How to Prevent Summer IBS Flare-Ups: Dietitian Tips for Constipation & Diarrhea Relief

Jessie (00:00): Thank you so much everybody and thank you for your patience. We’ve got a really helpful session for everyone. Yeah, because summer, of course summer, our schedule is different with traveling, we have a lot of gathering, maybe eating foods that we are not so sure of. So we are going to talk all about that to help you be prepared. And the goal is to prevent symptoms from happening this summer and also give you tips and tools to find relief as soon as possible if symptoms do flare up. All right. Hi Brooke.

Brooke (00:36): Hi.

Jessie (00:37): How are you?

Brooke (00:38): I’m good. How are you?

Jessie (00:40): I’m doing great. Thank you for joining me today.

Brooke (00:43): Of course.

Jessie (00:44): Okay. All right. So quickly before we begin, we want to thank RDLEX and their patient advocacy engagement program to support

(00:56): This IG live and Facebook Live and this education contents to help you use evidence-based information to find relief. So let’s get started. So drop it in comments. If you have any summer plan that is different than what you normally do. Let’s see. And Brooke, would you want to talk a little bit about summer and maybe what IBSC is? We’re going to actually talk about different types of IBS and different types of flare up because IBS-C flare-up is going to be the management tools is going to be very different from IBS-D flare-up. There are some common tools that we will talk about as well, but let’s start with IBS constipation. Brooke, do you want to talk a little bit about constipation?

Brooke (01:51): Sure. So constipation would be hard incomplete or infrequent stools. They usually can be accompanied by bloating pressure discomfort, but not all constipation is the same. That would be why some tips that might work for other people don’t work for you or vice versa. It can be very individualized, but there are some general guidelines that we can give you.

Jessie (02:31): Yeah. I love that you’re talking about different types of constipation because it’s not one size fits all, right? When we talk about constipation, we’re really talking about six different, at least six different types of constipation. And it ranges from, what is this? Functional constipation, which is also chronic idiopathic constipation, IBS constipation, slow transit constipation, the synergic defecation, which is a pelvic floor dysfunction. And then there’s medication or supplements induced constipation and also constipation from inadequate energy intake. Now in this session, we’re really meaning going to focus on IBS constipation and a little bit overlap with chronic idiopathic constipation because the treatment method, it’s very similar, especially in the summer. So let’s talk real quick about maybe summer specific triggers, right? So one is temperature. As it gets hotter and hotter, it’s really important for us to remember to stay hydrated because I see broke taking a zip right there.

(03:43): Because when weather heats up, we tend to sweat more. We tend to be more active. We’re going out a little bit more. And what that means for us is that if we don’t have enough fluids that can slow down gut mtility. But would you like to talk a little bit about what the colon’s job is when it comes to moving stool through?

Brooke (04:05): Yeah. So the colon is kind of where fluids are absorbed back out back into the body. So that’s where stool, if it sits too long, can get really dried out and harder to pass. So making sure that you’re having a bowel movement regularly, but also that you’re well hydrated to help you have a bowel movement can be super helpful when you’re possibly sweating more outside more or you’re more busy being outside or like at a theme park or something so you’re not drinking as much as you might normally do or be outside and sweating more than you normally do.

Jessie (04:50): One of the things that we really recommend our patients do is to calculate your baseline hydration rates, right? And during summer or anytime you are sweating a little bit more, if you’re a little bit more active, you need to add to that baseline. So to calculate your baseline, for those of you using pounds, it’s half of your body weights in pounds and change that unit two ounces. So if you are 150 pounds, you divide that by two, becomes 75 and 75 ounces would be your base hydration rates that you need to hit. And over the summer it probably might go up to somewhere closer to 80 or 90 ounce to 100 ounces to keep your body hydrated depending on your lifestyle, activity level and so much more. So that’s something to consider. And the easiest way to really keep your hydration up is to bring a big water bottle with you and refill it everywhere you go.

(05:47): Now that may not be possible for everybody, but you can always go to a grocery store and buy a case of water and keep it in your car if you are going somewhere, if you are traveling so that you always have access to water. But of course, as dieticians, we love our planet, so we really recommend bringing your water bottle. Travel sometimes you can bring a plastic water bottle that you can use it over and over again during travel. It’s lighter. If you want to carry a stainless steel water bottle, that’s okay too. But now I used to just carry stainless steel to avoid having too much plastic, but then what is convenient for you? It’s going to be what you will do. So nowadays I find that if I’m going to bring a stainless to water bottle, sometimes I don’t even want to bring it.

(06:43): I just end up having to buy water. But what I’m doing now is I bring a plastic water bottle that I got from our dietician conference, which is kind of nice because they give one out every year when you go to the conference and it’s such a practical tool. But anyways, my point is, when it comes to hydration or when it comes to these tools, what is the easiest for you is going to be the most helpful in the long run. All right, we talked about heat and dehydration and the importance of hydration. Let’s move on to the next one, travel and routine disruption. Do you want to talk a little bit about this? This is one of our favorite topic with our clients. Yes,

Brooke (07:25): It is. So you can notice sometimes that your bowels run on a schedule. I was just talking to a client today and it was early in the morning where she was and she said, “Well, I haven’t had my bowel movement yet, but I also haven’t had my breakfast or done my morning yoga routine.” So she was hopeful that she would have a bowel movement so other people will wake up and go first thing. And so if that schedule is being disrupted, it’s important to kind of hold space for that. So if you know you’re going to be leaving early in the morning, maybe getting up a few minutes earlier to have a warm beverage or a small breakfast to kind of get things moving so you can have a bowel movement before you travel or realizing that maybe your schedule got thrown off so trying to work your schedule, your kind of vacation schedule so that you get a little bit more time in the morning or you still get that morning yoga routine in or you still try and eat something small in the morning, smaller or regular size meal to stimulate that bowel movement.

(08:40): So it’s trying to readjust your schedule, honoring the fact that you kind of need to leave some time in the morning to have that bowel movement.

Jessie (08:50): Yeah. I love what you’re talking about routine here and a lot of the times, right? Like what Brooke was saying, our body runs on routine. It thrives on routine. Most of the time we do recommend patients having the same or similar wake up time every day and then do the things that you normally do. And what we usually recommend patients is having a lot of fluids in the morning because again, your colon is a tool that resorps water and overnight our body is dehydrated and when we are dehydrated, our, what is that? Our colon will try to reassort more water from the stool and the stool becomes harder and more difficult to pass. Somebody actually in our women’s support group said, I think it was yesterday said her stool is so hard and so thick, so big that it’s difficult to pass and she’s really afraid of passing it.

(09:44): Now to avoid that, one of the things we really need to think about is to hydrate, right? To soften the stool to help it pass easier and make sure that we are supporting it every day. And we like to say that, do it in the morning so that you are not chasing it later in the day, you’re starting your day very well hydrated and that hydration also adds volume to your stomach. And one of the things we talk a lot about is gastrocolite reflex and what is gastrocolit reflex is a reflex when you have food or volume in your stomach. It sends a signal to your colon to say that, “Hey, food is coming through. You need to pass what has been sitting in there because new food is coming through.” So that signal, gastrocholic reflex signal is the strongest in the morning, which is why we recommend not skipping breakfast.

(10:40): And I see that there’s a question about breakfast here. Brooke maybe can talk a little bit about what we usually recommend as far as breakfast, but again, it will have to be things that you like, otherwise it’s not sustainable, but we could maybe talk about what we usually recommend. Yeah. Brooke, you want to take that?

Brooke (10:59): Yeah. So I always recommend, again, it’s hard to say specific things because I don’t want to recommend something that you absolutely don’t like and we’ll never eat. But if you think about it in terms of something with protein, so meat, chicken fish, eggs, Greek yogurt, something with protein, something with fiber, so berries. I like ground flax or ground chia and thing like that and then a little bit of healthy fat. That combination helps to keep you full, which can be helpful and it also is a good balance of nutrients. A good example would be Greek yogurt, ground flax or ground chia and some berries or a banana or doing an egg like frittata with veggies, a piece of some kind of a high fiber or moderate fiber, bread rice or rice cereal, something like that can be a good breakfast go- to. Also, Jessie has some great smoothie recipes to get a variety of different fruits and veggies in there.

(12:18): I’m a big smoothie person in the summer just because it’s hot and it’s nice to sip on something cold when it’s hot out. So anything that when you think about that balance and can give you a little bit of fiber is always helpful.

Jessie (12:35): Yeah. I love you touched on a balanced breakfast, right? Carbohydrates, protein and fiber and a little bit of fats. Fats can really stimulate a good bowel movement, so it can be very helpful for a lot of us just to add a litle bit of fat. And one thing we always recommend is if you can tolerate this coffee, coffee is a laxative, right? And we all know that. So for those of us, IBS-C girlies, myself included, having that cup of coffee can be really helpful in stimulating a good bowel movement in the morning or just getting things moving. And again, we’re thinking about volume in your stomach, food, fluids, right and then that stimulates the bowel movements and giving yourself time to in the morning and this is something what we like to call protected party time because if you are on the run, our body knows, hey, this is not the time to go to the bathroom.

(13:28): I’m just going to hold it until you have time later. But usually for us IBS girls, if we hold it, it may or may not happen later on in the day. So make time, make time for it. It’s tricky when you have IBS. Sometimes I hate to say this, but sometimes I do have to plan my day around the bathroom just to make sure I know I have access to bathroom and I’m not going to be worried when the urge comes, because I know if I skip the urge, it may not happen. But the good thing is, if you have the right tools, you know it’s going to happen tomorrow so you don’t have to worry so much about it. But it’s hard with that anxiety because if you’ve been struggling for a long time, it can be difficult. All right, let’s talk about eating out and social eating during the summer because this is a very tricky topic, especially for those with IBS and maybe you have a specific food trigger, it could be format trigger or if you have noncelier wheat sensitivity or if you have celiac disease, then we’re talking about gluten, which is very difficult to avoid.

(14:39): So what are some of the ways people can control their food exposure when they’re traveling or when they have gathering?

Brooke (14:49): Well, if you’re having a gathering or attending a gathering, I always say you can bring something that’s safe for you to eat. So you at least know sometimes being the dietician in the group, I’m the one that brings the veggie tray or the fruit bowl or always make sure there’s fruit and veggies at a gathering I have, but to also if you’re eating out looking at the menu, if you’re going to a restaurant and you know beforehand to look at the menu and see ahead of time what you can eat, you can also call the restaurant and say I have these, I don’t know if I’d say trigger foods, but I have to have these, we can call them allergies and see what they recommend a little bit maybe at a downtime in the restaurant if it’s busy like beach time or eating prior, having a snack prior so that if you get there and there’s just nothing on the menu that you can eat, everything’s deep fried and that’s a big trigger for you so you’re not starving.

(15:53): But I always try to have people find something on the menu that they can have so they can enjoy their time and not just be sitting there with a glass of water or something like that.

Jessie (16:05): Yeah. I love what you’re saying and something I learned from a colleague who has celiac disease when she’s traveling sometimes at events she may not have food that she can eat because with sale disease or non-sealant weed sensitivity, people have a very sensitive gut and you have to avoid gluten at all costs. What she would do is she would Uber eat the food to the events and that’s what she will have. And on travel days she sometimes would Uber eat two meals to the events. So one would be for the lunch, whether if it’s a lunch gathering or something and then one would be for the airports because she does not trust the airport to provide gluten-free food for her. So if that is your problem, think of ways to make sure you still get food and get what you need and what Brooke was saying too is bringing some snacks with you at all times.

(17:00): Some of our favorite snacks are probably like rice crackers, peanut butter, peanut butter pouches, right? There are ready to eat pouches that you can just open and squeeze. So these will give you some energy and of course protein and fats that will keep you full for longer. So it’s one of those things that we recommend consistently because it’s a little bit easier and of course if you are sensitive to FODMAPs, there are a lot of low FODMAP options these days like FODE has good options. One of our fan favorites or our client’s favorite is Go Macro Bar and 88 acres where a lot of their bars, their bars are made with seeds, which again will give you some more fiber will also give you fullness when you are eating them fiber and protein, so fullness.

(17:54): Okay, and one more thing that Brooke touched on is getting enough fiber. So for those of us with IBSC, we do still want to make sure we are getting enough fiber even when we are traveling or when we are doing summer gatherings and that can be tricky. So if you are traveling, one of the things we always recommend is go out to a grocery store, get some fruits for yourself. Don’t wait until you are there for two weeks and you’re like, “Oh no I haven’t had any fruits this whole time.” Or maybe not two weeks, but maybe five days and you’re severely constipated and you’re like, “Oh, I’ve really neglected getting enough fiber.” So prepare ahead of time, plan ahead of time, go to grocery store, get a lot of fresh fruits and sometimes maybe cut up fruits for the convenience because again, buying the fruits is only the first step.

(18:51): Eating the fruits is what will really matter. So make sure you are getting things that you know you will eat. Convenience is the key. And also some cut up vegetables as well, right? Maybe get a salad tray just to make sure it’s like you have some fiber with you. And if you are staying at a hotel that has continental breakfast, again, load up on the fiber, get the fruits. Well, I don’t know if this is something good to say, but I always sneak out a orange or a banana from the breakfast. I was just going to say that. Keep it with you, that could be a great snack for later on in the day. Then there you go, that’s your two servings of fruits, right?

(19:38): Yes. Okay. Hormonal shifts and how it impacts motility. How about we talk about maybe normal hormonal ships? So for those of us who are women, we know that during certain part of our cycle, usually right before our period starts, that’s when our progestron peaks and that’s when our gut motility is usually a little bit slower because progesterone do have the effects of slowing down gut motility. But usually when our period starts, another hormone kicks in, it’s called prostate glanding and when prostate glanding kicks in, it can cause more muscle contraction in the bowels and that can help us have better evacuations. But let’s talk about when the progestron is really high and when we have slower motilities. So for anybody with constipation, pre-menstruation, take care of yourself, right? Self-care is always very crucial drinking more fluids and make sure you are again, getting those fiber in, especially during summer.

(20:45): And one of the good things about summer is that we have a lot of fruits options.

(20:54): Well, we know a lot of fruits are higher in FAR maps and that really includes your watermelon, mangoes. I just want to cry. What else are there? The stone fruit. Stone fruits, apples, cherries, peaches, which is again, all of these things are rip being in the summer. I will say if you’re worried about fat maps, there are tools that can help you. There is one brand co-intolerant, they can help break down fructose if that is the farm map that you’re worried about. But also we want to say, in our experience working with patients, a lot of the times if your constipation is resolved, farm maps are not going to cause you much symptoms in your gut, or at least you don’t have to avoid it completely. So just think about other things to help keep your gut motility moving so that you are not stuck constipated.

(21:55): If you’re constipated and then you eat high format foods, the high format foods is going to ferment, it’s going to cause traps gas, it can cause pain, right? But if you don’t have that trapped stool or stew burden, then more likely than not the FODMAP will only cause very mental symptoms. Again, before you cut out food, think about how you can support your gut motility first.

(22:23): Okay. I think this is about it. I think our last topic here is doing more fiber is better for IBS-C. Yes or no? It depends.

Brooke (22:40): Yeah. If you are not eating very much fiber and then you all of a sudden eat a lot of fiber that is going to make your constipation worse. So it’s like adding cars to a traffic jam that definitely just backs you up more. But if you can slowly increase that fiber, a higher fiber diet has been shown to help constipation and you also need to make sure that you’re drinking more water when you’re eating more fiber or else that can also jam things up even worse if you’re not balancing your fiber and hydration.

Jessie (23:24): Yeah. Okay. We’ll talk about IBSD in a little bit and one of the things we like to tell our patient is that fiber supplements can be helpful, especially if you’re not getting enough fiber. However, you have to be drinking enough fluids. So even the gentlest fiber like psyllium has, if you don’t drink enough fluids, if it can cement up in your gut and cause a lot of irritation. So make sure you follow the instructions and drink plenty of fluids. And we do for those people with more of a constipation base, we do recommend psyllium and because psyllium is very gentle, but start at a slower dose if you’re taking fiber supplements and make sure you’re chasing it with water and then slowly increase your syllium if you have a sensitive guts. Don’t go in on day one, I’m going to do two servings because more is better.

(24:20): No, absolutely not. More is not always better and you have to unclog the traffic jam first before you start adding fiber. Okay. Treating constipation is, I think what we like to say is multifactorial. So many things can cause constipation and treating it is a step by step approach. The constipation didn’t happen overnight. Dumping your system with fiber is not going to resolve it the next day for you and sometimes that can backfire and really make things worse. So if you are struggling with constipation, go talk to your healthcare provider. If you’re wondering about food triggers, work with a dietician to help you. Don’t just cut out food. Like we said earlier, most of the time when we work with patients, we see that patients have cut out so many foods out of fear, but the reality is once the constipation is resolved, their tolerance to these foods, especially FODMAP foods increase drastically and they don’t have food triggers anymore after that.

(25:21): If you want to hear more about that, go listen to our patient’s stories. A lot of them will tell you on the IBS Nutrition Podcast, a lot of them will tell you, they thought they couldn’t eat garlic, they couldn’t eat onion, they couldn’t eat apples or mangoes or peaches. At the end of the day, once they resolve their underlying causes to their gut symptoms, they are able to eat all of those things again and tolerance levels to FARMAPs can vary person to person. So even if they can’t eat a whole apple or maybe a whole on the end at one setting, they can eat some of it and that’s the start to restoring your tolerance or improving your tolerance to these foods.

(26:06): We’ve got a questions about I have IBSC, often have gut blockages. Any advice, please like we said earlier, I think you might have to go back to watch what we talked about earlier. You have to resolve the blockage first and then work on your foundation. We’re talking about hydration. We’re talking about meeting your fiber goal, but you don’t want to be dumping fiber when there is a blockage. You really need to increase your fiber gradually and make sure you’re staying hydrated and also working on some lifestyle, what are some lifestyle triggers when it comes to IBS that we just talked about. We talked about creating a morning routine, right? Another thing we didn’t talk about is consistent meal timing. Our guts needs routine. You really need to have a consistent meal schedule. And for IBSC, what we recommend is three good meals in a day because that’s going to be very helpful with your MMC migrating motor complex.

(27:03): So I’m not going to get into too much detail about this, but you want to stick with three good meals. And then using a squatty body, because squatting can really help open up the butts or that part of the pelvic floor to help things slip out. So squatting when you’re going to the bathroom, it’s a little trickier when you’re traveling or if you’re staying in hotels, but what I have find to be the most convenient for my case is using the trash can. I

Brooke (27:30): Was just going to say that. Yep.

Jessie (27:32): Yeah. Using the trash can. We have seen influencers using a whole host of different tools. Some even bring a travel squatty body with them. I’m just not going to do that, but I will use what I have in the room to create it. Some people use suitcases. That’s another thing to consider. I think it might be a safer alternative. So you just need to raise up your feet so that it opens up in the back. Anything else that got brain connection? Oh, and don’t ignore your urge. Don’t hold it because for those of us with IBS, right? Like I said earlier, if I hold it, it may not happen. And for me, I know it’s going to come again tomorrow because I have other tools that I can use to manage my IBS. But for those of you, if you need more tools, talk to your provider or work with a dietician to really help you.

(28:20): Don’t just cut out food because food oftentimes for IBSC is not the issue. Yeah. Okay. What else? Also other things to consider too, right? Using over the counterlaxative, that can be a really powerful tool.One of our favorite ones is MiraLX. It’s very gentle. It’s osmotic. It draws water into your colon to help the student move out. So that’s one that we recommend a lot. Another one that we recommend a lot is Cena. We know Cena is very safe even for long-term use. In the past, we were worried about dependency, but your research suggests that it actually does not cause dependency. It does cause changes in the color in your colon, but it’s short lived. Once you stop the medication, it will go away. So nothing to be concerned about. And if over-the-counter medication doesn’t work for you, there’s also prescription medication that are stronger and sometimes it can be very, very helpful for patients.

(29:18): And we have seen in even in our patient population, right sometimes the prescription just works better for them. So things to think about, don’t just cut out food.

(29:32): Okay. Let’s go on to talk about IBS diarrhea, because we’ve got some questions about diarrhea as well. And I think one of the things when we talk about diarrhea, one of the things we really want to talk about is that not all diarrhea are the same. Even among IBS diarrhea, there are a few different types and we are going to talk about that today. So we’re going to talk about the three most common types of diarrhea that We see in a clinic and tell you what to do to find relief for that specific type of diarrhea. So number one, well, the three types are flare up diarrhea. This is more related to constipation causing a flare up and a lot of stool comes out. Okay, that’s type number one. Type number two is overflow diarrhea. This is when people have blockages and your body is still actively trying to empty out the bowels.

(30:29): So you may get multiple small diarrheas throughout the day, but every time it’s just mush and liquid coming out. So that’s overflow diarrhea. And the third type we see very commonly is of course food intolerance, diarrhea. Now food intolerance doesn’t just cause diarrhea. Sometimes it does cause constipation. But if you do suspect food triggers causing you gut symptoms, you don’t want to do elimination diets by yourself and listen to the part where we talk about food intolerance, diarrhea. So that’s the type number three that we’ll talk about. And point number four with diarrhea is what we’ll share, what we see in clinic two, what makes diarrhea worse in a lot of our patients. All right, let’s start with flare up diarrhea. Brooke, do you want to kick off with what that is?

Brooke (31:19): Well, I’ve actually got to jump to a patient.

Jessie (31:22): Oh, you have a patient. Okay. Okay. I’ll take care of the rest of this. All right. I forgot about

Brooke (31:28): That. That’s okay. Bye. Thank

Jessie (31:30): You. Bye. All right. Let’s keep talking about IVS diarrhea. So to treat diarrhea, you have to treat your specific type or else it can backfire. So out of the three types of diarrhea I was talking about just now, type one and type two, the flare up diarrhea and overflow diarrhea, these are actually caused by constipation. So with flare up diarrhea, a lot of the times, let me put it this way. Let me give you a scenario. A lot of the times patients come into our office to tell us that, “Hey, I have diarrhea, I have IBSD, I need help with it. ” And they’ve been to their doctors, they tell their doctors they have diarrhea and they get an IBSD diagnosis. But when we look at their pattern and trends when it comes to stool patterns, what we are seeing is the patient is not going to the bathroom for days and then all of a sudden they have a flare up.

(32:23): They have a lot of diarrhea coming out in one day, maybe multiple bowel movements, a lot of stool coming out. This is what we call the flare up diarrhea. Also, you can call it IBS mixed biotype if it fits the criteria from the Rome foundation. And what this is stool is building up in the colon. Patients are not able to have full evacuations daily and as the buildup gets worse and worse, it hits to a point where the body cannot take it anymore and everything comes up. In cases like this, we need to treat the constipation. We don’t want to put patients on antidiarrheal medication or any kind of medication that can slow down your gut motility even further. In cases like this, what we need to do is to resolve the constipation.

(33:12): Let me share a real life situation with you. So one of our patients came to us. Her name is Kinsey. She’s actually a dietician herself and she was diagnosed with IBS diarrhea. And when she came to work with us, her GI had recommended for her to do the low format diet and being a dietician herself and looking at the diet, she’s like, “This is way too restrictive for me. I cannot do this diet by myself.” So she came and joined our program. But when she joins the program, what I found was that she’s already cut out a lot of food. She was eating probably only a handful of foods that she felt safe eating. When I looked at her bowel habits, like I said earlier, she wasn’t really going to the bathroom every day for maybe a week to two weeks and then all of a sudden she has these really horrific diarrhea that just doesn’t stop and a lot of stool come in.

(34:06): And when I noticed that pattern, I told her actually, I told her to not worry about the diets because she’s already cut out so much food. I don’t want her to cut out any more food that can make her gut motility worse because the loft diet can make your motility worse if you’re not doing it correctly. And for her case, we worked on improving her gut motility, making sure she was having full evacuations every single day. And just by doing that, her diarrhea stopped completely. She didn’t have any more flare ups and what we worked on the whole time when she was in a program was really improving her gut motility to make sure that she is having that full evacuation and teaching her what to do when that full evacuation doesn’t happen for one day. But again, even if you don’t have that full evacuation for one day, as long as you have a full evacuation again, maybe on day two or day three, that flare up is not going to happen because it does take a lot of buildup sometimes for somebody to go into a flare up when it comes to IBS diarrhea.

(35:16): So if that is you, work on your constipation, work on improving your biomotility first before you cut out food. For her case, we didn’t cut out any food and we really worked on expanding her diet as fast as we can because she’s cut out over 50% of her food just because she was so afraid. She was even afraid of going into a car for 10 minutes because near accident experience has happened. And I’m sure for a lot of people with IBS diarrhea, you can relate to that. You understand the fear. If it’s happened once or if you’ve had a close call once, it can be really scary, but understand what’s causing your diarrhea or flare ups and work on the underlying root cause. Don’t just cut out food. At the end of working together, she actually was able to pick up a job that she had to drive an hour away, but she said at the end of the programs like Jessie, I don’t have any fear sitting in my car, driving an hour away because my IBS is under control and I know I’m not going to have a flare up when I’m driving to work.

(36:23): So for those of you thinking about food delimination, don’t just cut food out. Most people don’t have food triggers, but work on your underlying problem. Now, if she went on low forma and didn’t resolve her constipation, she probably would get a little bit of symptom relief. Again, I talked about this earlier. If you’re very constipated, you eat high format foods, that’s going to cause a lot more trap scare, that’s going to cause a lot more maybe water movements into your guts and that can cause a flare ups. But at the end of the day, it’s not the fall maps causing the symptoms, but the stool burden. So think about that before you cut out food. Okay. So that’s the first type of diarrhea that we are talking about. And then the second type of diarrhea is overflow diarrhea. So over the flow diarrhea is overflow doesn’t resolve itself.

(37:15): Whereas a flare up diarrhea, once you have that flare up, you kind of go back to your baseline, right? And then the buildup of stool starts happening again. It kind of goes in a vicious cycle. Overflow diarrhea is different because there may be blockage near the rectum or at the end of your colon. And I’m talking about stew blockages because somebody is so constipated. And what happens in these cases is that your body may continuously want to go to the bathroom because it’s trying to get rid of the stool burden, but it cannot and because it cannot, it will still try to go to the bathroom and what usually happens is people may have multiple diarrhea throughout the day, but these are very watery and very runny diarrhea and the volume is small. So a little bit of liquid stool is coming out. And in cases like this, right again, you need to resolve the constipation, you need to resolve the blockage.

(38:14): One of the examples I want to give is actually one of our clients, Mercedes, she came onto the IBS nutrition podcast to share her story. She went to four different GIs to help her GI condition, which at the time was a lot of debilitating diarrhea. She can’t even eat a meal without worrying about needing to run to the bathroom. So in her case, this is kind of a tricky case because she does have a food trigger, but her food trigger actually caused her to have significant constipation and that constipation caused her to have overflow diarrhea. And in that case, what we really needed to investigate was what, one, what type of diarrhea she has. And when we figure out it was overflow diarrhea, we worked on improving her gut motility, resolve the diarrhea or the constipation first and then we could really see what’s going on with her guts.

(39:06): And then we found that there was a particular group of food that when she eats it, it slows down her gut motility significantly and that’s what’s leading to the blockage in her GI tract, which leads to overflow diarrhea. You can’t comment pot at any time and I’ll send you the link to the IBS nutrition podcast and I would really love for you to listen to Mercedes story because she shares about her encounters with the four GI doctors she saw. She didn’t even get an IBS diagnosis until the third GI doctor. However, even the first GI doctor had told her to go on the low formap diet. Now mind you, she actually didn’t really have any format triggers. She cut out a lot of food again prior to working with us, but after resolving her motility issue and resolving the overflow diarrhea, we found that she tolerated most of the FAMAP groups.

(40:02): There were a couple of FAMA groups that if she eats too much, she may get a little bit of symptom, but it’s nowhere as debilitating as the overflow diarrhea she was experiencing. And for people with diarrhea, you would understand the debilitation of it because you’re so afraid of having a flare up. It makes it difficult to live a normal life. People are often afraid to leave their house, get on public transports, or even driving around. So if that’s you, don’t give up. There are ways that can manage. And if it’s overflow diarrhea or flare up diarrhea, again, the key is to resolve the chronic constipation or the underlying constipation that is there. Now the third type of diarrhea that I want to talk about is the food intolerance diarrhea. This is a group of patients where there are food triggers causing the motility issue and this is not constipation leading to diarrhea.

(41:01): This is ingesting foods that actually triggers the diarrhea. Now there can be so many different types of triggers. It could be somebody with celiac disease that could be gluten or somebody with IBS. It could be FODMAP triggers or sometimes it could be very high fat foods. It could be caffeine. It could be so many things, but FODMAPs of course is the one that everybody knows and FODMAP does have efficacy of about 70% when it comes to reducing symptoms in IBS diarrhea, but the LOFOMAP diet is not a long-term diet. We have a women’s support group on Facebook and one of the things I am seeing on here is that people have put themselves on the LOFOMAP diet for long term. And I want to remind you that the LOFOMAP diet is not long term. In fact, it’s got three phases. Phase one is eliminating FARMAPs or reducing your FORTMAP load and that’s usually only two to six weeks.

(42:01): And when you work with an experienced provider during the elimination phase, what we do is we investigate what is going on in your guts, what’s causing all of these symptoms. Then we try to resolve the underlying root cause to your symptoms. Then the second phase is reintroducing FODMAPs group by group. I’m seeing some questions coming in. I’m going to address them or comment.

(42:27): And then reintroducing the FOTMAPs group by group in varying quantities to identify if you have a trigger or not and what is your tolerance level to that food. I’ll give you an example. A lot of patients come to us cutting our garlic, cutting out onions, cutting out apples and peaches and when we do the food challenges, we find that they can actually tolerate most of these foods. If not at the highest quantity, then they can tolerate the smaller quantities. Okay. A lot of questions about IBSD. I’m going to get to them. Okay. So what was I saying? But with food intolerance, right again, don’t do it by yourself. And with the low forma diet, the third phase is personalization. So after elimination and reintroduction, we understand what a patient’s tolerance level is with the food. Then we expand the diet as much as possible and that’s what we call personalization, personalization phase.

(43:21): Now it’s go listen to some of our clients’ stories on there. One of our clients, her name is Lauren. Actually, let’s talk about Laura’s story. Actually, one of our clients, her name is Laura. She had IBS diarrhea for almost for five years. Actually, she was working with her GI doctors throughout this time and trying different things to manage and in four months we were able to resolve her diarrhea and she moved on with her life. So let me tell you a little bit about her story because this is a real example is when you are not resolving the root cause of your diarrhea, it can keep going and going and going. So for the longest time, she was treated with IBS diarrhea and she was told to cut out food. She was also told to bring Imodium and it was still not helping. When we first worked together, we looked at all her symptoms together and found that she actually has SIBO, more intestine bacteria overgrowth and that was caused by prolonged use of antibiotics.

(44:27): More than five years ago when she had some procedures done, I can’t remember what was the reason why she took probiotics for prolonged periods, but that changes her gut microbiome and it caused her to have SIBO. And for five years, she just worked with her GI to treat the IBS diarrhea and they were just not treating the right thing. And the next step was, well, you need to do the low format diets and I want you to work with team IBS dietician to work on the low format diets. And what we found now, she did came to us with a lot of diarrhea and we are talking about five to 10 diarrhea a day and these are not diarrhea caused by constipation. These are thorough fully MTAing diarrheas. And I think somebody was saying mucus, what is the mucus in my stool, why I have undigestive food in my diarrhea This is caused by faster gut motility and there’s so many reasons why it causes it.

(45:25): And for her case, it was actually SIBO and we identified it just by asking her symptoms, really understand what symptoms she has when the symptoms happened. And when we identified it, we worked with her gastroenterologist to get her SIBO treated. And after treating the SIBO, we had her reintroduce FODMAPs one group at a time to see if any of the FODMAP groups were triggering a little bit more of her symptoms. And she tolerated out of the 12 groups of FAMAPs that we had her reintroduce, 12 groups of FAMAP. There’s only one group that she didn’t tolerate at higher amounts and that was the stone fruit group. So it is the group that contains both fructose and sorbitol. And for that group, she can still eat a smaller amount of the food. She can still eat half an apple without symptoms, but if she eats a full apple, she may have a little bit more symptoms and the symptoms were not diarrhea when she was eating a full apple or full serving of that group of FARMAPs.

(46:24): But she was able to tolerate all of the outer FORMAP groups and I’m talking about garlic, onion, wheat, avocados, what else? Fructose, so watermelon, all asparagus, all the other pharma groups, she was able to tolerate it. And when she came onto the podcast, she really talked about her whole experience, really trying to work through all of this for five years by herself and really not getting anywhere. And mind you, this is somebody who has a PhD and she works as she’s a healthcare provider as well. And IBS is very complicated for those of you with diarrhea, don’t just cut out food. Some people may have a food trigger, but it’s not always a food trigger. You really need to understand what’s triggering your diarrhea so that you can’t stop it for good and not just cut out food. Now, cutting out farm maps can help you manage the symptoms, right?

(47:25): Because you are reducing the foods that’s irritating your guts. Pharmas can be irritating if you have a very sensitive gut, but ultimately they’re not the reason why you’re having all of these symptoms. Investigate the root cause, resolve the root cause, and then eat all the foods you love again. So don’t just cut out food. Okay, let me go answer some questions, but before I answer some questions, we have opened a couple spots to work with us in the IBS Freedom Program that starts in June. So we only have about two spots and if you want to get our help to support you through summer, this is a great time to join a program, work on your gut and really understand what your triggers are. Is it food related? Is it not food related and expand your diet after understanding what is going on with your guts.

(48:18): Okay. And comment class if you’re on Instagram, you can comment class at any time and I’ll send you a link to watch our free IBS Masterclass. This is a completely free education for you to better understand different types of IBS, different types of triggers. We talked about what to do to identify food triggers on there. We also talk about brain connection in the free masterclass is 45 minutes of education. At the end, there’s 15 minutes where I talk a little bit more about our program, how it works, what we do with our clients. So if that’s something you want to learn more, go watch that first and understand our approach and see if it’s suitable for you. It’s not suitable for everybody and not everybody needs that kind of intense supports, but if you want to get your IBS freedom back, it can be very helpful.

(49:12): Okay, let me go back and answer some of the questions we have. Mucus in my stool, what’s the reason? There’s so many reasons why there’s mucus in my stool. One of the most common reason that I see is actually one is people having food intolerance and there’s irritation in their guts, especially irritation in the small intestine that can really speed up the motility and sometimes causing mucus in the stool. And another thing that I see this happening a lot is people taking the wrong types of probiotics.One of the things we always recommend that patients do is stop all the probiotics when they join our program because we really want to see a baseline without all things. If you’re piling on multiple things, right? If you’re doing fiber, if you’re doing probiotics or if you’re adding an enzyme on top of it, that really muddies the water and it’s really hard to see what your baseline is.

(50:07): And unfortunately, most probiotics on the market are not evidence based for IBS. There are some that are and there are some that we recommend in our program as well, but for most people it’s not really necessary and a lot of the times it can make things worse. Okay. Then somebody wrote here, for my case, I see a lot of undigestive food in my stool. So I take digestive enzyme with my food and no more diarrhea even though my pancreatic enzymes are normal. So there are different types of enzymes that can help with diarrhea. So for somebody there’s also bioassas a question. There are about 20% of IBS diarrhea patients may have bioacid myo absorption and that causes a lot of diarrhea. Sometimes it’s very foul smelling. Sometimes it’s different colors, more green. In those cases, the treatment is actually bioacids or questions. And then there are cases where there is pancreatic enzyme insufficiency and in those cases, pancreatic enzyme replacement therapy is the treatment options.

(51:09): And then there are also cases where if you have a FAMAP intolerance, then we target it with FAMA enzymes. And then if it’s something else, but even among format enzymes, right? There are multiple different ones. We’re talking about lactase here, we’re talking about BNO that can help you break down GOS and fructose. Lectase, of course, can help you break down lectos and then there is intolerant also has one that can help you break down fructose, but it really, again, depends on what your particular trigger is so that you can match the right tool with the right condition. Don’t be very careful. And most of the supplements on the market, they are not evidence-based. So make sure you choose something that is more evidence-based. Does IBS cause weight loss? And how do you differentiate IBS and IBD? Oh, this is a really good question. IBS don’t technically cause weight loss, but we do see a lot of that in our program whether it’s with somebody with significant IBS constipation causing weight loss or somebody with diarrhea causing weight loss.

(52:12): A lot of the times people become really afraid to eat. In IBS constipation cases, because they’re so uncomfortable, they’re so bloated. And then with diarrhea cases, of course, they’re not absorbing the nutrients. So in cases like this, we really want to investigate what is causing the weight loss. Is it the food fear or is it malabsorption? If my absorption is happening, usually we also investigate overlapping conditions such as celiac disease or SIBO. Now inflammatory bowel disease is fundamentally different than IBS. IBS doesn’t have inflammation in the GI tract IBD has inflammation in the GI tract and we are talking about maybe significant inflammation in the GI tract that can cause bleeding.

(53:00): There are tests that can be done, blood tests and stew tests that can be done to rule out inflammatory bowel disease versus IBS and there are also scopes that can be done. Oftentimes by the time patients come to us, we’ve seen, they’ve gone through scopes, they’ve gone through everything and sometimes patients may have microscopic colitis, that’s one form of IBD. Actually, Lauren, one of our past clients came onto the IBS nutritions podcast to talk about her IBD and IBS journey. So she was somebody who has microscopic colitis and IBS and how we figure it out her food triggers. So in cases like this, right sometimes people do have food triggers and you do have to identify it. We were able to help her figure out her triggers and she stopped her IBS diarrhea for good and expand her diet. And it turns out that she really didn’t have a lot of BODMAP triggers, but she did have a couple triggers that she had to remove from her diet for good.

(54:01): The differentiation between IBD and IBS is the inflammation and there are tests that can be done to differentiate both. So if you are worried about IBD, ask your doctor to get more tests done. As deserts, can we eat here with no lactose milk and fruits? Yes, you can. Shia is one of the things we recommend a lot, but make sure you are fully soaking it, fully hydrating the chia before eating it. Otherwise, it can soak up your digestive juice and again, like become a cement in your gut. So make sure you’re drinking a lot of fluids when you are adding more fiber, even chia seeds. Don’t do dry chia. So if you add maybe like a teaspoon of chia into water like this, you will see that it soaks up and it expands. If you are taking dry cheer, it’s going to do the same in your stomach and cause blockage.

(54:55): So don’t do that. And people have been had to go to ER when they do stuff like this. What was that? The eternal rain challenge, there was a TikTok challenge where people would put two tablespoon. Remember when I said teaspoon, people were putting tablespoons of chia in their water and we do not recommend that. Okay. Start slow and add more. And then somebody else asked, what’s the difference between diverticulosis and IBS? My partner has this and IBS and I’m trying to understand his condition and how to take care and better support him. So diverticulosis is when your colon has little pouches.

(55:36): Let me see if I have any images that I can use to share with you so you can see this a colon here and for people with diverticulosis, you will see they have little pouches in different places that sticks out. And when those pouches get inflamed, they become diverticulitis and that’s when people have a lot of diarrhea. And for diverticulitis or diverticulosis, the goal is to have a good full evacuation every day so things don’t stick in there. Sometimes you may hear doctors say, “Go on the low fiber diets.” Actually we don’t recommend that anymore and what we recommend these days is a low residue diet. One of our past clients actually came onto our podcast. His name is Ian and he talks about that. He’s another case where he came to us with significant diarrhea that was actually caused by probiotics and we resolved it and we worked with his doctors to treat his SIBO, get his scopes done and that was about five years ago.

(56:39): We worked together on treating his IBSD and SIBO and he came back to us last year to work on treating or managing his diverticulitis. Go listen to his story. It’s very inspiring and he shared all the tips and tools that we told him to do during the treatments as well, whether it is for IBS or for diverticulitis. And he was able to, I think he came back to us March or April or May last year for diverticulitis and he had a trip to go to the hemallis in October. So he really need to get everything sorted, get his symptom down to baseline before his trip to the hemallis because he was in a remote village in India. There’s no access to a hospital if he had a flare up. It would be devastating. And he almost canceled his trip because he was so afraid, but we did quite a few things with him to get him back to his baseline to rebuild his strength and stamina and also keep his diverticulitis at bay or diverticulosis at base.

(57:45): So go listen to it. And we also work with all GI conditions as well, not just IBS. If your husband has diverticulitis, send them our way, we can help him as well. And one last questions and I’m going to go. I have IBS constipation and I get diarrhea lately. Why? We actually talked a lot about this in the video, so go back and watch the replay. So in part two of our video today, we talked about three types of diarrhea and actually two of those types are actually caused by constipation. So go back and listen to them and they’re called flare-up diarrhea or overflow diarrhea.