Another case study of IBS clients from my Gut Reset programme. In this episode listen to Priya and her story.

• Symptoms and Diagnosis: Bloating, gas, and mucus, despite managing coeliac disease well.
• Treatment Approach: Delve into the process of identifying triggers and implementing dietary changes.
• Managing a health weight - the importance of proper nutrition for managing IBS symptoms.
• Reintroduction and Progress: Follow Priya's journey of gradually reintroducing foods and experiencing symptom relief.
• Stress and Emotional Impact: Recognize the role of stress and emotions in exacerbating digestive symptoms.
• Focus on Self-Care: Explore strategies to prioritize self-care and maintain digestive health during stressful times.
• Better digestive health through increased self-awareness.

You might also like to listen to

• Episode 24 about disordered eating practices in IBS.

Work with me

• Group Gut Reset - https://www.goodnessme-nutrition.com/group-course-ibsc/
• 1:1 Gut Reset - https://www.goodnessme-nutrition.com/consultations/

Ready for your gut reset? 🌍 I work with clients worldwide, providing remote consultations and a wealth of educational resources.

Instagram - @goodnessme_nutrition

Welcome to a case study episode of the

Inside Knowledge, where I share with

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you some clinical insights from the

work I've done with certain clients.

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Sometimes when I meet someone before we've

started working together, the things I

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think are going to be important actually

turn out to be something quite different.

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And this episode is a

good example of that.

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The same applies to some of my clients.

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Some of the things that they think

are most important and take up all

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of their brain space are actually

not the things that are going to

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drive the biggest improvement to

their irritable bowel symptoms.

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In this episode, we'll talk a lot

about how to gain weight with IBS and

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how to change your approach to eating

in order to get better digestion.

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Welcome to the case study episode.

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These are always quite popular

when I look at my analytics.

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I think you really enjoy Seeing some

of the things that I do with individual

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clients and some of the ways that it

hasn't worked as well because I like to

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be really honest about what I've tried

and what people have enjoyed and what

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people are not prepared to do as well.

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So let me tell you a bit about Priya.

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I worked with her over four months.

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When she first came to me, she

had been diagnosed with celiac

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disease for four years or so

and had had IBS for another two.

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This is quite common in people who have

another health condition, where they are

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treating and managing the symptoms, and

yet they've still got ongoing problems,

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so they actually are diagnosed with IBS

on top of another digestive condition.

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The sorts of symptoms that she was getting

was a lot of bloating, some exposure

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Explosive gas and a lot of mucus as

well and it came in flare ups over the

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course of those two years But prior to

working with me it was becoming more

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and more frequent and she was finding

she was reacting to lots of different

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foods There didn't seem to be any clear

triggers really there was nothing obvious.

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So she was looking for somebody to give

her some structure and help her find a way

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out of this very confusing food landscape.

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She was managing her

celiac disease very well.

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She was super careful in terms of

not having any gluten in the house.

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She was very cautious around eating

with other people or eating out and

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so there was no thought that she

was being contaminated with gluten.

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It was really well managed condition

and she was very educated about it.

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So that was great because it

sort of ruled out that potential.

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Sometimes people who have been recently

diagnosed with celiac disease, and I've

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also worked with people who haven't been

taking it as seriously as they could be,

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and perhaps they're sharing butter with

their husband or whatever, and there's

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crumbs in the house and just getting

some level of gluten contamination

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and it can lead to digestive symptoms.

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So that was great that she could really

easily reassure me that that was not

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the issue, and that was not her problem.

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She came to me really because she'd also

worked with another nutritional therapist

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in the past, but they hadn't been able

to give her any personalized advice.

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They'd just literally given her a lot

of handouts that seemed very generic

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and they weren't helping her tailor

it and helping her actually implement

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it, which was what she needed.

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She was a busy person she just really

needed some reassurance, some support

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really, and so she was very Pleased about

the weekly calls that we had, the space

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to chat, to ask questions, just for really

informal conversations about digestion and

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food, and she was really open to learning.

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Now, as I mentioned, her main

problems was this, like, explosive

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gas and mucus, and she had had all

the kind of tests that you can run

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at the doctors, they all were clear.

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She didn't have any ongoing

doctor's appointments, she's

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had like a clear ultrasound.

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She'd had a stool test She'd had a blood

test to look at the fecal calprotectin

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Levels and like general blood levels of

inflammation and all of them were low.

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She'd also had her gluten Antibodies

tested and again, they were low.

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So it was really great.

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We had A clear round of tests.

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The problem is, is that it doesn't

really lead you down a treatment route.

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So sometimes you get all the tests

coming back saying, Yes, you're fine.

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There's nothing wrong with you.

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And actually, you're not fine.

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You're really not fine.

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And it can be extremely frustrating.

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When I started going a bit more into

detail with Priya about what she ate,

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the list of foods that she couldn't eat

was very long, and this is one of the

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first things I noticed, that there was

a lot of foods on the restriction list.

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The major problem with this was

that she had a very small body size.

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She was underweight if you look at the

BMI testing and I know we all know that

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BMI is not a great measure of health.

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However, when I can also put

this together with symptoms

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that the client is telling me.

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about their digestion, but also

other symptoms, like energy

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levels and headaches, for example.

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And I can see their food diary, so

I can see the kinds of foods they're

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eating, how often they're eating, etc.

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This does give me a picture of whether

they're eating enough, and they are

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underweight for their body size.

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In this case, I really strongly

felt that she was not eating enough.

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In situations like this, I have to be,

as a, you know, nutrition professional,

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I have to be really certain about

the way people feel about eating.

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So whether it's disordered eating,

or an eating disorder, or is it just

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restrictions that have been put in place.

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around food in order to control

symptoms and it kind of got out of

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hand and escalated a little bit.

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So, I was very clear that I

would only work with this person

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if she agreed to eat more food.

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And she was very happy to do that.

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But she was wanting to manage

the symptoms and wanted a lot

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of reassurances not to eat foods

that are increasing her symptoms.

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So, we had, you know, a little bit

of back and forth at the beginning.

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Some of the things that were also Making

me think she wasn't eating enough was

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really that she was getting frequent

headaches, particularly in the morning.

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Her energy levels were quite low, but

she also had a real tendency to push on

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through, try not to take breaks, like just

keep on working, keep on going, despite

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feeling pretty ill with her stomach and

with her headaches and energy levels.

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So let's get into what we actually did.

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I started off by, as I said, making

sure she was eating enough and trying to

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stick to low FODMAP foods to begin with.

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She was already on a very

restrictive diet and I didn't want

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to cut anything out of her diet.

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I wanted to increase it and

make sure that she was eating

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more food but also more variety.

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So we started off just increasing

low FODMAP foods until she

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was eating more quantity.

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Part of the reason for her many

restrictions and eating, you know,

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little small meals and not wanting to

get full was that she felt that food

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sits really heavy in her stomach, and

she just said, I can't eat big portions.

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It makes me feel awful.

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We had to think about foods that were

gonna be easy to digest, but I also spent

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quite a bit of time with her working on

how to chew your food, sitting upright,

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try to make a nice special meal of it

rather than just eating small portions,

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totally scared of what you're eating

and how it's gonna be affecting you.

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That was quite a big thing at the

beginning, just to make sure that she was

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eating more food and eating more often.

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We worked on a clear reintroduction

plan, like picking some foods that

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she thought that she would want to eat

and gradually bringing them back in.

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It was very, very simple.

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slow process.

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Everyone I work with has a different

pace and things that they can manage.

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But this was a pretty

slow one, I have to say.

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But that's fine, that's, that's

what she could manage at that time.

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There's no pressure, there's no rush.

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You have to start from where you are.

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You can't work on my deadlines.

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It has to be what fits with you.

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Another thing I want to just sort of draw

to your attention though, is when you are

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in that state where you are afraid to eat

anything, You feel like when you do eat,

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it sits really heavy in your stomach, and

you're worried about digestive symptoms

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lower down, like gas and bloating and

mucus and, you know, explosive poos.

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Then, that was definitely

changing her appetite.

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So when you don't eat much, you tend

to, over time, reduce your appetite

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and actually it's quite hard to

eat a normal amount of food or what

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you should be eating for your body

size when you don't have a desire

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to eat like you're not ravenous.

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If it was me and I suddenly went to eat

the amount of food that she was eating

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I'd be really really hungry but over

time she'd kind of reduced it down and

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down and down and so was really eating

small amounts but not getting enough

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nutrition and that was what I was

working on with her like hammering home.

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This is why you need protein.

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This is why you need zinc.

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This is why you need iron.

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It's like really trying to educate and

trying to push in some reasons for eating.

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So it's not just about regulating

your digestive system.

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It's also about making sure that

you've got enough energy to function.

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You've got enough energy to perform

high pressured jobs, you need a certain

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amount of energy for your brain to

be able to function well at work.

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And particularly where you're

someone who has, a key role in

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your business, or maybe you're a

business owner and you're the only

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person who's running that business.

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You need to be looking after

yourself and prioritizing yourself.

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As a business asset, because

actually, if you don't, who's going

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to look after you, who's going to

run the business if it's not you.

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So if you are someone who runs

your own business, you need to

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prioritize some self care in order

to keep your business on the road.

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Just going back to the appetite as well.

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I want to mention sometimes.

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Where people have got very low

appetite, something that might be

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worth checking is your zinc levels.

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There is some research showing

that people who have got reduced

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appetite sometimes are low in zinc.

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It's a fairly cheap nutrient that you can

get and it's quite easy to get hold of.

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Sometimes it can help to make

sure that your appetite is not

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being suppressed by low zinc.

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It might just be worth a blood test,

taking some zinc to see how you feel.

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for a short amount of time.

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You shouldn't take zinc long term

unless you know that you are low in it.

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However, it's worth trying.

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All food sources of zinc include

pumpkin seeds, meat and fish.

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Priya also was not very good at eating

in the morning and I felt that her

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headaches were A byproduct of not

having enough glucose in your system

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and her body was just alerting her

to the fact that she needed to eat.

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So we had an agreement that she would

eat within 30 minutes of waking up.

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There were a couple of foods we

introduced that she just didn't think

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she was going to be able to cope with

like broccoli and pineapple and steak

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but these went really well and she was

happily eating them and like really

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incorporating them into her diet.

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So she was just starting to get some

good sources of you know, iron, some

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different sources of fibre and that

was really helping actually and after

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about two months of working together

The gas and the mucus was very rare.

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She was having kind of loose ish

stools, like a type 5 if you look

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at the Bristol stool chart, but

it was not considered diarrhoea.

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It was just on the looser side.

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But this was, so this

was really encouraging.

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Her digestive symptoms Basically went

away over the course of those two

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months and she started to eat more food.

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So it was going well.

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Then she had a little setback in

that she had a pet that died and

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she also had a very big work project

that all coincided at the same time.

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This really set her back a lot in

terms of reverting to eating behaviors

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like not eating enough, not really

looking after herself enough and kind

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of Just dropping all of those self care

practices that we've put into place.

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Now when she did that it also

kicked off her digestive symptoms.

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So it was a really clear indication

that stress and emotions were also

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tied up with digestive function.

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So you know the gut brain connection

is really strong and where people

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are nervous, stressed and not

sleeping well, not eating well.

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This does play out in our digestive system

and you definitely get an upset stomach

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when you feel nervous, when you haven't

eaten properly and then you eat a big

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meal or you're just running around and not

feeding and fueling your body properly.

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The main focus for the last few months of

working with Priya was really about trying

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to set up some self care practices that

would actually sustain her in busy times

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but also to get her out of this flare up.

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So I was working a lot on how to work

out what your body actually needs, how to

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listen to your body so that you understand

the signals that your body is giving you.

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This is quite common, I find, with

people I work with who have minimized

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their digestive symptoms by not

eating, and it can happen over time.

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But basically, You ignore your hunger

so much that you forget what hunger

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actually feels like and maybe you

are feeling hunger But you're not

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noticing it as that and registering it.

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So for example Getting headaches, feeling

a bit dizzy, feeling a bit weak and tired

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These can be signs that you're not eating

enough and the rumbly tummy feeling is

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sometimes not the start of a flare up,

it is the sign that you need to eat more.

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So this is what we spent a

bit of time working on is what

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Does hunger feel like for you?

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Everybody has a slightly

different sensation of hunger.

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But when you've ignored hunger for so

long because you're trying to not eat,

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because every time you eat, you're

getting these terrible symptoms,

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then you start to blank it out.

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And so when you do that, this person

had a tendency to block out other

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sensations in her body as well and

just had really Tried to ignore the

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terrible symptoms, but had kind of

lost that connection to her own body.

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One of the questions that I really

like to ask people in this kind of

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situation, and maybe it's something you

can think about if this resonates for

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you, is thinking, what is the most kind

thing I could do for my body right now?

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Maybe it's go to eat, maybe it's

go and have a lie down, maybe you

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take a deep breath, maybe you need

a drink of water, maybe you need

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a cuddle from somebody you love.

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Sometimes, what your body

actually needs and what you

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want to do are different things.

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But when we learn to listen properly to

what the body is asking for, then we're

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much more connected and we are better

able to manage the symptoms because we are

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not overriding some of the early warning

signs that are being sent from the body.

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So for example, if you are constantly

overriding hunger, then actually

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learning to tune into that and

eat when you start to feel hunger.

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can stop an escalation of those

symptoms which might be the headaches,

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it might be feeling completely

drained, feeling anxiety increasing

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because your blood sugars have dipped.

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This is fairly common with

people who I work with with IBS.

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We worked on increasing her

appreciation of her own senses.

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So for example, she would take one

day and try to, really smell five

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things, for example, really noticing

the smell of, it could be a food, but

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it also could be a perfume, a flower.

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Washing liquid, anything really,

just to really notice the smells.

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Then the next day, really focusing in

on touch, like what does, um, I don't

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know, a piece of clothing, like a

nice soft scarf, some grass outside.

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Really thinking about the sensation

that your body is giving you, because

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tapping back in, it's just like a

practical way to tap back into some of

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the messages from your body to your brain.

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The thing we worked on was really

trying to create a list of self care

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activities that she could go back to.

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Sometimes when you get overwhelmed

you just can't think and so making

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sure that she had it written down

these are the things that I can do

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When I feel overwhelmed or when I feel

like things aren't going well for me

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digestively, maybe I can buy myself

some flowers, maybe I can have a little

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dance to some music if I feel like it.

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Maybe I can go and lie down for

10 minutes and have a mini nap.

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Maybe I can take some deep breaths

or like do some basic yoga.

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Those kind of things are very helpful

when you don't practice self care.

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So when it's not something that comes

naturally, it's having it written down

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that says, these are things that I

can do that are helpful for my body.

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And it doesn't have to be

about food all the time.

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So yes, there were loads of

things we talked about with her

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diet, like increasing her range,

increasing her volume of food.

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And like I said, the digestive

symptoms really did calm down.

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A lot of my gut reset program is

actually focused on Helping you feel

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better in other aspects of your life,

not just focusing on what you eat.

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It's also your relationship to your

food, your relationship to your body.

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This was a little bit of a different case

for me, in that the digestive symptoms

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calmed down pretty quickly, and during the

time together we were working on really

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her relationship with her body and her

relationship with her food and her diet.

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And it kind of went a bit broader

than just the things I normally do.

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And I just thought that it might be

useful for you to listen to that.

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If any of it resonates, maybe you

can take something from this episode

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and apply it to your own life.

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By the end of our time working

together, Priya said, Yes, I

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got what I wanted out of this.

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It was targeted advice,

and I know how to carry on.

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Like, she still had a long way to go in

terms of her relationship with her body,

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her relationship with food, and, just

general self care, like I was talking

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about those kind of practices, making

it something natural and normal to do.

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But, she really knew what to do.

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Steps were, and I think that's

sometimes where you get a bit muddled.

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There's so many things you could be doing.

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You can read all the blogs, listen to

all the podcasts about IBS, and everybody

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is telling you to do different things.

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And that's because they're probably

all good things, but they don't all

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apply to you in your life right now.

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And having someone to help you work

it through can be very transformative.

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So that is where I'm going

to leave it for this week.

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If you want to work with me, you

can reach out, just get in touch

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in my email addresses in the show

notes and also on my website.

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And I'd love to hear from you if you are

interested in finding out a bit more.

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You can also follow me on Instagram,

where I post a lot of videos and other

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information about IBS, digestion and diet.

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That's it for this week,

I will leave it there.

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Thanks for listening to

The Inside Knowledge.

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Better digestion for everyone.