colonic
permeability, an increase incolonic permeability.
And this is just giving usinsights into some of the
mechanisms why FODMAPs maytrigger pain in some of these
IBS symptoms.
So very, very interesting.
Love seeing this head in adirection where we're
(08:10):
understanding not just like oh,this makes you better, but why
it might make you better.
I love that because you know welike science, right, dr Real?
That's right.
That's right.
First, let me just tell you thatthe low FODMAP diet is
typically done in a three-phaseapproach.
So you eliminate FODMAPs.
This is the beginning of thediet.
(08:31):
You don't stay here, okay.
So reminder to my listeners,our listeners out here this is
the beginning of the diet.
We're reducing FODMAPs.
Seeing how you do?
You stay there about six weeks.
Then we do a reintroductionprotocol, which we
systematically add FODMAPs backto really understand which
FODMAP subtypes whether that'slactose or fructans these are
(08:53):
all different types ofcarbohydrates that are commonly
malabsorbed which ones aretriggering you.
And then the last phase is thepersonalization phase, when we
add back the foods that you cantolerate, because there's no
reason to restrict all FODMAPslong-term.
In fact, studies have shown usthat the average amount of
FODMAPs that are problematic forIBS patients it runs about two
(09:15):
to three of the groups.
So not everyone has issues withthe polyols or everyone has
issues with the monosaccharides.
It's really variable person toperson and we want you to have a
liberal diet and enjoy food.
So that's really important.
Dr. Megan Riehl (09:31):
And this is why , if you've ever Googled a
dietary therapy and you've usedthe low FODMAP diet, you picked
up one of Kate's books and youhave gotten some relief, but you
have never resumed thereintroduction phase.
This is key.
We don't want you staying onthe low FODMAP diet long-term.
(09:52):
So if you're still on that diet, you're still in the
restriction phase, work with aGI dietician or experiment
yourself, knowing that it'snormal to have maybe some slight
increases in your GI symptomswhen you're going through
reintroduction.
Your body will get used tothose foods that you've been
missing for a little while andthat maybe you avoid.
The foods that really, if theydo cause you a big flare of
(10:14):
symptoms or more severe symptoms, there you go, ding, ding, ding
.
That's the group that you wantto stray away from.
Absolutely.
Kate Scarlata, MPH, RDN (10:22):
And I think that's a really important
point, Megan, is that you know alittle gas bubble, a little
distention after you add FODMAPsback, totally normal.
It's really when you'retriggering like a major IBS
flare and you're feeling thepain and you're like, oh, this
was really bad, then you knowthat would sort of warrant a
trigger, not necessarily alittle gas.
(10:44):
We all get gas when we eatFODMAP, so you're not alone out
there.
And then, briefly, I'm going tojust talk about a couple other
diets that have been studied forIBS.
One of them is theMediterranean diet and, to be
honest, there's been threestudies.
Two showed favorable results.
The third was very mixed andnot definitive on that.
For me personally, I do think aMediterranean diet which is
(11:07):
rich in things like lots ofplants, legumes, nuts, seeds,
olive oil, a little bit of fish,a little bit of yogurt, healthy
, has a lot of evidence for justgeneral health cardiovascular
risk, diabetes risk, so manyhealth benefits.
So eating like that, great, ifyou can.
Mental health, mental healthtoo, and even in the IBS studies
(11:29):
mental health was noted as abenefit.
So yeah, give it a go.
There's some evidence, not asstrong as a low FODMAP because
there's not as much studiesright.
So the weight of the studiesout there, it's just less but
interesting could be beneficial.
And then the other diet I oftenkind of go to and we'd kind of
morphed it and used it as partof our Mind Your Gut Gentle Diet
(11:51):
Cleanup is the UK NICEguidelines for IBS and in
general this is really a cleanup.
It's like don't skip your meals, eat in a relaxed setting,
don't have a bunch of junk food.
Limit your fruits, becausefruits tend to have a lot of
these fermentable sugars thatare problematic.
Don't overdo it with alcohol.
(12:12):
None of us should be, by theway.
Keep caffeine at bay if ittriggers your symptoms.
More of a problem for thosewith diarrhea-predominant IBS,
for those with constipation.
I find my patients tend tobenefit from the caffeine.
It stimulates colonic motility.
That's not a bad thing when youhave a sluggish gut.
So those are really the threemain diets that I look at.
(12:32):
There are some studies lookingat very, very low-carbohydrate
diets.
I'm not a huge fan for thatbecause, quite honestly, fiber
is a carbohydrate, so we needfiber.
We know that fiber isbeneficial for our gut
microbiome, so I don't know thatwe have to go that low, right?
Yep.
Dr. Megan Riehl (12:52):
So that is all a really nice overview of some
considerations with ournutrition and IBS, and let's
also talk about this mind-gutconnection that is at play.
This is a very complexinteraction between the brain
and the gut, but guess what?
We all have it.
It's complex, but we all haveit, and many, many different
(13:14):
factors can impact your mind-gutconnection.
Kate just covered a big onefood, but also our environment,
stress, mood, genetics,medications and really a lot
more.
And so you know, as we thinkabout putting all of these
pieces together in powerful waysthat we can address our overall
GI health.
Knowing that the brain and thegut communicate and can produce
(13:38):
symptoms that are very real isimportant, and that
communication pathway, yourbrain-gut access, includes your
vagus nerve as well as differentneurotransmitters that are
produced in your brain and yourgut.
And when we see changes in thiscommunication pathway that can
affect your gut motility, thesensations that you feel, and it
(13:59):
can potentially then lead toIBS-like symptoms, can
potentially then lead toIBS-like symptoms.
And so, given this intersectionbetween brain-gut behaviors, we
utilize brain-gut behavioraltherapies that have now really
become a gold standard as partof treatment for patients living
with IBS.
And also today, I want you tobe thinking about ways that you
(14:21):
might incorporate some of thesesuggestions that you might
receive in therapy.
But also, maybe you mightreceive in therapy, but also
maybe you're not in therapy andyou're just again.
Just like we would do a gentlediet cleanup, we want to kind of
think about doing a gentle,mindful lifestyle cleanup as
well.
So some of the science-backedinterventions that we use that
come from this brain-gutbehavioral therapy world, or
(14:44):
also known as gastropsychology,include cognitive behavioral
therapy that's specific to GIconditions and concepts,
gut-directed hypnotherapy,mindfulness-based stress
reduction techniques andrelaxation training.
These are all aspects oftreatment that you may receive
if you're working with a GIpsychologist, and there are many
(15:07):
, many studies out there thatsupport the efficacy of
utilizing these strategies, andI'll use hypnosis as one example
where patients that have beenrefractory to pretty much every
other medical treatment that'savailable for IBS.
Those patients have responserates of over 60% when they are
(15:29):
using a protocolized,evidence-based gut-directed
hypnotherapy program.
So it's really exciting that wehave so many different targets
and ways to get at helping youlive a better life if you're
somebody that's affected by IBS,and these psychological
interventions are going to betailored to your needs.
(15:50):
So when you're working withsomebody like myself.
We're going to be looking atwhat's your mood like anxiety,
stress Do we need to really honein and build some additional
coping strategies for when yoursymptoms are unpredictable and
can feel uncomfortable anduncontrollable?
And a GI psychologist is goingto help you gain insights into
(16:11):
how you respond to uncomfortablesensations in your body.
Sometimes those uncomfortablesensations are going to activate
your body's sympathetic system,which is the fight, flight or
freeze response, and that alonecan trigger more
neurotransmitters that canexacerbate your GI distress.
So a lot of work is done foralmost every patient that I work
(16:35):
with to have some early,tangible strategies you can turn
to.
So we've got things like properpooping position, making sure
that you are using a squattypotty and your knees are
elevated above your hips with atoileting stool, diaphragmatic
breathing We'll link a quickYouTube clip to make sure that
you're aware of how to do thistechnique and also making sure
(16:58):
not to sit on the toilet for toolong.
I believe it was Dr.
Darren Brenner in one of ourprevious episodes who really
highlighted you should not besitting on the toilet longer
than five to 10 minutes.
So if you find that you'restruggling with things like this
, seek support.
Sometimes lifestyle changes canbe really critical in terms of
making some long-term changesfor your overall gut health, and
(17:21):
there are certainly providersout there that can help you with
this.
Another type of therapy thatI'll mention is something called
biofeedback.
So sometimes when you Googletherapies for constipation,
you'll find biofeedback comes up, and this is usually not a type
of therapy that's delivered bya mental health provider, though
sometimes in the context of aholistic practice, together with
(17:44):
a physician, you might receivethis type of training, but
usually you receive biofeedback,which is a type of therapy
where you're using an electronicdevice to help you gain some
awareness and control over yourphysiological functions, and in
the constipation world, this isto help you better coordinate
your pelvic floor muscles, andso a pelvic floor physical
(18:05):
therapist is usually somebodythat you will work with, and you
can't talk about constipationmanagement without mentioning
pelvic floor PT.
This can be a reallylife-changing type of therapy
for somebody that hasconstipation.
If you've ever been diagnosedwith something called
(18:26):
dyssynergic defecation,definitely talk with your
provider about how this fitsinto your treatment plan, and
what I've seen incollaboratively working with
pelvic floor physical therapistsis that either they have
already taught their patientdiaphragmatic breathing or some
type of massage.
That again similar to how Itreat and teach everybody
(18:48):
diaphragmatic breathing, so dothey.
So this is something that, evenif you haven't formally worked
with a pelvic floor physicaltherapist yet, it's something
you can get started with, justlike something like abdominal
massage, and we discuss amassage called the I Love U
Massage.
In Mind Your Gut.
You can easily find this on theinternet, too, which can really
(19:11):
be helpful for somebody that'seither struggling with chronic
or occasional bowel problems.
Ardelyx (19:21):
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 option
(19:42):
for you.
Ready to try somethingdifferent for your IBS-C
symptoms?
Ask your doctor about Ibsrela.
Do not give Ibsrela to childrenless than 6.
You should not give Ibsrela topatients 6 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.
(20:03):
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 (20:28):
The last therapy that I'll mention has
growing interest in the world ofkind of complementary and
alternative therapies, and thisis acupuncture.
So we know that acupuncture hasbeen around for literally
centuries but in terms of usingit for therapy, there have been
several systematic reviews,including meta-analyses, that
have shown the effectiveness ofacupuncture for chronic
constipation and in this type oftreatment, an acupuncturist
(20:52):
will use acupoints on the skinthat are manually stimulated
with needles and very specificpoints, and we won't get into
the nitty gritty details, butwhat I will say is that back in
2023, we hired an acupuncturistin our GI division at the
University of Michigan and hisclinic was full within a very
(21:13):
short period of time and there'ssome really cool research that
people like Dr Borko Nojkov isdoing with our acupuncturist,
Henry Buchtel, and it's, I think, going to help further the
interest of this type of therapythat you know our division
chief, Dr Chey, has reallypromoted as getting outside of
(21:36):
the traditional therapies forconstipation and IBS and really
thinking broadly about what wecan learn from other types of
medicine.
So this is exciting stuff and weknow that now there is a place
certainly for medication, but Ithink also there are a lot of
people that are interested inother ways to address their
(21:59):
health.
That hit some of the tips andtricks that we're going to give
you right now.
Kate Scarlata, MPH, (22:04):
Absolutely , and you know I'm glad you
brought that up because I dothink, and it's been shown in
the research, that people thatare living with IBS are very
interested in more of theseholistic approaches.
And I certainly don't want todiscount medication either,
because I would say the vastmajority, or at least 50% of the
patients that I've interfacedwith have required some level of
(22:26):
medication, whether it's alaxative or a neuromodulator or
something to manage their IBS.
No shame there.
If you need a medication, youneed a medication.
You want to feel better to livethe best life you could live
right.
But this growing arsenal ofholistic therapies is really
(22:49):
exciting to see because it'smeeting a need that many
patients are truly interested in.
Dr. Megan Riehl (22:52):
That's right.
Let's say, the medication isthe thing that allows you to
leave the bathroom right, butnow you have the rest of your
life to live.
You still have to eat, youstill want to feel fulfilled,
you want to have joy in yourlife, and so when you can choose
foods that you know alsonourish your gut, when you can
choose activities that are goodfor you, such as yoga, it kind
(23:14):
of kills two birds with onestone.
Right when you're approachingyour lifestyle from a healthy
perspective, that includeswhatever strategies help to let
you have complete bowelmovements, exactly, exactly.
So, kate, what are your tips?
Give us some nutritiontakeaways that I'm going to be
thinking of when I'm at thegrocery store and are going to
(23:35):
help the Riehl family to havehealthy guts and butts.
Kate Scarlata, MPH, RDN (23:44):
Healthy guts and butts?
Okay, well, you know.
My first thing is to eatregular meals, don't skip.
A lot of people living with IBSthink, well, if I don't eat, I
won't have symptoms and that'llbe great for my work day.
Or fall into the habit ofrushing and eating standing, or
with working on the computer andinhaling a sandwich and not
even tasting it.
None of that really works well,if you're skipping meals,
(24:07):
you're going to overeat.
You're going to come homeyou're going to indulge in
getting rid of those hungerpains that you're experiencing.
It's too much food for your gut.
At once, it impacts your sleep.
So many downstream effects tothat.
Just learn what you can toleratefor breakfast so that you can
start your day, to nourish yourbrain, to take on the day and
(24:27):
you have the strength and energyto face all that comes our way,
because we all have differentthings coming our way.
Right, I'm dealing with a labright now, a chocolate lab puppy
, and she's keeping me on mytoes over here.
So wherever you are in, youknow we're always up against
something.
So the other thing I thinkthat's really important with
(24:47):
eating and something that we'vedone with our kids as they've
grown up.
Light, music, a candle, ifyou're into it, just to kind of
set the tone also for relaxing.
Once your body's relaxed you'reready to take in the food.
So you're in more of thatparasympathetic mode rest and
digest.
So if you need some externalcues, that can also be helpful.
(25:09):
The other thing, just foreating breakfast, really
important because you have thisreflex called the gastrocolic
reflex.
It's most active in the morningand that's stimulated.
It stimulates colonic activitywhen you're eating.
So if you're doing that in themorning, it's more active in the
morning.
You're more likely to have acleansing bowel movement in the
morning.
So again, for thoseconstipation predominant
(25:31):
listeners out there, payattention certainly to that.
So the other thing I think isreally important is to eat a
variety of different coloredplants.
Eat the rainbow and that helpsfuel a healthy gut microbiome.
Your rainbow may look a littledifferent than mine and that's
okay, but think about gettingdifferent colors into your diet.
I think the other thing that'sreally important is what you can
(25:53):
go easy on and that's the booze, the alcohol, really limiting
to no more than one drink ifyou're a woman, two drinks for
men and just keeping that incheck.
Caffeine, if your diarrheapredominant.
Keep a button up on that one.
Get your fiber on and I talkedabout that with the different
types of plants, but it's reallyimportant to have a wide range
(26:15):
of fibers.
We're going to get that in ourplant foods.
But find things that are alittle bit more gentle on your
gut If you have the sensitivegut, which you do if you have
IBS.
So things like kiwi, fruit,blueberries I love wild
blueberries, they're rich inpolyphenols, better for your gut
microbiome.
Chia seeds, white potatoes eatthe skin oats and things of that
(26:36):
nature.
Start there, those tend to be alittle bit easier on the gut.
And then reducing FODMAPs ifyou find a lot of gas, a lot of
bloating, and work with a GIdietitian to make sure you're
appropriate for that diet and tomake sure you have the right
guidance to do it.
So those are kind of my toptricks and tips, Dr Riehl, and
how about you?
All right.
Dr. Megan Riehl (26:57):
So I really thought about five lifestyle
recommendations for everybody,and the first thing is thinking
about stress.
So stress affects the chemicalsin your body, and when we also
think about constipationspecifically, you're tense,
you're irritated, you're seekingrelease, and so the more stress
you have in your life, the moreyou're just going to kind of
(27:18):
wind yourself up, and so what Iwant you to do is be really
intentional about finding sometime in the near future to sit
and reflect.
Think about what are some ofyour occasional stressors, like
vacations or travel or thefamily coming into town, as well
as your daily stressors, andthese are going to be things
(27:40):
like your family morning routineor your nighttime routine.
Assess how that's going, assessif your blood pressure shoots
up during those periods of time,and come up with a new plan.
Recognize that there can besome kinks to work out as you
make some changes and developnew routines, but these usually
(28:00):
stabilize within a couple daysor weeks, and if you find that
you need a little help to makesome changes in your routines,
then seek that support with,typically, a mental health
provider can be very helpful incoming up with exactly what you
need.
I always say that everything isharder if you're not sleeping,
and so that's the other side ofthis is to create consistency in
(28:23):
your sleep, and not sleepingenough or sleeping too much can
have really adverse healtheffects, and in fact, in one
study it was found that shortsleep duration posed a higher
risk of constipation in men,whereas sleeping too much
correlated with higherconstipation risks in women.
So this is really important forall of us to think about in
(28:46):
terms of adopting a routine foryour bedtime that you can be
consistent with, and thisdoesn't mean it has to be some
million-dollar facial routinelike you're at the spa or use of
a Vegas nerve pillow spraythose exist.
What it really means isteaching your body that it's
time to wind down.
You can give yourself an idealbedtime and really work
(29:10):
backwards from that.
So whatever will get you eighthours of sleep, work backwards.
And then we've talked aboutthis in the past where you want
to keep the bedroom for sleepand sex, and that is it.
Turn off screens a couple hoursbefore you plan to close your
eyes and then come up withthings that are tangible, like
having a cup of tea before youbrush your teeth, turning off
(29:31):
the lights and doing some gentlemuscle relaxation.
I also think it can be reallypowerful to end your day with
constructive and self-affirmingtalk.
So it could be as simple astoday.
I did my best and that's it.
That's it.
Aim to do this routine everysingle night.
We also want to work and thinkabout how we can reduce the
(29:53):
physical effects of stress thatbuilds up throughout our day,
and this can come in the form ofwhat I call a breath check and
a body scan.
So as you move through your day, we're dealing with whatever
life throws at us.
Our breathing can change andreally be reflective of where
we're at from a stress andanxiety perspective.
So the more busy we are, theshorter and the shallower our
(30:13):
breath can become.
You might even catch yourselfholding your breath, and so I
recommend setting an alarm, asyou're getting used to doing
these types of check-ins threetimes a day.
So I kind of think to anchor itnext to things that you do all
the time Drive to work, midday,drive home.
Waking up, lunchtime, going tobed.
And this can be when you stop,you deepen your breath, you
(30:36):
notice how your breathing is.
Could it be a little deeperinto the belly?
What does that feel like?
Does it make you naturally dropyour shoulders.
And if you pair this with abody scan where you ask yourself
, where do you carry yourtension?
And usually people have apretty good idea about this oh,
it's in my shoulders, or my jaw,or my gut, my stomach.
(30:57):
Start there, take a couple deepbreaths, kind of focusing your
attention to that space,noticing what it feels like when
you do release tension there,and then kind of do a quick scan
of the body from head to toe,relax the forehead, the jaw,
pull the shoulders down, wigglearound a little bit, notice how
(31:17):
that feels and then, onward withthe day, this can be done in 60
seconds or less, also having anidea of when you're going to do
this.
So, as I was saying, anchoringthis into things that you
already do goes along with mynext tip, and this is organizing
life via a planner.
My friends and family know thatI have been using a planner
(31:40):
diligently since I was in fifthgrade and, in fact, if you ever
need to know what I was doing ona particular date or time, I
can tell you what it was becauseI have it documented in my
planners.
And so, having some way toorganize and know what you're
doing on a day, in a week in amonth.
Also, having vacations plannedor times off gives us little
(32:01):
sparks of endorphins to thinkabout that vacation that we're
going on in a couple of months.
But also we can do somethingcalled time blocking, where you
dedicate specific slots of timefor specific tasks, and this can
be so that you know where arethe family activities.
How does that fit in with yourwork schedule?
When are you exercising, whenis your specific time for
(32:23):
relaxation?
And also how does self-care fitin?
Now, this brings us to kind ofwe're getting ready to wrap up,
and I think that self-care andwellness can be really
triggering words, and so I'mgoing to give you some tangible
tips on self-care.
So, Kate, how much do you thinkthe wellness industry is worth?
Kate Scarlata, MPH, RDN (32:43):
I'm going to say $2 billion,
Dr. Megan Riehl (32:45):
$2 billion.
Well, the Global WellnessInstitute found that this
wellness industry, which ismostly targeted at us women, was
worth $4.4 trillion Trillionwith a T.
Kate Scarlata, MPH, RDN (32:57):
Wowza.
Dr. Megan Riehl (32:58):
So I think that this can be an area where we
can get taken advantage of, andthat's why I loved the book
called Real Self-Care by DrPooja Lakshman, who is a
psychiatrist and she wrote thisbook, and this book came out by
her last year, and what I justwant to highlight for people is
(33:19):
that we have to be on thelookout for faux self-care and
this is a noun typicallydescribing a product or an
activity that's prescribed bysomebody else.
And real self-care this is thestuff that originates within you
, what you value.
It's a verb describing aninvisible internal
decision-making about how you'regoing to spend your time, to
(33:41):
bring yourself joy.
And she writes and I'll justread this directly because I
think it's beautiful, "realself-care requires treating
yourself with humanity and beingin tune with what you need and
want at any given moment, and so, when you're practicing real
self-care, self-compassion isthe lens through which you view
(34:02):
yourself" and so figuring outfor yourself what self-care
means.
And that might mean that you,from a guilt-free perspective,
stop every single day and youtime block 20 minutes or an hour
on Peloton, or going for a walk, or being out in nature to fill
(34:22):
your cup, and you do thiswithout guilt, and so I think
I'll leave you with that.
We hope that you will allowyourself the time to reflect on
what this all really means foryou and what your needs are, and
as we put all of this together,we recognize true constipation
and IBS management requiresnourishing your gut as well as
(34:44):
your mind and your body.
Kate Scarlata, MPH, RDN (34:46):
Thanks for listening, friends, please
subscribe to The Gut HealthPodcast.
We appreciate your support,friends.
Dr. Megan Riehl (34:53):
Thank you for joining us as we grow this gut
health community.
We hope you enjoyed thisepisode and don't forget to
subscribe, rate and leave us acomment.
You can also follow us onsocial media at The Gut 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
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.
(00:23):
The Gut Health Podcast willempower you with a fascinating
scientific connection betweenyour brain, food and the gut.
Come join us.
We welcome you.
Hello friends, and welcome toThe Gut Health Podcast, where we
talk all things related to yourgut and well-being.
(00:44):
I'm Kate Scarlata, a GIdietitian.
Dr. Megan Riehl (00:48):
And I'm Dr Riehl, a GI health psychologist,
and today's episode Mind YourGut: Diet and Lifestyle
Solutions for Constipation ispart two of our three-part IBS
series.
I hope that you listened topart one with Dr.
Justin Brandler, because he isa true wealth of information and
enthusiasm and we had such agreat time.
(01:10):
So please make sure you'vechecked out part one.
And now we get to dive intopart two.
Kate Scarlata, MPH, (01:16):
Absolutely , and Megan and I really love
talking about diet, behavioraltherapies, lifestyle and how
that can really play a role inIBS symptom management, and you
know we wrote Mind Your Gut forthat reason, because we know
these therapies can beextraordinarily helpful if
you're living with irritablebowel syndrome.
(01:37):
So certainly, as a GI dietitian, I'm going to delve right into
my favorite topic and that'snutrition.
I'm really grateful to see theinterest in nutrition and how it
intersects with IBS.
Finally, because I've beendoing this for over 30 years and
really for years we had nothingto say to patients other than
(01:58):
hey, try to increase your fiber.
And often that just reallyfailed and made their symptoms
worse, and often that justreally failed and made their
symptoms worse.
So now we know a lot more andpeople are interested,
researchers are interested inreally looking at this, and so,
although we're in the beginningstages of understanding
nutrition and IBS, and we allknow that individuals with IBS
(02:20):
have somewhat of a differentindividual experience, we need
to personalize nutrition, butthere are some general takeaways
that can be applied to mostpeople living with this
condition and I really wanted totalk a little bit about, just
in general, ibs and how patientsexperience eating.
(02:40):
There was a great survey studyof about 200 IBS patients and
84% said just eating any foodtriggered their symptoms.
That's quite a lot of people,and that's not surprising to me,
because I certainly hear thatfrom patients that I intersect
with on a regular basis.
Dr. Megan Riehl (02:57):
And I think even the ears that you are
listening to this podcast witheven if you don't have an IBS
diagnosis, some of us are goingto have occasional bouts of
constipation, some people aregoing to have more chronic IBS
with constipation, but Ipersonally love hearing your
wealth of information, becauseoccasionally things are going to
(03:20):
slow down a bit, and so whatare some of the foods that we
need to be thinking of when ourtummy is upset or when we're not
having complete evacuation inthe bathroom?
So I think that that's justimportant for us to be thinking
of as we move through thisconversation about food and mood
.
And you kick it off, kate.
Kate Scarlata, MPH, RDN (03:41):
Yeah, absolutely agree with you.
You know, when we think abouthow food intersects with the gut
, all of us are going to beaffected at some point, and
constipation is a hard one,because most people living with
constipation, especially withIBS, they're the ones that tend
to be a little bit moresymptomatic.
They're more likely to havebloating associated with their
(04:02):
symptoms.
So let's get into a little bitabout diet.
So the survey study that Imentioned earlier 84% felt that
eating anything triggered theirsymptoms, but the vast majority
of them pinpointed actuallyfermentable carbohydrates as
their top trigger and the lowFODMAP diet that is, a diet
specifically for reduction offermentable carbohydrates shown
(04:26):
to be the most beneficial diet,the most researched diet for IBS
.
It's really no surprise.
I mean, these patients knowwhat's bothering them, they
identified them and now we havea diet therapy that really
addresses how we can reduce someof these fermentable
carbohydrates.
So we've got the most researchon IBS.
The vast majority of studiesshow efficacy or the ability for
(04:50):
the diet to manage symptoms inabout 50 to 80% of people.
There was a recent study in TheLancet journal that suggested
efficacy around 76.
So it's in that range.
Not everyone's going to benefitfrom reducing fermentable
fibers, but at least half will.
That's pretty amazing.
(05:10):
It's better than any medicationthat's out there for IBS.
So diet is, and can be, verytherapeutic.
Dr. Megan Riehl (05:14):
It's comparable to our behavioral therapy
outcomes.
Kate Scarlata, MPH, RDN (05:18):
Yes, and we are going to dive into
those with Dr Riehl, who is theexpert in all of those
behavioral therapies, which Ican't wait to just dive into
that in just a moment.
I'm talking FODMAPs, I'mtalking about the fermentable
carbohydrates it's really anacronym and I don't want you to
get caught up in these sciencyterms, don't ask me to say this.
(05:39):
Okay, you have to.
No.
So fermentable oligosaccharides, disaccharides, monosaccharides
and polyols and in general,just so what you really need to
know.
They're small carbohydratesthat are commonly malabsorbed.
They pull water into the gutand or are rapidly fermented by
our gut microbes, creating a lotof gas.
(06:00):
That water in the gut, the gasin the gut kind of stretches the
gut, makes us feel a little bituncomfortable, makes us gassy,
right?
So all of those symptoms thatcan be problematic when
experiencing IBS, but alsosometimes just all of us, it can
be really uncomfortable.
So common FODMAP foods dairy,but it's not all dairy.
(06:24):
It's the dairy that's rich inlactose and that's the wet part
of milk.
So think of milk and ice creamsas wet, not a hard cheese
(that's dairy) or butter.
Those are very low in lactose,but those that have a lot of
like fluid consistency to themtend to be higher in lactose.
Also, big FODMAP rich foods areyour onion, your garlic, your
(06:45):
wheat.
Those are big triggers for alot of different people.
And then there's some fruitslike stone fruits, peaches,
plums, prunes.
We know we use them forconstipation a lot of times and
part of the reason we do isbecause of their FODMAP activity
, pulling a lot of water intothe gut.
It does soften the stool but itcan be a little bit gassy for
people with IBS, so sometimesthose prunes or prune juice
(07:08):
doesn't work as well in thatsensitive gut that we see in IBS
.
So additionally, when it comesto FODMAPs, there's been some
really interesting research outof UMichigan and this has been
led by Dr.
Prashant Singh, and whatthey've looked at in animal
studies and in a small subset ofhumans, that in humans,
(07:28):
particularly when they respondto the low FODMAP diet, when
they give them high FODMAP foods, a cascade of effects occur in
the gut and what happens is thatthere's more of a dysbiosis, so
more sort of pathogenicpotential microbes in the gut,
or what we call bad microbes,versus health-promoting microbes
(07:50):
, and this leads to immuneactivation as well as colonic
permeability, an increase incolonic permeability.
And this is just giving usinsights into some of the
mechanisms why FODMAPs maytrigger pain in some of these
IBS symptoms.
So very, very interesting.
Love seeing this head in adirection where we're
(08:10):
understanding not just like oh,this makes you better, but why
it might make you better.
I love that because you know welike science, right, dr Real?
That's right.
That's right.
First, let me just tell you thatthe low FODMAP diet is
typically done in a three-phaseapproach.
So you eliminate FODMAPs.
This is the beginning of thediet.
(08:31):
You don't stay here, okay.
So reminder to my listeners,our listeners out here this is
the beginning of the diet.
We're reducing FODMAPs.
Seeing how you do?
You stay there about six weeks.
Then we do a reintroductionprotocol, which we
systematically add FODMAPs backto really understand which
FODMAP subtypes whether that'slactose or fructans these are
(08:53):
all different types ofcarbohydrates that are commonly
malabsorbed which ones aretriggering you.
And then the last phase is thepersonalization phase, when we
add back the foods that you cantolerate, because there's no
reason to restrict all FODMAPslong-term.
In fact, studies have shown usthat the average amount of
FODMAPs that are problematic forIBS patients it runs about two
(09:15):
to three of the groups.
So not everyone has issues withthe polyols or everyone has
issues with the monosaccharides.
It's really variable person toperson and we want you to have a
liberal diet and enjoy food.
So that's really important.
Dr. Megan Riehl (09:31):
And this is why , if you've ever Googled a
dietary therapy and you've usedthe low FODMAP diet, you picked
up one of Kate's books and youhave gotten some relief, but you
have never resumed thereintroduction phase.
This is key.
We don't want you staying onthe low FODMAP diet long-term.
(09:52):
So if you're still on that diet, you're still in the
restriction phase, work with aGI dietician or experiment
yourself, knowing that it'snormal to have maybe some slight
increases in your GI symptomswhen you're going through
reintroduction.
Your body will get used tothose foods that you've been
missing for a little while andthat maybe you avoid.
The foods that really, if theydo cause you a big flare of
(10:14):
symptoms or more severe symptoms, there you go, ding, ding, ding
.
That's the group that you wantto stray away from.
Absolutely.
Kate Scarlata, MPH, RDN (10:22):
And I think that's a really important
point, Megan, is that you know alittle gas bubble, a little
distention after you add FODMAPsback, totally normal.
It's really when you'retriggering like a major IBS
flare and you're feeling thepain and you're like, oh, this
was really bad, then you knowthat would sort of warrant a
trigger, not necessarily alittle gas.
(10:44):
We all get gas when we eatFODMAP, so you're not alone out
there.
And then, briefly, I'm going tojust talk about a couple other
diets that have been studied forIBS.
One of them is theMediterranean diet and, to be
honest, there's been threestudies.
Two showed favorable results.
The third was very mixed andnot definitive on that.
For me personally, I do think aMediterranean diet which is
(11:07):
rich in things like lots ofplants, legumes, nuts, seeds,
olive oil, a little bit of fish,a little bit of yogurt, healthy
, has a lot of evidence for justgeneral health cardiovascular
risk, diabetes risk, so manyhealth benefits.
So eating like that, great, ifyou can.
Mental health, mental healthtoo, and even in the IBS studies
(11:29):
mental health was noted as abenefit.
So yeah, give it a go.
There's some evidence, not asstrong as a low FODMAP because
there's not as much studiesright.
So the weight of the studiesout there, it's just less but
interesting could be beneficial.
And then the other diet I oftenkind of go to and we'd kind of
morphed it and used it as partof our Mind Your Gut Gentle Diet
(11:51):
Cleanup is the UK NICEguidelines for IBS and in
general this is really a cleanup.
It's like don't skip your meals, eat in a relaxed setting,
don't have a bunch of junk food.
Limit your fruits, becausefruits tend to have a lot of
these fermentable sugars thatare problematic.
Don't overdo it with alcohol.
(12:12):
None of us should be, by theway.
Keep caffeine at bay if ittriggers your symptoms.
More of a problem for thosewith diarrhea-predominant IBS,
for those with constipation.
I find my patients tend tobenefit from the caffeine.
It stimulates colonic motility.
That's not a bad thing when youhave a sluggish gut.
So those are really the threemain diets that I look at.
(12:32):
There are some studies lookingat very, very low-carbohydrate
diets.
I'm not a huge fan for thatbecause, quite honestly, fiber
is a carbohydrate, so we needfiber.
We know that fiber isbeneficial for our gut
microbiome, so I don't know thatwe have to go that low, right?
Yep.
Dr. Megan Riehl (12:52):
So that is all a really nice overview of some
considerations with ournutrition and IBS, and let's
also talk about this mind-gutconnection that is at play.
This is a very complexinteraction between the brain
and the gut, but guess what?
We all have it.
It's complex, but we all haveit, and many, many different
(13:14):
factors can impact your mind-gutconnection.
Kate just covered a big onefood, but also our environment,
stress, mood, genetics,medications and really a lot
more.
And so you know, as we thinkabout putting all of these
pieces together in powerful waysthat we can address our overall
GI health.
Knowing that the brain and thegut communicate and can produce
(13:38):
symptoms that are very real isimportant, and that
communication pathway, yourbrain-gut access, includes your
vagus nerve as well as differentneurotransmitters that are
produced in your brain and yourgut.
And when we see changes in thiscommunication pathway that can
affect your gut motility, thesensations that you feel, and it
(13:59):
can potentially then lead toIBS-like symptoms, can
potentially then lead toIBS-like symptoms.
And so, given this intersectionbetween brain-gut behaviors, we
utilize brain-gut behavioraltherapies that have now really
become a gold standard as partof treatment for patients living
with IBS.
And also today, I want you tobe thinking about ways that you
(14:21):
might incorporate some of thesesuggestions that you might
receive in therapy.
But also, maybe you mightreceive in therapy, but also
maybe you're not in therapy andyou're just again.
Just like we would do a gentlediet cleanup, we want to kind of
think about doing a gentle,mindful lifestyle cleanup as
well.
So some of the science-backedinterventions that we use that
come from this brain-gutbehavioral therapy world, or
(14:44):
also known as gastropsychology,include cognitive behavioral
therapy that's specific to GIconditions and concepts,
gut-directed hypnotherapy,mindfulness-based stress
reduction techniques andrelaxation training.
These are all aspects oftreatment that you may receive
if you're working with a GIpsychologist, and there are many
(15:07):
, many studies out there thatsupport the efficacy of
utilizing these strategies, andI'll use hypnosis as one example
where patients that have beenrefractory to pretty much every
other medical treatment that'savailable for IBS.
Those patients have responserates of over 60% when they are
(15:29):
using a protocolized,evidence-based gut-directed
hypnotherapy program.
So it's really exciting that wehave so many different targets
and ways to get at helping youlive a better life if you're
somebody that's affected by IBS,and these psychological
interventions are going to betailored to your needs.
(15:50):
So when you're working withsomebody like myself.
We're going to be looking atwhat's your mood like anxiety,
stress Do we need to really honein and build some additional
coping strategies for when yoursymptoms are unpredictable and
can feel uncomfortable anduncontrollable?
And a GI psychologist is goingto help you gain insights into
(16:11):
how you respond to uncomfortablesensations in your body.
Sometimes those uncomfortablesensations are going to activate
your body's sympathetic system,which is the fight, flight or
freeze response, and that alonecan trigger more
neurotransmitters that canexacerbate your GI distress.
So a lot of work is done foralmost every patient that I work
(16:35):
with to have some early,tangible strategies you can turn
to.
So we've got things like properpooping position, making sure
that you are using a squattypotty and your knees are
elevated above your hips with atoileting stool, diaphragmatic
breathing We'll link a quickYouTube clip to make sure that
you're aware of how to do thistechnique and also making sure
(16:58):
not to sit on the toilet for toolong.
I believe it was Dr.
Darren Brenner in one of ourprevious episodes who really
highlighted you should not besitting on the toilet longer
than five to 10 minutes.
So if you find that you'restruggling with things like this
, seek support.
Sometimes lifestyle changes canbe really critical in terms of
making some long-term changesfor your overall gut health, and
(17:21):
there are certainly providersout there that can help you with
this.
Another type of therapy thatI'll mention is something called
biofeedback.
So sometimes when you Googletherapies for constipation,
you'll find biofeedback comes up, and this is usually not a type
of therapy that's delivered bya mental health provider, though
sometimes in the context of aholistic practice, together with
(17:44):
a physician, you might receivethis type of training, but
usually you receive biofeedback,which is a type of therapy
where you're using an electronicdevice to help you gain some
awareness and control over yourphysiological functions, and in
the constipation world, this isto help you better coordinate
your pelvic floor muscles, andso a pelvic floor physical
(18:05):
therapist is usually somebodythat you will work with, and you
can't talk about constipationmanagement without mentioning
pelvic floor PT.
This can be a reallylife-changing type of therapy
for somebody that hasconstipation.
If you've ever been diagnosedwith something called
(18:26):
dyssynergic defecation,definitely talk with your
provider about how this fitsinto your treatment plan, and
what I've seen incollaboratively working with
pelvic floor physical therapistsis that either they have
already taught their patientdiaphragmatic breathing or some
type of massage.
That again similar to how Itreat and teach everybody
(18:48):
diaphragmatic breathing, so dothey.
So this is something that, evenif you haven't formally worked
with a pelvic floor physicaltherapist yet, it's something
you can get started with, justlike something like abdominal
massage, and we discuss amassage called the I Love U
Massage.
In Mind Your Gut.
You can easily find this on theinternet, too, which can really
(19:11):
be helpful for somebody that'seither struggling with chronic
or occasional bowel problems.
Ardelyx (19:21):
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 option
(19:42):
for you.
Ready to try somethingdifferent for your IBS-C
symptoms?
Ask your doctor about Ibsrela.
Do not give Ibsrela to childrenless than 6.
You should not give Ibsrela topatients 6 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.
(20:03):
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 (20:28):
The last therapy that I'll mention has
growing interest in the world ofkind of complementary and
alternative therapies, and thisis acupuncture.
So we know that acupuncture hasbeen around for literally
centuries but in terms of usingit for therapy, there have been
several systematic reviews,including meta-analyses, that
have shown the effectiveness ofacupuncture for chronic
constipation and in this type oftreatment, an acupuncturist
(20:52):
will use acupoints on the skinthat are manually stimulated
with needles and very specificpoints, and we won't get into
the nitty gritty details, butwhat I will say is that back in
2023, we hired an acupuncturistin our GI division at the
University of Michigan and hisclinic was full within a very
(21:13):
short period of time and there'ssome really cool research that
people like Dr Borko Nojkov isdoing with our acupuncturist,
Henry Buchtel, and it's, I think, going to help further the
interest of this type of therapythat you know our division
chief, Dr Chey, has reallypromoted as getting outside of
(21:36):
the traditional therapies forconstipation and IBS and really
thinking broadly about what wecan learn from other types of
medicine.
So this is exciting stuff and weknow that now there is a place
certainly for medication, but Ithink also there are a lot of
people that are interested inother ways to address their
(21:59):
health.
That hit some of the tips andtricks that we're going to give
you right now.
Kate Scarlata, MPH, (22:04):
Absolutely , and you know I'm glad you
brought that up because I dothink, and it's been shown in
the research, that people thatare living with IBS are very
interested in more of theseholistic approaches.
And I certainly don't want todiscount medication either,
because I would say the vastmajority, or at least 50% of the
patients that I've interfacedwith have required some level of
(22:26):
medication, whether it's alaxative or a neuromodulator or
something to manage their IBS.
No shame there.
If you need a medication, youneed a medication.
You want to feel better to livethe best life you could live
right.
But this growing arsenal ofholistic therapies is really
(22:49):
exciting to see because it'smeeting a need that many
patients are truly interested in.
Dr. Megan Riehl (22:52):
That's right.
Let's say, the medication isthe thing that allows you to
leave the bathroom right, butnow you have the rest of your
life to live.
You still have to eat, youstill want to feel fulfilled,
you want to have joy in yourlife, and so when you can choose
foods that you know alsonourish your gut, when you can
choose activities that are goodfor you, such as yoga, it kind
(23:14):
of kills two birds with onestone.
Right when you're approachingyour lifestyle from a healthy
perspective, that includeswhatever strategies help to let
you have complete bowelmovements, exactly, exactly.
So, kate, what are your tips?
Give us some nutritiontakeaways that I'm going to be
thinking of when I'm at thegrocery store and are going to
(23:35):
help the Riehl family to havehealthy guts and butts.
Kate Scarlata, MPH, RDN (23:44):
Healthy guts and butts?
Okay, well, you know.
My first thing is to eatregular meals, don't skip.
A lot of people living with IBSthink, well, if I don't eat, I
won't have symptoms and that'llbe great for my work day.
Or fall into the habit ofrushing and eating standing, or
with working on the computer andinhaling a sandwich and not
even tasting it.
None of that really works well,if you're skipping meals,
(24:07):
you're going to overeat.
You're going to come homeyou're going to indulge in
getting rid of those hungerpains that you're experiencing.
It's too much food for your gut.
At once, it impacts your sleep.
So many downstream effects tothat.
Just learn what you can toleratefor breakfast so that you can
start your day, to nourish yourbrain, to take on the day and
(24:27):
you have the strength and energyto face all that comes our way,
because we all have differentthings coming our way.
Right, I'm dealing with a labright now, a chocolate lab puppy
, and she's keeping me on mytoes over here.
So wherever you are in, youknow we're always up against
something.
So the other thing I thinkthat's really important with
(24:47):
eating and something that we'vedone with our kids as they've
grown up.
Light, music, a candle, ifyou're into it, just to kind of
set the tone also for relaxing.
Once your body's relaxed you'reready to take in the food.
So you're in more of thatparasympathetic mode rest and
digest.
So if you need some externalcues, that can also be helpful.
(25:09):
The other thing, just foreating breakfast, really
important because you have thisreflex called the gastrocolic
reflex.
It's most active in the morningand that's stimulated.
It stimulates colonic activitywhen you're eating.
So if you're doing that in themorning, it's more active in the
morning.
You're more likely to have acleansing bowel movement in the
morning.
So again, for thoseconstipation predominant
(25:31):
listeners out there, payattention certainly to that.
So the other thing I think isreally important is to eat a
variety of different coloredplants.
Eat the rainbow and that helpsfuel a healthy gut microbiome.
Your rainbow may look a littledifferent than mine and that's
okay, but think about gettingdifferent colors into your diet.
I think the other thing that'sreally important is what you can
(25:53):
go easy on and that's the booze, the alcohol, really limiting
to no more than one drink ifyou're a woman, two drinks for
men and just keeping that incheck.
Caffeine, if your diarrheapredominant.
Keep a button up on that one.
Get your fiber on and I talkedabout that with the different
types of plants, but it's reallyimportant to have a wide range
(26:15):
of fibers.
We're going to get that in ourplant foods.
But find things that are alittle bit more gentle on your
gut If you have the sensitivegut, which you do if you have
IBS.
So things like kiwi, fruit,blueberries I love wild
blueberries, they're rich inpolyphenols, better for your gut
microbiome.
Chia seeds, white potatoes eatthe skin oats and things of that
(26:36):
nature.
Start there, those tend to be alittle bit easier on the gut.
And then reducing FODMAPs ifyou find a lot of gas, a lot of
bloating, and work with a GIdietitian to make sure you're
appropriate for that diet and tomake sure you have the right
guidance to do it.
So those are kind of my toptricks and tips, Dr Riehl, and
how about you?
All right.
Dr. Megan Riehl (26:57):
So I really thought about five lifestyle
recommendations for everybody,and the first thing is thinking
about stress.
So stress affects the chemicalsin your body, and when we also
think about constipationspecifically, you're tense,
you're irritated, you're seekingrelease, and so the more stress
you have in your life, the moreyou're just going to kind of
(27:18):
wind yourself up, and so what Iwant you to do is be really
intentional about finding sometime in the near future to sit
and reflect.
Think about what are some ofyour occasional stressors, like
vacations or travel or thefamily coming into town, as well
as your daily stressors, andthese are going to be things
(27:40):
like your family morning routineor your nighttime routine.
Assess how that's going, assessif your blood pressure shoots
up during those periods of time,and come up with a new plan.
Recognize that there can besome kinks to work out as you
make some changes and developnew routines, but these usually
(28:00):
stabilize within a couple daysor weeks, and if you find that
you need a little help to makesome changes in your routines,
then seek that support with,typically, a mental health
provider can be very helpful incoming up with exactly what you
need.
I always say that everything isharder if you're not sleeping,
and so that's the other side ofthis is to create consistency in
(28:23):
your sleep, and not sleepingenough or sleeping too much can
have really adverse healtheffects, and in fact, in one
study it was found that shortsleep duration posed a higher
risk of constipation in men,whereas sleeping too much
correlated with higherconstipation risks in women.
So this is really important forall of us to think about in
(28:46):
terms of adopting a routine foryour bedtime that you can be
consistent with, and thisdoesn't mean it has to be some
million-dollar facial routinelike you're at the spa or use of
a Vegas nerve pillow spraythose exist.
What it really means isteaching your body that it's
time to wind down.
You can give yourself an idealbedtime and really work
(29:10):
backwards from that.
So whatever will get you eighthours of sleep, work backwards.
And then we've talked aboutthis in the past where you want
to keep the bedroom for sleepand sex, and that is it.
Turn off screens a couple hoursbefore you plan to close your
eyes and then come up withthings that are tangible, like
having a cup of tea before youbrush your teeth, turning off
(29:31):
the lights and doing some gentlemuscle relaxation.
I also think it can be reallypowerful to end your day with
constructive and self-affirmingtalk.
So it could be as simple astoday.
I did my best and that's it.
That's it.
Aim to do this routine everysingle night.
We also want to work and thinkabout how we can reduce the
(29:53):
physical effects of stress thatbuilds up throughout our day,
and this can come in the form ofwhat I call a breath check and
a body scan.
So as you move through your day, we're dealing with whatever
life throws at us.
Our breathing can change andreally be reflective of where
we're at from a stress andanxiety perspective.
So the more busy we are, theshorter and the shallower our
(30:13):
breath can become.
You might even catch yourselfholding your breath, and so I
recommend setting an alarm, asyou're getting used to doing
these types of check-ins threetimes a day.
So I kind of think to anchor itnext to things that you do all
the time Drive to work, midday,drive home.
Waking up, lunchtime, going tobed.
And this can be when you stop,you deepen your breath, you
(30:36):
notice how your breathing is.
Could it be a little deeperinto the belly?
What does that feel like?
Does it make you naturally dropyour shoulders.
And if you pair this with abody scan where you ask yourself
, where do you carry yourtension?
And usually people have apretty good idea about this oh,
it's in my shoulders, or my jaw,or my gut, my stomach.
(30:57):
Start there, take a couple deepbreaths, kind of focusing your
attention to that space,noticing what it feels like when
you do release tension there,and then kind of do a quick scan
of the body from head to toe,relax the forehead, the jaw,
pull the shoulders down, wigglearound a little bit, notice how
(31:17):
that feels and then, onward withthe day, this can be done in 60
seconds or less, also having anidea of when you're going to do
this.
So, as I was saying, anchoringthis into things that you
already do goes along with mynext tip, and this is organizing
life via a planner.
My friends and family know thatI have been using a planner
(31:40):
diligently since I was in fifthgrade and, in fact, if you ever
need to know what I was doing ona particular date or time, I
can tell you what it was becauseI have it documented in my
planners.
And so, having some way toorganize and know what you're
doing on a day, in a week in amonth.
Also, having vacations plannedor times off gives us little
(32:01):
sparks of endorphins to thinkabout that vacation that we're
going on in a couple of months.
But also we can do somethingcalled time blocking, where you
dedicate specific slots of timefor specific tasks, and this can
be so that you know where arethe family activities.
How does that fit in with yourwork schedule?
When are you exercising, whenis your specific time for
(32:23):
relaxation?
And also how does self-care fitin?
Now, this brings us to kind ofwe're getting ready to wrap up,
and I think that self-care andwellness can be really
triggering words, and so I'mgoing to give you some tangible
tips on self-care.
So, Kate, how much do you thinkthe wellness industry is worth?
Kate Scarlata, MPH, RDN (32:43):
I'm going to say $2 billion,
Dr. Megan Riehl (32:45):
$2 billion.
Well, the Global WellnessInstitute found that this
wellness industry, which ismostly targeted at us women, was
worth $4.4 trillion Trillionwith a T.
Kate Scarlata, MPH, RDN (32:57):
Wowza.
Dr. Megan Riehl (32:58):
So I think that this can be an area where we
can get taken advantage of, andthat's why I loved the book
called Real Self-Care by DrPooja Lakshman, who is a
psychiatrist and she wrote thisbook, and this book came out by
her last year, and what I justwant to highlight for people is
(33:19):
that we have to be on thelookout for faux self-care and
this is a noun typicallydescribing a product or an
activity that's prescribed bysomebody else.
And real self-care this is thestuff that originates within you
, what you value.
It's a verb describing aninvisible internal
decision-making about how you'regoing to spend your time, to
(33:41):
bring yourself joy.
And she writes and I'll justread this directly because I
think it's beautiful, "realself-care requires treating
yourself with humanity and beingin tune with what you need and
want at any given moment, and so, when you're practicing real
self-care, self-compassion isthe lens through which you view
(34:02):
yourself" and so figuring outfor yourself what self-care
means.
And that might mean that you,from a guilt-free perspective,
stop every single day and youtime block 20 minutes or an hour
on Peloton, or going for a walk, or being out in nature to fill
(34:22):
your cup, and you do thiswithout guilt, and so I think
I'll leave you with that.
We hope that you will allowyourself the time to reflect on
what this all really means foryou and what your needs are, and
as we put all of this together,we recognize true constipation
and IBS management requiresnourishing your gut as well as
(34:44):
your mind and your body.
Kate Scarlata, MPH, RDN (34:46):
Thanks for listening, friends, please
subscribe to The Gut HealthPodcast.
We appreciate your support,friends.
Dr. Megan Riehl (34:53):
Thank you for joining us as we grow this gut
health community.
We hope you enjoyed thisepisode and don't forget to
subscribe, rate and leave us acomment.
You can also follow us onsocial media at 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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