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Ep 58 - Case study - Vegan with slow transit constipation to normal bowels
Episode 5818th June 2024 • Inside Knowledge for people with IBS • Anna Mapson
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This week hear about Sian's IBS success story. She had slow transit constipation (methane dominant SIBO) and was struggling with a vegan diet based on convenience food.

Over 3 months together Sian managed to turn her diet around from fast food focus to a healthy vegan diet.

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The information in this podcast is not medical advice and is not designed to treat, diagnose or provide personalised health advice. This podcast content is information only and any changes you make are at the user's own risk. Please consult with your doctor or healthcare provider before implementing any new treatment.

Transcripts

Speaker:

When I went healthy, it was really bad.

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That is what my client, Sian, said to me.

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She was suffering with daily

bloating and pretty bad constipation.

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She was only going to the toilet

every three days and really

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straining to get anything out.

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She was just sick of having

such a sluggish digestion and

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wanted to eat a more varied diet.

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I pull out these kind of case

studies to show how Sian turned

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things around, as hopefully it will

inspire you if you also have IBS.

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On this week's episode of the

Inside Knowledge podcast, I'll be

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sharing Sian's story and how she

managed to get more regular bowel

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movements and enjoy her food again.

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Welcome to episode 58

of the Inside Knowledge.

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I'm Anna Mappson.

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Choosing case studies to share

with you is always really good.

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It gives me a chance to reflect

a little bit on What's gone well

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and actually how my practice

might have changed over the years.

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And also I know from speaking to

people that you enjoy listening to

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these case study episodes as well.

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I often have people contact me saying,

Oh, I heard this story that you and I

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think storytelling is really powerful.

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So hopefully you will get

something out of today.

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It's going to be about SIBO,

about constipation and bloating.

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So if any of those are your

problems, then listen up.

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Um, now also just to reiterate that,

Obviously I do change some details about

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all of my case study people so that

you won't be able to tell who it is.

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I will change their name, obviously,

but I will also change a few other

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details like their job or anything

that is relevant, because I wouldn't

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want anybody to be identified.

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So let's meet Sian.

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So Sian was relatively young in terms

of people I normally work with, she

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was in her mid twenties and she had

had an episode of food poisoning ten

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years ago when she was a teenager.

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Then, apart from that food poisoning

episode, she had no problems for a

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little while, but then over the years

her constipation got worse and worse and

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worse and the bloating was unbearable.

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She was passing a bowel movement every

two to three days and it was type 1 or

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2, on the Bristol stool chart, is very

small, hard, pebbly poos, or large, big

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ones, which required a lot of straining.

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She was also eating a, Relatively

processed, sort of unhealthy

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version of a vegan diet.

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And I say that just, that's

how she described it to me.

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And like I said in the introduction,

when she felt she ate a healthy

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vegan diet, that's when her digestive

symptoms got 100 percent worse.

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She had a goal in mind to try and lose

some weight, and in order to do that,

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she was fasting, and missing breakfast

most days, so like intermittent fasting,

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where she was just eating two meals a day.

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The meals were a lot of vegan

fast foods, or vegan ready meals.

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So she was having a lot of vegan

sausages, vegan sort of pizzas, burgers.

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for breakfast, if she did eat it, it

would be rice krispies, and a lot of

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vegan biscuits and that sort of thing.

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She didn't enjoy cooking, she really

didn't enjoy making food and just

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wanted things to be better, but didn't

really want to have to engage in the

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cooking process, which is fine, not

everybody likes being in the kitchen.

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Before she came to me, She'd already had a

SIBO breath test, and she'd had a private

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stool test, and this was with a company

online, so she'd done the tests and then

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got a quick online consultation from

the company that did the tests for her.

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But they didn't really leave her

with a treatment plan that she felt

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she could follow, or didn't really

give her anything that would help.

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Her SIBO breath test showed that she

had high methane producing microbes,

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especially in the large intestine,

as the methane went up quite a

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lot as it hit the large intestine.

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Uh, if you don't know what I'm talking

about, do listen to my previous

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episodes on SIBO, episodes 11 and

12, where I explain a bit more.

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What that is and what all the

testing involves, so you can

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go back and listen to that.

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But just to know that when you have

methane producing microbes in your

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gut, then you're gonna slow down your

digestion because methane affects

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the nervous system of the gut and

just slows down the movement of food.

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So It is important to get on top of that.

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So because she didn't get

anywhere with her previous online

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nutrition support, she did take

her SIBO test to a private doctor.

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Then she got prescribed some

antibiotics to address the SIBO.

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As soon as she took the antibiotics,

which was rifaximin and neomycin, she

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felt really awful and was unable to

finish the course of the treatment.

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She just only took it for a few days and

then, felt very sick, her stomach was

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very unsettled and she had pains and the

bloating was worse and she just didn't

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want to carry on and also she didn't have

any follow up with the doctor to check

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back in with her so she just stopped

taking them and then didn't know where to

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go from there so that is how we started.

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Sian came to me because she wanted

somebody to walk her through what to

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eat and also how to do it so she'd

had Testing done, and an online

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consultation that wasn't very helpful.

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She'd then been to a functional

doctor and had antibiotics prescribed,

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but had a horrible reaction and

didn't then trust to take them

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or trust what he had recommended.

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Because there was no follow

up, she felt on her own.

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So she wanted somebody Who

would speak to her each week?

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And so that is what we did and

that is how I work with people

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in my three month gut reset.

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I speak to clients weekly

for six weeks and then it's

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fortnightly for the last few weeks.

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So you get nine half hour calls with me

throughout the three months and during

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that time that is when you can really

explore what's going on and I can push you

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a little bit more to make some changes.

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So I started off with Sian suggesting

that she goes through her basic checks,

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what I would call the constipation

basics, and these weren't changing

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anything about her food as yet.

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So I wanted to see what would happen with

her constipation if she just ate three

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meals a day, because at the moment when

she started she was skipping breakfast and

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then would go to work and then just have

lunch and dinner and they were, like I

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said, mostly fast food type vegan meals.

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quite low in fibre and vegetables

because she felt that they were her

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biggest triggers for the bloating.

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I also encouraged her to start

drinking more water and to

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actually start tracking it.

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So getting up, drinking a bit of water

first thing in the morning, having a

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little bit of water when she went for

her break at lunch in the morning, like

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trying to use some Key points in the day

to hang the water hat on so you say right

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every time I go to the toilet I'm gonna

have a little glass of water or every time

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I Go and have a meal I'm gonna make sure

I've had some water in the preceding hour

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before that just things like that just

to really try and Get drinking water a

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habit because if your stools are hard And,

pellety, you may be not drinking enough

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water because the longer it's sitting

in your digestive tract, the more water

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is being absorbed, and that is where

you can end up with really hard stools.

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So, it's not the only thing that would

cause constipation, but it's one of

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the basics to just cross off the list.

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So, eating three meals a day,

because every time you eat,

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it kickstarts constipation.

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The gastrocolic reflex, which

is going to push food through

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your gut, and you want that.

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Then making sure there's water there,

so that fibre that you do have can, um,

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draw water in and create a softer stool.

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And then the other basic that she

started on was mindful eating.

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So really chewing her food

properly, sitting at the table.

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This was quite a challenge for

her, and she found sitting at the

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table on her own really difficult.

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She lived with her mum and dad,

but they had different sort of work

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schedules, so she often ate on her

own, and would just make herself

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really quick meals in the kitchen, but

really struggle to sit and eat without

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distraction or in front of the TV.

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So we came up with a compromise of

listening to her favourite podcast

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and trying to fix something funny,

something where she could sit up

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right at the table, but still, get

a little bit of concentration on

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chewing and digestion and food.

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Sian really wanted to lose some

weight as well as part of this, and

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although weight loss wasn't a focus

of our work, I explained to her that

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her diet was very low in protein.

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Because she was eating a vegan diet,

it was mostly carbohydrates that she

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was eating, and so we talked about

how Vegan proteins and what sort

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of things she could look out for.

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For example, tofu and beans

and pulses in small amounts.

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And then also vegan alternatives like

veggie burgers and things which she

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was already eating quite a few of.

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But I really wanted her to experiment a

bit with tofu and she wasn't mad keen on

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it, but she did give it a go and introduce

things like Scramble tofu, for example,

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in the mornings instead of scrambled eggs.

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The thing about eating a vegan diet that

is low in protein is that you generally

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tend to be very high in carbohydrates

and particularly, in this case, it was

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very high in wheat because a lot of

things she had were wheat based proteins.

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or there was a lot of just

carbohydrates like pasta.

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because that was a lot of the bulk

of what she was filling up on.

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When you eat a lot of wheat, like to that

extent, it can be difficult to digest

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and can, when you're already constipated,

cause a lot more bloating because it's

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slowly going through the large intestine

and your gut bacteria are going to ferment

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those fructan molecules that are in the

wheat and cause a lot more bloating.

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So adjusting the balance and

eating more diversity is helpful.

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The other thing that I thought would

help with weight loss was increasing

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the amount of movement that she did.

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She was not going to the gym or doing

any walking or anything because the

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bloating had been bad and she just felt

really sluggish with the constipation.

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She felt slow, like everything was

heavy and hurting and she would just

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felt very full in her stomach and

hadn't wanted to do any movement.

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But I was explaining that if you can get.

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Your gut moving through some gentle

walking every day, maybe going to the

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gym and doing a little bit of exercise.

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That would not only help with the weight

loss, but also would help with digestion.

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So we agreed on a, you know, a

gentle pattern of reintroduction

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of some movement, as well as

increasing her vegan protein sources.

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For supplements, I advised her to start

taking magnesium oxide, which is not a

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very well absorbed form of magnesium.

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This can draw water into the large

intestine and create a softer stool.

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So it makes things mushier,

easier to pass and just helps to

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speed things along a little bit.

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So she started taking a

couple of those at night.

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There were some other supplements that I

suggested that she take that would start

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to reduce the methane producing microbes.

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So remember, methane gas producing bugs

will slow down your transit time and

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we needed to speed it up because often

the bloating is down to constipation.

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When you're full of stool that can't come

out, not only does gas get trapped and

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feels much more painful but It's really

hard to keep things moving, so we need to

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speed things up and try and get the whole

digestive tract operating as it should.

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I wanted to see what happened if

we reduced down methane producing

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bugs using allicin, which is

a garlic extract, and oregano.

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She was really, really nervous about

taking these because of the bad reaction

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that she'd had to the antibiotics.

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These kind of antimicrobials supplements

can have a similar effect, to be honest.

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They are as effective in some studies

as taking antibiotics, although they

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are much slower working, so you will

have to take them for six to eight

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weeks instead of just two weeks.

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So she did very gently start taking

them, but it was a very slow process.

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In fact, The first few weeks she didn't

buy the supplements and I kept saying, How

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are you feeling about the supplements now?

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And then she would say, Oh, okay.

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Yeah, I'll get them next week.

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I'll get them next week.

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And then she actually got them,

she didn't want to take them.

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So there was more than just, um, not

being sure about the supplements,

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whether they're effective, but it

was like a fear of bringing back that

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same experience with the antibiotics,

which was so understandable, she'd

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had a really horrible time of it.

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Eventually, we did managed to talk

through how to take them and doing it

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in such a gentle way and she started

to take these supplements which

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reduce the methane producing microbes.

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After one month she was having a poo

every other day and it was more formed,

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it was not as pebbly and it was easier

to pass, so still straining a bit, and

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she still had a sense of like incomplete

evacuation, but the stools were more

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formed and easier to pass than before.

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So this was really encouraging,

and she could see, okay, actually

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maybe it is working, maybe there

is something to all of this, and we

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carried on increasing up vegetables.

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At the beginning, she was starting to have

raw salads, so she really wanted to eat a

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healthy vegan diet, but found that eating

lots of salads made her feel very bloated.

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So I explained that sometimes raw food is

more difficult to digest than cooked food.

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So we increased vegetables, That started

off in the low FODMAP vegetables.

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So really trying to bulk out things that

felt safe and eat them in a cooked way

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to try and increase low FODMAP fiber.

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Now this actually helped and then

she was able to experiment with some

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higher FODMAP foods like raisins.

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And she started taking little boxes of

raisins to work with her, which would

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really help her get looser, softer stools.

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I also really encouraged her to eat fruit.

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She was very nervous about this

because she felt fruit was too sugary

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and it might stop her losing weight.

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And so I explained again that actually

increasing the amount of fruit wouldn't

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really have an impact on her energy

intake because fruit is quite low calorie

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and And the rest of her diet was vegan.

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It wasn't like she was

eating a lot of fatty foods.

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Adding in some fruit was going

to add in essential antioxidants,

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fiber as well, which is critical

for a good, healthy bowel movement.

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And just really upping that diversity

that would help her with better stools.

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When we were two months in, she was still

only going to the toilet every other

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day, but the poos were a lot fluffier.

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less straining, a lot easier to pass,

and she'd managed to start at the gym.

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So she started going back to the

gym and she was really loving it.

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She was really enjoying moving her body

and being able to get into the stuff

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that she'd wanted to do for a long time.

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She felt like It was really sort of

engaging back with her body after

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feeling like everything's broken,

nothing's working, it's all terrible.

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Actually to feel like, yeah, I'm building

some muscle, like I'm getting stronger.

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I'm a bit more active and sort of growing

into that person that she wanted to be.

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Now, remember I said she had been

fasting, so skipping breakfast?

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Interestingly, about two months

in, she really noticed that on the

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days that she thought, actually, I

want to go back to losing weight,

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I'm going to start fasting again.

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Those were the days when she

struggled to go to the toilet.

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If she went and had breakfast every

day, then she normally went to the

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toilet within 30 minutes, and then

the rest of that day, felt better.

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She felt less bloated, less painful,

and she could move around a lot freer.

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Um, in her job she did quite a

bit of walking and so she was

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able to move a lot more freely.

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That just made a big difference

actually noticing when you

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start to see some changes.

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And then things go back to how they were.

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Then you're like, oh, I remember.

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This is how it used to be.

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This is what I used to have

to deal with all the time.

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So it was really great, in a way, that

she had those days when she noticed the

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change and the difference because then

she could see, Oh, actually it is working.

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It does make sense.

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And it reinforces what it is you're

doing and why you're doing it.

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This doesn't mean it was easy.

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One of the things she struggled with

a lot was eating in the morning.

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And just because I said she did breakfast

doesn't mean, uh, She found it easy to do.

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So she did feel a little bit nauseous

and she was getting up relatively

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early for her breakfast as well.

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So we talked about, you know, is there

a way she could eat when she got to

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work, get there a bit earlier and

go to the staff room and eat there?

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Or is there a way she could do that?

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get everything else ready and then

eat just before leaving the house.

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But then there was like an added

complication of, Oh, well, will I

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need the toilet on my journey to work?

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It is hard to change your routine and

hard to change your body, especially when

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you have got timed deadlines that rely

on you leaving the house at certain times

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or attending work at by a certain time.

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This is really challenging when your

digestion's all over the place, but.

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I felt so proud of her for really

sticking with it and trying a lot of

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these things, but like I said, she

did do it relatively slowly in her own

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time because she was so nervous about

the consequences of changing her diet.

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The other thing I provide all my clients

with is access to the Gut Reset video

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portal, and in there is a whole series

of videos, each one's quite short.

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there's a specific section on

constipation, including things about

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creating a morning routine, how to sit on

the toilet more effectively, um, thinking

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about what to eat for constipation, so

it's all really laid out topic by topic.

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So my clients can access the bit that

they need to learn, but she actually

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found watching these videos and then

returning to them a few months later

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was sometimes also helpful because she

didn't always take it in on the first

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time and was sort of skimming them.

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And then we would chat about it in

the one to one sessions and realize,

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actually, maybe go back and have

another look at that video and

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see if there's anything else that

you might be able to find useful.

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At the end of three months, her bowel

movements were practically normal.

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She was going four to five times a

week, so almost every day, but she

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would still miss a day, They were

type 4 on the Bristol Stool Chart,

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which is a normal stool, easy to

pass, and this was just fantastic.

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Like, she was not getting as bloated

as she was, she still did fine.

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Some meals, particularly, like

a vegan burger in a bun, might

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have increased her bloating.

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bloating.

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But I think that's relatively normal

and a lot of people will get that.

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But she was just eating so much more

and throughout this process she'd

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learned to cook for herself, learned

how to make some simple foods that

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could be batch cooked and saved and

like packed away or frozen so that

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she could eat them later in the week.

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Because when you've got to cook for

yourself all the time it is quite boring

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and sometimes you don't really have the

energy or the desire to make a fancy meal.

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Trying to make some batch

cooked foods is really helpful

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in those kind of situations.

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If listening to this story has made you

think you would like some one to one help

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to really target better interventions

to get your digestive system working

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as it should and get you eating a broad

range of foods again, then you can email

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me about applying to work in my three

month gut reset with me, where we get

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lots of time together to talk through

your issues and what you need help with.

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You can email me on

info@goodnessme-nutrition.Com

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or book a call via my website.

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I offer a 30 minute free call for

anyone who's interested in working

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with me just to check if we're a good

fit and you want to work with me and I

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think I can help you with your issues.

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So we'll leave it there for

this week, back next week

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with another podcast episode.

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If you've got any suggested topics

or things that you'd like me to

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cover, then please do get in touch

as well via my email address, or

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you can reach me on social media.

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I'm on Instagram, @goodnessme_nutrition.

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Thanks for listening to this

episode of the inside knowledge,

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better digestion for everyone.

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