We’re getting the truth about Irritable Bowel Syndrome from Meghan Donnelly—GI dietitian and certified FODMAP practitioner.

We start with the basics: What IBS is, the common symptoms, how many people it affects, and what causes it. Then dive into diagnostic challenges, conditions IBS can overlap with, and why it is commonly misunderstood, misdiagnosed, and mistreated. With those ambiguities in mind, we identify the red-flag symptoms we never want to ignore.

Meghan walks us through the steps to an accurate diagnosis. She covers the importance of working with a gastroenterologist to rule out other digestive issues. Then lays out the benefits of working after diagnosis with a dietitian and a GI psychologist—both specializing in IBS.

We turn to the most effective dietary-intervention strategies, from small food and lifestyle changes to the more restrictive Low-FODMAP Diet, which is a short-term tool and not appropriate for everyone. Meghan explains how misinformed food restrictions can not only be unnecessary, but make symptoms worse, leading to nutrient deficiencies and mental health issues.

She wraps up with medications, supplements, stress management, gut-directed hypnotherapy, cognitive behavioral therapy, and nervous system regulation. All of these help manage symptoms and transform outcomes for people living with IBS.

The key takeaway: Don’t self-diagnose or self-treat. Work with medical practitioners who specialize in IBS to develop a multi-pronged treatment plan that’s specific to you.

TESS’S TAKEAWAYS:

1. Irritable Bowel Syndrome affects 10–15% of the population, and can be managed.
2. IBS is more common in women, due to fluctuating hormones.
3. 1 in 10 people develop post-infectious IBS after food poisoning or traveler’s diarrhea.
4. IBS is a disorder of the gut-brain interaction. Food can be a trigger —but it isn’t the cause.
5. IBS symptoms include gas, bloating, abdominal pain, and changes in bowel movements.
6. Stress and nervous system regulation play a major role in triggering IBS symptoms.
7. IBS is diagnosed through symptoms and by ruling out digestive diseases and colon cancer.
8. To diagnose and treat IBS, consult with a gastroenterologist and GI dietitian who specialize.

ABOUT MEGHAN DONNELLY, MS, RDN, CSDH

Meghan is a registered dietitian specializing in gastrointestinal nutrition, and is Director Of Health Communications at the Celiac Disease Foundation.

Her experience spans clinical practice, nutrition counseling, medical nonprofits, and the food industry.

In her private practice at Nutmeg Nutrition, Meghan helps her clients establish a balanced and joyful relationship with food, particularly when managing digestive disorders (IBS and SIBO), food intolerances, gluten-related conditions (celiac disease), and disordered eating.

She also provides nutrition counseling for heart health, kidney disease, weight management, and food intolerances. Monash University certified, she guides clients on Low-FODMAP diets.

As lead dietitian for Skinny60®, Meghan provides nutrition education and support for participants in the 60-Day Reset.

CONNECT WITH MEGHAN

Consult with Meghan: https://www.nutmegnutrition.org/

Low FODMAP Diet Podcast: https://ithastobeme.com/podcast/episodes/meghan-donnelly-the-low-fodmap-diet-a-dietitians-guide/

MEET TESS MASTERS:

Tess Masters is an actor, presenter, health coach, cook, and author of The Blender Girl, The Blender Girl Smoothies, and The Perfect Blend, published by Penguin Random House. She is also the creator of the Skinny60® health programs.

Health tips and recipes by Tess have been featured in the LA Times, Washington Post, InStyle, Prevention, Shape, Glamour, Real Simple, Yoga Journal, Yahoo Health, Hallmark Channel, The Today Show, and many others.

Tess’s magnetic personality, infectious enthusiasm, and down-to-earth approach have made her a go-to personality for people of all dietary stripes who share her conviction that healthy living can be easy and fun. Get delicious recipes at TheBlenderGirl.com.

CONNECT WITH TESS:

Website: https://tessmasters.com/

Podcast: https://ithastobeme.com/

Health Programs: https://www.skinny60.com/

Delicious Recipes: https://www.theblendergirl.com/

Facebook: https://www.facebook.com/theblendergirl/

Instagram: https://www.instagram.com/theblendergirl/

YouTube: https://www.youtube.com/user/theblendergirl

LinkedIn: https://www.linkedin.com/in/tessmasters/

Thanks for listening!

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Megan, I am excited to do this deep dive on IBS with you, because it affects so many people, and we get so many questions in our skinny 60 community, and it's been a long time coming. So let's start with what IBS is.

Yeah, so it's a very common functional gastrointestinal disorder that it basically is characterized by problems with gas, bloating and bowel movements, and it is one of the most common things that I see as a GI dietitian. We are in a society where so many people are living with this chronic

condition, and they don't know what to do about it, because there's so much information out there that is not accurate and actually harmful in contributing to symptoms.

Yeah, and when you say gas bloating, abdominal pain, dear listener, you might be going, Oh, I have IBS then, because so many people have gas, bloating and abdominal pain regularly. So let's talk about I want actually, first of all, I want to ask you why you've made this one of your particular

areas of specialty, because you treat so many people with IBS, and why you went into digestive diseases as a dietitian when you could have gone into anything. Yeah.

I mean, I sort of ended up with an IBS specialty out of necessity. It seems like the most common thing that I get referrals for, the most common thing people reach out about, and so many of the symptoms overlap with other conditions that when you're working in any sort of digestive

disease, it seems like we come back to treating these same symptoms in a lot of different groups, which means you kind of have to learn as you go. And I was fortunate enough to have some really good training early on in my dietetics journey, and so, yeah, just kind of ended up that way. But I, you know, I've

had so many patients and clients over the years who have come to me saying, you know, I I can't go anywhere, I can't travel, I can't eat out. I need help. I'm so afraid that if I go anywhere, I'm gonna have to go to the bathroom, and that really motivates me, as a dietitian, to help, because that is one of the

worst things ever. You know, not being able to eat when you leave your home because

you're I know food is one of the great pleasures of life. We want to be celebrating and dining out with friends and family and eating what we want and feeling great about it, not feeling terrified. Let's talk about these numbers, because they really are alarmingly high. So what is the prevalence? How

many people are estimated to have IBS,

yeah, in in the United States. And this is similar globally, but we tend to see higher rates in more western societies where there's a higher intake of processed foods and higher stress and all of the things that we know are not great for our health, but it affects about 10 to 15% of the

population, which is massive.

I mean, that's millions and millions and millions and millions of people. So where do we get the 10 to 15? Let's talk about this, this change of the 5% is this, people that just don't know that they have it. Is this? Where do you get that range from? Yeah.

I mean, there's always some overlap with other things going on. So sometimes people, if they have another condition, like celiac disease or inflammatory bowel disease, for example, and they don't know that they have that, but then that gets treated in their IBS, which maybe they had, or maybe

they didn't really have, kind of goes away. So there's a lot of things like that. And then it does seem like IBS is more common in women. That is pretty much true across the different studies that we see, but we don't totally know why we can get more into that later on in the conversation, I'm gonna ask

you about that. Yeah, yeah. I mean, I think it's important too to think about all the hormonal transitions that women go through, and could that be contributing to why someone might have something going on earlier on in their life or later in their life, and then it changes as their life cycle

changes. So I think there's a number of reasons for the shift. I also think some people learn how to manage their symptoms really well, and while they still maybe have IBS, they're not really actively experiencing the symptoms.

So yeah, oh, I'm going to ask you about that too, because that is something we see all the time in our community, don't we? Let's talk about how we know that we have it diagnosis. Yes, and the fact that there's no biomarker,

yeah, it makes diagnosis challenging. I mean, IBS is diagnosed based on symptoms. There's no blood test. It's not going to show up in your colonoscopy. It's not going to show up in your endoscopy, where you get a biopsy of your small intestine. And this takes an emotional toll on people. I

mean, people are told very often it's all in your head, or, you know, they get very discouraged because they get all these tests back that say everything's normal, and sometimes the psychological of stress, of that exacerbates the symptoms.

So what is the diagnostic criteria then, where you would say you've got IBS.

So the key thing really is abdominal pain associated with change in stool frequency and texture. So this has to be ongoing. You don't just have IBS. If you have a week or two where you're constipated or you're experiencing loose stools, and then it kind of resolves itself.

IBS is chronic, so usually the criteria, like the cutoff point is three months of having these symptoms every week

and once a week, twice a week, sort of, what would you say? Yeah. I mean at least

one day per week, and the abdominal pain tends to be associated with gas and bloating, and then it can very clearly be exacerbated or helped by having a bowel movement. So sometimes, with people with looser stools, they they might feel that pain with their bowel movement, but then

it sort of gets better, and constipation, similar, like the symptoms improve typically when someone has a bowel movement. So a doctor is going to look at your symptoms. They're going to check your blood work to test for like anemia, other inflammatory markers. Hopefully they're ruling out other

conditions like celiac disease or inflammatory bowel disease. Sometimes they're doing a colonoscopy just to make sure everything's normal. On that front I mean, especially if someone's over 45 it's really important that they're getting a colonoscopy so that they make sure that this is not cancer or

any other type of colon condition, and then they're going to really listen to your symptoms and make a determination so that can take a while. Sometimes all that work up is it can take months, and that's some

leads into the more, more of the frustration to just, I don't even know what I've got. I need. I need a label. I need to know. I need. I need a diagnoses. I just want to know what I've got. And it really can lead into anxiety and depression and social anxiety, all the things that we talk

about, you talked about other disorders, and we sort of do it by a process of elimination, often with diagnoses. Let's talk about some of the disorders or the diseases that IBS is not that you could have, that have these crossover symptoms. Yeah.

I mean, the big ones that we always look out for are celiac disease, Crohn's disease, or ulcerative colitis and colon cancer. These are distinct conditions, but someone could have IBS on top of these conditions, and so sometimes we are managing multiple things that requires medication

intervention or other diet restrictions or something like that. It really is a crossover condition, and we see that people with existing gi conditions can have increased risk for IBS and why. It's probably just because the intestines are inflamed, but we don't totally understand the

connection at this point.

So you could have IBS and one or two of these other things.

Yeah, absolutely

therein is a labyrinth of testing diagnosis or all kinds of stuff. Oh, yeah. So talk me through the symptoms to look out for. You talked about the gas, the bloating, abdominal pain. Is there anything else that we need to be looking out for that might indicate that we would have IBS?

Yeah.

I mean, those are the biggest things. Sometimes we'll look for diarrhea or constipation or a mix of both. Sometimes people have kind of alternating diarrhea and constipation urgency, so having to go to the bathroom really quickly, without much warning, being unable to

completely evacuate the colon. So when you feel like there's more stool in there, but you can't push it out, sometimes having mucus in the stool. Any sort of bowel movement alteration can be an IBS symptom, but gas and bloating and abdominal pain are pretty much always present to an

extent.

So when we're, you know, using Google or chat GPT, I say we, but we don't. We don't recommend anybody do that. I. For their health, but that is what a lot of people are doing, is they're checking for symptoms, and they're Googling late at night because they're frustrated. They don't know

what's going on. Can you talk me through some of the symptoms that would not indicate that you that I have? IBS, let's say,

Yeah, waking up in the middle of the night to have a bowel movement. Blood in stool. If you ever have blood in stool, you need to get that checked out by a doctor immediately. Unexplained Weight Loss, anemia, fever, all those would not be signs of IBS. And so sometimes, what people, you

know, if they've had IBS for a while, they might have the symptoms of an IBS flare where they have really significant symptoms, but it's not actually related to their IBS. It could be related to some sort of infection or something, and they ignore these other red flags, and that is dangerous,

potentially. So, yeah, any of those red flag symptoms I mentioned you want to seek medical attention immediately.

Oh, let's talk more about these red flags and some of the other mistakes that we might make while we're searching for answers. Yeah.

I mean, I find that self diagnosis is a massive problem. Sometimes people just they go online and they think their symptoms meet this criteria, and they treat it a certain way, and they'll go on a restrictive diet, or they'll take a random supplement, or they'll start taking all kinds

of fiber supplements, or something like that. And it's completely them, the wrong intervention for them. So it's very misunderstood, and I really getting the right diagnosis is so important in terms of how we can actually treat what's going on. So even if someone has symptoms that look like IBS, and

they try something and they feel a little bit better, and they think that's good enough, it's really not because you could be missing something else, right? If you have symptoms that improve when you cut out certain foods from your diet, but then you develop vitamin and mineral deficiencies, or you're not

meeting your protein needs, or your gut microbiome is disrupted because you're on a restrictive diet. That's not actually a helpful intervention. It could hurt you more in the long term. So really, I do not recommend people try to figure this out by themselves, they need to be working with a healthcare team

that really understands the data system and what's going on.

Yeah, it's alarming, isn't it, the statistics now of how many people are using chat GPT as their doctor and having a full on conversation like they would be at the doctor with chat GPT, which might be spitting out completely false information, and it's scraping from, you

know, websites that don't have reliable information. So you talked about the red flags, about in terms of symptoms, I want to talk about the family history, piece of this, and things to watch out for, looking at our at our family members, and what they may have had in terms of how it might inform our

predisposition for having IBS. Yeah.

I mean, it's always a good idea to look at your family members and what they've experienced in their health so that you can sort of understand what you might be at higher risk for if you have a family history of colon cancer or inflammatory bowel disease or even celiac disease, these are

things you want to bring up when you go to the doctor, especially if you have some of those red flag symptoms, but also any GI condition, because those things can inform again, the level of seriousness of which the doctor is going to take what you're telling them, and the testing that you might need to go

through. You know, if someone has a family history of colon cancer and they come in with some non specific gastrointestinal symptoms, a colonoscopy is indicated, right? Because you don't want to miss potentially early stages of some of these things. I see this. I work in celiac disease a lot,

and I see this happen all the time, where the family members never get tested, and then someone has think something like blood in their stool and very bad digestive symptoms, and they never think to mention, oh, you should get tested too. And so it really matters. And so with IBS, every condition is somewhat you

do sort of have a predisposition for it, if it's in your family, but IBS can mask something else, and if you're online looking for a diagnosis that matches your symptoms, you could be missing something like this.

Oh, I want to ask you more about celiac disease, because you are the Director of Health Communications at the celiac disease foundation in the United States, how many people do you estimate have celiac disease and don't know it?

That's there are different estimates. We think in the United States, it could be anywhere from 30 to 70%

Wait, wait, what I know I was. Not expecting you to throw out that large number that's I almost fell off my chair.

Yeah, it's a huge range, too, and it's because, you know, we don't, we don't really know who doesn't have something, right? So we're kind of estimating based on 1% of the population having celiac disease, and making assumptions based on how many people we know are diagnosed? But yeah, it's a

large amount of people. They call it the celiac iceberg, where there's all these people who are just living with celiac disease and don't know it. And I've seen, I've had people working with me who get diagnosed when they're 70 years old, and it's kind of wild, a lot more symptoms went

unnoticed. Astonishing.

And what there's over what is it? 200 symptoms of celiac disease, and so many of them are not gastrointestinal symptoms. Can you just talk us through some of the symptoms that we just might go what like infertility is one right?

Infertility neurological issues like migraines or brain fog or neuropathy, which is like tingling in your extremities. There's it can affect your bone health. So sometimes early osteoporosis is the symptom. You name it, any system of the body can be affected with celiac

disease. And so yeah, it just goes to show you, too, how the intestines are. They're so important for your overall health, right? And celiac disease, where the intestines are affected and nutrient absorption is impaired and so but this could happen with any condition along the digestive

tract where you can have these kinds of symptoms that don't seem related, but very much are

so seen in a more Prudential light. A diagnosis of IBS could reveal some other things that have been left undiagnosed for a very long time. You know, I you know, you know, we talk about this all the time. I call it a gift wrapped in dog shit, where it's uncomfortable, it's

inconvenient. It might not be what you wanted or expected, but it can absolutely be a gift of knowledge that leads you into a better level, a higher level of self care. You're talking about the gut brain connection. We talk about this a lot together, and we have on other episodes of the podcast with you, and IBS is

considered a disorder of the gut brain connection. So let's dive into that a little bit more. Yeah.

So like I said before, there is no test where they're going to look in your digestive system and see any physical damage, because IBS is not causing structural damage in the traditional sense, your gut brain connection is either hyper stimulated or somewhat impaired. So yeah, it's considered with

this broader category of conditions where we're not just looking at the digestive tract, we have to look at the gut brain connection and calming the gut brain connection in order to really have an effective intervention. And so that's why we are oftentimes doing a number of things with our IBS people.

We've got diet interventions, mental health interventions, sometimes medication management. It really is no one size fits all for anyone.

I want to ask you about the difference between IBS and IBD and celiac disease, and this idea of you talk, you're talking a lot about inflammation versus a structural damage issue,

yeah, I mean IBD. A lot of people get them confused. IBS stands for irritable bowel syndrome, IBD stands for inflammatory bowel disease. And IBD has two well, it has a few different subtypes, but the main ones are Ulcerative Colitis and Crohn's disease. And these are conditions where

there's an inflammation happening at very specific points along the intestines or any point in the digestive tract, actually, in the case of Crohn's disease. And so that's like a very clear inflammation pattern that happens where there's damage that can be physically seen and that will

also show up in your blood work when they test inflammatory markers. With celiac disease, it's an autoimmune condition that affects the villi of the small intestine. So the villi of the small intestine, which are normally grabbing onto your nutrients from food so you can absorb them, they become

flattened, and so that nutrient absorption is impaired. And with celiac disease, again, when they go and do an endoscopy, and you know, they take samples of your small intestine, they can actually see that that damaged area, so IBS is not like that. You're not going to go inside the intestines and find any

points where they can pinpoint exact inflammation. Now that doesn't mean there's not distress. We know there is distress. It's just different than what's happening with those other conditions.

Oh, those villi and the small intestine, they're like the superheroes of the body, aren't they, these little hairs of discern. And we see this all the time, that with people with digestive distress, The discernment that that we see, or the lack of discernment, there's a direct correlation.

But if we could do a whole other podcast episode about that and the relationship between emotions and the gut and so forth, it's just fascinating. So there are subtypes of IBS, and they really do determine the treatment protocol. So let's go over those. Yeah.

So probably the one I see most often is IBS D, which is a diarrhea predominant form of IBS where you've got a lot of urgency and loose stools. IBS C is kind of the opposite. It's constipation predominant, and so you're going to have Infrequent bowel movements or straining, or that incomplete

evacuation that I mentioned before, where you feel like you've you can't get any more out, but you feel like there is still stool in the colon. And then there's a mixed subtype, which is a little bit tricky because it's kind of an alternating diarrhea and constipation pattern, and this

is unpredictable and very frustrating for people that have it, because an intervention that might work sometimes doesn't necessarily work as well the other times. So sometimes with those people, we have to be really creative and to give them tools for both types of stool changes that they're having. So

maybe they have a plan for when they're having more loose stools, and maybe a plan for when they're feeling more constipated and they've got to adjust that that one can take a little bit more time when you're working with someone with IBS, yeah.

So what causes IBS? Let's go back to the source for a minute. Well, you know,

we don't totally know. We know certain things that can trigger it for sure. I mean, the gut, brain connection is certainly one of these things where in certain people, because of stress or trauma or food borne illness, they've got a hyper sensitive gut, and this and stress can

amplify their symptoms and their pain signals. And you know, the nervous system is overreactive. So you know, we don't. There are people who they tell me, you know, they went on vacation five years ago and they got a little bit of food poisoning, and they've never been the same since then. Or, you know,

there's people who they had a traumatic event or some sort of long term stress in their life that that started, that's when their symptoms started. So sometimes people can pinpoint and not always, though, especially in children, we don't always know, but we do know that stress is a major trigger, and

so we have to be addressing that when we're even when we're doing diet interventions.

Yeah, wow. I want to ask you about motility issues. You were talking about diarrhea before, and how that may be a trigger for IBS changes in motility. Yeah.

I mean, so motility really is just the rate at which food moves through your intestines. So if it's too fast, you could have diarrhea. If it's too slow, you could have constipation. If it's somewhat erratic, you could have the mixed subtype. And so motility, we always talk about it because

we want to understand what is causing your digestive system to speed up or slow down. But you know, it can be affected by a number of things, hormones, the types of foods you eat, how often you eat, what's going on in your in your environment, your stress levels, all those things can affect what's going

on with motility. So it's not always straightforward,

yeah, and it could just be that you ate something that didn't agree with you, and then, like you said, it has to be ongoing over three months every, you know, once or twice a week. We talk about the gut microbiome a lot, and this gut brain connection, what about if you've been on antibiotics for a

long time because you had an infection and you've been on success, you know, successive courses? Can that trigger IBS in people? Yeah.

I mean, we don't totally know, but the understanding that I have is that probably yes. So anytime you have an altered gut microbiome, you're going to have to try to replenish the stores of the good gut bacteria and try to reduce the amount of the less beneficial or harmful gut

bacteria. And so when you when someone's on antibiotics for a long time, the gut microbiome gets kind of wiped out. So yeah, you're going to have disturbances to the gut microbiome, and all the symptoms associated with that. And one of the things that people miss is they go on antibiotics, maybe

they they think they're helping their gut microbiome by. Immediately going on a probiotic, but they're missing the diet piece, where you need to gut with plants and fibers in order to repopulate the good gut bacteria. And so sometimes, you know, it's interesting when you look at some other IBS

protocols, sometimes the intervention is just reduced processed food, increase plants, yes. And that is, I mean, that's powerful for anyone who's been on antibiotics, not just people with IBS, but you know, you if you don't feed your gut the right types of foods, you're not going to have robust gut

bacteria to help support your health.

So, yeah. So it's a domino effect. This, this interactivity that we've been talking about when we talk about post infectious IBS. I went on a holiday. I got food poisoning. I've never been the same since. I want to get some hard stats from you about this. How many people are affected by that

situation? A lot. Do I need to see? Do I need to anchor myself to my chair again?

I mean, it's thought that one in 10 people develop IBS after food poisoning or travelers diet. Yeah, wow. More when people get infections that we don't understand a lot about, like covid and other nasty viruses. It's not always

just, Oh, yeah. What are the stats about that? About covid related IBS? Is that another one of those gray areas?

Wow, yeah. We're still learning, but I would, you know, I'm, I treat it the same way I treat food poisoning. You know, it's a high percentage. We don't know if it's 10% but it's, it's a lot of people who have ongoing digestive distress after covid Or having long covid.

Oh, so, wow. So talk, let's go go through a little bit of the science of why this happens. When we have an infection, we have food poisoning, we have pathogens that are affecting the balance of our gut microbiome. Take me inside of that a little bit more so we can understand what's

actually going on in our body. Yeah.

What's tricky here is, you know, a lot of times the infection clears or it's not detectable, but the symptoms don't, so it's really frustrating. But yeah, I mean, basically you have this acute infection which causes inflammation, alters the gut microbiome. Also, you're

oftentimes taking medications Alongside this, antibiotics, very often, to kind of wipe stuff out, especially when you've got, like, travelers, diarrhea or something like that. And there's these, there's these mast cells, which are near the enteric nerves. And these are cells that are activated by your

immune system, and they cause heightened nerve sensitivity and ongoing immune activation, so that you basically need to get that to calm down, those mast cells to calm down. And then also you you need to get that nerve activation to calm down. And so some people, you know, it resolves few weeks, few months,

but some people it can take years, and it can become chronic. And so how do you deal with that? We're still kind of learning a lot about post infectious IBS. I think people didn't know this was such an issue until somewhat recently, you know, the last five or 10 years, and that helps with

treatment, because it also helps us understand, okay, what could be causing these symptoms in the first place, and what can we do about it? And, you know, I wish people would have, you know, when they have this traveler's diarrhea, do more, more things to support their gut, instead of just, you know, kind of waiting

it out and thinking these symptoms are just going to clear up on their own. I wish they would see dieticians to help them get through. Yeah, we can help, and especially if it's not been going on for as long.

So if you're listening right now and you don't actually understand what a dietitian is, Can I, can we just go over that for just a minute? Because there is some misconceptions about the difference between a dietitian and a nutritionist and a health coach. And, you know, there's a

lot of terms out there. What's the difference with it? Why? Why do we need to be seeing a dietitian?

Yeah, well, dietitians are the experts in how to apply what we're eating to treat our to treat whatever medical condition is going on. We practice what's called medical nutrition therapy, and so we're doing a diet intervention to help inform a health outcome. And we have to

go through hours, 1000s of hours of clinical training in a hospital. We have to do we have to take a test. We have a mandatory master's degree requirement, and a lot of times we even specialize. In the United States, we just came out with a new credential for gi dietitians, which is the csdh

credential. And I, I have that credential because I want people to understand that there are specialists in this. So even a dietitian, a dietitian is a better place to start. But the best is really. A gi focused dietitian, and so now we have this credential to identify that fantastic.

I love that so much. So you have a medical license. That's the fastest way I describe it to people. A dietitian has a medical license, just like any other medical practitioner, and you train in hospitals and learn how to work with other medical practitioners and all kinds of doctors and

specialists, and you work on a medical team with somebody's doctor. I'm going to ask you more about this, because it's such an important piece of this. But something that was coming up as we were talking was about SIBO, small intestinal bacterial overgrowth, which is so prevalent as well, and there is

a lot of confusion between SIBO and IBS. So what are the statistics about the number of people you estimate are affected by SIBO? And just take me inside what you're seeing with this confusion.

Yeah, so SIBO stands for small intestinal bacterial overgrowth, and it's basically an inappropriate relocation of bacteria that should be living in the large intestine, and they kind of overgrow and move into the small intestine, and that that causes a lot of unpleasant symptoms,

because you're still digesting and absorbing your food in the small intestines. And when those gut bacteria get in there before you can digest and absorb the nutrients. It's unpleasant. You get gas and bloating, oftentimes diarrhea or constipation. So again, things that look a lot like IBS and sometimes nutrient

deficiencies are present. So that's kind of an important distinction. Is that sometimes you will see nutrient deficiencies like E 12 deficiency with SIBO, which isn't it tells you that it's probably not only IBS, or even IBS at all. It could just be the SIBO that's causing those

symptoms. So again, if you're working with a doctor who knows what they're doing, they're going to be testing you for nutrient deficiencies to see if that's a possibility, but the thing with SIBO is it looks a lot like IBS, and we're learning more and more about how to treat it and how to recognize it. The

nutrient deficiencies is a big one, and it's kind of like a differentiator. But sometimes people get diagnosed with IBS and they actually have SIBO, and it's very frustrating because they try all of the diet interventions, they try all the other interventions, and doesn't seem like it gets better. So big

red flag for me is when we try a diet intervention for IBS and it does nothing, or it does nothing, it just does not do what we expect it to do, which is give you significant relief. So SIBO is treated by medication, antibiotics and diet interventions are not as effective for SIBO, although,

you know, you can certainly reduce symptoms with diet interventions, but it's not going to be to the level we see with IBS, because it's not really treating what the issue is with SIBO, I find that people who get really full and gassy and bloated quickly after eating, and their symptoms start

pretty much like right after eating. That's another one of the clues to me that it could be SIBO more likely causing the issues than IBS. But again, someone can have IBS and SIBO, and that's really

Yeah, and we see that in our community, don't we, food intolerances are on the rise. This is another area of your your specialties, and that can trigger IBS. Is that correct? That's, that's something that that you can see. So tell me more about that.

Yeah, so, so food intolerances, it's kind of tricky, because food intolerances don't necessarily cause IBS, they but they can contribute to the symptoms of IBS. So if you, for example, get gassy and bloated after you eat beans, that's not necessarily a food intolerance or IBS. It's

just kind of a fact of eating that food, eating that food more often is not going to cause you to develop IBS. And a lot of

people, oh, that's an important distinction, isn't it? That is one of the big popular misconceptions.

Yeah, exactly that. FODMAPs can cause IBS. Yes, food intolerances and and I see this a lot. You know that if you were, if you have a food intolerance, and you continue to eat the food, because you don't really know what's causing your issues, sometimes that can make your symptoms a lot worse, and

it can make the symptoms difficult to calm down, reduce the flare. And so sometimes we see this overlapping GI distress then, and it's like, is it IBS? Is. Food intolerance. Sometimes it's both. We don't always totally know, so we have to do kind of a deeper dive and try out different things with diet

in order to understand what's causing the problem.

And I think one of the key takeaways is that IBS is not simply a food intolerance issue or a food allergy issue, and this is a popular misconception that we see all the time in our community. Let's talk about hormones. Why do women get IBS more than men? Yeah. I mean,

we don't totally know, but there seems to be some thought that the estrogen and progesterone hormones that women have can directly affect motility and pain perception and can cause bloating. We know that our hormones fluctuate during the month when you have a menstrual

cycle, that's why some people get they might get very constipated prior to having a period, and then once they have their period, their progesterone drops, and then they have loose stools. And so there's some natural fluctuations. Even when people are no longer menstruating, you still have

sort of a natural fluctuation of hormones every month. And so, yeah, I mean, I think it's probably related to this hormone fluctuation, we don't, we can't say that's true for everyone. Like why that might affect one woman versus another? Might it might be really different. But yeah, it does seem like those

hormone changes can affect, I mean, we know they affect motility, but also the bloating that comes with having a menstrual cycle very often, and then sometimes pain perception.

Certainly, it makes sense, though, doesn't it that? I mean, we know as women, whether you're menstruating or not, we are cycling every 30 days, and it's interesting to look at those fluctuations in hormones. But because there's over 150 hormones, and we talk about this with you know, GLP

one and leptin and ghrelin, our hunger and satiety hormones and insulin for our blood sugar and adrenaline and cortisol for stress, and all these things that our hormones affect our blood sugar affect all kinds of things. And it makes sense then that those fluctuations in those sex hormones affect our insulin

resistance. And, you know, insulin sensitivity, I should say, and causing insulin resistance. It's much more common in women in perimenopause and menopause, and there's just the flow on effect of all of it. And one of the things that's coming up for me as I'm talking to you is, what are you seeing

in terms of IBS, in people that are on GLP one medications that are, you know, they're injecting hormone replacement, you know, injecting a synthetic form of these peptide hormones, and how that's affecting all of their hormones and their digestive system, because it's, you know, it slows down gas, you know,

gastric emptying, and all the stuff we know about these drugs now, what are you seeing with that?

Yeah, we're still learning. I think one of the biggest things I see is that motility is affected when people are on those medications, and so slowed digestion and all the symptoms that can come with that sometimes feeling very full and bloated and gassy after small amounts of food, constipation is

a big one. So again, is it IBS, or is it just related to the effects of taking that medication? Sometimes it doesn't totally matter. We're treating it the same way, because we know that some of the interventions we use for IBS, we're reducing the gas and the Bloat by altering certain types of

carbohydrates we're taking in. So sometimes that can be helpful for someone on a GLP one, but it might not be the first thing I want to try when someone's intake is already limited because their appetite is suppressed. So it's totally changing the way I look at this type of diet intervention,

because they think we can't be restricting as much as maybe we think that taking a certain food out of someone's diet will help. It's maybe not an appropriate thing to do is to restrict more in that case,

oh, I know you'll be gone. Restrict restriction only when restriction is necessary. And that's one of the big things that we see, isn't it? People over restricting what they eat because of this analysis paralysis and this fear that they're going to have to go to the bathroom and have all

these horrible symptoms. So let's talk about treatments. And there is a whole lot of things so, and often it's a combination of things. So take us through that.

Yeah, so we're seeing more and more medications being developed for use in IBS, and I would say also for some of these other GI conditions, like associated with medications, like the GLP one medications. But there's, there's, there's, like four main class. Is, which is like motility modulator. So

when they're going to change the they want to slow things up, or, sorry, slow things down or speed things up. Sometimes they're looking at secretion modifiers, so affecting the fluid movement in the intestines, which is helpful. You know, if someone's constipated, perhaps they need more fluid in the intestines. If

they're they have very loose stools. We want less fluid. So those are some medications out there. Now we're seeing some antibiotics and things that affect the microbiome. Rifaximin is a very common treatment for IBS D and SIBO, and it's really to help restore healthy gut microbiome balance, and so that

can be a helpful one. And then we're seeing more use of neuromodulators, which is fascinating, because these are historically used as antidepressants. So the the SSRIs and the TCAS, these are we are trying to lower the pain signaling, and so maybe it's a lower dose than someone would

take if they were taking the medication for depression or anxiety or another psychological disease, but that calming down, that pain signaling, seems to help with certain symptoms. Now I have people working with GI psychologists who, you know, maybe they should be taking these medications for other

reasons, and then that treatment actually is better than what we're doing with diet or supplements or things like that. So sometimes you don't necessarily like, I'm a dietitian. I want to do everything through food, but it's not always the best treatment for someone, although

it's very often a supportive treatment, even if it's not the most effective one, right? Like you get you have to do diet with mental health support.

Yes, yes. I'm definitely going to ask you about the diet intervention strategies, but I want to ask you about supplements first, because I know that in order to give somebody immediate relief because they're so uncomfortable, I know that's why you would often maybe prescribe

a medication with a supplement or something, just to give somebody a few days of a reprieve from feeling miserable. What supplements do you recommend?

So we have a lot available to us now, and a lot of these are new, but they're so effective and so again, like I'm trying these supplements, it almost feels irresponsible as a dietitian to not try these supplements along with diet interventions, because it's like, if I can get someone

relief without restricting their diet, I would like to do that. So peppermint is a big one. Peppermint is an anti spasmodic it helps calm that that inflammatory cramping or constant like over I guess it's like too much cramping that's associated with IBS and that abdominal pain. And so there are

some great peppermint oil supplements out there where they're actually meant to you swallow them, they don't break down in your stomach. They actually start to become activated in your small intestines, which is where you actually need the support to calm down those those spasms. So

that's a great one. Glutamine is another.

Yes, you know, I'm a big fan of the metagenics, glutogenics. Yeah, yes. It's just a gift from the gods, yeah.

I mean, so glutamine is food for the the cells of the small intestine, of the small intestine and lining.

Oh, that's a great way to look at it.

Yeah, yeah, it's fuel, food for the small intestine. Yes. So, I mean, it's an amino acid, but we see that this is really effective in people with post infectious IBS, because it helps restore the intestinal barrier. When you have an infection, glutamine is depleted, and so you need to

build up your stores. And so there's, there's a really good, randomized, controlled trial. It was a fairly small study, but I know that we're going to see larger studies soon. But they showed that when you took glutamine in five gram increments, three times a day, so 15 grams total for eight

weeks, it improved symptoms, that it reduced your bowel movement frequency, improved stool consistency and reduce abdominal pain. So all the main problems with IBS D really?

Wow, wow. And the incremental intake throughout the day was that part of the success of it?

Yeah, I think so. I mean, because if you think about you, your body doesn't do very well with anything too much at once. And so I think spreading it out, like we always say. You know, spreading things out throughout the day is going to help your body really efficiently use what you're

giving it.

Yeah, and it's so exciting to see glutamine embraced as a digestive health supplement, because historically, it's been used as a bodybuilding supplement, and we've been recommending, you know, the meta. Genetics, glutagenic specifically, for many, many years now, over eight

years. And what we love about the metagenics glutagenics is that it also contains aloe and licorice and other things that soothe the lining of the digestive tract from environmental pollutants and stress and processed foods and all kinds of things. And Megan that is really considered the

gold standard, isn't it by gastroenterologist digestive health specialists like yourself. I mean, it's a widely recommended supplement,

yeah, absolutely, especially if the goal is calming digestive distress. I mean, people can certainly take other forms of glutamine, but I would say that the most effective way to calm your symptoms down. If gastrointestinal distress is an issue for you, that's the best

supplement, for sure. But you know, if you're just doing some maintenance, glutamine supplementation, maybe you don't need that in particular. Yeah.

And sidebar, if you suffer from acid reflux or GERD, it is a godsend, that supplement. Let's talk about digestive enzymes, because that's another area where it's getting very exciting, where there's targeted enzymes that can help for IBS,

yeah, this is one of the best things that's developed in the last few years. I think, I mean, we there are a lot of enzymes out there now which are targeting specific types of foods that are more problematic for people with IBS. So we'll, we'll talk about dietary triggers and FODMAPs.

But when you, when you think about digestive enzymes, and what some of the challenges that people have is that they're having too much of something, and they're not able to break it down. Digestive enzymes help you do that. And so there's great products out there now that are targeted at the some of the more

common FODMAPs specifically. Well, we know that most people with IBS have trouble with two FODMAP categories, fructans and galactoligosaccharides, which those are your guard, like your onion, your wheat, your beans, your cruciferous veggies, leeks, asparagus, like these are the foods I think people, a lot of

times, are like, Oh my gosh, I can never Have those again.

But there's some of the most powerful detox foods, health promoting foods. They help to, you know, the body detox excess estrogen. I mean, we need to be eating these foods. And, you know, asparagus is a powerful prebiotic, and all the things we know. I mean, this is the tough thing about this

stuff, and that's why we don't want to get into that analysis paralysis, and be restricting it for too long, because these foods are so

powerful, yeah, and I mean, the enzymes make it so that you can have some some of these foods and not have as many symptoms, because it's helping you break down the foods. And so if you're, if you know, you know that there's certain types of foods that trigger you. You want to look

for a digestive enzyme supplement that contains the enzymes that are going to help support the breakdown of that food. And so alpha galactosidase is the enzyme that helps break down galacto LIGO saccharides, or GEOS on the FODMAP

chart, I'm glad you. I'm glad you're throwing out those terms because that's not rolling off my tongue.

They're not easy names. And then inulin is and fructan hydrolase help break down fructans. So your garlic, your onions, your leeks, your asparagus, your cabbage, all those delicious foods that are strong flavors. So those are the things you want to see. And there's some great products out

there. Now there's a number of them. I really like the fodzyme brand, and those are great products to try.

Yeah, yeah. And you know, our body produces enzymes, but we produce less of them as we age, so digestive enzyme supplementation could be a prudent choice for you, if you're over 40, specifically, let's get into dietary intervention, because this is such a huge piece of of

managing. IBS, I want to start with this food anxiety, though, that we've been talking about that is such a big piece of this and how we find that balance of attending and managing and figuring this out without diving into over restriction.

Yeah, I mean, digestive distress can exacerbate psychological stress, and psychological stress can exacerbate digestive distress, and so this gut brain connection is something we have to get at what is really distressing to me as a dietitian is that a lot of people, they feel better. They

think they feel better by cutting out certain foods, you know, they they cut out, you know, maybe they cut out gluten and dairy, and they feel better. And that's very common with IBS, by the way. But then, you know, they cut. Cut out all kinds of other foods that are really health promoting, foods, things

like garlic and onion or cabbage, you know, things we want people to be able to eat. And then they their, their food list, all of a sudden, it's very small. And I've had people come to me, you know, they've, they've sort of been doing this journey for a long time, and they, they have maybe five to 10

foods that they're eating on a regular basis with very little, yeah, variety, yeah, yeah. And that's a problem. I mean, you're going you're trying to control your symptoms by further restricting your diet. It can turn into a very intense food fear and eating disorder. I mean, we see this happened to a

lot of people, but on a physical level, you're not going to have enough nutrients, so you're going to develop nutrient deficiencies. Your gut microbiome is going to be disturbed, and your symptoms are very likely going to be exacerbated by that heightened gut brain connection distress.

And it's a vicious cycle that keeps going.

So yeah, so we talked about FODMAPs, and you throwing out all of those terms that none of us can produce can pronounce, except for you, the low FODMAP diet is the number one intervention strategy for IBS. So let's talk about what FODMAPs are and how this protocol came to be. Yeah.

So, FODMAPs, it's an acronym. I can say the acronym. Should I say it?

Oh, please, do again, please. Because I you know it's like my favorite sport is watching you say those. Yeah.

So FODMAPs stands for fermentable oligosaccharides, disaccharides, monosaccharides and polyols. And all that really means is carbohydrates that cause a lot of gas and bloating and are difficult to absorb. So, yeah, and so again, there's different categories of FODMAPs. Every

word I just said in that acronym kind of represents a different category of carbohydrates, but we do have, like the main categories are fructans, galacto oligosaccharides, lactose so dairy products, and then sugar alcohols. People who are eating a lot of non nutritive sweeteners, sometimes that's the

easiest thing I can fix. If I see someone is a lot of non nutritive sweeteners, I'm like, that is where we're starting, yeah.

And it's so prevalent in everything sugar free, everything. I mean, so many people are taking in these non nutritive sweeteners, yeah.

So the way the FODMAP protocol works is we want to reduce FODMAPs in the diet try to calm down symptoms, and then we want to try to reintroduce them or challenge them in a very slow and systematic way so that we can understand what's really triggering symptoms. And then

we're hopefully going to personalize it by using some of these other tools I mentioned digestive enzymes or really specific combinations of foods will create sometimes. So I always have, like a do not combine these types of foods list. And you know, that's all part of the personalization

phase where we're working to get someone towards the most varied and liberal diet as possible without triggering their symptoms, but it's important for people to know like the FOD the low FODMAP diet, or the FODMAP protocol, is not a cure for IBS, it's a treatment for symptoms. And so when someone's eating a

high FODMAP food, they're not causing damage to their intestines, but they are triggering symptoms. And so this personalization phase has to be done with a dietitian, because I have, I have a friend who's a gastroenterologist, who she always says IBS is kind of like, is it worth it? And there are

instances where I think, you know, maybe it is worth it to have something take a supplement to calm down your symptoms. You know, you just want to know. A lot of this is about discovering what is the trigger for you so that you can live your best life and move forward in a way that makes sense for you. I have

people who, you know garlic is like, they need it, you know, they want to eat. Yeah? That would be me. Yeah.

Yeah, I often be busy. I had IBS and I couldn't eat a garlic. Oh, gosh, I would really struggle with that. I would do it. I would do it, yeah.

But so what do we do? We we have a lot of solutions, right? We can do digestive enzymes. We can give peppermint we can there are cooking techniques where you can infuse oils and cook your food and garlic infused oil, but you're not actually getting the problematic properties of the

garlic. So if I know that's your trigger, I can give you a lot of tips, but we can't understand whether or not that's a necessary intervention for you, unless we go through this protocol and. More and more we're starting to or a lot of trained Monash dietitians are starting to look at people's

food journals, looking at what types of foods are commonly in their diet, and seeing if we can get relief by just changing certain things I said before, like non nutritive sweeteners. If I see that like, I'm pulling those out immediately and seeing if that gives me a change, but sometimes it's just, you know a

few things, but if you're eating them every day, that's really what's driving the symptoms. And so it takes someone who really knows what is, what the foods are in the low FODMAP protocol, but then also understanding that, like there are certain things that are just not supportive for quality of life,

and we need to do something different, and so we gotta get creative sometimes.

Yeah, using the protocol in a way that serves you and your lifestyle and fits you and your personality and is actually doable. So Megan and I did an episode all about the low FODMAP diet and protocol and all of the misconceptions, because the biggest one is that it's a long term diet that you can be

on. It is a short term intervention strategy. And there are all kinds of problems, nutrient deficiencies and food and food disordered eating being the two big ones. But Megan and I did a whole deep dive, hour long episode about the low FODMAP diet. And I will put the link to that episode in the show

notes if you want to go and listen to get a way more, a lot more information about the low FODMAP protocol. But I will just say case you're never going to go and listen to that episode that Megan just alluded to, just named Monash University. So Monash University is in Melbourne, Australia, and as an

Australian, can I just be a bit parochial and just say we're very, very proud that it was discovered and developed in in Australia, and it is now just a worldwide intervention strategy. And Megan is a FOD Monash University certified FODMAPs practitioner, and so they're the people that you want to go and

work with if you're going to embark on the low fat map diet journey. And obviously you can go and connect with Megan at Nutmeg nutrition.org she's amazing and does telehealth. I'll just give you a great shout out there, Megan. I want to ask you about bloating, because they can't. They kind of call it the

bloating dilemma, or the bloating conundrum, or the bloating maze or the bloating puzzle. You know that bloating can be caused by so many different things, and most people are experiencing bloating on a daily basis, whether we have IBS or not. So I just want to ask you for a little bit more

information around that, because I know that you treat people with bloating all the time, and I think that that's another misconception that I just want to make sure we cover.

Yeah, Bloating is it's a tricky symptom, because there are so many causes of bloating. So Bloating is when you it's kind of that sensation of heaviness. It's when there's excess, you kind of feel extra gas and water in the intestines, and that that heaviness in the gut, and it can, it can

certainly be caused by diet. There are certain foods that are always going to cause bloating. It can be caused by constipation. It can be caused by gas buildup, or the sensation of it can be caused by gas buildup. It can be caused by motility issues, pelvic floor health problems. If you're not

moving your body very much, it can be a trigger for bloating, nervous system distress. So there's just so many causes of bloating as that is, I think, other than IBS, it's probably something that I get more referrals for, and people don't often realize it's more of a symptom of something else going

on than addition itself. Such an important distinction like they'll realize that they've had a pelvic floor problem for children and now we have, you know, bloating and gas and constipation, and it's really not a diet issue, but diet can certainly help.

So yeah, I did a fantastic episode with Dr Tanya Goodrich, who is a pelvic physiotherapist, and she talked about this very thing, about how all of our plumbing down there is connected. So when there's a problem with one part of the plumbing, it affects all the other plumbing in the house. So

when you've got pelvic floor issues, it can cause digestive issues, it can cause bladder issues, it can cause, you know, sexual health issues. And it's really interesting. So if you want to go and listen to that episode, it is phenomenal about pelvic floor issues. And then she moves into bone health and

osteoporosis. It's just jam packed with fantastic information. So I want to ask you about stress because stress management is such a huge piece of managing IBS. So what are you seeing around this?

Yeah, I mean, it often has to go hand in hand with any diet and nerve end. Education we're doing. So medications are very often part of this. We see gi psychologists, which is a whole specialty, by the way, a lot of people don't know that they have psychologists specializing in

gastrointal Health. Very exciting. Yeah. So sometimes medication management is part of it, but we also have a lot of other strategies that a dietitian can recommend. We're not necessarily the experts in them, but we know they can be good adjacent therapies if you don't have access to a GI

psychologist. So there's gut directed hypnotherapy, which can help support changes in gut sensitivity, and then there's cognitive behavioral therapy, which can help with nervous system regulation. And there's apps actually out there that have both of these mindset health is a great one that kind

of has two tracks, and you can sort of determine which one is the right one for you, and it guides you through exercises that are either gut directed hypnotherapy based or cognitive behavioral therapy based. And so those can be great resources.

I mean, you recommend this all the time, don't you? And what's so exciting about this is, is that hypnotherapy and cognitive behavior, it used to just be considered this hippie dippie, weird thing that you wouldn't touch. And mainstream medicine was like now people are getting

such extraordinary results that mainstream physicians and dietitians like yourself are actively telling their patients to go and do this because the results are so extraordinary. So just talk us through what you're seeing as a dietitian with this, yeah. I mean, they

can be just as effective as diet interventions. We see this in people, where stress is a trigger for their symptoms, yeah, yeah. And, I mean, it doesn't have to go so far where you're seeing a therapist for this, although I think that's great if you do. I think, you know, a psychologist

can be really helpful. But breath work, making sure you're sleeping well, other things that calm down your nervous system. For some people, it's exercise. For some people, it's just meditation. Like you don't have to necessarily go full in on some of this stuff, but these are the most evidence based

treatments that we have, and so I recommend, especially if I think someone's symptoms are triggered by stress, or a stressful event triggered their IBS some time in the past. I think this is imperative. I use it with everyone. I'm always talking to my clients about stress and how to handle stress

in their life, and even if I'm not the person that's going to solve that, I can give them the tools to help support their journey. What I find is that a lot of people, they want cutting foods out of their diet to be the answer, and it's just not sometimes. And so I like people to, you know, people get afraid

of eating because they've been on restrictive diets, and they're afraid to reintroduce these foods, and they think that that's going to cause the symptoms. But sometimes it has nothing to do with that. And it's this gi psychology field is amazing for those people, is

extraordinary, isn't it? And stress is the keynote address, isn't it, at most of the gastroenterology conference, the digestive health, I mean, all health conferences. I spoke to a cardiologist the other day. And you know, stress, stress, stress, stress. And even though

we hear it all the time and we know it, we still ignore it. And so what I'm hearing from you is that it's a multi prong treatment plan that you're helping people put together in consultation with their practitioner. That is not just one strategy, that we've got a whole buffet of options on the

table, and we can, you know, keep trying different things to find, you know, a cohesive, comprehensive treatment plan to to manage this condition.

Yeah, and that's amazing, because the developments in the last few years have gotten us to this point. We used to only have the low FODMAP diet, which is an amazing diet, but it's not the right approach for everyone. So now we have all these things. We have supplements, we've got

stress based therapies, we've got all kinds of diet interventions, diet interventions, you know, we've really evolved, and it's great because it gives people options.

Oh, yeah, you must be so excited as an IBS specialist, about the next frontier, what's coming in the future too,

yeah, and I think we'll get more personalized, like maybe we will, in the future, have a test for IBS that allows us to very specific diet recommendation. That'd be amazing. I mean, we don't have that at this point. Anyone who tells you there's like, a food sensitivity test

that's going to tell you exactly what's triggering your IBS is not scientifically accurate. But you know, maybe in the future, I think that would be amazing and very helpful.

So exciting. And because you are on the forefront of all of this research into auto immune protocols at the celiac disease Foundation, you've got access to all of the latest, the latest science and studies and practitioners and what they're doing. And it's just so thrilling. And I know

we're all geeking out about it on our weekly calls on skin easy. Sick. What did you learn this time? What did you learn at this conference? What's going on? It's so fantastic to have you as a resource. I want to ask you about IBS and weight management, because this is another area where there's a lot

of misconception, misinformation, anxiety, stress around around that, and particularly women over 40 and perimenopause, menopause, post menopause, who are really struggling with weight issues? Yeah.

I mean, I always treat IBS as sort of separate to whatever weight someone is, so I'm treating the symptoms as they are with the diet interventions I would use for someone of any shape and size, but if someone has existing shape and size, body image related concerns and

anxiety about those things, then, you know, I'm probably not going to put them on a restrictive diet. I mean, none of these conditions inherently cause someone's weight to go up or down, but restriction can, and sometimes people perceive bloating and distension as weight gain. They say, you know,

I look like I'm so big in the abdominal area, I look pregnant. I hear that all the time. And it's not like you're gaining weight, but you are having a physical response to something to related to your IBS. And so I think it can be challenging to get at that. I mean, someone's hunger fullness cues could be

altered by the fact that they are going through psychological stress, or that they're having appetite changes and maybe restrictions because of that, chronic stress can raise cortisol, which can affect your appetite regulation and also your blood sugar control. And I find that so many people end up

in a position where they're actually not eating enough, but they perceive, they don't perceive that as a problem. They they they see it as, you know, kind of a means to an end and or there. This is the only way they can control their IBS symptoms, for example, and so it's a big problem. And so honestly,

getting someone to nourish themselves adequately has to be part of this, or we can do all the diet restrictions in the world, but your symptoms are not going to go away because your body's metabolism is not functioning properly. And so I have to get people eating more often, very often. I get them

eating every three to four hours more regularly throughout the day, so that they can at least not have and also going long periods without eating. Can cause symptoms that feel like IBS, that can cause bloating. It can cause, oh yes, it can cause reflux, it can cause nausea. So sometimes that's a big hurdle,

and it's more important than limiting FODMAPs. I'm not going to do a FODMAP restriction in someone where I think maybe they need to nourish themselves first. So first thing is adequately nourishing yourself. And then we'll get into restrictions where appropriate, if it's indicated. Yeah.

I mean, we talk about this all the time in our community, don't we? We've spoken about it on several episodes of the podcast together. Is most women are undernourishing themselves and not eating enough, whether you have IBS or not, if you are not eating every few hours and only

eating one or two meals a day, your body just cannot function at optimal levels. So this is why we have the pace strategy in skinny 60, don't we? It's pacing our intake of food and caloric beverages throughout the day. It's just better for digestion, better for your mental health, better for your mood stability,

your hormones, your blood sugar, your gut health, everything so and also, it's just more joyful. I mean, Megan and I like to eat. Just have fun with your food. You know, so even more important to work with a dietitian like yourself, who one of you know, one of your many superpowers, is meeting everybody where they're

at, getting to know, you know, a good practitioner will get to know you and your lifestyle. What you like to eat. Who do you live with? Do you have kids? Do you have elderly parents? Where do you work? How do you work out all these what foods do you actually like? All these things play a role in formulating

strategies and a plan that will work for you and actually be sustainable? And that's that's what Megan does. This mental health piece is so key to this with any medical condition, whether it's IBS or something else. So what do you see as a dietitian, the biggest obstacles with that, and the things that

that help alleviate some of those, those those problems.

I mean, we have to be treating the nervous system in order to for any diet intervention to work and so reducing anxiety and depression and health anxiety, of course, but it's also what you said before about meeting someone where they are. You know, I am not going to make a

recommendation for someone to follow a specific diet protocol if I don't think they can actually do it. So a lot of times those other things. Are saying, you know about their cooking ability, their time, their family situation, their willingness to put in meal prep. That is, that goes with the

mental health piece, because it's not helpful if I recommend make a recommendation that you can't follow, and then it adds to the anxiety and the stress. And so sometimes it's very simple things, and people will sometimes get a little frustrated. They're like, I thought I was going to be doing

a whole overhaul. And my response is always like, that is not appropriate if you can't do it. And so another reason why, working with a dietitian who understands the nuances of the low FODMAP diet and other diet interventions for IBS, where we're we're looking at, okay, like, can this person actually

restrict this food or actually do this eating plan that I'm recommending? And if not, what can I do to help them along? And that reduces anxiety and food fear, I find a lot of times and sometimes,

and also just self esteem, feeling like you're not failing or you're not cutting the mustard or meeting the mark, or I'm doing less than or there must be something wrong with me just going in the flow of going with the flow of what is. And I you know, again, that's another one of your strengths. And I see

that every day in skinny 60 you helping people and meeting them where they're at. Oh gosh, I could talk to you about this for five hours. It's just such important stuff, and this affects so many people. So let's do a bit of a recap. If you don't mind, what are the most important things that we need to

know about IBS?

I mean, I think the definition that is a disorder of the gut brain interaction helps reframe it in a way where it's not necessarily a diet issue. Food can be a trigger, but it's not the cause. It's a it's a gut brain disorder. And so stress matters more than people realize over

restriction can worsen it. You want to improve the health of your gut and your intestines and reduce symptoms in a way that is not stressful, and that requires personalization and really understanding where we can make the most appropriate changes for you when it comes to IBS. So oftentimes it's not just a diet

intervention which people just they don't understand. They see online low FODMAP diet, low FODMAP diet, Lofoten of diet, and they they miss the other stuff, and it's the low FODMAP diet. Can only get us so far with some people.

Yeah, and I just want to go over the things that we're getting wrong. I hate to say it like that, but some of the most common mistakes, let's put it that way, that people are making you alluded to searching and making generic conclusions that may not apply to you, but what else are some of the

mistakes that we may be making?

Well, not working with a provider that's testing you for other conditions. I mean, the amount of people who are self treating their IBS and then they find out they have something like Celiac disease is alarming, so you got to be working with a doctor who's testing you for all of the

other stuff. So going on a restrictive diet forever, you know, going on a low FODMAP diet long term, it's not appropriate, cutting out fiber or gluten completely without understanding whether or not those are really triggers, ignoring stress, assuming certain supplements will just fix everything. The

amount of supplements on that list are too long to name, but, you know, thinking something like a probiotic or some other crazy supplement that's like a GI health blend that has all kinds of stuff in it, and just assuming that's going to help you, and

just going gluten free, that's a huge one that we see don't know I'm gluten free, dairy free and sugar free. They're just isolated strategies.

Yeah, exactly. So you're not really getting at what's causing the problem. And so how do you fix that? You got to work with people who know what they're doing in this space and can help you navigate that. Yeah.

And when people are hyper vigilant and really aware and educated and are still not working with the practitioner and can actually get in the way of the diagnosis, we see this all the time, don't we, where people are gluten free, dairy free, sugar free, they're eating fermented foods,

they're eating lots of vegetables, and it puts a band aid and masks the symptoms. And then you go for years and years and years. You see that all the time with people not being diagnosed with celiac disease because they've been gluten free for

so many years. Yeah, and especially in the celiac disease space, we have a lot of great studies showing that hyper vigilance reduces quality of life. So that's an important consideration.

Gosh, we could do a whole episode about that, and we may Okay. I'll put a pin in that for right now, but that's piqued my interest, because, wow, yeah, and I fit into that category. I would absolutely put myself in that category sometimes, for sure. So we talked about the importance of

having a good medical team. What are your recommendations for where we find practitioners? And it's doctors, dietitians, gi therapists, all these people that you've named. How do we assemble a great medical team of people that understand IBS and can help us manage it?

Yeah, well, from a dietitian standpoint, the Monash University app has a great list of dietitians who are IBS specialists. You can also look for that. It's csdh credential after someone's name, it sends for certified specialist in digestive health. And that's a new thing in the

United States, where we have a credential specifically for gi conditions. So that's a good clue. And then, you know, I think the American gastroenterology Association has a good list, the Canadian Digestive Health Foundation, the International Foundation for gastrointestinal disorders.

There are a lot of these resources out there now. So those would be my go to places. There are also a number of of great gi psychology resources. There's a GI psychology website. I believe the website is just gi psychology.com but you can always look for good gi psychologist that way. And then

a gastro neurologist is going to be the doctor that specializes in these conditions, your your primary care doctor, your general provider, they're just not going to be the experts in this, and so you got to be working with someone with a gastrointestinal specialty.

Thank you so much for all this valuable information. As always, you can connect with Megan at nutmeg, nutrition.org, but gosh, I cannot wait, like, a year from now, two years from now, doing a follow up episode about this with all of the new studies and information, because it's such

an emerging field, and what you and your colleagues are going to be learning about this, it's a really exciting time.

Yeah, absolutely. I think it's changed so much since I become a dietitian, and I expect that will continue. So it's really exciting. Yeah.