February 24, 2025 • 39 mins
What if you could navigate the complexities of IBS without falling into restrictive habits or feeling overwhelmed? Join us for an insightful conversation with Erin Judge, a registered dietitian nutritionist as she shares her compelling journey from childhood challenges with IBS-C to becoming an advocate for patient-centered care. Erin opens up about her early experiences with gastrointestinal issues, exacerbated by a Giardia infection painting a vivid picture of the emotional and physical hurdles she faced living with the complexities of IBS, in a time in which, IBS research and treatment modalities were limited.
Erin's story is a testament to resilience and the important ways resources for IBS management have evolved over the last decade. She reflects on how understanding balanced nutrition, avoiding restrictive habits and adopting an enriched lifestyle have been key to her management strategies.
Listeners will gain valuable insights into practical strategies for constipation relief, emphasizing the gut-brain connection's role in managing symptoms. Erin discusses the significance of lifestyle adjustments, such as movement, adequate hydration, supportive dietary changes, and stress regulation, offering a toolkit to empower individuals facing similar challenges. By sharing her knowledge and experiences, Erin aims to foster hope and confidence, encouraging a guilt-free approach to health and wellness for those living with IBS.
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.
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Kate Scarlata MPH, RD (00:17):
This podcast has been sponsored by
Ardelix, or a healthcareprovider, 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 (00:39):
Welcome to the Gut Health Podcast, where we
talk about all things related toyour gut and well-being.
We are your hosts.
I'm Dr Megan Riehl, a GI healthpsychologist.
Kate Scarlata MPH, RD (00:49):
Hi, and I'm Kate Scarlatta, a GI
dietitian, so today's episode ispart three of a three-part
series that we have on irritablebowel syndrome, specifically
IBS-C or constipationpredominance IBS.
This is our last part three ofthe series, and we've really
covered a wide range of topicsrelated to this diagnosis.
Dr. Megan Riehl (01:12):
Yes, last but not least, a very, very
important piece of the storywith IBS.
Today, with our guest, who isErin Judge, I'm going to tell
you a little bit about her, withthe topic of IBS being very
near and dear to us.
It's a subject matter of ourbook, Mind your Gut, but also
one that Erin speaks veryeloquently on as a registered
(01:34):
dietitian and nutritionist.
She's also a certified personaltrainer and founder of Gutivate
, a virtual nutrition counselingpractice for digestive
disorders and gastrointestinalconditions.
Erin's wealth of expertise isin providing medical nutrition
therapy for functional gutdisorders with a
patient-centered focus.
(01:54):
She is proud of her work ineducation and advocacy for the
IBS patient community throughsocial media, as well as her
work in providing resources fordieticians in the GI field.
In addition to the importantwork that Erin does in her GI
practice, she's also anindividual living with IBS-C.
So for today's topic Findingyour Path A Personal Journey to
(02:17):
Constipation Relief.
We are so delighted to have youtoday, erin, to highlight your
resilience and share yourinsights, so welcome.
Erin Judge RD (02:26):
Thank you so much for having me.
I'm excited to be here.
I admire you both and so I'mvery excited to be able to chat
and talk about this topic that,you are correct, I love very
dearly.
Dr. Megan Riehl (02:38):
Yes, yes.
Well, there's lots ofchallenges and solutions, and so
we're going to dive in there'slots of challenges and solutions
, and so we're going to dive in.
Kate Scarlata MPH, RD (02:49):
I know I think of so many GI dieticians
that have gone into this field,often because we haven't had
really satisfactory care alongour own journey or we're hoping
to learn a little bit more tomake this journey a little bit
easier for others that arewalking our path.
So, with someone that liveswith a GI condition post-surgery
, I know that you have your ownpersonal journey and experience
and we'd love you to share that,erin, starting from the early
(03:12):
days of a diagnosis to where youare now.
Erin Judge RD (03:16):
Absolutely so.
My story is not unlike a lot ofpeople in our community, but it
is also very different than alot of adults I typically see.
So my story with IBS did startin childhood and my diagnosis
came around fourth grade.
Whatever age that was, a lot ofit, as you'll probably figure
out from my own story, has beena bit blocked out in my memory,
(03:38):
but I remember getting adiagnosis after three full years
of kind of going back and forthto specialists having many
different tests run, and it allstarted with what we found to be
a Giardia infection that I hadaround like kindergarten, first
grade.
I don't know how they found itmuch later but it makes sense
with my history, but I wassomeone who was constantly
(04:01):
getting sick.
I would have the stomach virusover and over and over again and
you know it was on multiplerounds of antibiotics throughout
those years.
In first grade my dad wasdiagnosed with a chronic illness
that we did not believe wouldbe he would live very long and
so he went through experimentallike drugs at that time within
(04:22):
and out of the hospital.
So you have this child that wasbombarded with a gut infection,
chronic antibiotics, againconstantly getting sick.
I grew up in what we wouldconsider to be a food desert in
rural South Arkansas.
Most of my food intake wasbread and cheese.
I did not eat a lot ofvegetables and fruits and those
(04:44):
things, especially when I wasoften sick and then was hit with
this family childhood traumaadverse event that was really
hard to process as a young child.
So I held a lot of anxiety inmy body, held a lot of stress in
my body and I kind of grew upin a space where we just didn't
(05:05):
talk about it if we werestruggling, right.
I'm now almost 33 years old, soI know a lot of people who grew
up even at the same time that Idid.
That was before we had accessto social media and information,
but we also grew up where wedidn't discuss hard things and
especially when it came tohealth as a kid.
(05:25):
I didn't learn a single thingabout health as a young child in
school and from my family, andwe didn't have access to those
resources.
And so I found myself overthose years, you know, going
from getting you know stomachviruses off and on so getting
the Z-Pak every time for somereason, you know, just going
through the cycle of all thesedifferent infections and gut
(05:45):
issues, to then that settling alittle bit but it turned into
these more significant flares.
So I found that I would have,you know, accidents at school
which now I believe to be kindof that overflow diarrhea Like I
was so backed up and full ofstool.
You know I would constantlyhave like smearing, you know, in
(06:06):
my underwear and need to changeand was really overwhelmed and
stressed about that.
Again, I was in second, thirdgrade.
I was a very young child wherethis was not expected.
I would get in trouble for itbecause my family believed it to
be more behavioral and I wouldalso find myself in the flares
of so severe pain that I wouldbe crying on the bathroom floor
(06:30):
in the middle of the night andmy mom would always think, okay,
you have gallstones, you havepancreatitis, like something is
seriously wrong because you'rein significant pain.
So she would end up taking meto the hospital, which was an
hour and a half away, thechildren's hospital.
So we would drive to thehospital, get the initial test.
It wasn't anything more thanconstipation.
(06:50):
I would come home, have to dosuppositories and enemas and all
these extreme measures and thatwas my life for three to four
years before I finally got alittle bit more testing and they
ruled out as much as they couldand decided that I had IBS and
that was kind of all we weregiven at that time.
(07:11):
I remember going off from thatpoint and I got the like little
Metamucil cookie things whichwere so gross.
Speaker 4 (07:20):
Why would you ever give a?
Erin Judge RD (07:21):
child, these little biscuit things like I
can't even look at them now.
I have such an adverse effectfrom those.
But I was sent home with thoseand Gatorade when needed, which
I don't understand, and then thesuppositories are in them as I
needed them.
That was kind of all that I wasgiven and thankfully I
transitioned into middle school.
(07:42):
I started playing sports.
I became a little bit more,maybe involved in my health.
Not consciously or with a lotof effort.
I did become aware of my body.
I was going through puberty sothere were things maybe I was
doing that.
I wasn't intentionally trying toimprove my constipation, but I
did improve the flares just bymoving my body more and doing a
(08:05):
few different things, and I alsolearned how to kind of control
and mask a lot of the flares andthe symptoms I was having.
So they turned into not havingaccidents that's called,
thankfully.
But I did learn how to not beaway from home too much.
Before football games everyonecame to my house so I would have
(08:26):
the comfort of my bathroom inmy home, in my comfort zone.
If I was too full, orcheerleading camp and all these
different environments where Iwould get so severely
constipated, I would just eat alittle less or skip a meal and I
would wear looser clothes oralways make sure my cheerleading
uniform was a little big enoughin case I was bloated.
And I didn wear looser clothesor always make sure like my
cheerleading uniform was like alittle big enough, like in case
(08:46):
I was bloated and I didn't knowwhat I was doing.
But looking back on it, I waslearning how to live with it.
Not well, because I also wouldfind myself in that significant
pain where I would sneak away tolay on a bathroom floor and
pass gas or maybe go home for alittle bit to maybe have a bowel
movement or manual evacuation,like there were so many things I
(09:09):
kind of learned to do to try tosurvive and get through it.
And it was finally.
Whenever I went to college andhigh school again, things got a
little bit better.
I was moving more, I was eatingsome fiber.
You know I was doing things Iwasn't necessarily treating IBS
for, but now I know I was atleast helping and supporting my
gut and the constipation and Iwas getting older.
(09:31):
But in college I found that Ireally struggled because I
didn't have my comfort bathroom.
I was in a dorm room, anotherlife transition.
I cried on my way to college andso many people will relate to
this, but I was going from atown of 1,000 people to what
would be considered to be a bigcity in Arkansas, the University
(09:53):
of Arkansas, our biggestuniversity, and that alone was a
huge change.
I was going to be living in adorm, I was stripped away from
all my friends and I was reallyinvolved in my high school.
I did well in school and I wasstripped away from all my
friends and I was reallyinvolved in my high school.
I did well in school and I wasgoing into like a pre-med and
kind of AP.
I got out of that reallyquickly, but the more advanced
(10:14):
classes I was going into that,and the thing that I cried in
the car on my way to collegeover was being in a public
bathroom.
That's what I was the mostafraid of was how am I going to
poop in a public bathroom on myfloor?
And what I did was all thegirls on my floor were in
(10:35):
sororities.
They went out on Thursday,friday nights.
That's whenever I could poop.
That's whenever I would havethat space to myself and I felt
comfortable.
That's whenever I would, youknow, have that space to myself
and I felt comfortable.
That's how I lived my entirefreshman year of college and
thankfully, I learned pre-medwas not for me.
I found dietetics and, you know, found nutrition and it was a
(10:56):
great change.
In my nutrition classes we hadone lesson on it was like our GI
lesson for M&T and there was afive minute part of that lecture
that was about IBS and it wasthe first time since.
So this is sophomore year ofcollege, since I was in fourth
grade and diagnosed with IBS,actually talked about IBS and
(11:26):
explained, you know, the thingsthat we could do and you know it
was low FODMAP diet.
I'm pretty sure that was allthat they said.
That's all we really had at thetime.
This is 2012, I think, and sobrief lecture, everyone just
moved on and I was thinkingabout I'm like wow.
I remember like I was told thatthis was something that I had.
This connects a lot with me.
(11:46):
And then I started going downthe path, which then was kind of
messy, tried doing everythingon my own.
I went to the doctors like Ineed to be tested for celiac
disease, I need to be tested forlactose intolerance.
I was trying to figure it out.
I was like none of this wasrolled out for me.
I need to make sure, and youknow the test came back as
negative.
But I was like, okay, well, Iguess I have IBS, like that
makes sense.
(12:07):
And so I started doing all ofthese different things in a not
so healthy way, because I wasliterally just reading a
textbook that had maybe achapter worth of information and
just getting as much, liketrying to grab, like what is
anyone saying about this?
What can I try?
I was trying to be healthy, youknow, as nutrition students
often do, and I found myselfvery restricted.
(12:29):
I had a lot of rules.
I definitely didn't go about itthe best way, but after many
years of trying to figure it outand reading the research and
becoming a dietitian and workingwith patients and just seeing a
little bit more I guess, depthof information that was
available, I kind of figured itout for myself and got to the
(12:52):
point where I didn't have flaresanymore and I learned how to
prevent the trapped gas paincompared to hiding away to like
go to the car and try to pass it, you know secretly away to like
go to the car and try to passit, you know secretly.
And so now I find myself.
I still have IBS and I alwayssay that.
I think it would be unfair tome to say I healed my gut and
I'm perfect.
(13:12):
I don't have painful flares.
But I'm also very intentionalevery day with the things that I
do and how I live my life toprevent that, because I lean
towards constipation still livemy life to prevent that, because
I lean towards constipationstill.
But now I get to also helpother people and patients across
the spectrum of IBS andfunctional GI disorders deal
(13:33):
with some of those symptoms.
But also, how do youhealthfully take care of your
gut and put all the piecestogether as you as a whole
person in a way that's actuallygoing to be supportive across
the board and not restrictive orisolating or all of those
things?
So very long winded way toshare my story.
But if you are familiar with mywork at all, it makes sense
(13:55):
where I come from personallybecause I've kind of woven that
into my communication and what Ilike to do now as a dietitian.
Dr. Megan Riehl (14:03):
I mean, first of all, thank you for your
openness and vulnerability andreally highlighting how
everyone's journey to IBS isdifferent, that you know there
are ways we can look atenvironment and genetics and you
know a post-infection andfamilial stress and life change
(14:28):
and all of those people with IBSwill have a variety of
potential factors that can leadto their diagnosis.
And you beautifully andvulnerably share your journey
there and arriving at being ahelper at somebody that has
taken what they've learned.
Is there something that, whenyou think back, would have been
(14:53):
helpful to have known back then,and maybe even highlighting
where the research has gone,even in?
You know I'm a bit older thanyou, so in that couple of years
since you've been in college andthen when you were a little one
, it is wild to think of howmuch more research we have.
Erin Judge RD (15:10):
Even since I was in college, I've been a
dietitian for it'll be 10 yearsthis year officially as a
dietitian, which is also hard towrap my head around.
But in the last 10 to 15 yearsthe research has completely
changed and you guys have been apart of that, and I mean even
looking at where we are today.
It's going to change even morein the next 10 years, which is
(15:32):
really exciting, especially forpatients, but also as a provider
, and so, of course, I wouldlove to know what we know now.
Whenever I was a kid I think Iactually have.
I'll share it with you.
I think that you guys wouldappreciate this, if I can
actually find it I think apsychologist is who I met with
after my diagnosis, very, veryyoung.
(15:55):
So I have this note.
My mom saved it.
She found it like in a drawer afew years ago, but I met with a
psychologist or a psychiatristsomebody after we got my
diagnosis, and this is the planthat I've received for my IBS,
and it says Erin needs to do atoilet sit after snack, after
dinner, in order to keep herprivileges.
(16:15):
Which advice.
Not so bad the result?
Maybe not.
Erin will earn $1 for eachaccident free day and Erin will
pay mom 50 cents each time shehas an accident.
And then Erin must continuecleaning up after an accident
and washing out her ownunderwear, and that was my plan,
(16:36):
that's horrendous.
It's not great and I know I wasmaybe motivated differently as a
child and I understand you knowa little bit of where they may
have been coming from.
But the idea that I was toldand I can see it in the way that
I maybe lived my life afterthat I was told that this was
(16:57):
all within my control, that itwas completely behavioral, and
this was really isolating tothink like someone who's in
fourth grade.
This child, you know, is havingthese problems and it's
completely within her control.
And I was very smart, I hadfriends, I was very outgoing, I
wasn't a very isolated kid.
(17:18):
You wouldn't think thatcompared to some of the things I
had gone through.
So what I had wished that I hadreceived at the time was a lot
more practical day-to-day ideasand strategies that my family
could have helped me implement.
I wish I would have been taughthow to eat a balanced diet,
(17:40):
because I was not taught that atall and I wouldn't have wanted
someone to say like, oh, youcan't eat certain.
You know I don't.
I wouldn't have wanted thatapproach and I'm glad I never
had that, but I would have lovedto understand that probably
eating just cheese nonstop wasnot helping me.
Like what else could I haveeaten that would have been tasty
and good and would havesupported me at the time.
(18:00):
You know, fruits, how thatwould have impacted me.
Was I drinking water?
Probably not.
I was probably drinking sodasand Gatorade and things like
that, because that's what peopledrank in my school.
Juice boxes, Juices yeah, Maybemilk at the time.
So I would have loved tounderstand hey, this is actually
going to be supportive in thisway.
(18:21):
Understanding the whole toiletsit thing, I wish someone would
have taught me how to relax andbreathe, not just force me on
the toilet after meals, buttaught my family what that
actually would look like.
I wish I would have understoodthe impact of movement, because
movement for me has been such akey part of the way that I've
(18:41):
managed my symptoms for the restof my life.
If I would have known that as akid like go play more, go like
run around and after that maybe,you know, make sure you're
drinking water and go to thebathroom I probably would have
been a much different place thanI ended up being.
And I don't think I needed alow FODMAP diet.
(19:02):
I don't think I needed a listof supplements and maybe things
that I would use as an adult.
I don't think I needed that asa kid.
But I would have appreciatedsome interventions that could
have stuck with me and my familybecause I could have addressed
that so much differently throughmiddle school and high school.
I maybe even avoided some of thedisordered eating and that side
(19:23):
of things, hopefully, becausethere was a lot that was tied
there as well.
So that's something I wish Iwould have gotten.
And then even in college youknow I did go to it was the
campus doctor whenever I waslike I have these issues, I've
had them forever, can you testme for celiac disease?
And even with them, you know Ibrought up, I got this IBS
diagnosis whenever I was a kidand they kind of just stopped
(19:46):
and said, oh well, that's whatit is, that's what you're
experiencing, and that wasprobably true.
But even then it just felt likeokay, it felt like the hard line
of great, okay, providers arenot going to help me.
This is not something likemedically that I can get support
with.
And if I could have just gottenmaybe a referral or something
(20:06):
at the time or a littleeducation, you know, I wanted
the bare minimum of justsomething.
That would have been helpful,that would have likely made a
lot of things easier for me orhopefully had gotten me to a
place where I had symptom reliefand even just understanding and
confidence in what my body wasgoing through at an earlier age.
(20:27):
I mean, I wouldn't have missedout on so much or done all those
kind of weird things that I didto try to cover it up.
Kate Scarlata MPH, RD (20:35):
The avoidant behaviors.
Speaker 4 (20:49):
Yeah, belly pain and bloating are still bothering you
.
It may be time to try somethingdifferent.
Ibsrella tenapenor is aprescription medicine used to
treat adults with IBS-C.
Ibsrella works differently torelieve the symptoms of IBS-C,
so you can focus on what'simportant to you.
Ask your doctor if Ibsrellacould be right for you.
Do not give Ibsrella tochildren less than six.
You should not give Ibsrella topatients six to less than 18
(21:10):
years.
It may harm them.
The most common side effect isdiarrhea, sometimes severe, and
your child could get severedehydration.
Stop taking Ibsrella and callyour doctor if you develop
severe diarrhea.
Do not take Ibsrella if youhave a 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.
(21:36):
Learn more at Ibsrellacom.
Slash PI or call 1-844-IBSRELLAand press option 4.
Ready to try somethingdifferent for your IBSC symptoms
?
Ask your doctor about Ibsrella.
Kate Scarlata MPH, RD (21:45):
You needed someone to you know,
empower you and not maybe punishyou for something you had
little control over.
It breaks my heart to think thatyou had to.
You know experience that whenyou know you had no control over
what was going on and andsomeone thought you did, and
that's unfortunate.
(22:05):
But you can see, like I see in alot of dietitians and other
practitioners that have gonethrough hard things, they do
weave that beautiful compassionthrough their practice, which
you absolutely do, and just yourwillingness to be so open with
pretty raw moments in your lifeis going to make a difference
(22:26):
because a lot of people will belistening and that validation is
powerful.
It really is so powerful toknow that you're not alone in
maybe experiencing something.
Maybe you feel like, oh, Ishould have said something or
maybe I could have pushed harderfor that test that they slammed
the door down for, andsometimes we're just not in the
(22:48):
right place with the rightpractitioners or it's just years
before we had a lot to reallyoffer and but you know, your
story is just, is unbelievableand I know we'll, we'll make a
difference in in people that arelistening.
It's really hard and beautifulat the same time to see where
you, how far you've come.
Erin Judge RD (23:09):
Yeah, I absolutely agree and I
definitely don't blamepractitioners at the time
because, again, research wasn'tthere.
My experience, if I was thatage today, would have looked so
different.
It was also in a very we didn'thave the resources right, and I
think with internet and socialmedia and that's why I'm so
adamant about being on socialmedia is that it does allow
(23:30):
people in rural places wheremaybe you don't have the best
teaching hospitals or like asmuch access to information.
You don't have specialists thatyou can be referred to, even if
you wanted to be, and you knownow, with costs and all of that
included, it does hinder peoplefrom getting the information
they need, and so I'm very muchrecognized that and I know that
it would have been differenttoday or in a different place,
(23:52):
but being able to provide thatis really empowering.
And one thing I always say topatients that I have to tell
myself is that you know thereare different factors that maybe
could have been controlled inmy life that would have
prevented IBS right, there arefactors that were environmental,
that were choices that we as afamily made for me at the time,
(24:13):
but it is not my fault that Ihave IBS Right and someone who's
making the same decisions I'mmaking on how they move their
bodies, how they sleep, how they, you know, handle stress, what
they put in their bodies.
They could do the same thing asme, and they don't have IBS,
but I do right.
They could do quote unquoteworse than me or better than me,
and they may or may not have anillness or a condition.
(24:36):
And so I always tell patientsit's not your fault, you have
IBS.
Because you have IBS, your bodydoes require different things.
So my body needs more from me.
It's maybe not as flexible asother bodies may be because I
have the condition flexible asother bodies may be because I
have the condition and so I dohave to be really mindful and
(24:57):
intentional and understand howthings impact me and like be
wise about that, right.
But that doesn't mean thatthat's my fault and that I
should feel guilty or shamed ifI don't do it perfectly, because
that doesn't mean that I'm bador I'm wrong.
It just means, okay, my bodyjust needs a lot more from me
because of this condition I have.
(25:17):
That it's okay for me to beangry and upset that I have,
because it is unfair in a way,but it wasn't my fault and
that's okay and I think that's areally good part of the
acceptance piece and thenfighting to make sure we're
getting answers and we're notjust settling for, you know,
severe symptoms or no resultsfrom treatments.
You know the things that youguys have talked about as well,
(25:39):
that sometimes it's not just IBSand we can't tell patients it
is always just IBS.
But it's also empowering to sayyou know, my body is struggling
with something.
It does have a condition.
There is something going onthat hinders the way that maybe
I respond to certain things inmy life.
So I have to be intentional.
I have to be aware I have to bemore consistent than others in
(26:02):
order to keep this in a placethat's manageable for me.
And that is okay.
That's just my reality.
Kate Scarlata MPH, RD (26:28):
And the whole guilt thing, because I do
see a lot of patients sort oflike, ah, like I shouldn't have,
or, you know, bring that pieceon.
You do need to be a little moreintentional.
You have to do specialpractices, whether it's
diaphragmatic, and that'sguilt-free zone too right, you
just jump back on the saddle andget yourself back in a good
place.
But I think the guilt piecedoes come through with a lot of
the clients that I've seenthroughout the years and I want
that not to be removed fromtheir experience, because no
(26:48):
one's supposed to be perfecteither.
Even with an intentioned,beautiful plan that we put
together, we all step off theplan sometimes, so don't feel
bad about it if you do.
If you're listening.
I'd love to just transitioninto just a simple question here
.
Maybe, maybe not.
How do you describe IBS to yourpatients that you work with?
(27:09):
What is your elevator pitch forIBS?
How do you describe that?
Erin Judge RD (27:15):
I would say I don't have the best elevator
pitch.
I probably say too many wordsmost often, but I do describe it
as it's a functional GIdisorder that impacts how your
body responds to differentthings in your environment.
That's how I typically willphrase it.
And then we might get into theweeds of because your gut brain
connection is altered or there'ssome miscommunication with IBS
(27:38):
that impacts how stress impactsyour body.
That impacts how differentsensations in your body may
result in pain because of thisdisorder.
And then the same with becauseyou may have increased levels of
intestinal permeability.
You may have an altered gutmicrobiome.
There may be some immuneactivation going on, maybe the
(27:58):
role of mast cells, like there'sa lot that could be happening
in complexities and that mayimpact how your gut motility is
going.
You know day to day and howyou're pooping every day.
That may impact how you respondto certain foods or food
intolerances that you notice.
That may impact why when youget sick you are thrown off and
(28:18):
things seem to spiral a lotdifferently than other people.
So that's typically how I willexplain it, to try to pull
together some of the more theresearch we have.
That's maybe a littlemysterious to some patients, but
bring it back to like apractical place of, okay, here's
why you feel the way you feel,as much as you know, we can know
(28:39):
and understand.
And then we can come back tothat as we put interventions in
place to say, okay, we'retargeting gut brain connection
here, we're targeting thissensation, we're targeting the
gut microbiome here, we'relooking at the immune system
here.
Like, those are some of theways we can kind of pull it
together.
Yeah, it's complicated.
Dr. Megan Riehl (28:56):
Yeah, it's complicated, and I love what you
started the interview withtoday, just saying you're not
trying to cure IBS.
That is not an option.
But what we can do is improvethe severity of your symptoms
and improve your quality of life, improve your confidence, get
(29:16):
you back doing things that maybeyou had been avoiding and
hiding and keeping in, and whenwe think about constipation,
there's so much keeping in andtension and literally holding in
the beep, and so we have toinstill this level of hope with
the treatment plan.
And you certainly have, like,walked the walk.
(29:39):
You've really kind of talked alot today about moving your body
and some of the lifestylestrategies that you find helpful
.
Tell us a little bit more aboutthat.
Like, what are the strategiesthat you find to be so helpful?
Erin Judge RD (29:56):
Yeah, so with constipation.
I do love working with patientswith constipation, so I say
there's so many tools at ourdisposal, there's so many things
that could potentially help,which is exciting because
there's creativity involved,like patients who are high
achieving, people who areworking really intense jobs
versus the mother that's homewith five kids, and versus the
(30:17):
student versus the person that'sretired.
You know we have so manydifferent strategies we can use
in different scenarios, so someof my favorites.
Movement is definitely one ofthem, and I love exercise and
fitness in that world.
But the everyday movement isoften neglected and that's what
I tend to focus on the most ishow are you walking throughout
the day, like, can we get yoursteps up, can we get your blood
(30:39):
flowing through the day, notjust in one exercise, and that
seems to really help.
I love I always call it toilettime how we adjust toileting
technique and how you sit on thetoilet, adjusting posture,
teaching patients how to relaxand leading them towards those
diaphragmatic videos where theyknow how to breathe properly.
(31:01):
I think that can be soempowering.
Patients don't learn that often.
From a diet perspective,obviously there's so many
options there as well.
Fiber is my favorite thingincreased.
As a GI dietitian, I personallylove increasing fiber more
slowly and I like using kiwi aswe can.
I'm a big fan of flaxseed.
I probably prescribe flaxseed alot more than I prescribe kiwi
(31:25):
or some of those other kind ofconstipation remedies, just
because I find it easy forpatients to obtain, and so I'm a
big fan of ground flaxseed, oneof the two tablespoons a day.
Proper hydration and evenlooking at you know, increasing
water again throughout the day.
I think with gut motility,sometimes we forget to teach
(31:45):
patients that the gut needs tomove consistently, and so it's
not just about on paper whatyou're checking off and doing,
but are you doing it throughoutand is it spreading out?
So it's fiber spreading out.
Are you eating consistent mealsand actually feeding your body
throughout the day?
Are you moving throughout theday?
Are you hydrating throughoutthe day?
Do I have a study to back it up?
No, but I think it makes senseright, when you understand how
(32:08):
the gut functions and how ourbody functions, like you have to
keep feeding the body and doingthose things.
Same with relaxation and thestress side of things.
You can't just do a meditationin the morning and then have a
stress-loaded day that you nevertake time to regulate and
expect that meditation in themorning to solve all your
problems.
We have to keep regulating.
(32:29):
So that's really big.
I do love utilizing differentkind of laxatives or laxative
agents with patients withconstipation, in addition to
those other pieces.
I always say it's sort of likeretraining the bowels, you know,
to work when they've been slow,and so using things like
Miralox or magnesium or maybethe kiwi or things that are a
(32:49):
little bit more intense, thatcan help clear stool out while
building up fiber, I think thatcan be really empowering again
to patients understanding I canclear the stool out while
building up fiber.
I think that can be reallyempowering again to patients
understanding I can clear thepoop out, I can add the fiber in
my gut's.
Moving with that, I'm alsomoving my body and I'm giving it
, increasing my blood flow,keeping things soft with fruit
and water.
You know, understanding allthose little pieces and knowing,
(33:11):
okay, each step I'm taking isleading in the direction I'm
trying to go and I'm sitting onthe toilet, well, and I'm
pooping, well, and all of that'shappening.
So I'd say those are probablythe things that I would use the
most.
I recommend abdominal massage.
I have patients who do that,and then sometimes we do have to
think outside of the box and weget a little bit more nitpicky
about maybe adjusting thetexture of foods or playing with
(33:35):
.
Are you three meals per dayspread out, kind of person, or
do you benefit from five mealsper day?
Is that more beneficial?
Maybe we use things likedifferent teas, maybe
supplements can fit in, butusually we like to start with
those basics and that typically,when done well and done
consistently, I find reallyworks for patients before
(33:56):
needing all the sexy things thatare really complicated and can
be hard to maintain over time.
Dr. Megan Riehl (34:04):
If you haven't heard our episode with Dr Justin
Brandler in this series, hegets into the nitty gritty of
medications and prescriptions ina very digestible way.
So we encourage you to checkthat out.
And I'll say, if you followErin on social media, you can
see her living her lifetraveling, going to concerts,
(34:24):
eating out and a lot ofdifferent strategies that you
have woven into your life.
And it's not that it doesn'ttake effort and planning and
thought, but it's amazing to seeyou living your life, a full,
busy, active life, and reallyimplementing so many different
strategies that really hitacross the board, from moving
(34:47):
your body to being relaxed, toputting your legs up on the wall
to stretch out.
You know all the things.
It's very helpful, very helpfulto see, absolutely.
Erin Judge RD (34:58):
I think again you have to think of the whole
person, especially with IBS, gi,any area of health, but again
GI often that's missing is thewhole person matters, you know.
Feeding the body what it needs,that really does matter.
But also having a goodrelationship with food also does
matter.
Right Moving your body alsomatters.
Knowing where your limits arealso matters.
(35:21):
Sleeping matters, social timematters.
Moderating alcohol intake, thatmatters, you know there's so
many things that actually doreally matter.
And I think sometimes we getinto that black and white
thinking that either isolatesomebody where they're like,
well, I can't do anythingbecause it's outside of my
little bubble, that doesn't work, because then we're missing out
(35:43):
on the social or missing out onthe quality of life or what's
life for if you're not doinganything that you enjoy right?
Or I think people tend to focusjust on one thing and then they
don't want to recognize thesleep or the stress or those
other pieces.
And so it's really to me, Ifind it.
I often say I wish I didn'thave IBS, I wish I lived a
(36:03):
different life, I wish I wasdoing some other job.
If I'm honest, I do, I wish Inever had gotten IBS.
That would have been wonderful.
At the same time, I'm reallythankful that, because I've had
IBS for the majority of my life,it has forced me to truly take
care of myself.
It's forced me to not in a waythat's like a slap on the wrist,
because I've worked really hardto understand the power of my
(36:26):
own choices and think aboutthose in terms of what I want in
my life and what matters to meand knowing that they're
improving my life.
But at the same time I can'tbinge drink on the weekend and I
can't.
I'll end up in a lot of painand I don't want that for myself
.
So I have to be more intentionalabout how I'm relaxing my body,
(36:49):
what I put on my platemetaphorically the overall plate
, but also the physical plate.
I just have to be mindful andaware of that and that's how I
found a lot of freedom in mylife that I have.
But it does come with reallyintentional choices, priorities,
some sacrifice, but I weigh outwhat matters.
(37:11):
I accept I know how to takecare of myself if things fall
apart.
You know that took a lot ofwork.
It takes a lot of effort, but tome it's worth it, because I do
get to experience all of thosethings, and patients do have
that option, and it's going tolook different for every person
because there's a lot ofdifferent ways IBS affects
somebody and what they need maybe completely different than me.
(37:33):
Their barriers may lookdifferent than mine, what
they're willing to accept intheir life and how they feel is
going to look different than me,but it is still very empowering
to know that, being intentional, a little intuition, a lot of
intentionality, you can see theresults that you want and you
can do the things in your lifethat you want.
It's very much possible.
So I'm always happy to sharethat and be really honest, even
(37:57):
about where it is a struggle,because it's not perfect, but it
is very much possible.
Kate Scarlata MPH, RD (38:03):
Well, on that note, Erin, that was just
so amazing, so beautiful I don'teven know how to say just.
It was a beautiful, eloquentdiscussion about your patient
journey and how you help otherswith their individual journey
with IBS.
So it's beautiful.
Thank you for coming on.
We really appreciate your timeand, to all our listeners, we
(38:26):
hope that you comment, like andshare the Gut Health Podcast.
Your support means the worldfriends, thanks so much.
Dr. Megan Riehl (38:36):
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
Ardelix, or a healthcareprovider, 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 (00:39):
Welcome to the Gut Health Podcast, where we
talk about all things related toyour gut and well-being.
We are your hosts.
I'm Dr Megan Riehl, a GI healthpsychologist.
Kate Scarlata MPH, RD (00:49):
Hi, and I'm Kate Scarlatta, a GI
dietitian, so today's episode ispart three of a three-part
series that we have on irritablebowel syndrome, specifically
IBS-C or constipationpredominance IBS.
This is our last part three ofthe series, and we've really
covered a wide range of topicsrelated to this diagnosis.
Dr. Megan Riehl (01:12):
Yes, last but not least, a very, very
important piece of the storywith IBS.
Today, with our guest, who isErin Judge, I'm going to tell
you a little bit about her, withthe topic of IBS being very
near and dear to us.
It's a subject matter of ourbook, Mind your Gut, but also
one that Erin speaks veryeloquently on as a registered
(01:34):
dietitian and nutritionist.
She's also a certified personaltrainer and founder of Gutivate
, a virtual nutrition counselingpractice for digestive
disorders and gastrointestinalconditions.
Erin's wealth of expertise isin providing medical nutrition
therapy for functional gutdisorders with a
patient-centered focus.
(01:54):
She is proud of her work ineducation and advocacy for the
IBS patient community throughsocial media, as well as her
work in providing resources fordieticians in the GI field.
In addition to the importantwork that Erin does in her GI
practice, she's also anindividual living with IBS-C.
So for today's topic Findingyour Path A Personal Journey to
(02:17):
Constipation Relief.
We are so delighted to have youtoday, erin, to highlight your
resilience and share yourinsights, so welcome.
Erin Judge RD (02:26):
Thank you so much for having me.
I'm excited to be here.
I admire you both and so I'mvery excited to be able to chat
and talk about this topic that,you are correct, I love very
dearly.
Dr. Megan Riehl (02:38):
Yes, yes.
Well, there's lots ofchallenges and solutions, and so
we're going to dive in there'slots of challenges and solutions
, and so we're going to dive in.
Kate Scarlata MPH, RD (02:49):
I know I think of so many GI dieticians
that have gone into this field,often because we haven't had
really satisfactory care alongour own journey or we're hoping
to learn a little bit more tomake this journey a little bit
easier for others that arewalking our path.
So, with someone that liveswith a GI condition post-surgery
, I know that you have your ownpersonal journey and experience
and we'd love you to share that,erin, starting from the early
(03:12):
days of a diagnosis to where youare now.
Erin Judge RD (03:16):
Absolutely so.
My story is not unlike a lot ofpeople in our community, but it
is also very different than alot of adults I typically see.
So my story with IBS did startin childhood and my diagnosis
came around fourth grade.
Whatever age that was, a lot ofit, as you'll probably figure
out from my own story, has beena bit blocked out in my memory,
(03:38):
but I remember getting adiagnosis after three full years
of kind of going back and forthto specialists having many
different tests run, and it allstarted with what we found to be
a Giardia infection that I hadaround like kindergarten, first
grade.
I don't know how they found itmuch later but it makes sense
with my history, but I wassomeone who was constantly
(04:01):
getting sick.
I would have the stomach virusover and over and over again and
you know it was on multiplerounds of antibiotics throughout
those years.
In first grade my dad wasdiagnosed with a chronic illness
that we did not believe wouldbe he would live very long and
so he went through experimentallike drugs at that time within
(04:22):
and out of the hospital.
So you have this child that wasbombarded with a gut infection,
chronic antibiotics, againconstantly getting sick.
I grew up in what we wouldconsider to be a food desert in
rural South Arkansas.
Most of my food intake wasbread and cheese.
I did not eat a lot ofvegetables and fruits and those
(04:44):
things, especially when I wasoften sick and then was hit with
this family childhood traumaadverse event that was really
hard to process as a young child.
So I held a lot of anxiety inmy body, held a lot of stress in
my body and I kind of grew upin a space where we just didn't
(05:05):
talk about it if we werestruggling, right.
I'm now almost 33 years old, soI know a lot of people who grew
up even at the same time that Idid.
That was before we had accessto social media and information,
but we also grew up where wedidn't discuss hard things and
especially when it came tohealth as a kid.
(05:25):
I didn't learn a single thingabout health as a young child in
school and from my family, andwe didn't have access to those
resources.
And so I found myself overthose years, you know, going
from getting you know stomachviruses off and on so getting
the Z-Pak every time for somereason, you know, just going
through the cycle of all thesedifferent infections and gut
(05:45):
issues, to then that settling alittle bit but it turned into
these more significant flares.
So I found that I would have,you know, accidents at school
which now I believe to be kindof that overflow diarrhea Like I
was so backed up and full ofstool.
You know I would constantlyhave like smearing, you know, in
(06:06):
my underwear and need to changeand was really overwhelmed and
stressed about that.
Again, I was in second, thirdgrade.
I was a very young child wherethis was not expected.
I would get in trouble for itbecause my family believed it to
be more behavioral and I wouldalso find myself in the flares
of so severe pain that I wouldbe crying on the bathroom floor
(06:30):
in the middle of the night andmy mom would always think, okay,
you have gallstones, you havepancreatitis, like something is
seriously wrong because you'rein significant pain.
So she would end up taking meto the hospital, which was an
hour and a half away, thechildren's hospital.
So we would drive to thehospital, get the initial test.
It wasn't anything more thanconstipation.
(06:50):
I would come home, have to dosuppositories and enemas and all
these extreme measures and thatwas my life for three to four
years before I finally got alittle bit more testing and they
ruled out as much as they couldand decided that I had IBS and
that was kind of all we weregiven at that time.
(07:11):
I remember going off from thatpoint and I got the like little
Metamucil cookie things whichwere so gross.
Speaker 4 (07:20):
Why would you ever give a?
Erin Judge RD (07:21):
child, these little biscuit things like I
can't even look at them now.
I have such an adverse effectfrom those.
But I was sent home with thoseand Gatorade when needed, which
I don't understand, and then thesuppositories are in them as I
needed them.
That was kind of all that I wasgiven and thankfully I
transitioned into middle school.
(07:42):
I started playing sports.
I became a little bit more,maybe involved in my health.
Not consciously or with a lotof effort.
I did become aware of my body.
I was going through puberty sothere were things maybe I was
doing that.
I wasn't intentionally trying toimprove my constipation, but I
did improve the flares just bymoving my body more and doing a
(08:05):
few different things, and I alsolearned how to kind of control
and mask a lot of the flares andthe symptoms I was having.
So they turned into not havingaccidents that's called,
thankfully.
But I did learn how to not beaway from home too much.
Before football games everyonecame to my house so I would have
(08:26):
the comfort of my bathroom inmy home, in my comfort zone.
If I was too full, orcheerleading camp and all these
different environments where Iwould get so severely
constipated, I would just eat alittle less or skip a meal and I
would wear looser clothes oralways make sure my cheerleading
uniform was a little big enoughin case I was bloated.
And I didn wear looser clothesor always make sure like my
cheerleading uniform was like alittle big enough, like in case
(08:46):
I was bloated and I didn't knowwhat I was doing.
But looking back on it, I waslearning how to live with it.
Not well, because I also wouldfind myself in that significant
pain where I would sneak away tolay on a bathroom floor and
pass gas or maybe go home for alittle bit to maybe have a bowel
movement or manual evacuation,like there were so many things I
(09:09):
kind of learned to do to try tosurvive and get through it.
And it was finally.
Whenever I went to college andhigh school again, things got a
little bit better.
I was moving more, I was eatingsome fiber.
You know I was doing things Iwasn't necessarily treating IBS
for, but now I know I was atleast helping and supporting my
gut and the constipation and Iwas getting older.
(09:31):
But in college I found that Ireally struggled because I
didn't have my comfort bathroom.
I was in a dorm room, anotherlife transition.
I cried on my way to college andso many people will relate to
this, but I was going from atown of 1,000 people to what
would be considered to be a bigcity in Arkansas, the University
(09:53):
of Arkansas, our biggestuniversity, and that alone was a
huge change.
I was going to be living in adorm, I was stripped away from
all my friends and I was reallyinvolved in my high school.
I did well in school and I wasstripped away from all my
friends and I was reallyinvolved in my high school.
I did well in school and I wasgoing into like a pre-med and
kind of AP.
I got out of that reallyquickly, but the more advanced
(10:14):
classes I was going into that,and the thing that I cried in
the car on my way to collegeover was being in a public
bathroom.
That's what I was the mostafraid of was how am I going to
poop in a public bathroom on myfloor?
And what I did was all thegirls on my floor were in
(10:35):
sororities.
They went out on Thursday,friday nights.
That's whenever I could poop.
That's whenever I would havethat space to myself and I felt
comfortable.
That's whenever I would, youknow, have that space to myself
and I felt comfortable.
That's how I lived my entirefreshman year of college and
thankfully, I learned pre-medwas not for me.
I found dietetics and, you know, found nutrition and it was a
(10:56):
great change.
In my nutrition classes we hadone lesson on it was like our GI
lesson for M&T and there was afive minute part of that lecture
that was about IBS and it wasthe first time since.
So this is sophomore year ofcollege, since I was in fourth
grade and diagnosed with IBS,actually talked about IBS and
(11:26):
explained, you know, the thingsthat we could do and you know it
was low FODMAP diet.
I'm pretty sure that was allthat they said.
That's all we really had at thetime.
This is 2012, I think, and sobrief lecture, everyone just
moved on and I was thinkingabout I'm like wow.
I remember like I was told thatthis was something that I had.
This connects a lot with me.
(11:46):
And then I started going downthe path, which then was kind of
messy, tried doing everythingon my own.
I went to the doctors like Ineed to be tested for celiac
disease, I need to be tested forlactose intolerance.
I was trying to figure it out.
I was like none of this wasrolled out for me.
I need to make sure, and youknow the test came back as
negative.
But I was like, okay, well, Iguess I have IBS, like that
makes sense.
(12:07):
And so I started doing all ofthese different things in a not
so healthy way, because I wasliterally just reading a
textbook that had maybe achapter worth of information and
just getting as much, liketrying to grab, like what is
anyone saying about this?
What can I try?
I was trying to be healthy, youknow, as nutrition students
often do, and I found myselfvery restricted.
(12:29):
I had a lot of rules.
I definitely didn't go about itthe best way, but after many
years of trying to figure it outand reading the research and
becoming a dietitian and workingwith patients and just seeing a
little bit more I guess, depthof information that was
available, I kind of figured itout for myself and got to the
(12:52):
point where I didn't have flaresanymore and I learned how to
prevent the trapped gas paincompared to hiding away to like
go to the car and try to pass it, you know secretly away to like
go to the car and try to passit, you know secretly.
And so now I find myself.
I still have IBS and I alwayssay that.
I think it would be unfair tome to say I healed my gut and
I'm perfect.
(13:12):
I don't have painful flares.
But I'm also very intentionalevery day with the things that I
do and how I live my life toprevent that, because I lean
towards constipation still livemy life to prevent that, because
I lean towards constipationstill.
But now I get to also helpother people and patients across
the spectrum of IBS andfunctional GI disorders deal
(13:33):
with some of those symptoms.
But also, how do youhealthfully take care of your
gut and put all the piecestogether as you as a whole
person in a way that's actuallygoing to be supportive across
the board and not restrictive orisolating or all of those
things?
So very long winded way toshare my story.
But if you are familiar with mywork at all, it makes sense
(13:55):
where I come from personallybecause I've kind of woven that
into my communication and what Ilike to do now as a dietitian.
Dr. Megan Riehl (14:03):
I mean, first of all, thank you for your
openness and vulnerability andreally highlighting how
everyone's journey to IBS isdifferent, that you know there
are ways we can look atenvironment and genetics and you
know a post-infection andfamilial stress and life change
(14:28):
and all of those people with IBSwill have a variety of
potential factors that can leadto their diagnosis.
And you beautifully andvulnerably share your journey
there and arriving at being ahelper at somebody that has
taken what they've learned.
Is there something that, whenyou think back, would have been
(14:53):
helpful to have known back then,and maybe even highlighting
where the research has gone,even in?
You know I'm a bit older thanyou, so in that couple of years
since you've been in college andthen when you were a little one
, it is wild to think of howmuch more research we have.
Erin Judge RD (15:10):
Even since I was in college, I've been a
dietitian for it'll be 10 yearsthis year officially as a
dietitian, which is also hard towrap my head around.
But in the last 10 to 15 yearsthe research has completely
changed and you guys have been apart of that, and I mean even
looking at where we are today.
It's going to change even morein the next 10 years, which is
(15:32):
really exciting, especially forpatients, but also as a provider
, and so, of course, I wouldlove to know what we know now.
Whenever I was a kid I think Iactually have.
I'll share it with you.
I think that you guys wouldappreciate this, if I can
actually find it I think apsychologist is who I met with
after my diagnosis, very, veryyoung.
(15:55):
So I have this note.
My mom saved it.
She found it like in a drawer afew years ago, but I met with a
psychologist or a psychiatristsomebody after we got my
diagnosis, and this is the planthat I've received for my IBS,
and it says Erin needs to do atoilet sit after snack, after
dinner, in order to keep herprivileges.
(16:15):
Which advice.
Not so bad the result?
Maybe not.
Erin will earn $1 for eachaccident free day and Erin will
pay mom 50 cents each time shehas an accident.
And then Erin must continuecleaning up after an accident
and washing out her ownunderwear, and that was my plan,
(16:36):
that's horrendous.
It's not great and I know I wasmaybe motivated differently as a
child and I understand you knowa little bit of where they may
have been coming from.
But the idea that I was toldand I can see it in the way that
I maybe lived my life afterthat I was told that this was
(16:57):
all within my control, that itwas completely behavioral, and
this was really isolating tothink like someone who's in
fourth grade.
This child, you know, is havingthese problems and it's
completely within her control.
And I was very smart, I hadfriends, I was very outgoing, I
wasn't a very isolated kid.
(17:18):
You wouldn't think thatcompared to some of the things I
had gone through.
So what I had wished that I hadreceived at the time was a lot
more practical day-to-day ideasand strategies that my family
could have helped me implement.
I wish I would have been taughthow to eat a balanced diet,
(17:40):
because I was not taught that atall and I wouldn't have wanted
someone to say like, oh, youcan't eat certain.
You know I don't.
I wouldn't have wanted thatapproach and I'm glad I never
had that, but I would have lovedto understand that probably
eating just cheese nonstop wasnot helping me.
Like what else could I haveeaten that would have been tasty
and good and would havesupported me at the time.
(18:00):
You know, fruits, how thatwould have impacted me.
Was I drinking water?
Probably not.
I was probably drinking sodasand Gatorade and things like
that, because that's what peopledrank in my school.
Juice boxes, Juices yeah, Maybemilk at the time.
So I would have loved tounderstand hey, this is actually
going to be supportive in thisway.
(18:21):
Understanding the whole toiletsit thing, I wish someone would
have taught me how to relax andbreathe, not just force me on
the toilet after meals, buttaught my family what that
actually would look like.
I wish I would have understoodthe impact of movement, because
movement for me has been such akey part of the way that I've
(18:41):
managed my symptoms for the restof my life.
If I would have known that as akid like go play more, go like
run around and after that maybe,you know, make sure you're
drinking water and go to thebathroom I probably would have
been a much different place thanI ended up being.
And I don't think I needed alow FODMAP diet.
(19:02):
I don't think I needed a listof supplements and maybe things
that I would use as an adult.
I don't think I needed that asa kid.
But I would have appreciatedsome interventions that could
have stuck with me and my familybecause I could have addressed
that so much differently throughmiddle school and high school.
I maybe even avoided some of thedisordered eating and that side
(19:23):
of things, hopefully, becausethere was a lot that was tied
there as well.
So that's something I wish Iwould have gotten.
And then even in college youknow I did go to it was the
campus doctor whenever I waslike I have these issues, I've
had them forever, can you testme for celiac disease?
And even with them, you know Ibrought up, I got this IBS
diagnosis whenever I was a kidand they kind of just stopped
(19:46):
and said, oh well, that's whatit is, that's what you're
experiencing, and that wasprobably true.
But even then it just felt likeokay, it felt like the hard line
of great, okay, providers arenot going to help me.
This is not something likemedically that I can get support
with.
And if I could have just gottenmaybe a referral or something
(20:06):
at the time or a littleeducation, you know, I wanted
the bare minimum of justsomething.
That would have been helpful,that would have likely made a
lot of things easier for me orhopefully had gotten me to a
place where I had symptom reliefand even just understanding and
confidence in what my body wasgoing through at an earlier age.
(20:27):
I mean, I wouldn't have missedout on so much or done all those
kind of weird things that I didto try to cover it up.
Kate Scarlata MPH, RD (20:35):
The avoidant behaviors.
Speaker 4 (20:49):
Yeah, belly pain and bloating are still bothering you
.
It may be time to try somethingdifferent.
Ibsrella tenapenor is aprescription medicine used to
treat adults with IBS-C.
Ibsrella works differently torelieve the symptoms of IBS-C,
so you can focus on what'simportant to you.
Ask your doctor if Ibsrellacould be right for you.
Do not give Ibsrella tochildren less than six.
You should not give Ibsrella topatients six to less than 18
(21:10):
years.
It may harm them.
The most common side effect isdiarrhea, sometimes severe, and
your child could get severedehydration.
Stop taking Ibsrella and callyour doctor if you develop
severe diarrhea.
Do not take Ibsrella if youhave a 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.
(21:36):
Learn more at Ibsrellacom.
Slash PI or call 1-844-IBSRELLAand press option 4.
Ready to try somethingdifferent for your IBSC symptoms
?
Ask your doctor about Ibsrella.
Kate Scarlata MPH, RD (21:45):
You needed someone to you know,
empower you and not maybe punishyou for something you had
little control over.
It breaks my heart to think thatyou had to.
You know experience that whenyou know you had no control over
what was going on and andsomeone thought you did, and
that's unfortunate.
(22:05):
But you can see, like I see in alot of dietitians and other
practitioners that have gonethrough hard things, they do
weave that beautiful compassionthrough their practice, which
you absolutely do, and just yourwillingness to be so open with
pretty raw moments in your lifeis going to make a difference
(22:26):
because a lot of people will belistening and that validation is
powerful.
It really is so powerful toknow that you're not alone in
maybe experiencing something.
Maybe you feel like, oh, Ishould have said something or
maybe I could have pushed harderfor that test that they slammed
the door down for, andsometimes we're just not in the
(22:48):
right place with the rightpractitioners or it's just years
before we had a lot to reallyoffer and but you know, your
story is just, is unbelievableand I know we'll, we'll make a
difference in in people that arelistening.
It's really hard and beautifulat the same time to see where
you, how far you've come.
Erin Judge RD (23:09):
Yeah, I absolutely agree and I
definitely don't blamepractitioners at the time
because, again, research wasn'tthere.
My experience, if I was thatage today, would have looked so
different.
It was also in a very we didn'thave the resources right, and I
think with internet and socialmedia and that's why I'm so
adamant about being on socialmedia is that it does allow
(23:30):
people in rural places wheremaybe you don't have the best
teaching hospitals or like asmuch access to information.
You don't have specialists thatyou can be referred to, even if
you wanted to be, and you knownow, with costs and all of that
included, it does hinder peoplefrom getting the information
they need, and so I'm very muchrecognized that and I know that
it would have been differenttoday or in a different place,
(23:52):
but being able to provide thatis really empowering.
And one thing I always say topatients that I have to tell
myself is that you know thereare different factors that maybe
could have been controlled inmy life that would have
prevented IBS right, there arefactors that were environmental,
that were choices that we as afamily made for me at the time,
(24:13):
but it is not my fault that Ihave IBS Right and someone who's
making the same decisions I'mmaking on how they move their
bodies, how they sleep, how they, you know, handle stress, what
they put in their bodies.
They could do the same thing asme, and they don't have IBS,
but I do right.
They could do quote unquoteworse than me or better than me,
and they may or may not have anillness or a condition.
(24:36):
And so I always tell patientsit's not your fault, you have
IBS.
Because you have IBS, your bodydoes require different things.
So my body needs more from me.
It's maybe not as flexible asother bodies may be because I
have the condition flexible asother bodies may be because I
have the condition and so I dohave to be really mindful and
(24:57):
intentional and understand howthings impact me and like be
wise about that, right.
But that doesn't mean thatthat's my fault and that I
should feel guilty or shamed ifI don't do it perfectly, because
that doesn't mean that I'm bador I'm wrong.
It just means, okay, my bodyjust needs a lot more from me
because of this condition I have.
(25:17):
That it's okay for me to beangry and upset that I have,
because it is unfair in a way,but it wasn't my fault and
that's okay and I think that's areally good part of the
acceptance piece and thenfighting to make sure we're
getting answers and we're notjust settling for, you know,
severe symptoms or no resultsfrom treatments.
You know the things that youguys have talked about as well,
(25:39):
that sometimes it's not just IBSand we can't tell patients it
is always just IBS.
But it's also empowering to sayyou know, my body is struggling
with something.
It does have a condition.
There is something going onthat hinders the way that maybe
I respond to certain things inmy life.
So I have to be intentional.
I have to be aware I have to bemore consistent than others in
(26:02):
order to keep this in a placethat's manageable for me.
And that is okay.
That's just my reality.
Kate Scarlata MPH, RD (26:28):
And the whole guilt thing, because I do
see a lot of patients sort oflike, ah, like I shouldn't have,
or, you know, bring that pieceon.
You do need to be a little moreintentional.
You have to do specialpractices, whether it's
diaphragmatic, and that'sguilt-free zone too right, you
just jump back on the saddle andget yourself back in a good
place.
But I think the guilt piecedoes come through with a lot of
the clients that I've seenthroughout the years and I want
that not to be removed fromtheir experience, because no
(26:48):
one's supposed to be perfecteither.
Even with an intentioned,beautiful plan that we put
together, we all step off theplan sometimes, so don't feel
bad about it if you do.
If you're listening.
I'd love to just transitioninto just a simple question here
.
Maybe, maybe not.
How do you describe IBS to yourpatients that you work with?
(27:09):
What is your elevator pitch forIBS?
How do you describe that?
Erin Judge RD (27:15):
I would say I don't have the best elevator
pitch.
I probably say too many wordsmost often, but I do describe it
as it's a functional GIdisorder that impacts how your
body responds to differentthings in your environment.
That's how I typically willphrase it.
And then we might get into theweeds of because your gut brain
connection is altered or there'ssome miscommunication with IBS
(27:38):
that impacts how stress impactsyour body.
That impacts how differentsensations in your body may
result in pain because of thisdisorder.
And then the same with becauseyou may have increased levels of
intestinal permeability.
You may have an altered gutmicrobiome.
There may be some immuneactivation going on, maybe the
(27:58):
role of mast cells, like there'sa lot that could be happening
in complexities and that mayimpact how your gut motility is
going.
You know day to day and howyou're pooping every day.
That may impact how you respondto certain foods or food
intolerances that you notice.
That may impact why when youget sick you are thrown off and
(28:18):
things seem to spiral a lotdifferently than other people.
So that's typically how I willexplain it, to try to pull
together some of the more theresearch we have.
That's maybe a littlemysterious to some patients, but
bring it back to like apractical place of, okay, here's
why you feel the way you feel,as much as you know, we can know
(28:39):
and understand.
And then we can come back tothat as we put interventions in
place to say, okay, we'retargeting gut brain connection
here, we're targeting thissensation, we're targeting the
gut microbiome here, we'relooking at the immune system
here.
Like, those are some of theways we can kind of pull it
together.
Yeah, it's complicated.
Dr. Megan Riehl (28:56):
Yeah, it's complicated, and I love what you
started the interview withtoday, just saying you're not
trying to cure IBS.
That is not an option.
But what we can do is improvethe severity of your symptoms
and improve your quality of life, improve your confidence, get
(29:16):
you back doing things that maybeyou had been avoiding and
hiding and keeping in, and whenwe think about constipation,
there's so much keeping in andtension and literally holding in
the beep, and so we have toinstill this level of hope with
the treatment plan.
And you certainly have, like,walked the walk.
(29:39):
You've really kind of talked alot today about moving your body
and some of the lifestylestrategies that you find helpful
.
Tell us a little bit more aboutthat.
Like, what are the strategiesthat you find to be so helpful?
Erin Judge RD (29:56):
Yeah, so with constipation.
I do love working with patientswith constipation, so I say
there's so many tools at ourdisposal, there's so many things
that could potentially help,which is exciting because
there's creativity involved,like patients who are high
achieving, people who areworking really intense jobs
versus the mother that's homewith five kids, and versus the
(30:17):
student versus the person that'sretired.
You know we have so manydifferent strategies we can use
in different scenarios, so someof my favorites.
Movement is definitely one ofthem, and I love exercise and
fitness in that world.
But the everyday movement isoften neglected and that's what
I tend to focus on the most ishow are you walking throughout
the day, like, can we get yoursteps up, can we get your blood
(30:39):
flowing through the day, notjust in one exercise, and that
seems to really help.
I love I always call it toilettime how we adjust toileting
technique and how you sit on thetoilet, adjusting posture,
teaching patients how to relaxand leading them towards those
diaphragmatic videos where theyknow how to breathe properly.
(31:01):
I think that can be soempowering.
Patients don't learn that often.
From a diet perspective,obviously there's so many
options there as well.
Fiber is my favorite thingincreased.
As a GI dietitian, I personallylove increasing fiber more
slowly and I like using kiwi aswe can.
I'm a big fan of flaxseed.
I probably prescribe flaxseed alot more than I prescribe kiwi
(31:25):
or some of those other kind ofconstipation remedies, just
because I find it easy forpatients to obtain, and so I'm a
big fan of ground flaxseed, oneof the two tablespoons a day.
Proper hydration and evenlooking at you know, increasing
water again throughout the day.
I think with gut motility,sometimes we forget to teach
(31:45):
patients that the gut needs tomove consistently, and so it's
not just about on paper whatyou're checking off and doing,
but are you doing it throughoutand is it spreading out?
So it's fiber spreading out.
Are you eating consistent mealsand actually feeding your body
throughout the day?
Are you moving throughout theday?
Are you hydrating throughoutthe day?
Do I have a study to back it up?
No, but I think it makes senseright, when you understand how
(32:08):
the gut functions and how ourbody functions, like you have to
keep feeding the body and doingthose things.
Same with relaxation and thestress side of things.
You can't just do a meditationin the morning and then have a
stress-loaded day that you nevertake time to regulate and
expect that meditation in themorning to solve all your
problems.
We have to keep regulating.
(32:29):
So that's really big.
I do love utilizing differentkind of laxatives or laxative
agents with patients withconstipation, in addition to
those other pieces.
I always say it's sort of likeretraining the bowels, you know,
to work when they've been slow,and so using things like
Miralox or magnesium or maybethe kiwi or things that are a
(32:49):
little bit more intense, thatcan help clear stool out while
building up fiber, I think thatcan be really empowering again
to patients understanding I canclear the stool out while
building up fiber.
I think that can be reallyempowering again to patients
understanding I can clear thepoop out, I can add the fiber in
my gut's.
Moving with that, I'm alsomoving my body and I'm giving it
, increasing my blood flow,keeping things soft with fruit
and water.
You know, understanding allthose little pieces and knowing,
(33:11):
okay, each step I'm taking isleading in the direction I'm
trying to go and I'm sitting onthe toilet, well, and I'm
pooping, well, and all of that'shappening.
So I'd say those are probablythe things that I would use the
most.
I recommend abdominal massage.
I have patients who do that,and then sometimes we do have to
think outside of the box and weget a little bit more nitpicky
about maybe adjusting thetexture of foods or playing with
(33:35):
.
Are you three meals per dayspread out, kind of person, or
do you benefit from five mealsper day?
Is that more beneficial?
Maybe we use things likedifferent teas, maybe
supplements can fit in, butusually we like to start with
those basics and that typically,when done well and done
consistently, I find reallyworks for patients before
(33:56):
needing all the sexy things thatare really complicated and can
be hard to maintain over time.
Dr. Megan Riehl (34:04):
If you haven't heard our episode with Dr Justin
Brandler in this series, hegets into the nitty gritty of
medications and prescriptions ina very digestible way.
So we encourage you to checkthat out.
And I'll say, if you followErin on social media, you can
see her living her lifetraveling, going to concerts,
(34:24):
eating out and a lot ofdifferent strategies that you
have woven into your life.
And it's not that it doesn'ttake effort and planning and
thought, but it's amazing to seeyou living your life, a full,
busy, active life, and reallyimplementing so many different
strategies that really hitacross the board, from moving
(34:47):
your body to being relaxed, toputting your legs up on the wall
to stretch out.
You know all the things.
It's very helpful, very helpfulto see, absolutely.
Erin Judge RD (34:58):
I think again you have to think of the whole
person, especially with IBS, gi,any area of health, but again
GI often that's missing is thewhole person matters, you know.
Feeding the body what it needs,that really does matter.
But also having a goodrelationship with food also does
matter.
Right Moving your body alsomatters.
Knowing where your limits arealso matters.
(35:21):
Sleeping matters, social timematters.
Moderating alcohol intake, thatmatters, you know there's so
many things that actually doreally matter.
And I think sometimes we getinto that black and white
thinking that either isolatesomebody where they're like,
well, I can't do anythingbecause it's outside of my
little bubble, that doesn't work, because then we're missing out
(35:43):
on the social or missing out onthe quality of life or what's
life for if you're not doinganything that you enjoy right?
Or I think people tend to focusjust on one thing and then they
don't want to recognize thesleep or the stress or those
other pieces.
And so it's really to me, Ifind it.
I often say I wish I didn'thave IBS, I wish I lived a
(36:03):
different life, I wish I wasdoing some other job.
If I'm honest, I do, I wish Inever had gotten IBS.
That would have been wonderful.
At the same time, I'm reallythankful that, because I've had
IBS for the majority of my life,it has forced me to truly take
care of myself.
It's forced me to not in a waythat's like a slap on the wrist,
because I've worked really hardto understand the power of my
(36:26):
own choices and think aboutthose in terms of what I want in
my life and what matters to meand knowing that they're
improving my life.
But at the same time I can'tbinge drink on the weekend and I
can't.
I'll end up in a lot of painand I don't want that for myself
.
So I have to be more intentionalabout how I'm relaxing my body,
(36:49):
what I put on my platemetaphorically the overall plate
, but also the physical plate.
I just have to be mindful andaware of that and that's how I
found a lot of freedom in mylife that I have.
But it does come with reallyintentional choices, priorities,
some sacrifice, but I weigh outwhat matters.
(37:11):
I accept I know how to takecare of myself if things fall
apart.
You know that took a lot ofwork.
It takes a lot of effort, but tome it's worth it, because I do
get to experience all of thosethings, and patients do have
that option, and it's going tolook different for every person
because there's a lot ofdifferent ways IBS affects
somebody and what they need maybe completely different than me.
(37:33):
Their barriers may lookdifferent than mine, what
they're willing to accept intheir life and how they feel is
going to look different than me,but it is still very empowering
to know that, being intentional, a little intuition, a lot of
intentionality, you can see theresults that you want and you
can do the things in your lifethat you want.
It's very much possible.
So I'm always happy to sharethat and be really honest, even
(37:57):
about where it is a struggle,because it's not perfect, but it
is very much possible.
Kate Scarlata MPH, RD (38:03):
Well, on that note, Erin, that was just
so amazing, so beautiful I don'teven know how to say just.
It was a beautiful, eloquentdiscussion about your patient
journey and how you help otherswith their individual journey
with IBS.
So it's beautiful.
Thank you for coming on.
We really appreciate your timeand, to all our listeners, we
(38:26):
hope that you comment, like andshare the Gut Health Podcast.
Your support means the worldfriends, thanks so much.
Dr. Megan Riehl (38:36):
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.
Popular Podcasts
Dateline NBC
Current and classic episodes, featuring compelling true-crime mysteries, powerful documentaries and in-depth investigations. Follow now to get the latest episodes of Dateline NBC completely free, or subscribe to Dateline Premium for ad-free listening and exclusive bonus content: DatelinePremium.com
24/7 News: The Latest
The latest news in 4 minutes updated every hour, every day.
Therapy Gecko
An unlicensed lizard psychologist travels the universe talking to strangers about absolutely nothing. TO CALL THE GECKO: follow me on https://www.twitch.tv/lyleforever to get a notification for when I am taking calls. I am usually live Mondays, Wednesdays, and Fridays but lately a lot of other times too. I am a gecko.