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Episode 6 - Tracking IBS - the data you need to collect
Episode 627th June 2023 • Inside Knowledge for people with IBS • Anna Mapson
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When my clients start working with me, I ask them all to complete a diet diary. Even in just one week of tracking your food and digestive symptoms, we can start to see patterns and useful data about your diet that can help shape a nutrition plan.

Listen for my tips on

  • Lifestyle factors to track to help IBS
  • How to look for patterns in your diet

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When my clients start working with me, I ask them all to complete a diet diary.

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Some people wonder whether it's worth the effort and feel like it's a bit of

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an inconvenience, which I totally get.

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We are all busy and it's just another thing to do.

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However...

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After even just one week of tracking your food and digestive symptoms, we can start

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to see patterns and useful data about your diet that can help shape a nutrition plan.

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In this episode of the Inside Knowledge, I'm going to give you

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a better understanding of diet and symptom tracking for IBS.

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So you can try it for yourself at home, and you can also download my

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actual template that I use with my clients to give it a go for yourself.

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Hello, welcome to episode 6 of the Inside Knowledge.

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I am Anna Mappson.

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I'm a registered nutritional therapist working with people who've got IBS.

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Today, we're talking about diet diaries and what you can track in

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order to try to find some patterns.

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it's something I do with all my clients and I find it really important part

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of getting a better understanding about where you are, what you're

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eating on a day to day basis and any pattern in your symptoms.

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It's not just looking at your food and writing it down, although at a basic

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level, that is a good place to start.

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In this episode, I'm going to go through some things that you could track and

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I will also give you access to the template that I use with my clients.

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and I'm happy to share it with you loyal listeners of my podcast so that you can

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try some of these things at home and see now when we talk about diet diary,

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there are lots of templates out there.

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You know, you can get apps.

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What I do is a Google spreadsheet with my clients, but it doesn't really

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matter what the format is, as long as you're tracking the right information.

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One of the things I'm looking at is patterns around eating, like

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what time you're eating, how often do you eat, do you snack?

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All of these things give us really important information and if you haven't

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yet listened to the other episodes that I've previously done, then go

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back and listen to the one about when to eat, which was episode three.

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It's really focusing on timing of meals, regularity of three meals a

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day and When and how you could snack because that's really important.

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But anyway, moving on.

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So for this, what I'm looking at is how often you're eating, what you're

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eating in those snacks, if you do snack, and also is there huge gaps between.

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the food intake.

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I'll also be looking at your symptoms against the food intake and looking at

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timing of when those symptoms occur.

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So, as you will know, if you think about episode one, where I talked

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about normal digestion, when you eat something, it's not always that

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particular food that comes out of you.

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If you get an quick reaction to food and you find you're rushing

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to the toilet after meals, it's rarely that particular food which

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is actually giving you problems.

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so what we're looking at is a lag of like 24 to 48 hours for it to come through and

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That is interesting information as well.

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So how long does it take for the symptoms to hit you?

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Those things are really key as part of the diet diary tracking.

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And I'm also really looking at, like, quantities of protein, fats

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and carbs, particularly fibre.

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Like, are you anywhere near getting 30 grams of fibre a day?

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Maybe you're eating too much fibre.

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are you not eating protein for breakfast and lunch?

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Which I have to say is very common.

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These things can be really apparent when you write it all out and

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you see everything laid out.

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The other thing You could probably do at home is to look for repetition.

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So often people might eat a lot more wheat than they think, whether it's in breakfast

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cereals, sandwiches, pasta for dinner.

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You know, just thinking about how much of that fermentable carbohydrates

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that you are eating on a daily basis.

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And are you eating a lot of the same foods?

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We also might see lots of common vegetables repeated

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again and again and again.

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And this is particularly if you've got a very restrictive diet because

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you've had to eliminate lots of foods due to your IBS symptoms.

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So, if we now look at the template that I use, and you can download this so you

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can follow along or you can just write out the categories that I'm talking about

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in your own notebook and, do it offline.

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so the first thing I'm asking is...

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the day, obviously you just need to record what day it is, but

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also the first bite that you have of the day and the last bite.

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And this is giving me an idea of your eating window.

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So if you go back to episode three, you can hear a lot about time restricted

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feeding and whether it's a good idea to have long periods of time without food.

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But what I'm looking for here is, are you eating a lot during the day, or are

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you eating in a shortened time period?

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There's no set answer for what this has to be, it's just interesting information,

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so there's no correct answer, but I think it's useful to look at whether

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there's regularity across five or seven days, um, and see whether you're eating

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at regular times during the day, or perhaps you're a shift worker and you

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have to do, irregular eating patterns.

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And coming on to the food, I ask people to write down breakfast, lunch

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and dinner, snacks and drinks, again, writing down the time that you eat

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the foods and just writing literally what you've had for breakfast, you

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know, porridge with raisins and seeds and lunch, cheese sandwich, whatever.

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And then dinner, you had stir fry with some brown rice and then write down the

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types of snacks that you had as well.

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I don't ask people to weigh out the food.

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I don't find it necessary.

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I'm not specifically working with people on their weight most of the time, so we're

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not trying to control for energy intake.

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Sometimes if I feel like people might be under eating, I will ask them to

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send me pictures of the food so I can get a sense of portion sizing.

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Especially making sure that they're eating enough, because that can

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be a real trigger of IBS symptoms.

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Now the one thing that is really important to think about here.

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And I asked my clients to track is how hungry they were

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before and after each meal.

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This comes from appetite retraining that I, have borrowed from Dr.

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Helen McCarthy.

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She is a health psychologist who's written a book called

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How to Retrain Your Appetite.

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And she's Come up with a great appetite pendulum, which thinks about swinging from

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minus five when you're extremely hungry to plus five when you're very, very full.

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Now, I like to use this with my clients to get a sense of when you

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actually have hunger in the day.

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And when you eat, are you eating to the point that you're

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full, that you're satisfied?

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Or are you still actually hungry after your meals?

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I find it really interesting.

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A lot of people with IBS maybe override some of their hunger or fullness signals.

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And that can be down to dysregulation in the hunger hormone production, or it can

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just be down to behaviours and learned ways of eating that you've had to do

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over the years to manage your symptoms.

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It's really interesting to think about when you get hungry, and do you get

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to the point where you're absolutely starving, or do you just get mild

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hunger and actually you never feel hungry because you're always nibbling?

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All of those things, are really interesting.

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Interesting and useful information.

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So before each meal, I ask you to rate whether you're hungry on a scale

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of minus five to plus five, and then after the meal, how hungry were you?

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And again, this can just give you some really good pictures of your

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patterns of hunger and satiety.

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for each day as well, I also want to know about your bowel

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movements, of course, people with IBS, this is really, really key.

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I want to know how many poos you've had and also what type were

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they on the Bristol stool chart.

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in episode one, when we talked about normal digestion, I talked about the

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Bristol stool chart but essentially it's just a pictorial way of looking

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at poo and saying one is really hard pebbly constipated type poos, type

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seven really loose watery diarrhea.

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I want you to rank the poos on that scale every time you go.

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Sometimes people are going multiple times a day so you can write that

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down as well what type it was and how many you had per day.

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This is also really important information when you're thinking about patterns.

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Is it that case that you always go at the same time every

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day or is it really erratic?

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And you could go throughout the day, whenever it is, you

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never know what's happening.

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This is helpful information for me.

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And I think it can be helpful for you as well, just to get a sense of tracking

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it because it can feel erratic, but then perhaps when you track it, it's

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not as bad as you think, or it's not as, um, Unpatterned, as you think.

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now, the next section is moving on to, three specific symptoms that

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you can, come up with yourself.

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So for you, it might be the fact that you get really, really bad gas.

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That is your main symptom, or maybe it's that you get nausea.

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And that's something else you want to track.

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I have a space for three symptoms, and you can write those in and track

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them over those five or seven days.

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And that gives us a good idea of any fluctuations in the symptoms.

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For example, with say it's bloating, like, is it bad every day, all day?

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Is it the case that it just comes and goes?

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Is it related to the amount of bowel movements that you have?

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Like trying to connect the dots and see if there's any patterns.

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I'm also going to ask about your sleep.

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So what time did you go to bed?

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What time did you wake up?

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And then to rate and rank the quality of your sleep.

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This is also really important, getting enough sleep and making sure we are well

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rested is such a key way to help us feel more resilient, to reduce anxiety, which

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strengthens that brain gut connection.

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So we want to try and Give ourselves the opportunity for sleep and what I can

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see here from this element and you'll be able to notice as well is how many

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hours did you actually spend in bed?

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You know, if you don't spend eight hours in bed, then there's no way

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you're going to get eight hours sleep.

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So you need to look at the opportunity for sleep and work out whether

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you can go to bed any earlier.

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Like, are you going to bed at a consistent time as well?

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This can be a really important part of just better understanding your own.

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Health practices like outside of digestion and then other lifestyle things I'm

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also really interested in is how much daylight you've been exposed to per

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day now that might seem a little bit strange But when we are going outside

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more it's easier for us to set our circadian rhythms You know, we tend to

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spend a lot of time indoors nowadays.

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You might work inside drive to work sit in the office all day, drive home again

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and then sit inside majority of the time.

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Of course in the summer we might spend a little bit more time outside

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but we really are not exposed to the elements as we used to be.

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Now when we have access to daylight time it helps to set that wake sleep

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cycle which can get you better sleep but also it's just really good for mood

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so there's Special, light that comes from the sun, even on a cloudy day, that

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you just can't replicate with a bright indoor bulb inside your house or office.

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So, getting outside, I want you to think about whether you're

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getting less than 30 minutes a day.

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Are you getting one hour a day or more?

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Or are you getting, um, one to three hours or even four hours?

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And that would be, like, the maximum, probably, that most

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people will get in a day.

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And then...

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Thinking about other lifestyle factors, I want you to track up

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well how much exercise you did.

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Have you, been for a walk, for example?

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Have you been to the gym?

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Thinking about how much exercise you did, so description of it, maybe you

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went to, like Zumba class or CrossFit or something, and then how intense was that

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exercise, because that is also really key.

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When you do really intensive exercise, sometimes that can trigger IBS symptoms,

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or it might make you feel a little bit ill the next day or something.

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So again, we're looking for patterns.

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You had a really intense workout one day.

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The next morning, you were a bit hungry.

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Maybe you had.

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Breakfast a bit late, then you've got a flare up.

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These are the kind of patterns that we might be able to pick up.

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And then also, just on the lifestyle, I'm just asking people

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to rate their stress so that I can see their stress levels per day.

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And again, is it constantly that your eight out of 10

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stressed or does it fluctuate?

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And does that have any impact on your digestion?

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And then for women, I also ask about which day of your

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menstrual cycle you are on.

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It's a really key factor for so many women.

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you can find additional bloating around your time of your period that might not be

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digestion related, it might be hormonal.

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Sometimes people will find they get, constipated in the run up to

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their period and then get diarrhea when their bleeding actually starts.

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These kind of patterns are really important.

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What I have found over the last year or so of using this particular

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template is that People are noticing patterns around ovulation more, and

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that is often to do with the peak in oestrogen that can be as, triggering

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for IBS symptoms as the actual bleed.

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So just getting a sense of where you are in your menstrual cycle

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and what effect that might have on your digestion is also important.

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So that is what I use with my clients, before they start to work

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with me in my three month gut reset.

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And it gives me an idea of what they're eating, how they're eating, their

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stress levels, their exercise levels.

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But the majority of it, I also gather through a conversation as

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we have our initial consultation.

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But the purpose of this podcast episode was to give

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you some things to think about.

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And once you can start tracking, Some of these individual factors, you might

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find some of the things that I'm talking about in the podcast, like around

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timing of eating around diversity of your diet, those kind of things

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start to become a bit more apparent.

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And that's where you could start to make some positive changes.

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Now, I also wanted to finish just really thinking about if there's any

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negative consequences to diet tracking.

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And we see this quite a lot in terms of weight loss, where people are tracking,

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maybe tracking their macros, using something like MyFitnessPal, really trying

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to better understand how much energy they're intaking, and can start to get

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a little bit obsessed with the data and tracking, and lose touch a little bit with

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Now I don't see that as much using this kind of approach because I, like I said

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at the beginning, I don't ask people to weigh their food and to measure it and I'm

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not so interested in your energy intake unless I think that might be a problem.

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The purpose of tracking this is to look for patterns.

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If you're tracking using something like MyFitnessPal, you can get quite

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obsessed with the data, is what I've found, so that you think I'm not

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going to eat that chocolate because then I'll have to track it and log

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it and I can't be bothered to log it.

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Now for some people, That provides them with a momentary pause before eating

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that stops them eating the snack foods.

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And that can be helpful in terms of weight loss.

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The other thing I wanted to talk about is that once you start tracking something,

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there is this phenomenon called the Hawthorne effect, where as soon as you

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start tracking something, It starts to improve and that is because subconsciously

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we are trying to maybe put our best selves into the tracker and literally

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writing down the good stuff and wanting to it to look overall impressive, even

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if it's just for yourself and you're not going to show it to anyone, but you

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can actually just get some improvements.

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Just from measuring things rather than, even starting

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to make any of those changes.

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So that's something else to look out for.

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Is this actually normal?

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And that's why if you do it for like two weeks or more, you probably will

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revert back to your normal patterns instead of thinking, Oh, I'll try and

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be healthy just because I'm tracking it.

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And I want to put in a good tracker.

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The other thing is just trying to be really honest with yourself and literally

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write down everything that you're eating instead of just thinking, Oh, I won't

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write down the biscuits that I had at work or a little bit of my Children's

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food that I finished up for them.

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Those things could be the triggers.

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So we just need to get a really good picture and make sure that

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you are actually writing down everything that you've eaten.

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That's it for this week.

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Give it a go, download the tracker from my website.

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There's a link in the show notes, get tracking, see what patterns you recognize.

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And I've got an idea to potentially do a little workshop or webinar

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where if you've downloaded it, I'll get in touch with you and ask you

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if you'd like to be part of it.

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Maybe we can review people's diet diaries as a group and see where we go.

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Let me know if you'd be up for that.

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And just finally to finish, please, subscribe, like my podcast

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and leave me a little review.

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If you're finding some of these things helpful, I'd love to be

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able to reach a wider audience.

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thank you so much for the support, though, for people who have been listening.

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It's been great getting your feedback and, , thank you for listening.

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