Meet my client Fran in this case study episode.

Fran had constipation, bloating and a very noisy digestion at the start of the Gut Reset programme. By the end her digestion had quietened down, and she was confident eating a wide range of foods.

Hear the details of how I worked with Fran navigating:

1. Fear of being hungry due to being a very picky eater as a child and always worrying about availability of safe foods
2. Expectations over losing weight on the low FODMAP diet
3. Understanding signals from your body and responding to them

I hope you enjoy this episode, email me your question about IBS - [email protected].

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

Are you listening to too many

different sets of voices in

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terms of what to do for your IBS?

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In this episode, I'm going to go through

another case study of a previous client

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I worked with who was listening to

so many voices in the nutrition space

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about what is good for gut health.

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But she had created a set of rules

that were actually inadvertently

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contributing to her IBS symptoms.

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She was suffering with constipation,

bloating, and constant gurgling,

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a really noisy digestion.

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This episode will explain

how I worked with Fran.

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To improve her digestion

and her trust in her body.

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Welcome to episode 49 of the Inside

Knowledge podcast for people with IBS.

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I'm Anna Mapson.

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This week is another case study.

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I would like to introduce you

to my previous client, Fran.

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Fran was completely overwhelmed

when we started working together.

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She had researched a lot of information

and was very knowledgeable in

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nutrition and dieting and foods and

had created herself a diet which was

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really trying to maximize growing the

good beneficial gut bacteria, really

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working on improving her diversity

and really had a lot of information to

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hand about how to improve gut health.

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The reason she was doing all of

this research is that she had very

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erratic bowel habits, so mostly

constipation with a lot of bloating

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and a very noisy, gurgling digestion.

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She felt hungry all the time and

described to me having to eat

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almost constantly throughout the

day because she always felt hungry.

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One of the things she was really

keen to avoid was an elimination

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diet Because she'd struggled in the

past with a strict Elimination diet

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like a FODMAP diet and restricting

foods and how that made her feel.

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She had previously tried a low

histamine diet, a SIBO elimination

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diet and an anti inflammatory diet.

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So these were all things she'd

researched in order to try

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to resolve her gut symptoms.

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Fran was a mum of two and was working part

time and Had, I would say, fairly high

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stress levels in terms of managing her

children, her relationship with parenting

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and also just general house management.

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So she had kind of constant state

of mild anxiety, I would say, and

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also had ways to manage it, like very

experienced in yoga and so had a lot

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of tools that she knew about as well.

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Because a lot of you out there might be

the same, you know, you've done a lot of

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research, you understand the connection

between the gut and the brain and how

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working with anxiety and your emotions is

really important if you want to get good

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gut health, it's not just about the food.

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One of the reasons she chose working with

me was the fact that it's a three month

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program and you get a lot of the one to

one calls, so she really wanted to be able

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to discuss So, Some of the technicalities,

I suppose, around gut health and really

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verify if what she'd been researching

and understanding was correct.

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And also just to feel supported.

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Like I said, when you've got a high degree

of worry and like an ongoing low level

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anxiety, it can be really helpful to have

a sounding board and to have someone who

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is confident to say, no, don't do that.

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Or yes, pick this first and

give you some direction.

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When I was looking at Fran's existing

diet, I noticed that there was a

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lot of high FODMAP foods which could

have been adding to her bloating.

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She was quite worried about going on

a low FODMAP diet though, and so we

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came to a bit of a compromise, which is

sometimes called the gentle low FODMAP

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or kind of semi low FODMAP diet, where

Working with someone who knows the low

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FODMAP diet quite carefully, you just

go through your diet and you don't have

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to follow the complete low FODMAP plan.

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But what you do is you cut out

the highest FODMAP foods for you.

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So we were able to do that in

initially it just go through her

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diet and think about what would make

the biggest amount of difference.

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One of the things that was really

important to her was to still have it.

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two biscuits every afternoon.

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This was part of her not feeling

like she was restricting and she

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felt if I asked her to give up eating

these biscuits in the afternoon she

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would feel In a restricted mindset.

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So I said, let's carry on

with the biscuits then.

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That's absolutely no problem.

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We will reduce down some of

the highest FODMAP meals.

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And I gave her some simple swaps and some

ideas to change things up, to just reduce

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down the amount of FODMAPs in other meals.

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But the thing that was going to be

non negotiable was to have these

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specific biscuits every afternoon.

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She felt if she didn't eat those

biscuits, she got Really bad cravings.

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And also she felt excessively hungry.

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So that was a non negotiable and

that was completely fine with me.

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Um, I'm really happy to work

around people's need to

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keep some things consistent.

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And actually, she took around two to

three weeks to even decide whether

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she could cope with the gentle low

FODMAP diet before we got started.

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In that time, we talked about lots of

other things, particularly around her

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sensations of hunger and appetite.

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So something I think I've mentioned before

is the appetite pendulum that I use,

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where I ask people to engage with how much

hunger they're feeling throughout the day.

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Before and after meals, particularly,

by rating it on a scale of minus 5

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to plus 5 before and after meals.

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This helps you get in touch with your

hunger patterns throughout the day, to

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know whether you've eaten enough food,

or whether you've eaten too much food.

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And how that's affecting your

enjoyment of the next meal and how long

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you're able to go in between meals.

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So all you need to do is to write

down if minus five is absolutely

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starving and plus five is really

full, where you are on that pendulum

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that's swinging backwards and forwards

throughout the day from minus five to

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plus five before and after every meal.

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Now this was really interesting for

her, and she spent a lot of time really

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thinking about it, and this is one of the

things I loved about working with Fran.

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She really threw herself into it, even

the difficult aspects of changing your

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diet and changing your attitudes to foods.

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What she found is that she had

a desire to eat intuitively.

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She was really keen on not being on a

diet, not restricting due to, you know,

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the diet culture that is so pervasive.

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Everyone's always told be in a smaller

body, eat less, take up less space.

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So I really, uh, could connect

a lot with this desire to

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knock all of that on the head.

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But what I wanted her to do was to

think more instead of having those as

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rules, actually just use your body as

a rule, and use your body as a guide

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for how much to eat, or when to eat.

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She realised sometimes she was going for

long periods of time without eating in

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order to fit around the kids schedules,

clubs after school, rushing around.

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Sometimes she was not eating.

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So she would get super, super

hungry and then snack on foods.

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And then when it came to the main meal,

she wasn't actually hungry for that.

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And then other days she would eat

more to a routine and eat, sitting

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down at a meal table, but other

times it was all over the place.

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So.

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This was just helpful for her by

mapping it out and just thinking

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about what symptoms correlated

with what eating patterns.

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Once she had committed to doing

this low FODMAP, gentle, approach

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with some non negotiables.

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Then what she realized is she probably

wasn't eating that much protein.

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She was on a vegetarian diet

for, you know, ethical reasons.

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And so we talked a lot about vegetarian

protein, how to increase tofu,

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eggs, nuts and seeds, and also meat

replacement products because she was

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open to eating , veggie sausages and

veggie burgers, that sort of thing.

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It's harder with vegetarians to get

enough protein to keep you fuller,

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and the more protein you can eat,

you tend to be fuller for longer.

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One really interesting thing that

came out from this work was talking

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about her fear of being hungry.

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So, What we uncovered as we got

further and further into getting to

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know each other and having deeper

conversations about where relationship

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to food had stemmed from, is that Fran

was a really fussy eater as a child.

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She literally only had a few meals

that felt safe to her and she

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couldn't bear to eat anything else.

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And so she had quite a lot of

panic about feeling hungry to

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her feeling hungry, meant feeling

very unsafe and very dangerous.

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I've had another client who had a similar

experience where her parent was massively

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over restricting with family meals and

the children weren't given enough food.

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Not because they couldn't afford it, but

because the mother was very controlling.

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And so, in the same way, my other

client had this fear of being

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hungry and this need to have

immediate food all around you.

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Sometimes really unpicking how you

feel about food and where this has come

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from can be absolutely transformative.

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So she hadn't really connected

that her fear of hunger was

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driving a lot of her behaviors.

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And this fear of hunger had stemmed

right back to childhood, where she

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worried a lot about what she could eat.

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And so this had, in some way,

carried on into her adulthood,

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even though she was the adult, she

was the one buying all the food.

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And also she'd done so much research

into what is good and what is healthy

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that she'd put a lot of expectation on

herself to go The complete opposite of

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her childhood, which was very restricted

in terms of what was acceptable to her,

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right up to a very broad diet where

she was eating probably too much fibre.

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The next really interesting thing that

came out of this work was, once she'd

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got a couple of weeks into doing

the low FODMAP diet, she found that

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her digestion really quietened down.

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So when we eat fibre, foods

that are rapidly fermentable.

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Often they're drawing water into the small

intestine and that can cause noises as

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food is moving through your digestion.

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It's not necessarily anything to be

worried about, but if you suddenly get

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a noisy digestion and it won't go away,

it is worth getting it checked out.

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with your doctor.

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But most of the time it's just noise.

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It's just the gas, food and

digestive juices moving through you.

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She'd had this noisy digestion

for a long, long time.

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She wasn't particularly concerned

about it, but in her mind it

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was really connected to hunger.

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And again, this fear of being hungry,

this fear of being without safe foods

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was, u mental trigger for her as well.

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So really triggering her anxiety.

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What she said within a few

weeks was, I didn't know my

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digestion could be this quiet.

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So when we do the low FODMAP diet,

we're cutting out a lot of that

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food that's rapidly fermentable

and it just quietened down.

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And what she thought was hunger was

actually this sort of unsettled feeling

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in her gut, partly down to the high

amounts of gas traveling through the gut.

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Fran realized that she was potentially

eating in order to settle her stomach.

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She didn't need as many snacks.

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So remember when we started out, she said

the things that were non negotiable were

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to have these certain brand of biscuits,

to have at least two every afternoon.

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As she got more into the low FODMAP diet,

she found she didn't even need them.

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She didn't have this noisy digestion.

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She didn't have the rumbling that was

ongoing that she thought was hunger,

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Partly down to eating more protein, partly

down to taking some of those fermentable

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fibres out, she just didn't need to snack

as much and her energy levels were fine.

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So, once we'd got to this point, she

was feeling relieved, I knew what I

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was talking about, that I had given

her some advice that had worked and

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she felt a little reassured by that.

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I was comfortable that this was a

good new baseline and then we were

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going to push on through the FODMAP

reintroductions to try and get her

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back to eating a more normal diet.

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Her FODMAP reintroduction phase was a

little bit chaotic, partly because there

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were times when she was going away for

the weekend or she had a family party,

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And she would just eat a meal that had

mixed FODMAPs in it, you know, a normal

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meal that might have had some spices

in it, some onions, and some other

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things that could have been high FODMAP,

and then she would get a reaction.

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She wouldn't know what

that was connected to.

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This is quite normal, I would say,

with a lot of people I work with.

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So the FODMAP reintroduction process

takes around another two to three

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months, and after doing the FODMAP

restriction phase for a couple of weeks.

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People are just keen to get off it.

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And there's often social events,

which means that you don't

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stick to the diet as clearly.

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So what we found is that she

could do the trials, but it got

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a little bit muddled at times.

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And to be honest, that is realistic.

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So if you're someone who struggled

with the FODMAP reintroduction process,

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Do not think that you are alone.

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A lot of people do it even when

I am telling them this is exactly

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how you should do it throughout the

week, because you know, things come

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up normally, I would say take a

little break, have the meal out, or

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go for your weekend away, whatever.

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Don't try and do any

reintroductions during that.

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Take a break, then come back to it, reset,

and then go to do the next reintroduction.

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And if you want more advice on that.

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I've got episode 17 and 18 where

I go through the low FODMAP diet

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and the reintroduction process.

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Now, something else that happened,

the third really interesting

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point was talking about

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intuitive eating, and diet culture.

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She was very keen that that was not a

part of our work, didn't want to weigh

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herself, talk about body measurements,

and actually it wasn't really relevant.

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So her weight wasn't relevant

to her digestive symptoms.

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However, partway through this process,

she weighed herself and, She thought

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that she would have lost weight

because she was restricting FODMAPs.

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However, she was not restricting

her calorie intake because this

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is not part of the FODMAP diet.

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The low FODMAP diet is not there

to help people lose weight.

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And so this was actually more of

a challenge than she realized.

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She thought that she

would have lost weight.

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doing the low FODMAP diet, and

she felt disappointed that she'd

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actually put on one or two pounds.

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She wanted to give herself a little ego

boost, she said, by weighing herself to

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think, Oh, I'm working really hard here.

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I'm losing weight and I'm getting

my digestion back on track.

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Actually, when she Putting on a few

pounds and improving your digestion

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have got no correlation really.

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It's partly back to that restrictive

mindset, that sense that I am

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restricting, therefore it must

be helping me lose weight.

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Whereas in actual fact, there's

no reason why you should lose

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weight on the low FODMAP diet.

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However, I will just say some

people do lose weight on the diet

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because they are restricting foods

that they tend to eat a lot of.

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Like if you're someone who snacks

on lots of bread, or you're often

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eating lots of biscuits and cakes

and you cut them out, then maybe

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your energy levels will go down.

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However, In this case,

that was not her goal.

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That was not, you know, anything

that she was working towards.

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It was just a side note, but that's,

what's really interesting is to think

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about our expectations of going on a

restrictive diet where energy is not.

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Part of the equation, but because

we're on a diet we might feel like okay

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Therefore we should be losing some weight.

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The final point I want to make

about working with Fran was She as I

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said really reflected on everything

to do with this process, like she

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went deep into how food affects

her and her relationship with food.

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And one of the things she realized is

that when her stress and worry went up

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in her life, her symptoms were worse,

but because they were up and down all

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over the place, before working with

me, she automatically assumed it was

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because of something she'd eaten.

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As she realized that food wasn't always

the trigger for her depression, Flare

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ups, she realized there were other things

that were actually harder to tackle that

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were causing her flare ups And what I

meant by that is that there were life

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stresses, you know relationship stresses

parenting problems Problems with running

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a business these all are stresses that

can impact on your digestion But they're

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much harder than just eliminating

onions, for example It's easy to blame

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the food cut the food out and then If

that doesn't work, cut more food out and

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think about more and need more research,

more, more, more about your digestion.

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And actually, once you've unpicked that

and almost like crossed the food off

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the list, then you have to turn your

attention to other things in your life

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that might be driving these symptoms,

this level of worry and anxiety that could

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be triggering your digestive symptoms.

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It is much harder.

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To face that and I was so proud of her

for realizing there are some things

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in my life that I actually need to

deal with and I've been spending all

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my mental energy focusing in on food.

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Because in a way that was easier and

it's not to say wrong because there

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probably were things that we changed

in her diet that were making an impact.

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But she was also able to see that

there was potential for other problems

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and other ways of living that would

make her life a little bit easier.

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At the end of working together,

she realized that she'd

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reset her digestive system.

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system so that she could notice a change.

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She had a good new baseline.

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And then if things went wrong,

things started to go haywire again.

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She knew how to reset.

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So she had all the FODMAP meals she

knew worked really well for her.

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She also had got back to a

really good level of diversity.

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So sometimes at the end of working

with people, when they're feeling

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good, I try to encourage people to

get to 30 different types of fiber.

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A week and she was pretty much meeting

that consistently so she was doing so

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well But without the symptoms and that

is the ultimate goal from all people I

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work with is to eat As wide a variety

as possible with reduced symptoms.

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Fran was a client who as I said, I

really enjoyed working with She Took

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a long time to think about things.

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For example, she contacted me about

working together and then I didn't really

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hear from her for about four months.

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But during that time,

she sent me a few emails.

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She was thinking it over before

she made the commitment to

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invest in working with me.

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She was someone who needed time.

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And because I work with my clients

for at least three months, we get

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that time to discuss, to change

things and to work together.

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And I think this also felt like.

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Well, from my perspective, anyway, it

felt like a really good partnership where

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I was able to provide her with guidance

and my input, but a lot of the work, as

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always, with all my clients is she did

it herself, she did all the work and the

307

transformation, especially around it.

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connecting her eating history

to her current symptoms.

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If you're someone who would like

some help with your digestion,

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then please do get in touch.

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My three month gut reset is open and I

welcome in people from all over the world.

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So wherever you are you can just

set up a call to speak to me,

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first of all, to see if it's a

good fit for us to work together.

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Do you want to work with me?

315

And do I think I'll be able to help

you with your digestive issues?

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I will leave it there

though for this episode.

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So, thanks very much for

listening to the Inside Knowledge.

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Better digestion for everyone.