Constipation, GLP-1, and Gut Health (Deep Dive on Constipation with Dr Carmen Fong, author of Constipation Nation)

Jessie Wong (00:00): Welcome to the IBS Nutrition Podcast, your go-to source for navigating the complex diagnosis of irritable bowel syndrome. Here we dive deep into IBS and discover the power of diets and lifestyle to find freedom from your IBS symptoms. I’m your host, Jesse Wong, fo map dietitian, and a gut expert. For years I suffered from debilitating gut symptoms that kept me out of work, feeling constant discomfort in my body and anxious around food. Today I’m in control of my IBS, able to eat the food I love, again, travel whenever I want, and spend quality time with loved ones. It is my mission to help you do the same and transform the way you live with IBS. Let’s get started. Hi everyone. Welcome to another episode of the IBS Nutrition podcast. Today we have an amazing guest and she is the author of Constipation Nation. Hello, Dr. Fong.

Dr. Carmen Fong (00:55): Hi Jesse. So glad to be here today. Thanks for having me.

Jessie Wong (00:59): Well, thank you for being here. So Dr. Carmen FG is a colorectal surgeon. She’s currently the medical director of Hemorrhoid Centres of America, where she sees Endorectal diseases daily in her clinical practise. She’s also the Chief medical Officer of bums, a digital platform for Anorectal Health launching in fall 2025. She’s born in Hong Kong and went to medical school in Michigan and did residency and fellowship in New York, and now she lives in Atlanta with her family. In her free time, she writes multiple blogs and wrote a book again, constipation Nation. And today we have so many juicy topics for you. I’m going to run it down our topic list so that you know what to expect and you can always jump to the section that you want to. So first, we are going to talk about GLP once effect on the GI tract. This is actually something Dr. F see almost on a daily basis, and we are going to talk about it because it is exploding in popularity. One in eight American are on GLP one and we are predicting or medical communities are predicting one in five Americans may be on GLP one in the very near future. This is one in five that’s 20% and it is very scary and we really want to better understand the side effects on GI health, on your gut health before you jumped on it and maybe have a better conversation with your physician or practitioner before you go on something that can or can be good and can have harms, pros and cons. Okay, and number two, we are going to address some stigma when it comes to gut health and why we really should be talking more about it and why looking at your poop is an incredible tool to help you improve your gut function and gut health. And number three, of course, ask the author of Constipation Nation and on an IBS podcast, we are going to talk about constipation and what are some ways to help you improve your gut motility without sacrificing too much, making small tweets that can really help. Alright, number four, something that we see a lot and Dr. F see a lot is an rectal health, why it is important and how it connects to your overall gut health and what you can do or what you need to do if something does happen. And at the end, number five, we’re going to debunk some myths. So we’ll talk about gut microbiome testing, food sensitivity testing, dairy intolerance, and some of the diets out there, whether they’re good for you or bad for you, and what you need to watch out for. So lots of things to cover. Let’s get started. Alright, GLP one, let’s go.

Dr. Carmen Fong (03:41): Well, you let in so well, honestly, I’m like, Jesse, you know everything and this is why you do such an amazing job on your website. But GLP one agonist the literature from about a couple months ago, even the most up-to-date literature shows that there’s about a 7% of constipation and 14% of diarrhoea with GLP one agonist use. And that is all the forms of it. So whether it’s wegovy, the other one, I’ve actually forgotten all the names because there’s so many of them now. There’s so many nowadays. And so with even those statistics, you’re most likely to have some kind of GI side effect because you probably can even have both. And what I was mentioning to Jesse earlier was that even a year or two ago maybe I would see one patient every six months who was on a GLP one agonist and suddenly came in with six months of constipation.

(04:40)And now I would say that in the last six months or so, almost everyone is on a GLP one agonist who comes in and they’re suddenly saying, oh, I’ve had six months of constipation, six months of diarrhoea, suddenly I have haemorrhoids, fissures, all of these things going on. And what we’ve found is that even though we have a medical intake form, sometimes people will not necessarily put that they’re on a GLP one agonist until I’m like, oh, have you had some recent intentional weight loss? And they’ll be like, oh yeah, I was on wegovy and lost 55 pounds, but then suddenly I stopped pooping. And I’m like, well, there’s your answer. Just like Jesse said, I would say that there’s not really a reason to not be on GLP one agonist, and there are ways to overcome constipation and diarrhoea due to these medications, but it really is good to be informed to know why these things happen.

(05:34)Just very briefly, one of the mechanisms is that it increases water absorption in your intestines and so increases the stool, makes the stool dry up essentially. So it’s just kind of sitting there and then it decreases the total absorption so that you’re not absorbing the fat, you’re not absorbing the nutrients, and it also decreases the motility. So you’re not as hungry and suppresses your appetite by doing those things alone. You’re going to have variances in your bowel habits, either constipation or diarrhoea. Either it’s too liquid or it’s too hard. But what I usually tell people is that they’ll be like, I had one patient who came in, she’s like, yeah, I’ve been on ozempic for three months or whatever, and she’s lost 35 pounds, but she only eats one meal a day, and her one meal a day is one of those tiny chicken wraps for McDonald’s with a chicken, a fried chicken in it.

(06:30)And I’m like, while that’s wonderful. There’s really no nutritional value in it. It’s not giving you the bulk to have a bowel movement, and it’s like a tiny amount of, there’s no vitamins, minerals, or anything else in that rapid cell. So once I point that out, they’re like, oh yeah, I don’t eat anymore. And if you don’t eat, you don’t poop. What goes in must come out. And that’s really kind of at the bottom line of it, pun intended. So I usually counsel people, you can’t overcome GLP one induced constipation with a laxative, whether it’s natural or not increasing your amounts of fibre. And at the very simplest I tell people to eat a baked sweet potato, you have the bulk, you have the nutrients, you have the fibre, and that will pass through your system better than chicken burrito. Chicken wrap.

Jessie Wong (07:29): Oh my goodness. That is really difficult. Only eating one meal a day and that meal doesn’t really contain any fibre. Well, I do also have to say something in here is that while GLP one can be helpful for weight loss, achieving health weight loss doesn’t mean you are achieving health. So you want to, for anybody listening, you want to be very specific with your doctor. What is the goal of this? What are the measurable beside weights? What are other the things that we’re measuring? Is it going to lower your A1C or lowering your blood cholesterol? These are the things that will actually improve your health. Losing weight doesn’t necessarily mean improving health, but it could mean improving motility as in your overall motility. It can mean you feel better in general, but you need to have some clear goal. And weight loss shouldn’t be the only goal in here.

Dr. Carmen Fong (08:21): And just remember that GLP one agonists were initially developed to help with type one diabetes, so it controls blood sugar levels and suppresses appetite. That was the intent of it. And one of the unintended side effects was weight loss. And then so people started using it as a weight loss drug. There are a lot of new papers out there that I’m like, oh, it can help from anything to this, that and the other. I think we’ll see how that pans out.

Jessie Wong (08:49): And I think it is quite concerning when they have so much effect on the GI tract. Right. In the long run, it can really cause nutrient deficiency, especially if people are not eating enough. And when we have deficiencies, it’s going to cause more side effects in the long run. You may not see it now, but osteoporosis down the road reducing, my brain is blanking, but your fingertips going numb.

Dr. Carmen Fong (09:11): Oh, like paraesthesia. Yep. So actually, I had one patient who told me that after months and months of having muscle spasms and constipation off and on, things going on from being on a GLP one agonist, she actually had a vitamin B deficiency, which sickly causes muscle spasms and numbness and tingling and sometimes even skin and hair changes. And so you can have very significant deficiencies.

Jessie Wong (09:38): Yes, exactly what I was thinking of because B12 and folate is always on the back of our mind when you’re not absorbing the food, you are losing first B12 and folate that can affect generation of red blood cells and also your brain health and neuron health and then other B vitamin, then it can start affecting your nails, your hair, your skin, and it can be a slippery slope. So yes, we’ll monitor the research long term. In the short term there might be some positive things, but we really have to be more careful of.

Dr. Carmen Fong (10:06): Think mindful, mindful eating and as a whole treating the per person.

Jessie Wong (10:13): Yes. And also we are, I think I hope Dr. Carmen Fong as well is that we are a practise where we really focus on health at every size. We are improving health no matter what size you are at. And we don’t believe that losing weight will improve everybody’s health. For some people maybe. But for most of us, weight is more genetic than we think. Of course, social determinants of health. There’s not a lot we can control. And cutting out food or forcing your body not to eat can lead to other effects that can be more difficult to deal with in the long run. Yeah, that’s an excellent point. Yeah.

Jessie Wong (10:50): Yes. Okay. I’m glad we’re on the same page sometimes. Yeah. Awesome. Okay. Well, let’s talk about some of the stigma when it comes to talking about gut health, talking about poop. What do you see in your world, the colorectal surgeon world?

Dr. Carmen Fong (11:06): Yeah, I mean, I think one of the reasons I’m out there on social media and doing a lot of education is that there is so much stigma and taboo about colorectal health and anal rectal health specifically. People don’t want to talk about poop. They don’t want to talk about their digestive issues, they don’t want to talk about having haemorrhoids. And they’re very, very embarrassed to go see a colorectal surgeon and have someone look at their butt. They don’t want to talk. I actually had one patient one time, she was actually a relatively young patient, like a young woman. She was so avoidant about talking about her butt that I could not get a history out of her. I was like, how many times do poop a day? What does the poop look like? How long do you sit on the toilet for her? And she’s like, I don’t want to talk about that.

(11:54)And I’m like, you’re at a doctor. This is a safe space. And eventually she opened up. But some people really just do not want to talk about it classically, as I’m sure there’s been a stigma around talking about gut health and colonoscopies with the Asian population. So for a long time there was a huge push to get people to do preventative colonoscopies because people would be like, if it’s not broke, you don’t need to fix it. But at the same time, they don’t want something like an invasive procedure going into your butt. So there had to be a huge push in the vision population. This was probably about five or 10 years ago.

Jessie Wong (12:32): Well, I think it’s still happening, and I actually want to share a story about this. So my mom, when she was in her forties, so I actually have to start screaming earlier because my mom found a cancerous polyp in her forties.

Dr. Carmen Fong (12:47): Oh, wow.

Jessie Wong (12:47): And the reason why she pushed for a colonoscopy at that time was she started having bowel changes, right? Bowel changes. I don’t remember whether she saw blood in her stool, but she was having a lot more diarrhoea than she normally do. And she went to the doctor. And in Hong Kong, doctors are very good. They would say, they’ll ask you for your history. And they said, well, it’s best to do a colonoscopy. And when they did the colonoscopy, they found a polyp and that polyp was actually cancerous. So it wasn’t quite cancer yet. I don’t know all the definition, and I don’t know the full detail of her case, but when they did the biopsy, it was cancerous polyp.

Jessie Wong (13:23): So I’ll have to say colonoscopy saved her life. I mean, if colon cancer develops, it is extremely difficult to treat very low survival rates. Very high mortality rates.

Dr. Carmen Fong (13:37): That’s a very excellent point. That’s exactly like the details that I want to hear, which is people don’t realise that prevention is the key here in colonoscopy save lives. And in the US recently there’s only been up to a 66 to 69% colonoscopy uptake rate in the entire population. And in some of the people of African-American, Asian and Hispanic populations, it’s even lower of screening rates. And so that’s why we kind of push to have access for people of colour and people in minority communities and stuff like that. But exactly for that reason, you can find a precancerous polyp that if you had ignored the signs and your doctors had ignored the signs, it would’ve become a full-blown cancer.

Jessie Wong (14:23): And I would say unfortunately, we lost a friend to colon cancer a few years ago. She was only 40 years old when she was diagnosed, and it was already stage four. So survival rate is very low. And she was so young. She has young kids, and yes, so whoever is listening here, especially for those of you with IBS, while IBS, don’t increase your risk of having cancer. But if you have symptoms and symptoms are not improving despite intervention, keep advocating for yourself, asking for more tests, you’re not a pain in the butt.

Dr. Carmen Fong (15:02): You’ll be the pain in the butt trying to get you to get your screening. And just to throw here, that’s absolutely true. And people ask me all the time, this is probably one of the debunking myths. Constipation does not necessarily lead to cancer, nor does cancer necessarily cause constipation. But if you have a late stage cancer, obviously that’s blocking the colon, you can have constipation symptoms like you can’t poop, you can’t fart. On the other hand, we do know that in some cases, constipation can cause irritation or inflammation of the colon lining, and that may potentially lead down a cancerous pathway or an inflammation pathway. We don’t know for sure yet, but I always tell people avoiding constipation is still super important, even if it weren’t for preventing cancer, the signs and symptoms to look out to advocate for yourself and go get a colonoscopy. Usually if you have obviously blood that doesn’t stop bleeding per rectum, that doesn’t stop. Unintentional weight loss, abdominal pain, bloating, and then generally, I always look for a constellation of those symptoms, which means all of those together rather than just one single one.

Jessie Wong (16:12): And of course, beyond colonoscopy, there’s also stool tests that patients can do if they choose to not go the more invasive routes. But of course with stool tests, they can tell you whether there’s blood and other things. I’m of course not an expert. They can tell you what’s in it, but they don’t remove the polyp for you if there’s already a polyp.

Dr. Carmen Fong (16:30): Correct. So colonoscopy is both diagnostic and therapeutic. So if you have symptoms, usually better to just get a colonoscopy. If you’re screening and you don’t have symptoms, a stool test is a great way of just screening. I have always been an advocate that people should start in the uk, they start screening some people with a fit test, which is just a stool test at age 25. And I think in the US we should probably start doing that too, just like 25, 30, 35, 40 all the way up because people are being diagnosed with colon cancer earlier and earlier,

Jessie Wong (17:02): Especially for folks with family history of colorectal cancer, right? Yes, absolutely. Yeah, that’s great. And I was going to say something earlier to despite my mom having that history of having a cancerous polyp removed, my dad in his seventies still have not gotten a colonoscopy. I cannot get through to him. So we really need to do more advocacy work. Well, there’s the other side.

Dr. Carmen Fong (17:26): Yeah, there’s that other side of the coin. Oh my goodness.

Jessie Wong (17:29): Yes. So whoever is listening, don’t be afraid. And I will have to say firsthand colonoscopy experience is not painful at all. I wasn’t put down to sleep. I was half a awake. So it wasn’t painful, it wasn’t irritating. It’s kind of like you just watch something, go into your colon and then you’re done. I think the next time I’m going to do it, I don’t like the sedatives that we use, but I think next time I’m going to try doing it without sedatives, which is what my mom does because she has to do so many colonoscopies after the cancerous polyps. So she’s like, it’s really not that painful. It’s a little bit irritating, but it’s not painful at all. You might have something to say.

Dr. Carmen Fong (18:07): It’s not painful and it’s not irritating, but it is uncomfortable. And generally, I find that having a little sedative is useful if you can stay completely still and you’re not uncomfortable with the insufflation. And maybe if the colonoscopist is very good and is very quick without sedation is okay, but otherwise having some sedation, most people tell me it’s the best nap of their life. It’s like 15 minutes you’re out with the propofol and you wake up and it’s done. I haven’t had a colonoscopy, but I had my appendix taken out when I was in medical school, and they told me one second that they were putting something in my iv, and the next moment I woke up and my appendix was out, and really it was relatively a traumatic, so there’s that too. Okay.

Jessie Wong (18:54): Okay. Yes, yes. Whatever is most comfortable for you and discuss options with your physician. Yes, oh that is awesome. Okay. Well, next thing we want to talk about is of course, constipation, right? And how to improve constipation. So do you want to share with us your maybe three to five big tips that can be helpful?

Dr. Carmen Fong (19:15): So generally, my rules of thumb, rules of thumbs, rules of thumb are 25 to 35 grammes of fibre a day, which generally equates to fruits and vegetables at every meal if you can. That’s an easy way to think about it without trying to count everything. And the general recommended guideline is at least two litres of water a day, three litres if you’re very active, if you’re pregnant, if you’re in a hot environment. So I always tell people that if you’re pregnant, your circulating blood volume is 30% more. And so in those cases, having that extra litre is very, very helpful. If you’re really in a hot environment like Atlanta and you’re sweating a lot, you have a lot of excessive fluid losses. And so you really need to stay hydrated for the stool is to stay hydrated. Mobility and exercise is important. You don’t need to overdo it. (

20:05)And in fact, there has been some research that overdoing research actually creates a fight or flight response in your body and therefore actually stops your colon from moving. So a good moderate amount of exercise, everything in moderation, including moderation. So 20 minutes, 30 minutes, three times a day is totally fine. Walking, doing yard work is totally fine. Those are my top three rules. Now, when people start asking me things about sitting on the toilet, I start to say two to five minutes on the toilet max, if you’re straining any more than that, get up, walk around, do something before you come back. Don’t strain on the toilet. And then we could go on forever. I could talk about this forever, like magnesium supplements and medications and blah, blah, blah, blah.

Jessie Wong (20:47): Well, I don’t want to go back to talking about that. No streaming on your toilets. This is the part you need to send it to. Your husbands who are sitting on the toilets, scrolling on their phones and avoiding childcare or whatever else they’re doing.

Dr. Carmen Fong (20:59): Exactly for an hour. And I’m always like, who has time to sit on the toilet for an hour, not me?

Jessie Wong (21:08): And it can put more pressure. Well, that brings us to maybe the next point. And rectal health, why is straining and sitting on the toilet for a long time bad for your butts?

Dr. Carmen Fong (21:18): So in my practise between my partner and I, we see it between six to 8,000 butts a year. And so sitting on the toilet for long periods of time actually stretches out those perianal tissues. And so it causes more swelling, increases the hemorrhoid flare up, which haemorrhoids are just blood vessels in your anus that will swell and get inflamed with prolonged sitting with straining with activities such as cycling or even horseback riding or riding your motorcycle, for example. So haemorrhoids, but the other problem is actually fissures, which we see almost more than haemorrhoids if that’s possible. Haemorrhoids are the little blood vessels, but fissures are small tears in your anus that happen because Yep, yep. It’s probably one of the more painful things we see because people will see some bleeding and be like, oh, it’s fine, it’ll stop. But when they have pain, they will come in.

(22:12)And fissures are more often a source of pain than haemorrhoids. So haemorrhoids I usually tell people are painless bleeding or it’s a lump on the outside that’s painful, but not bleeding. But fissures are pain and bleeding because that cut is like a paper cut, like a sharp people would describe it as glass scabbing almost. And it’s from a tear that happens when the stool is too dry and it causes a crack in the derm or in some cases, even with diarrhoea, with frequent wiping, they can tear. So not sitting for too long on the toilet is important. Bowel hygiene is important, so making sure you’re not straining, not sitting for too long, wiping properly and not wiping over wiping can also cause tears and sometimes not sometimes a lot of times pruritus anai, which is just itching around the anus,

Jessie Wong (23:01): Well, getting a bit dates is very helpful. That’s not a very American thing, but all around the world, in Europe, in Asia, it is a very common thing. Everyone else in the world, people have a days. And so here I’ve started to say bide is the way, and if you can just buy yourself a bide as a Christmas present, it’s actually going to save yourself a lot of anal rectal problems.

Jessie Wong (23:24): Yes, and I tell some of our clients are very reluctant about, and I tell them, it’s like giving your butt a shower every time after you go to the bathroom. It’s the best feeling if you are actually, if you’re a fancier person, the total one is on sale at Costco right now, so it’s a thing you put on your toilet and you pluck it in. The Japanese ones is really fancy, so they washes your butt and then they have an air dryer that comes and blows it dry a fan.

Dr. Carmen Fong (23:52): I’m going to have to look that up because I said one day I would get myself a toto. Right now I actually have a couple of tushies in the house and a lux spa day, but I’m going to look that up.

Jessie Wong (24:03): Have a Lux B Day and AHI too, and they are so affordable for anybody listening, they’re like 30, $40 on Amazon. It’s not a big investment.

Dr. Carmen Fong (24:12): Hundred percent. I actually got a third one, which was called a big cow B Day on Amazon days last year just to try it. And it was I think $25 and it installed really easily and it works just as well as the other ones. So it’s very affordable. In terms of debunking myths, there were a lot of studies earlier on in the late 1980s, I want to say, where people said that people had more yeast infections and UTI from using BDEs, but it’s actually proven to not be true.

Dr. Carmen Fong (24:45): True. Yeah, I think people were worried that you’re spraying some bacteria into the front parts as well. But yeah, it’s actually proven to not be true. And for the most part, proper use of a bidet is only helpful.

Jessie Wong (24:59): Absolutely. And you were talking about Endo Fisher just now, and I want to say that we have a podcast episode with Dr. Andrea Love where she talks about her Fisher experience, and she actually went to three different colorectal surgeon before she found her colorectal surgeon, and that is episode 15. If you want to learn more about it, check it out. It’s so painful she couldn’t even see it. Dr. Carmen Fong (25:23): Oh, for sure.

Jessie Wong (25:23): Or just do anything without paying because it’s so painful. Dr. Carmen Fong (25:29): I was just going to say fissures are actually so common and people don’t talk about it because again, people are embarrassed. One of my very first TikTok reels was about what a fissure is and can Jessie Wong (25:39): You tell us what it is? Yeah.

Dr. Carmen Fong (25:42): And way back when I posted it, Megan Trainor actually reposted it apparently because she had a fissure. And so that one had something like a hundred thousand views. But because a fissure is a tear on the derm, I always explain it kind of like this, if this was my hand for the viewer is looking, if you squeeze who aren’t looking, if you squeeze your fist together, pretend that that’s your anal sphincter and the muscle is squeezing really, really tight and the crease is where your fissure is. And when it’s squeezing too tight, there’s no blood flow going to the anod derm. And so actually it can’t heal. And so a lot of the treatments that we do are to relax the muscle so that the blood flow can go back. And you can see when I relax my fist, the fingers pink back up, and so the blood flow can go back to that muscle and allow the fissure to heal. So that’s actually one of the reasons why I helped start bummed is that I have so many people on social media telling me that they can’t get access to a colorectal surgeon or a GI who knows how to treat fissures and haemorrhoids, or they just are like, oh, get a colonoscopy and kind of ignore the anal rectal part. And with bums, you can get personalised treatments like the compounding medications that I use in my practise just shipped to you, which increases access for everybody.

Jessie Wong (26:55): Can we talk a little bit about why fisure happen? What are the things that leads to people having teared fissures?

Dr. Carmen Fong (27:03): So having a muscle spasm at baseline. So some people will have a pelvic floor dysfunction where a lot of, especially in young people, stress is often held in your pelvis by literally squeezing your butt tight and you hold your stress in your pelvis. And over time, that muscle forgets how to relax. And because it can’t relax, every time you have a bowel movement, it tears the skin. Then once the skin is torn, the classically is near your tailbone side has very poor blood supply, and so it really can’t heal. And so the ointments that we use, like calcium channel blockers and nitroglycerin actually help vasodilation or improve blood flow to the anal area so that the fissure can heal. So things that make fissures worse, stress number one, straining on the toilet, diarrhoea, wiping too much, but then other things such as caffeine actually cause vasoconstriction, so causes the blood vessels to become smaller and decrease the blood supply to the anus again, preventing it from heal. So healing, so caffeine makes things worse as well, sitting for long periods of time. If you’re sitting in front of your computer for eight hours a day, all of that pressure on the derm doesn’t allow it to heal.

Jessie Wong (28:19): Oh my. Isn’t that crazy? It’s crazy. Well, one cup of coffee is okay, maybe just not like four to five cups. Yes.

Dr. Carmen Fong (28:26): I love coffee and I always tell people just you can have one cup. It’s just that if you have three or four cups and some people are like, then I drink a Red Bull or whatever, caffeine drink or a monster, those all can contain caffeine too.

Jessie Wong (28:40): I actually know some young people that might be beneficial to hear this because it’s very popular among younger adults and they don’t realise they have a fissure. They think they have a hemorrhoid. And the most common thing is they’ll come to me and they’ll say, Hey, I have a hemorrhoid. It’s been hurting for months. I put preparation H on it, and it’s not getting better. In some cases, some over-the-counter compounds actually make fissures worse because it thins the skin. And again, phenyl rine will cause vasoconstriction. Right. So what you think you’re treating is actually making it worse.

Jessie Wong (29:13): Yeah. Well, talking about endo recal health, we actually have a lot of clients who have had issues in the past. And this particular client I’m thinking of, her name is Kay. She’s a healthcare provider, so she works a really stressful job. And when she came to us, she’s already had 20 years of constipation and she’s had three endo rectal surgeries related to constipation. Fisher was one of them, endo, fisher, hemorrhoid, and also prolapse.

Jessie Wong (29:41): The rectum was falling out. And then of course, because of her persistent IBS symptoms, she was also put on diets and she became really afraid of food as well when she came to us. Now what we did is very simple. What you were talking about is really adjusting her lifestyle to help her find ways to relax actually the pelvic floor muscles, the abdominal muscles, and then also create routine that works for her to go to the bathroom naturally in the morning or maybe using some help with over the counter laxative. And two other things that are really important is increasing fibre intake, really hitting that 25 to 35 grammes of fibre per day and maintaining hydration. I think people really don’t, I mean hydration is really not talked about enough. And one thing too, we’ll talk about this in a little bit is too much fibre can actually backfire, but anytime you’re increasing fibre really need to increase hydration.

(30:38)So she came to us being very bloated, very afraid of food. When you’re very constipated, everything you eat will bloat you. The key is really to resolve the constipation and improve gut motility. And for her case, once we resolve the constipation and improve her gut motility so she could poop every day, she did not have any food intolerance. Now there are, yes, yes. It really is just resolving that constipation and then regulating motility and giving you tools to manage if symptoms do come back, how do we resolve the constipation, not the bloating or the severe gas. That usually happens with constipation. We can prevent them from coming back when you know how to assess your poop, is the volume that is coming out today a little bit smaller than what it should be? If you know what your normal volume is, then it’s a lot easier to assess, say, when do I need to intervene? Before even going to the doctor, you can do intervention yourself.

Jessie Wong (31:36): Am I drinking enough fluids? Am I eating enough fibre? Am I pooping enough every single day with IBSC patients? I do think that having a full evacuation every day is really going to help and preventing the symptoms from coming back. For normal people with constipation, you probably won’t have symptoms if you are just constipated for one to two days, and then as long as you have a full evacuation in a couple of days, you’re good. But for IBS patients, that full evacuations every day is very crucial to reduce the colonic spasm and the gut irritation. Yes, but not everyone has a food intolerance. That is the key. Right? Before you cut out any food, talk to your doctor first. Talk to a dietitian who understands gut health first. Yeah,

Dr. Carmen Fong (32:19): I love that. I mean, I totally agree. Some of it is just very, very simple. You do the optimal number amount of fibre and the optimal amount of water for your body.

Jessie Wong (32:30): Absolutely. That’s all it’s, and actually, it’s so funny, a lot of people come to us. We actually have a self-paced programme as well that’s really affordable. It’s only $49 a, but anyways, a lot of people come through our programme, we teach them how to calculate how much water they need. And sometimes people say, I thought I’m drinking a lot of water, but it turns out I’m not even meeting half of my daily need.

(32:51)And especially now that it’s summer, it’s very hot. You really need to up your hydration to improve gut motility. So something to think about. Oh, and we were talking about looking at poop, right? So for those of you who want to learn more about stool, we have a website called poop pd org for you to learn more about different types of stool forms and how to improve your stool consistency, whether you are constipation or diarrhoea or if you go back and forth between constipation and diarrhoea. And on prep org, we have a symptom tracker that you can download for you to track your stool to learn more about your symptoms. I love our symptom tracker because we talk about fibre as well and talk about hydration as well, because these are again, key to improving your gut motility.

Dr. Carmen Fong (33:39): Yep, absolutely. No, I love that. And I totally agree with, if you’re curious about poop, pedia is a great resource.

Jessie Wong (33:47): Yeah. We’ll put everything into our description so you can find the links there. Yes. And then debunking myths, let’s talk about some of the myths We see a lot, both of us on social media, and I will be honest, I’m really afraid of scrolling the for you page where these are people I don’t follow and they come out and say a bunch of crap and I just get really angry about it. So I think the first one we want to talk about, maybe talk about is gut microbiome testing, which has exploded in popularity. You see ads of it everywhere, even in the professional.

Dr. Carmen Fong (34:22): What do you think about those?

Jessie Wong (34:24): Oh, I think it’s a complete waste of money. So we had an episode on the IBS Nutrition podcast with Dr. Andrea Love episode number six. I think it’s number six, but go find it. She explains it so well. She’s a scientist, she’s an immunologist and she’s a scientist and she is an active voice in debunking myths.

(34:48)And a few things we talk about that we really want people to know is that while it can test what it can give you an accurate picture of what microbes are in your stool, that doesn’t mean a complete representation of what is in your GI tract because some of the bacteria a better at populating and shedding themselves via the stool to infect another person, right? That’s like e coli, that’s like listeria other things. But then there are also other microbes who are maybe better at adhering to your GI tract that doesn’t get shed. So testing, just your stool is not a complete representation of what is actually in your GI tract. So that’s one. Number two is our gut microbiome or our skin microbiome. It’s constantly changing depending on what you’re eating, what you’re drinking, what you’re doing, even exercise and even hormones, right? Normal hormonal changes affects your gut microbiome or skin microbiome.

(35:44)So testing it at one time is really not going to give you any good picture by the time you receive the results. It’s probably changed already, and we don’t understand how much of it is changing, what is more consistent. And we also don’t have the population data to say that, okay, people in this region have more of a gut microbiome like this. People in a different region have different sets of gut microbiome rights, but we just don’t have that complete picture of what is normal for this region or what is normal for this ethnicity or population that eats more of these food and what is good in these reports and versus what is bad in these reports are not well studied, we just don’t understand. So again, having data on what your stool microbiome looks like, maybe an interesting read, but is it useful? Absolutely not. Nothing we can do to, there’s not a whole lot we know about how to change it. Now, we do know consistently about how to improve gut microbiome, and that is by eating a wide variety of plant-based food.

(36:53)I would say I think for the longest time we talk about 30 different types of plant foods, but then when you look at the American Gut Project, it’s like why is it 30? Why is it not 25? Why is it not 35? And then where’s the cutoff? I think what they have is zero and 30 or maybe 10 and 30. And it’s like, well, where’s the cutoff? But then we know variety really matters. We don’t know how much or how little, but we also know daily fibre intake really matters that 25 to 35 grammes of fibre. Now, if there’s one day you’re not hitting your fibre, go, it’s fine, chill. Just increase your variety, increase your fibre the next day your gut will rebound. That’s how resilient our body is.

Jessie Wong (37:32): So that’s my take. What is your take on the gut microbiome testing?

Dr. Carmen Fong (37:36): I think I’m like 98% with you on this, and I totally agree. A lot of the data is from that we know is not population based. I think that’s the largest problem. A lot of the companies that will do a microbiome test are just comparing you to other people who have tested with that test. And so there’s already some introduced bias there because it’s like people who are like, oh, I have GI problems are going to take the test. Or people who are like, I’m curious about GI problems. I’m going to take the test. And then when they compare you to that population, the useful thing I think is that they are able to say, Hey, a lot of people who are reporting IBS symptoms in this population also have a deficiency in physi bacteria or increase in bactes or something like that. But that thing is almost assumed.

(38:26)So it’s like if you want verification of that information, then maybe you can pay $300 for that test. That’s what I think. Now, the other 98% where I agree with you is that a variety of plants and vegetables or plant-based diet is a hundred percent the way to go. And when people say, eat from the rainbow, I just teach my kids that now it’s no matter what you do, eat every colour of the rainbow as much as possible. And having that variety already introduces those prebiotics into your gut and helps with the growth of good bacteria. The 2% where maybe I don’t agree is that maybe this is the best representation we have for people right now. I wish that people weren’t taking advantage of this and of people’s interest in gut health to say, here, pay $300 for a test. If eventually we can have colonoscopies that biopsy the gut mucosa, and then we would have, and in some studies they have where they biopsy the gut mucosa, and then you compare that microbiome to your stool microbiome. And we know that that’s different. And exactly for the reasons you said, which is that some of the bacteria are shed and some of them are not. Those are the gold standards that we’re comparing everything to. And I think that as long as we keep that in mind, there’s maybe that 2% value in doing microbiome,

Jessie Wong (39:47): Right? Yeah.

Dr. Carmen Fong (39:50): Yeah, I was going to say $300 is on the lower end of what we are seeing. I think people come to us, they’ve paid thousands of dollars for those tests.

Dr. Carmen Fong (39:58): I think the earlier ones were thousands of dollars, and now I feel like they’re becoming cheaper and cheaper and it’s going to be the COVID test and eventually it’s free. But eventually it’s gathering your personal data, right? Exactly. It’s just gathering your data. But it’s kind of funny. I think that another point is that you think I would take, we’d be more cautious with companies that take this data and then try to sell you a product because then they’re like, Hey, you need this probiotic, or you need this digestive enzyme, or you need this vitamin. That seems kind of sketchy to me. Now, my question to you is, I know what I prefer in terms of probiotics, and I know your feelings towards probiotics, but are there any probiotics that you recommend?

Jessie Wong (40:41): There are some evidence-based ones. I’m not going to say the names, but of course we know things like LGG. We actually had an episode, episode 17 with one of my colleague, her name is Bailey Hannah, and she developed a database for looking at the evidence on probiotics for IBS. It’s got i ibs probiotics.org. I think that’s website. But go listen to the episode first.

(41:08)And there are a lot of interesting things that she shared about supplements and probiotics in general. I think one of them that was kind of mind blowing is that one of the third party testing companies told her that they tested, they once tested a batch of probiotics and found that the company used something else. I think it’s a polyphenol with the probiotics and that polyphenol also have antimicrobial properties, and that just killed the whole batch of the probiotics. So my feelings with probiotics, and of course we see so many people taking probiotics and having nonstop diarrhoea running to us, it just breaks my heart. You spend so much money, you are in a state of you’re not better off and things get worse and worse and you are losing weight. You don’t know why. And then sometimes they may not tell their physician they are taking a probiotics. So my feeling is yes, there are some that can be helpful, but we have to target the right string with the right symptom, and not even just the right string. It has to be the right product. They might add sketchy stuff in there to be like, oh, we have polyphenol, we have ole acid or omega asset added. Everything is included where they include so many things. It really adds

Dr. Carmen Fong (42:19): Variability

Jessie Wong (42:21): To the product. Instead of adding more benefits, it’s really making the product less stable. And there’s another website, it’s called US probiotics charts that one also look at researches by gastroenterologists and pharmacists. They look at research, they match the right strain to the right condition. There are problems with these websites is that they don’t tell you how long you should take it for, and oftentimes you don’t need to take it for a long time for a quick adjustment. So there are things that we recommend like LGG, it prevents antibiotic induced diarrhoea. But then also we also want to think about when we recommend it is, is it going to cause more drug resistant microbes in the future? Do we want to use it together? I think that concern have made us change our policy. In the past, we would recommend a probiotics, one that is helpful with antibiotics alongside antibiotics, maybe taking it at a different time. But if there is an increased risk of drug resistant microbes

(43:22)From the use, the combination use, then we are doing more harm. So we actually changed our recommendation to after you’re done with the antibiotics, then take it for a few days to help readjust. But of course, the research is ongoing. We just don’t know. And with probiotics, we don’t have long-term safety data. That’s one of my biggest pet peeves before recommending anything. We don’t know what it’s going to do. We know that it really doesn’t change your gut microbiome in the long term, but we don’t know what it’s going to do. And we know with faecal transplant that sometimes that sometimes can transplant diabetes or transplant depression to people. So there’s just so much we don’t know in the realm of gut microbiome, and we have to be very careful. I want to tend to be more conservative in my recommendation, unless I know very clearly yeah, what we are doing.

Dr. Carmen Fong (44:14): Yeah.

Jessie Wong (44:14): I agree. What are your thoughts on probiotics?

Dr. Carmen Fong (44:18): No, I mean I totally agree with that. And I think we had this discussion once you and I where I agree that we have to target the right strain with the right symptom. And then I think that one strain that doesn’t work for somebody might work for somebody else. And my usual counsel is that if one strain doesn’t work for you, try a different one or try a combination of them. And sometimes the right variety of strains is going to help your constellation of symptoms. So I usually tell people not to give up because there is enough benefit of a probiotic in your gut, but also in the mind gut connection that you’re talking about with mental health and with autoimmune disease and with cardiovascular disease that I think that there is going to be a potential benefit in the future. So targeting the right strain or a right variety of strains is helpful. And I use the US probiotics website, and I’m always very, very surprised when I look at it and I’m like, wow, a lot of people think that they’re eating this one type of yoghourt that has this one strain in it, and therefore they think that all of their GI problems will be solved when that’s not actually true because it might be the wrong strain for you or just the wrong strain in general. Because a very standard strain, for example, and we actually hear this quite often when it comes to IBS, because we would have patients going to multiple different dietitians before coming to C us, and they’ve been recommended probiotics for IBS. Now the ones that they recommend was evidence-based for IBS, but the patients have diarrhoea, and that actually was a multistream one that has evidence for constipation, and it actually made her diarrhoea worse. So with IBS, I would be cautious.

Dr. Carmen Fong (46:03): Yeah, hundred percent. That’s a good point.

Jessie Wong (46:05): Yes. Let’s talk about the next myth that we want to debunk and I have here on the list is food sensitivity test. What are your thoughts on them?

Dr. Carmen Fong (46:18): So I mean, I would say that generally you would have to rule out almost everything else before you subject yourself to a food sensitivity test, which we kind of talked about earlier. You want to make sure that your fibre in your water or in order your daily activity is in order. And if all of those things are still, I mean all of those things are in place and you’re still having GI issues or IBS symptoms, then definitely have a food sensitivity test. But I would say the majority of people actually do not have a food sensitivity, and therefore you don’t really need one.

Dr. Carmen Fong (46:55): You can tell me because I know that there’s gluten sensitivity, which a lot of people will tell me that they’re gluten sensitive without actually diagnosed with gluten sensitivity. And I’ll usually explain that. Well, okay, if you’re eating bread or pasta all day long, you’re probably going to get loaded no matter what. Because that’s how your body digests those complex or those both simple and complex carbohydrates is that there’s gas producing bacteria, you’re going to produce gas and then you’re going to have to pass gas before you poop. And that’s just how it works. And people are like, oh, no, bagels do it, but pasta doesn’t do it. And so I’m just like, yeah.

Jessie Wong (47:36): So I’m going to quote the statement from American Academy of Allergy Asthma and Immunology. So food sensitivity test is using IgG to test your food levels. So this is different than food allergy or food intolerance. Actually, the episode I did with Dr. Andrea Love, we dive deep into the research and into why as well. So for anybody interested in learning more, go check out episode six with Dr. Andrea Love, but with food sensitivity when they are using IgG as a test. So I’m going to read it directly from their website. So unfortunately, no single test exists that can give you this answer whether you have a sensitivity or not. And it’s different than food intolerance. So what you were talking, it’s gluten intolerance that’s different.

(48:27)And then a test that claims to be able to diagnose food sensitivity and is commonly available is the food IgG test. This test offers by various company reports IgG level to multiple food, usually 90 to a hundred food with one single panel test, claiming that removal of the foods with high IgG levels can lead to improvement in multiple symptoms. Some website even reports that diet utilising this test can help with symptoms of irritable bowel syndrome, autism, cystic fibrosis, rheumatoid arthritis, and epilepsy. It is important to understand that this test has never been scientifically proven to be able to accomplish what it reports to do. The scientific studies that are provided to support the use of this test are often out of date in non reputable journals and may have not even used the IgG test in question. So the presence of IgG is likely a normal response of the immune system to exposure to food. In fact, higher level of IgG four to foods may simply be associated with tolerance to those food.

(49:44)So it’s really something we don’t recommend. And we have seen so many people come in crying to us with that test result hoping that we can help them implement the diets. And the first thing I say is throw it into your trash. Because what really happens is the food that you eat the most will have the highest score that you can’t eat them moving forward. And it could mean that you are tolerating it, your body is making more of the markers to say that you ate more of these foods and we need to digest it. So I’m I’m probably a no on this one with food sensitivity, but there are, sensitivity is different than intolerance with intolerance

Dr. Carmen Fong (50:27): The listeners out there, so you’re saying that we can diagnose food allergies, we can’t diagnose food sensitivity, and then people can have symptoms of food intolerance without it being a diagnosis. Right.

Jessie Wong (50:41): And the most common intolerance, of course, is lactose intolerance, and then FODMAP intolerance and lactose is actually one of the FO maps. And then also gluten intolerance, which is sometimes we see, and sometimes these are people who don’t have celiac disease or gluten allergy and they’re intolerance to gluten and we call the clinical diagnosis is non celiac wheat sensitivity in the past, in the US it’s called non-celiac gluten sensitivity. But because we don’t fully understand which part in wheat triggers symptoms, we think gluten probably trigger symptoms. But there might be other players in wheats like a TI that could trigger symptoms as well. So that’s another intolerance we actually see a lot of in our clinic as well.

Dr. Carmen Fong (51:26): So I guess maybe when the confusion comes in, because that’s an intolerance, but it’s called sensitivity,

Jessie Wong (51:32): I think the name is used interchangeably, but the sensitivity that these tests are claiming are not real sensitivity.

Dr. Carmen Fong (51:40): Right, right. Yeah,

Jessie Wong (51:42): It’s so confusing.

Dr. Carmen Fong (51:44): That’s where the confusion comes in for sure, because calling it gluten sensitivity, but it’s really intolerance,

Jessie Wong (51:50): An intolerance, and it’s really important for patients listening to understand what you actually tolerate and not tolerate instead of cutting out food. Because a lot of the times we see patients coming in, cutting out gluten, cutting out dairy, and then cutting out fault maps, which is five different, well, five primary different food groups. And that is a lot of fruits and vegetables. People are cutting out and their symptoms are not improving because they don’t know. Well, one is for those people who are doing these elimination diets by themselves, they’re probably not doing it correctly. They’re cutting out things that may not need to be cut out or they’re cutting out too many, not enough, or just not doing it Right.

Dr. Carmen Fong (52:28): No, I think that’s a really good point. I think that kind of leads to our next topic, which is kind of low FODMAP diets, but I guess that’s just so interesting because there’s really no test for it for the intolerances. So it’s really kind of trial and error by cutting out certain foods and doing it properly.

Jessie Wong (52:44): Right. Doing it properly is very key I think. Well, we want to talk about various diets, right? Let’s start with the loam diet. It is very common for IBS to be recommended the loam diet and sometimes before medications, but most of the time without recommending to a dietitian, thefor diet is extremely complex.

(53:04)There are three steps when it comes to the loam diet. One is elimination, and it’s usually only two to six weeks. And oftentimes we see people who have been on it for months or for years or for years. And like we talked about earlier, right? Variety of plant foods is so important. And when it comes to the diet, you’re cutting out a lot of plant foods. We’re talking about apples, peaches, watermelons, whatever. I’m thinking of things in season. Pears. All of the fruits basically. And then also some berries, tomatoes, avocados, and wheats in general, not fermented wheats. Fermented wheats are okay, but then it, it’s just a lot of food. Mushrooms, oh, that’s one of my personal favourites. And be like, I can’t go without eating mushrooms, but you’re cutting out so many foods and when you cut out so many foods, it’s going to impact your gut microbiome.

(53:56)Now the key is not to panic if you’ve cut it out, the key is to reintroducing them in a systematic manner so that you know how much of it you can tolerate. Usually with the low format diet, it’s not like you have to cut everything out. It really is to understand what you tolerate and how much of it you tolerate and that eat the amounts that you tolerate and don’t trigger symptoms. So that’s also a little bit different than gluten intolerance as well, because gluten intolerance is usually a gluten-free diet. There’s no amount of gluten is allowed, but low FOM map diet is low FOM map, so you can still have some, but the keys to low that amount, yes. And the testing process, and most people don’t understand the testing process. It’s very systematic. Usually we only do one thought map groups a week, and you test it over three days. And there are specific amounts of the FOM map you have to eat. I’ll use excess fructose as an example. So you can choose multiple foods that contains a lot of fructose, right? Fructose intolerance is a thing. And then mango is usually my favourite to tell people to do, or maybe asparagus on day one. You start with one asparagus. So there are a specific amount of thought maps in there that is fructose in there. On day two, I think it’s two to three asparagus. And then I think on day three is five asparagus. Okay? This is rough estimate. But then by doing this, you can do asparagus or mango. By doing this, you actually know how much fructose you can tolerate, and then moving forward, you eat amounts you can tolerate. So you can eat mangoes again, you can eat watermelons again, and you can eat other fruits that are higher in fructose. And yes, and you don’t have to cut it out forever, but the key is really to know how much you can tolerate The third step, well, the third step of the low diet is to personalise a long-term diets that allows you to eat the most food that you can tolerate. So really liberating people that you can eat out again. And you can probably eat that dish with a little bit of onion in there. Don’t eat, have an onion in one go, but if it’s one fourth onion, you’ll probably be okay. You can take a few deep breaths, not to worry so much and eat the food that you love.

Jessie Wong (56:11): And I think people, when they are handed the low diet, it’s like, oh, I have to cut out these foods. Some people are, I’m not doing this. And that’s okay if you don’t want do it. And then some people look at the list, they really focus on it and start cutting out food. And then if their symptoms still persist, they’re like, I’m going to cut out more food. And sometimes by the time they come to us, they’re eating five foods that they feel safe eating and that is not a good place to be. And it’s really bad for your gut microbiome.

Dr. Carmen Fong (56:39): That’s a very, very good point. I have patients who come in and tell me, yeah, I can’t eat onions, I can’t eat oatmeal. Onion is a very common one. Obviously that’s in the thumb milk group. But also one of my personal favourites is actually cherries, but I always use cherries as an example because it’s high in fructose because of the bacteria fermenting. It does cause a lot of gas in your belly, but you can eat a handful of them. But almost anybody eating an entire bag of cherries is going to have explosive diarrhoea

Jessie Wong (57:12): No matter what and who you’re, yeah. Cherries is actually one of the stone fruit groups. They have two types of thought maps. They have the fructose and they also have the sorbitol. And of course we know sorbitol or any of those ols, they will cause diarrhoea if you eat too much. But the key is to eat the amount that you can tolerate so that you don’t have those symptoms. Yes, I love, well, it’s cherry season, especially if you’re in Washington. Yeah. Okay. Well, we also want to talk about various diets that may not be the best for people. I just talked about low fat. Do you want to maybe talk about too much fibre? There are diets that can cause that symptoms.

Dr. Carmen Fong (57:54): I would start with actually too low fibre. So a very, very common scenario was they’ll have someone come in and say that they’ve been on a diet, they started a keto diet or a paleo diet. So it’s mostly going to be protein, right? Because trying to lose weight, you’re trying to build muscle. So it’s high protein, high fat diets. Some cases with the keto, you’re eating butter. And then paleo diet, which is very carnivorous like mostly meat. And so suddenly you’re too low in fibre because fibre is technically a carbohydrate. And people believe that all carbohydrates are bad. And so they come in and they’re constipated because they’ve haven’t had any fibre for six weeks. So that’s a pretty common scenario. And I’ll gently reintroduce the fibre. A lot of people will be like, oh, I love broccoli and sweet potato. I always go to broccoli and sweet potato because it’s easy to get, easy to make, just start eating one or two of those a day in your diet.

(58:47)But then on the other hand, the too much fibre I, it’s rare, very rare, but once or twice a year, I’ll have someone come in and be like, well, if a little fibre is good, more is better. And so instead of 25 to 35 grammes of fibre, they’re tracking it. They’re going up to 50, 60 grammes of fibre a day. In some cases eating these very high fibre cereals, that fibre will actually, so I always tell people, fibre with without water turns into concrete in your colon. It really needs that water to be absorbed and to wash it out. So when you have too much fibre, you could have a fibre stool ball, which I have also seen in my practise. And that can land you in the hospital because you need a faecal impaction or a very thorough clean out.

Jessie Wong (59:36): So more is not everything in moderation, right? Moderation is really key.

Dr. Carmen Fong (59:41): Yeah.

Jessie Wong (59:42): Okay. Yes. Alright, well, talking about that, let’s talk about another topic that is very popular detoxes. What are your thoughts on them?

Dr. Carmen Fong (59:51): Yeah, I think it really depends. I think that you can do a safety detox, but I never recommend just doing a juice cleanse or anything like that because I do think you need to have the nutrients, you need to have the bulk. You can’t just drink a green juice cleanse for six days. On the other end of things, kind of pun intended, I usually don’t recommend a colon cleanse of any sort. So doing a colon cleanse is usually not great for the colon mucosa and it’s also bad for the microbiome. So yeah, so actually it’s actually called colonic hydrotherapy where some people will go into a place that does a colon cleanse and they inject like 60 litres of water into your colon via a tube and wash out the entire colon content and suck it all back out. And this is supposed to help people lose weight, have better skin.

(01:00:43)This is actually in my book that I wrote in the chapter debunking Myths that there’s actually very little evidence supporting colon cleanses and for your health. And so I don’t usually recommend that people will ask me, oh my gosh, you said in your book never to do these. I did this once. Did it mess me up forever? If you did it once, it’s probably fine. It’s not going to mess up your gut and your microbiome and the mucosal lining forever. But if you told me you did it every week or example, or even every month, I would say pretty much stop doing that because your body is meant to clean out your stool naturally by eating a variety of fruits and vegetables. By drinking plenty of water, you should not need to do a colon cleanse.

Jessie Wong (01:01:23): And colon can increase, can put people at risk of even death if you get an infection or perforation of your colon. So if there’s tear in your colon, it can cause the bacteria from the colon to go into your bloodstream and that can kill somebody.

Dr. Carmen Fong (01:01:37): So very rarely seen that there have been cases of sepsis from a perforation after a colonic cleanse.

Jessie Wong (01:01:45): Yeah. Okay. Well, I’m glad we talked about that. Okay. I think last thing is intermittent fasting. Oh my goodness. Because people know that I’m a dietitian, if they’re on any kind of diets, they would come say, Jesse, I’m on this diet and I feel great. And lately, a lot of the times it’s been intermittent fasting and that’s something I don’t recommend, but let’s have your take on it first.

Dr. Carmen Fong (01:02:06): I am with you. I actually don’t recommend it. My work partner a few years ago in New York City actually started doing intermittent fasting and we would be together in the OR during the day and he was so grouchy because he wouldn’t eat all day until 8:00 PM and I’d be like, please, dear God, eat something. Because when you’re hungry and your body is starved of glucose, you actually get some mental fog. You do get some emotional liability and stuff like that. And I was like, please, dear God, just eats something. But he would be like, oh, but I lost 15 pounds and so therefore you’re going to keep intermittent fasting. And as colorectal surgeons, I’m pretty surprised. So there maybe are a few benefits to it. Again, not having the glucose spike and for example, in some weight loss and stuff like that. But there are definitely a lot of factors that make it a, it’s almost very difficult to do intentionally. At least B, if you’re not eating all day, you also can’t poop, right? So because you don’t have that obvious food bolus and the food load. So I don’t love that for your GI health and your constipation. And C, it really, I think that the low blood sugar is a worse symptom than any kind of potential benefit you could have. So I usually don’t recommend it. If you’re doing it, I’ll be like, oh, that’s great. How is it working for you? But if it doesn’t work for you, then go back to eating.

Jessie Wong (01:03:34): Normally we actually have a lot of clients who have tried that because there are myths on the internet that says intermittent fasting is good for ibs. Well, anytime you’re not eating, if you have a food trigger, then you might be feeling better. But it’s not the intermittent fasting costing it. I really don’t recommend it, especially for anybody with constipation is especially if you’re skipping over breakfast, breakfast is when your gastrocolic reflex is the strongest. And that’s when you have food in your stomach and your stomach sends a signal or you bring sense a signal to your colon to say, Hey, there’s food coming. You need to go to the bathroom that is the strongest in the morning. And if you miss your breakfast, that can cause you not to poop for the day. And then it will make your constipation worse and the nose falls into a lot more issues down the road like fisher or haemorrhoids or other things.

(01:04:22)So that’s number one, why I don’t love it. Number two, as a dietitian who really embraces and intuitive eating, eating when you are hungry, eating as culture, eating with families and friends when you have so much restriction you really cannot eat normally cannot go out with friends, maybe have a breakfast, a brunch or coffee, or if you’re cutting out food at night, then it’s dinner parties. That’s really difficult to live a normal life. And then number three, this is probably my least favourite thing about intermittent fasting. It’s like what you were saying, you are grouchy all day. It may or may not be the low blood sugar level because I do think your body adapts to it and maintains a normal level. But if you are only allowing yourself to eat in a very small window, what happens to the rest of the day? You are probably just going to be thinking about food all day long window. So are causing yourself to have an eating disorder. Well, not completely eating disorder because that’s clinical, but disordered eating behaviour because you are eating your calories at that allowed time. You are overt stuffing yourself. You are overt stuffing what you are probably GI tract can deal with at one time. And we know that for weight loss, it really doesn’t work long term. People experience initial weight loss and it actually balances out. And we know perfectly why that happens because your body will not allow you to die if you continuously have a deficit, right? Your body will compensate in one way or another. It will tell you to eat more in that time that is allowed, which really can be the beginning of binge eating disorder. And then number two is it will slow down your metabolism to compensate for the loss of calorie to maintain your body. So I really tell people don’t go the intermittent fasting route. And it is actually quite disappointing to see healthcare providers promoting that on social media and make it their personality and only talk about the good side of it and don’t talk about the best side of it because we know per research, it’s not helpful for long-term for weight loss especially. And we don’t talk about the fact that it can cause eating disorder and disorder. It’s eating. And again, I think this goes back to the diet culture, right? Weight loss is good for you, your body. You should be in a smaller body no matter your genetics and your forcing yourself. We are doing all these awful things to our body to try to be smaller, to try to fit into the diet culture narrative of your body should look like this when in reality we all just come in different shapes and sizes and we can be healthy

(01:07:01)In different shape and sizes. The goal of improving health is different than reducing weight. Reducing weight a hundred percent. No, I totally agree. That’s why they say breakfast is the most important meal of the day. But I do believe in people getting hangry though. I do think that’s a thing. Jessie Wong (01:07:18): Oh yes. If you are constantly thinking about food, you are not going to be in a good mood. You are hungry. And that’s really the beginning of potentially an eating disorder down the road, thinking about food all the time, creating different food rules you can’t eat at this time or you can eat over that much. In reality, if we don’t restrict, we don’t think about it as much. And we have a normal relationship with food. We’re talking about this. This is not quite the right topic, but my kids being a dietitian, we always, or being a healthcare provider, we always want our kids to be the healthiest when they grow up. And I’m probably one of those parents who restricted my child sugary foods and it was mostly my firstborn because I didn’t know better as a parent. And I would say, it’s not good for you. It will cause two decay. And of course the dentist tell you that and then you hear it from everybody else too. But can kids stop eating sweets? They cannot stop eating sweets when it is abandoned. When it is a treasure food, it makes it more precious and makes it want them more. And what ended up happening was my kid, I think three years old, I would find wrappers around the house. She was eating it somewhere else. So I didn’t know.

Jessie Wong (01:08:34): So I think I learned a huge mistake when you are making a food, a priced item or when you are restricting yourself to eat the food, you actually want it more. So when you are restricting, even time restricted eating, you want it more. And that in turn can make you a less pleasant person to be with because you’re so consumed about thinking about food or waiting for your window to eat food. Whereas my second kid, she has such a great relationship with food. She would open the fridge or go to the pantry and she would take a chocolate bar. She would break it into the size that she wants, like a tiny bit. She’ll eat it and she’s done. If you crave something, go eat it and be done with it. Yeah, have a little bit. And for her, she knows how much is enough for her. She’s not going to overstuff herself. Whereas other kids who are in the more restrictive mindset, right, they will seize on the opportunity when they can eat it and stuff themselves even to the level of discomfort because it’s not something they can have access to. Well, that’s kind of off topic here. It’s something I have very strong feelings about and really not causing that restriction unless for people who actually have food intolerances, because it’s so hard when people are eating certain things and they cannot eat it because it’ll give them symptoms. So setting those boundaries and knowing what is healthy and what can be harmful for your mental health.

Dr. Carmen Fong (01:10:02): Yeah, I love that. I think that’s great and so important to talk about. And obviously you and I could talk all day. I always like to tell the story of one of my best friends in college. I love her dearly, but as a child, she never got to have sweets in the house. They basically ate barley soup all the time and salads without salt or sugar. And so when we got to college, she would buy these giant sized packs of Oreos and eat the entire thing in one sitting, but then have to hide it under her blanket or hide it under her bed and not show us that she was eating Oreos. And we didn’t realise until we were older that this was such a disordered eating problem. But now obviously we realise it. And looking back, I’m like, wow, that really was the cause of her disordered eating. And so I am probably one of the less restrictive parents that I know, and I let my kids eat whatever they want. Even pizza, fries, ice cream, but in moderation as much as possible with children. But sometimes you really can let them get a giant pile of french fries and when they’re done, they’re done will stop at some point and then when they get sick it, they’ll move on to something else. But if you never let them have it, they’re going to eat. They’re going to want it forever.

Jessie Wong (01:11:19): Exactly. When they get sick of it, they will stop. They know their body, right? And one time I went to Costco, we got this giant tub of jelly beans, and my kids absolutely wanted this 10. This was during the pandemic times, not when everything is so expensive nowadays, but I was thinking in my head, do I want them to eat that giant tub of jelly beans? But then also in the back of my head, I know they’re going to get tired of it pretty quickly. And this big a tub, they only ate one centimetre and they were done. And I think that was the turning point, I think for my older kid to realise that she doesn’t need all that sugar. She doesn’t love it, she doesn’t like it. I know. And I really let go of my own control and be like, you know what? We have all these sweetss in our pantry, eat whatever you want. And they’re not going to eat it. They don’t care.

Dr. Carmen Fong (01:12:06): I know when they’re done, they’re done. I’m actually always very surprised if I give them a pile of chocolates if they don’t want it anymore. They just put it down and walk away and they’re only one and two and they’re already doing that. So you have to trust them and trust yourself. Yes.

Jessie Wong (01:12:21): Oh my God. Okay, let’s end it on this note. Trust your body. Know what makes you feel good.

Dr. Carmen Fong (01:12:27): Love that.

Jessie Wong (01:12:28): Advocate for better health. All right. Thank you so much, Dr. Fong.

Dr. Carmen Fong (01:12:31): Well, of course. Thank you so much for having me.

Jessie Wong (01:12:33): Hey friends, I got something really cool for you. I want to give you free access to my signature self-paced IBS course. This is the course we use to guide our clients through the three steps IBS freedom approach. It includes over a hundred low format recipes, meal plans, and systematic format reintroduction schedules. You can learn more about the course on ibs dietician.com/ibs-freedom. All you have to do to get access is to leave me a review of this podcast on Apple Podcast or Spotify. Take a snapshot of it and send it to me at info@ibsdietician.com, and we will get you set up with access. Thank you for tuning into the IBS Nutrition podcast. We hope today’s episode has brought you closer to understanding and managing IBS. Remember, you are not alone on this journey and finding freedom is possible for more on IBS. Make sure to follow us on your favourite podcast platforms and please leave us a five star review. We would really appreciate that you can access links mentioned in the show notes to learn more about your type of IBS and how to identify your own food or lifestyle triggers. Register for a free IBS masterclass, three steps to IBS Relief for our proven holistic three steps approach to managing IBS once and for all. Head to ibs dietician.com/masterclass to register. Until next time, take good care of your gut and here’s to your health and happiness.