Meet Liz, my client who became anxious after seeing blood in her stools, with constipation and bloating.

Hear what Liz changed to get back on track.

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After my client Liz saw blood in her

stools, she became really anxious that

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there was something wrong with her.

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Her job was quite full on, she had

two children and didn't have time to

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waste thinking about her digestion.

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But her bloating, constipation and

ongoing fatigue were getting in the

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way of her ability to show up at work.

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After three months of working

with me, Liz was finally able

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to stop thinking about her IBS.

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She was having regular bowel movements

and she said, I feel like a new woman.

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In this episode of the Inside Knowledge

podcast, I'll share what Liz did to

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resolve her digestive issues, as you

might be able to learn from that too.

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Hello, welcome to episode 65 of the Inside

Knowledge podcast for people with IBS.

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I'm Anna Welcome back to another case

study episode where I tell you a little

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bit about somebody I've worked with

in the past and What we did together

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to help them improve their digestive

symptoms and start eating a better

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diet That was more tailored to them.

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This week is all about Liz.

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I worked with her a little while ago and

She came to me because she'd had some

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blood in her stool and it had really

upset her and sort of worried her.

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So she'd gone off, had a

colonoscopy with the doctors,

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they couldn't find any problems.

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But she was still getting

quite a lot of constipation.

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really a lot of bloating and sometimes

occasionally she would get diarrhea.

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So it was like a weekly bout of

diarrhea but then the rest of

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the time would be constipated.

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She was also getting a noisy very

gurgly digestion and she'd really

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tried changing her diet but had

just never been able to stick to it.

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So she thought, oh I just need to

start eating more healthy and would do

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that for a few days Then give it up.

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Then she might say, Oh, maybe I need to

go gluten free and try that for a week.

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No improvement.

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So give it up.

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And so she was just sort of launching

from one thing to the next, not

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really knowing what to try in

order to make the symptoms better.

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She had a very busy life.

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She had her own business.

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Working with somebody else and

they had a really busy company,

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so she didn't have much time.

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You know, she was often traveling,

sometimes going up to London and she also

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had a family which was obviously busy,

you know, it takes up a lot of time.

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So she didn't have much headspace

spare, but the worry was really

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starting to encroach into daily life.

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It was taking up space and then

making her feel all sort of muddled

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at work and a bit forgetful.

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Although she had had a clear colonoscopy,

she still worried that there was something

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else wrong because she didn't feel good.

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Her symptoms were that she was feeling

rubbish, even though the tests that

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she'd had with the doctor were clear.

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She didn't have celiac disease, she

didn't have, IBD, those had all been

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cleared, and a colonoscopy was cleared.

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So, you know, She'd had a good set

of tests that the doctor thought were

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appropriate and they said it is just IBS.

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Now, we all know if you have got

IBS that just IBS doesn't mean that

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you don't have severe symptoms.

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It's more that, they just weren't going

to do any more tests and they weren't

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going to offer her any medication.

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the reason she wanted some help from

me is that she tried adjusting her diet

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already and she just couldn't stick to it.

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And so with that and the fact

that the worry was now starting to

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take over a little bit, she really

wanted somebody to guide her.

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And she thought that,

I'd be able to help her.

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She'd started taking an SSRI,

like an antidepressant, around

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six months before working with me,

which was also really helping with

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stress and anxiety management.

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She just wanted to do something more

practical to try and get on top of it.

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One of the first things that I talked

to Liz about changing was increasing

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variety in her diet in order to try and

get better, more regular bowel movements.

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I also advised her to start taking

a laxative in the short term,

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just to try and get things moving.

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Because if you are quite backed up and

you've got a lot of hard stool inside your

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colon, it's really difficult to know if

you actually have any food intolerances

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because almost everything you eat is

going to be sitting there for a long time.

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Think about how your digestion works.

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Your food waste goes through the

small intestine and there a lot of

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the nutrients are getting absorbed.

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Then it's in the large intestine,

water is being reabsorbed.

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And, you know, some other

stuff is happening too.

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But generally that is where

your water is being reabsorbed.

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So if it's sitting there for a long time,

it could potentially end up with quite

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hard stools that are difficult to pass.

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And this can lead to, like, pebbly

poos that which are like type

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one on the Bristol stool chart.

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So if you get those then you know

that your stool has been sitting

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there for quite a long time and

you could be dehydrated or it could

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just be that it's such slow movement

that more water has been reabsorbed.

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I suggested taking a laxative in the short

term in order just to try and get things

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more regular and try Create a little bit

more softer stools and then once you get

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that then often the bloating does go down.

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The ongoing bloating is really difficult

to get on top of if you can't have

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regular bowel movement So that is often

the first place that I will start.

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Now some people already take laxatives and

still are constipated So that means maybe

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there's other things that you need to do

But if you haven't tried taking laxatives,

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I would recommend It's nothing to to

avoid, like it's okay to use them in the

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short term because what it does is it just

gets the vowel moving and gets it cleared.

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After the first few weeks of working

together, it took a little while

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for her to try out the recipes.

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She looked at the menu and was like,

yeah, these all look great, I'm happy to

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make them all, but actually finding some

time to do the cooking and to try new

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foods and new meals took a little while,

but once she had started doing that,

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she started to feel a little bit better.

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better, but she didn't try the

laxatives straight away because she'd

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had an experience with another family

member trying laxatives and they had

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ended up taking a little bit too much

and getting a bit of leakage, a bit

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of incontinence, and she was really

worried about that happening to her,

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which is completely understandable.

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So it took a little while to actually get

the confidence up to start the laxatives.

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But, another week later, once she'd

actually tried that and got on

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with it, then she started to notice

that the bloating was going down.

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And then that gave her a lot more

scope to try and play around with the

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dietary changes that I was advising.

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Even though you might feel like you have

a good healthy diet, eating lots of fruits

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and vegetables, You may find that you're

only eating the same types of fibres.

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So this is where getting a good

diet diversity can really help.

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So with this particular client, I didn't

advise that she would cut anything out.

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It was more about adding foods in

and trying to create a bit more

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diversity and variety in the types

of foods that she was eating.

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This doesn't have to involve

eating different meals necessarily.

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It can just be about adding to the Current

family meals that you're already cooking.

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It's maybe like adding one extra

piece of vegetable to your plate.

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Maybe having an extra

piece of fruit after lunch.

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It's just thinking about the

small steps that you can take

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throughout the day, rather than.

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Trying to completely overhaul your diet.

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This is where I was trying to get a long

term solution for her because as I said

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at the beginning She'd already tried quite

a lot of things tried going on different

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and various elimination diets and hadn't

seen much change but partly because She

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was doing it on her own and it's tricky

to know exactly how to implement those

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sort of changes, but also because she was

going all in and changing everything all

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at once and it was just so overwhelming.

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So sometimes your progress can be a

bit slower when you make small changes,

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but when you're kind of building up,

stacking these small changes bit by

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bit by bit, then this also really

Helps to cement it in your life.

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It doesn't become like a diet that

you're on or off It's like just

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developing a new way of eating and I

don't think you can do that overnight

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It is a slow and steady change and

that is what My process is all about.

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That's why I work with people over three

months It's not just throwing you in and

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giving you some changes and see you in six

weeks and hope you've made the best of it

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After about three weeks working together

Liz was really keen to try some pulses

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and lentils because she loved them.

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But she'd never been able to eat them

because they always gave her so much

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gas and bloating So she started off

with a really small amount now what if

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you haven't eaten pulses for a really

long time, but you want to include

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them a good portion to start off with

is Around two tablespoons of you know,

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whether it's chickpeas or lentils black

beans, whatever This is not too much.

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And this is what's still considered

a low FODMAP amount for most beans

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and pulses So, just a really small

amount, adding it to your plate.

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That would be a good first day

challenge to see if you can

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tolerate some beans and pulses.

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If you get on okay with that,

then you could start with a bigger

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portion the next day, and see if you

can get on okay with it like that.

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Once She was getting regular bowel

movements and wasn't constipated anymore.

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Then actually she found she

could do lentils and chickpeas.

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It did give her some gas, but if

the gas is not getting trapped and

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it's not particularly smelly, Then

I tend to not to worry about it.

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Most people will get a bit more gassy

when they eat a bean heavy diet.

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And it's actually okay.

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As long as the gas is not causing you

any pain, it's not really smelly and

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like offending your family members.

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Then actually, you don't

necessarily need to worry about it.

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It's a sign of fermentation and

actually Feeding your good gut bacteria.

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beans and pulses is a very good

source of the galactooligosaccharides,

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which is like one of the prebiotics

that really helps to feed them and

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create a good diverse gut microbiome.

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So, getting a little bit of

gas is not something that you

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need to avoid at all costs.

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It can be quite normal.

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It's just where that causes you

significant pain, and that can

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sometimes then lead to sleep loss

if it keeps you awake at night.

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And that is, much more in keeping

with people who have IBS rather

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than somebody who just gets a bit

gassy after having a few more beans.

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One of the things that this client said to

me halfway through the process of working

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together is, I feel like a new woman.

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And this was really amazing.

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She felt Such a weight lifted that it

really had cleared a lot of the mental

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anxiety and the burden that was like,

just like a black cloud sitting over her.

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Partly worrying that she

had a significant illness.

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Not that IBS isn't significant,

but that she had something else

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that was going to be more serious.

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That was still a worry, but

also just feeling so tired.

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Like once she was able to eat a

better diet with more variety,

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actually some of her energy came back.

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And once she had got more confidence

in cooking and eating more variety,

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it lifted some of the worry.

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So when you are going out with work

for lunch, or like if you're going to

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different offices around the place,

and you don't know what you're going

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to be able to get, actually having the

freedom to eat more of those foods just

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is such a weight off people's shoulders.

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So if you're thinking, Oh my God, I can

only have these five types of lunches.

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And I don't know if there's going to

be a cafe nearby that will do this.

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And it just creates

quite a lot more worry.

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Whereas when you can just eat all

of these little things and feel okay

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with them, Then you, it's just one

less thing to worry about in your day.

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And that in itself was

just really lifting.

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So halfway through the process,

she actually said, I want

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to come off antidepressants.

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I feel like everything's

just clicking into place.

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And I really want to start.

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Looking at my other medication as well.

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So she made an appointment with the

doctor to have a discussion about that.

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By this time she was not seeing any blood

in her stools at all and 5 days out of 7

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she was having a normal bowel movement.

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So like a normal Bristol stool

type 4 poo with no straining.

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No gas, no pain.

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Some days she was still getting a

slightly pellety poo, like a little

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bit harder, and then that was five

You know, two days out of seven.

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So majority of the time it was normal,

easy, and those two days a week in a

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way, just serve to remind her why she

needed to keep up with the small changes.

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And actually sometimes that is helpful

in and of itself is just to have.

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Some kind of setback or something

that reminds you why all these things

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are still important to keep you going

Because the other days when it doesn't

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happen, it's like oh such a relief.

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She also said it felt like it was

easy to slip into the old ways.

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It was easy to go back to snacking on

sweets or like eating out a lot for lunch

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without thinking too much about fiber and

different fruits and vegetable intake.

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Once you have those like new thought

patterns, it does take a long

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time for it to become a bit more

normal or that you even notice that

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you're doing things in the old way.

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So, for example, if she had a lot

of lunches out, it would generally

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be like a sandwich or something that

you can get in a cafe and then that

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didn't really leave as much room

for eating fruits and vegetables.

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So we talked about how to bring

things with you, like take.

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Food along for snacks that you can add

to your basic meal that you're buying

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out and about when you're having lunch.

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And it just means that you're starting to

get that five a day as your minimum, like

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five fruits and vegetables as a minimum.

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That's your baseline, you just

don't deviate from that because it's

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normal for you to add things to each

of the meals that you're having.

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In terms of, supplements and things as

well as changing her diet, I did, advise

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Liz on a couple of supplements to take.

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One of them was magnesium oxide,

which is very good at drawing

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water in to soften the stool.

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It's not a well absorbed form of

magnesium, so it's pretty useless if

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you take magnesium oxide and you're

hoping to absorb the magnesium.

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And it's mostly in the cheapest sort

of supermarket brands of magnesium,

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you'll find it's magnesium oxide.

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So it's good, you know, it's relatively

cheap and easy to get hold of, but it,

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because it's not very well absorbed,

it tends to, by osmosis, draw water

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into the colon and loosen the stools.

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There was a few other supplements that

she took as well alongside, The work

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on her diet, but essentially I felt

like I wanted to share this case study

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because it was a relatively simple case.

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It's a relatively simple set of

changes that she made and had

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such a dramatic result for her.

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guess following on from the podcast

last week where I was saying some of

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the things that are holding you back

from getting improvements with your

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IBS is going down rabbit holes of very

specific niche rare conditions and

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researching them and taking tons of

supplements and you know really going

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hard into internet research territory.

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Whereas actually, sometimes some of the

basic kind of changes being supported

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to do it, to give you the confidence

that this is the right thing to do, can

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have very dramatic improvement results.

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So sometimes you might feel like I've

tried all of these things, I've tried

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this basic approach of just eating

more variety, but what I find is that

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You Some people with IBS can say that

they have done that, given it a go.

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But because the symptoms don't

change either quick enough or you

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don't really understand why and how

they're changing, you might then give

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up on certain dietary interventions

such as increasing your fibre.

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So where I would suggest people

with constipation start if you were

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looking to how to do this, would

be to start with low FODMAP fibres

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that are less likely to create more

fermentation and that sort of thing.

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So, whilst I'm not saying go on the

low FODMAP diet, but if you're just

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looking for places to start, foods

to include, that would be helpful.

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You might also think about fruits

like kiwi, pineapple, and papaya.

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Papaya and pineapple are also very good

because they contain some enzymes in them

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which naturally help us digest our food.

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So there's papain in papaya

and bromelain in pineapple.

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They're just naturally in the fruit,

plus, you know, they're tasty, they're

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quite sweet fruits and nice to eat.

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So you can add those kind of

things to your diet and in terms of

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vegetables, it's things like carrots,

parsnips, spinach, green beans.

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Just start with those ones.

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If you don't feel confident about

eating more highly fermentable foods,

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like, I don't know, cauliflower

or lentils, don't start there.

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Start with the lower fermentable foods.

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And if you're not sure about which

ones those are, you can listen to

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my episodes on the FODMAP diet.

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That's episodes 17 and 18, which is

an introduction to the FODMAP diet.

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Then episodes 25 to 29, which

is a summary of each individual

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FODMAP kind of grouping.

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And what you might find if you have

a fructose intolerance or maybe

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you have an issue with sorbitol.

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So it kind of goes into each one of those,

what are the foods to look out for, and

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how might you go about reintroducing them.

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And I've also got episode 37, which is

what can you eat on the low FODMAP diet.

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And that is where you'll find more

discussion about low FODMAP foods.

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So if you were looking for fiber types

that you wanted to try and include, that

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would be a good place for you to start.

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If you feel like you need help with

your individual diet and support in

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order to change things in your life

to try and get a better diet and

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digestion, then you can work with

me wherever you are in the world.

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I have a three month gut reset program.

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And over those three months, It's

working together very closely with me.

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We start off speaking weekly and

really trying to dig into where

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you need to make some changes and

also critically how to make the

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changes so that you feel supported.

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You know what you're doing and

you have all the resources to do

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it like meal plans and ideas for

foods as well as a supplement plan.

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necessary and also looking at a lot of

gut health information and education

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that I have in my video portal.

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So I have a whole set of videos that

you can just watch in your own time and

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then you can use the calls with me to

ask me questions or to, check anything.

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I always have a discovery call with

people ahead of working with them and

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that's really important part of my

process to work out if it's a good fit.

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Most people I feel like I can work

with, but I just want to make sure that

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you've had the relevant involvement

with your doctor for example, that you

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have actually got IBS or SIBO and that

actually you like me as well, that

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we're a good fit to work together, that

you feel like you can tell me all your

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health history, you can tell me all

about your diet and your bowel movements.

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You have to feel comfortable with it.

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Some people just don't come back

to me and that's completely fine.

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Some people will think about it for

a couple of months and then come

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back to me and that's also fine.

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So if you feel like it could

be worth investigating, you

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can set up that discovery call.

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It's like 30 minutes over zoom.

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Where we just have a quick chat

about what you need help with.

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So I'm going to leave

it there for this week.

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Thank you very much for listening to

this episode of the Inside Knowledge

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Podcast . Better digestion for everyone.