Aidan
00:00:10 – 00:00:39
Hello and welcome to The Ideal Nutrition Podcast. I am Aidan Muir and I’m here with my co-host, Leah Higl. And this is now episode nine and today we’re gonna be talking about what to do if FODMAPs don’t work. So, pointing out the obvious or what to do if the low FODMAP diet doesn’t work. So, to point out the obvious, as we said in a previous episode, so far it seems to work for about 50% to 80% of people with IBS. The obvious point there is…
Aidan
00:00:39 – 00:00:59
There is a percentage of people 30% to 50% that it doesn’t work for. So, what is the next step if you have tried some of those frontline treatments, maybe not all the way, but then have gone on and done the low FODMAP diet and you still experience symptoms? What is the next step? So starting with you, Leah, what are some of the things you’d look at first?
Leah
00:00:59 – 00:01:40
Well, first things first, because low FODMAP diet is kind of considered the gold standard for IBS treatment. I would also be considering, like, what was that person’s compliance to a low FODMAP diet because that can be really important as to why it may not work. For some people, the low FODMAP diet is something that is really difficult to do and generally people do need a fair bit of guidance and help through that process. So, you know, what was their compliance like to the low FODMAP diet during that elimination phase? And were they doing it in a way that actually would reduce symptoms? So that would definitely be the number one thing I would look at.
Aidan
00:01:41 – 00:02:19
It’s very 0 to 100 as well. Like I said this in a previous podcast as well. But it’s kind of like, it took me like, two years to be comfortable with identifying most foods in terms of being that’s low FODMAP, that’s high FODMAP and then kind of guessing amounts and stuff like that. If you have just learned about the FODMAP diet and have tried to implement it, from the moment you’ve talked about it, it’s very unlikely that you’ve nailed things right off the bat. There’s a solid chance that something has been messed up. That’s not to say that’s what’s happened. It’s just like statistically speaking, that is, that’s a good chance to happen unless you’ve spent a long time learning about FODMAP first.
Leah
00:02:19 – 00:02:51
Yeah, that’s a good point because it’s not even compliance from the point of “Oh, I just didn’t feel like doing it this day”. It’s accidental in many circumstances, so even when it comes down to oh, you have a really great understanding of what is a low and high FODMAP food, which takes a really long time firstly. But then you’ve also got the serving sizes to worry about. So, some foods are low FODMAP at lower serving sizes and then high FODMAP, higher serving sizes and all that nuance can be really hard to understand.
Leah
00:02:51 – 00:03:30
So for a lot of people in practice, I do put them on like meal plans, because for a lot of people, that is easier when they know, you know, exactly what they need to eat. Um, as opposed to going it alone. So, I would definitely be looking at compliance to that plan. Um, I think something that fits into that as well is like this social life aspect of being on a low FODMAP diet, so you’re just not able to dine out for the most part, um, so it really does take away your ability to be social because food is such a big part of how we interact as humans. So, there’s definitely that, and that feeds back into compliance.
Leah
00:03:31 – 00:04:04
Another thing I would be looking at specifically in my own practise working with a lot of plant-based people is that maybe they followed the plan, I mean, the low FODMAP diet quite well in terms that they’re eating all low FODMAP foods in the right serving sizes, but they still have these symptoms. So, if they’re just eating a really high amount of plant based foods, even though they’re low FODMAP, that can build up with their total daily intake, um, and therefore not reduce their symptoms to the point of being non-existent almost.
Aidan
00:04:04 – 00:04:32
For sure, and something you touched on previously as well in another podcast was you can go too high fibre like if you have a lot of fibre, gas and bloating are not uncommon. They’re often going to go hand in hand with really high fibre diets. And there’s a line I heard from Lane Norton very early on, before I learned about FODMAPs and stuff like that. He was talking about bodybuilders classic diets, like chicken, broccoli, brown rice kind of meal, trying to get really high calorie intakes on those kind of foods,
Aidan
00:04:32 – 00:04:58
and then replacing some of that with pizza as an example, just some of this really calorie dense and low fibre. So, taking the broccoli, which is really high fibre and a ton of food volume and just taking it away for something like that, it’s like maybe someone in that position could get caught up looking at FODMAPs and stuff like that when maybe it’s simpler than that. Maybe it is just overly high food volume and high fibre at the same time as well.
Leah
00:04:58 – 00:04:59
Totally.
Aidan
00:05:00 – 00:05:43
The next point I want to talk about if FODMAPs hasn’t worked is another kind of obvious one, but stress and anxiety and mood and how it all links into this kind of topic. So, there is a gut brain connection, our brain and our gut communicate with each other. Our brain communicates to our gut, obviously, but our gut also communicates to our brain. So that is something to be aware of. And if you’re constantly stressed out, there’s a few ways to think about, even just think about in terms of that fight or flight mode and blood being diverted away from the gut. Of course, food is going to be more poorly digested in those kind of conditions versus that quote unquote rest and digest kind of state. That’s another thing to think about.
Aidan
00:05:44 – 00:06:31
Another area that to make this even more clear cut, actually, is that a pretty high percentage of people with IBS also have depression or anxiety. About 40% of people with anxiety have IBS or diagnosed IBS from what I understand. And for people with depression, it is about twice the rate of IBS in that population versus people without depression. So, there’s a clear, like statistically speaking, clear connection between the two, something that’s even deeper than that, though, is there some antidepressants, so selective serotonin reuptake inhibitors that can be used for IBS-C. So, constipation, because these SSRIs may stimulate nerve activity and restore normal nerve function between the brain and intestines.
Aidan
00:06:32 – 00:07:13
So sometimes even medications do help with that. And I’ve had clients in a position where they have seen their GP and their GP’s given them a medication to kind of help out with that and at the other end of the spectrum, using a little common sense, it seems like the SSRIs are more common for constipation. But if you use a bit of common sense, it’s understanding that serotonin plays a role as well. This can also work for diarrhoea at the other end of the spectrum with drugs that block serotonin receptors as well, because that’s one of the things that goes on. There’s too much kind of exposure with this. So, like it goes both ways, like diarrhoea is the opposite of constipation and that kind of thing. And digging deeper down that rabbit hole of stress, anxiety, mood, all of those kinds of things.
Aidan
00:07:14 – 00:07:53
Um, there’s a 2014 meta-analysis, obviously, there is more recent data than this, but this just was like the study that I’m most aware of that showed 50% of IBS patients benefit from CBT cognitive behavioural therapy. That’s an interesting one to start off with because not many people IBS are going down that route for that purpose. Not many people even make the connection. I’ve also long been aware of research showing yoga and stuff like that being really good for IBS and honestly having similarly good kinds of statistics in comparison to the low FODMAP as well. And then the next thing that I’ve been on the hype train for the past year or so, but like I was aware of, I didn’t have a practical way of doing it, is gut directed hypnotherapy.
Aidan
00:07:54 – 00:08:33
Around 70% of people who undertake gut directed hypnotherapy noticed significant improvements. Let’s go back to that FODMAP statistic. 50% to 80%. What’s easier: 15 minutes a day of gut directed hypnotherapy or the low FODMAP diet? I don’t know and like it’s a complicated topic as well because there’s even been studies where they’ve tried to do both treatments, as in the low FODMAP diet, and gut directed hypnotherapy, and it hasn’t really improved outcomes any more than just doing one or the other. It’s a very nuanced topic, like it seems to me like putting both together would work even more effectively. But it’s still early days from a research perspective, and what I mean about I didn’t have a practical way of doing it..
Aidan
00:08:34 – 00:09:10
It’s very expensive to see a professional for gut directed hypnotherapy because it’s going to take a lot of sessions. Most likely, it’s not just gonna be a one off and you’re done. It’s going to take multiple sessions. The way around that I’ve found now is Nerva. It’s an app called Nerva, and it basically involves – There’s six sessions of gut directed hypnotherapy around 15 minutes, and those sessions go and repeat for six weeks. So, it’s a six-week programme. But because repetition is a key component of hypnotherapy, you just do that. It’s kind of like a guided meditation with a little bit of gut directed stuff in the middle of it.
Aidan
00:09:11 – 00:09:43
I’ve got no affiliation with them. I get nothing out of it. It’s just the easiest way I’ve found of getting people to actually do it. I think it is still pretty expensive. It’s like $100. But compare that to seeing a practitioner even compare that to changing your whole diet. It’s cheaper. Iif you’re somebody with IBS and stressed at minimum, it’s 15 minutes of your day where you’re not stressed, where you’re not focusing on anything that makes you stressed. At best, you’re one of the 70% who get significant improvements from that.
Leah
00:09:44 – 00:10:23
Yeah, I just say, like it makes sense with Nerva. If you are a pretty stressed out or anxious person and you do suffer from IBS, I feel like the buy-in process for using an app like Nerva is a lot more simple, a lot easier than buying into the low FODMAP diet, which is especially if you’re working with the dietician can be really expensive. If you’re seeing them every couple of weeks, as opposed to $100 for a six week course on Nerva. So, I have kind of gone down that rabbit hole as well and I’d say for many people, it makes sense to just try that before the low FODMAP diet. Before you kind of go dabbling in something so aggressive.
Leah
00:10:24 – 00:11:14
But moving on to gut health. So, your overall gut health and the quality of your gut microbiome as a whole could be playing a factor in your symptoms. So, outside of low FODMAP diets, it could be that you do have poor gut health for whatever reason. That could be because you’ve maybe had a poor diet up until now, or you’ve taken long courses of antibiotics. Or there’s many reasons that your gut microbiome may not be at the highest quality that it could be. Um, and that could potentially be causing symptoms like constipation, diarrhoea, bloating, etcetera. So we don’t actually know what the gold standard gut microbiome looks like. So that does make it a little bit confusing in being able to, you know, if we don’t know what
Leah
00:11:14 – 00:11:53
a great gut microbiome looks like or what the gold standard is, you know, What are we aiming for? Um, so that can be a little bit hard, but we do know that the variety of the gut microbiota is pretty important and also increasing the variety and quantity of those healthy bacteria within the gut. So, there are several ways that you can do that, and you can improve your gut microbiome variety. Um, and the biggest way is to eat more than 30 different plant-based foods a week. So, there’s pretty good research to say that the people that do have over 30 different plant based foods every week do have a more diverse gut microbiome.
Leah
00:11:54 – 00:12:22
Um, so if you’re someone who’s tried the low FODMAP diet and that’s not worked for you. But you know, in the past you’ve had a diet that’s a bit lacking and not that diverse in plant based foods, it’s definitely worth a try. And even outside of people that do have symptoms, it’s something I recommend to everybody, because I think everybody can benefit from having a really diverse amount of plant-based foods in their diet. So, it’s definitely something that you could try
Aidan
00:12:22 – 00:13:03
and for me to add on to that as well there’s heaps of angles to look at. I remember, probably like two or three years ago I saw a certain dietitian on TV with people with IBS. She was getting them to increase garlic and onion intake, even though very clearly they were intolerant to it as in like they were having issues related to that, just to slowly build up a tolerance to it, because that’s one thing that can work. But then building on that because, like, honestly, that’s not an approach I’m going to use with clients because I’m like, I’m not going to give you something that causes your symptoms. But it is a valid way of thinking about from the overall gut microbiota kind of perspective because those are great prebiotic foods and can help build this better overall gut health and
Aidan
00:13:03 – 00:13:31
to dig deeper on that as well. To be more specific, one of the things that we know that is good in terms of IBS management is certain short chain fatty acids. So, butyrate is one of those ones that comes to my mind. And if butyrate is produced by a certain healthy gut bacteria, you look at the foods that produce butyrate, and a lot of them are high FODMAP. You’re hard pressed finding low FODMAP one, they exist, but you’re hard pressed to find them, and that’s a really interesting angle because it’s like
Aidan
00:13:31 – 00:13:59
if the low FODMAP diet hasn’t worked, we already know that FODMAPS aren’t your issue, like you might even want to double down and actually increase some of these foods that can increase butyrate production. And that might help overall. And you can’t really just take a butyrate supplement because it just doesn’t get absorbed. Well, it doesn’t actually make that much of a difference. But if you eat these foods that are prebiotic foods that are food for the bacteria that produce these short chain fatty acids overall, that could help as well.
Leah
00:13:59 – 00:14:36
Yeah, and definitely looking at just your fibre intake in general to nourish the gut is a good idea. So, on top of having foods that are probiotic rich and having a variety of foods, just hitting that basic recommendation of having your 30 grams of fibre daily and potentially even a little bit more than that, it can be a little different for everybody. But 25 to 30 grams of fibre a day is the recommendation. Um, so if that’s something you’re not already doing, it’s something you could absolutely start doing to further nourish your gut microbiome.
Aidan
00:14:37 – 00:15:06
For sure. And the next thing we’ll touch on is severe food restriction and how that impacts IBS. So, there’s two things I’m going to touch on. The first one I’m gonna touch on there is going to be eating disorders. Actually no, I’ll leave eating disorders for you. I’ll let you do that one. I want to touch on the competition prep for bodybuilders. I wanna touch on that aspect. So, it’s a space I’m actually working in quite a bit. Mostly female bikini athletes. Post show, about six months post show, tons of them with constipation. Super, super common.
Aidan
00:15:06 – 00:15:51
What I want to touch on with that is there’s two aspects. One is relative energy deficiency, going back to all that stuff I talk about diverting blood away from the gut and stuff like that – similar kind of concept to a certain degree. If you’re going through competition prep to get stage lean, you get exceptionally lean and you are on low amounts of calories in relation to the amount of training that you’re doing and all these kind of things. The body starts shutting down certain processes because it’s trying to conserve energy in some way and either shutting them down or down regulating stuff. Think of it as battery saver mode, and one of the things that goes on is there’s a reduced amount of calories spent on digestion. That’s part of what goes on there. Another aspect is
Aidan
00:15:51 – 00:16:30
Competition prep diets are usually quite restrictive. You’re usually minimising your food intake. You’re usually eating the same stuff over and over and over. You don’t have this great diversity of plant-based foods, particularly if you track macros. It’s like most people do in competition prep even on a meal plan that’s relatively strict or they’re tracking macros. If you’re tracking macros, it doesn’t exactly encourage diversity of intake because it makes it harder. It’s easier to track stuff if you just have the same stuff over and over and over and over. So, there’s this nice, neat combination of this relative energy deficiency kind of syndrome kind of thing, or you could just call it getting too lean whatever you want to go with. It doesn’t really matter. It’s still the same kind of symptoms or
Aidan
00:16:30 – 00:17:05
the combination of that and the restriction that goes on. And then post show, there are a lot of reintroductions of foods that haven’t been had in anywhere near those amounts and stuff like that and digestion is already poorer. So, a lot of people have stuff going on there, and in some cases, FODMAPs don’t work there. Some of these people are stressed individuals as well and anxious, and there’s a whole bunch of stuff that factors into it. Then 12 months post show no symptoms at all. Just, it’s literally just a waiting game. Just getting calories higher, reintroducing foods, doing all those things and just taking far longer than you’d expect to take to get the job done.
Leah
00:17:05 – 00:17:45
So, we do see a very similar thing in restrictive eating disorders. So, we know a very high amount of people that have eating disorders do have IBS. So, one of the papers that we did find said that around 50% of people that do have a diagnosed eating disorder also have IBS going along with that, um for like a range of reasons very similar to what we see in comp prep athletes, but potentially also there may be the issue of a low fibre intake as well. So, with a lot of comp prep athletes, they typically tend to eat enough fruits and vegetables to get adequate fibre intake.
Leah
00:17:45 – 00:18:31
But that’s not always the case with an eating disorder. So, you know, you might also have that there at play as well. Another study that we found is, this is kind of a crazy statistic, and I actually didn’t know this previously, but 98% of people that are admitted to an eating disorder unit have a functional gastrointestinal disorder. So, they are experiencing these symptoms of IBS at such a high rate that we know that this restrictive eating pattern is kind of going hand in hand with these IBS symptoms. Um, and I’m not really sure too much about the background of this study and the exact participants, but I’d say if you’re using any compensatory mechanisms like if you’re purging and if you’re
Leah
00:18:31 – 00:18:38
taking laxatives and doing things that go along with some eating disorders, that would absolutely play a role in gut health.
Aidan
00:18:38 – 00:19:16
For sure and like I was thinking about this as well in terms of like, we’re often thinking about eating disorders in terms of like anorexia nervosa and stuff like that. But what about just binge eating? Not even binge and purging. Binge eating. There are periods of times where there’s this massive calorie intake, and then there is, probably periods of time where there is much lower calorie intake. It’s inconsistent, even just using constipation as an example. People having a very consistent intake seems to help with that, using one example, the 5:2 diet not really talked about. But a lot of people on the 5:2 diet get constipation because there’s these days where there’s not much food coming in, and the lack of routine and stuff like that plays a role in all of this. So, the same kind of concept for binge eating as well you have a massive amount of food,
Aidan
00:19:16 – 00:19:55
probably gonna get bloated even if you don’t have issues with normal amounts of foods and normal amounts of FODMAPs and stuff like that. There is often such a large amount in one hit that some of these foods that are poorly digested anyway will be poorly digested, so it makes a lot of sense, and it’s food for thought as to why the low FODMAP is contraindicated for those with disordered eating habits. Because it’s like the disordered eating habits alone could be explaining the symptoms, and then you’re just doubling down on it by restricting further. So that’s food for thought as well. Personally, I have seen people who are being in that kind of space who had tried to low FODMAP before seeing me
Aidan
00:19:56 – 00:20:06
and still get symptoms, and it’s very hard to get them off of it because it’s the attraction to restriction as well. Um, anything else you want to touch on before I go to my hot take?
Leah
00:20:06 – 00:20:08
Go to your hot take. I’m excited.
Aidan
00:20:08 – 00:20:43
So, the hot take I’ve got is vitamin D. This is not really talked about much in the IBS space at all, but it’s something that I’ve always been quite curious about because the number I’ve given for many years is that about 80% of people with IBS are deficient in vitamin D, and I’ve never really gone out on a limb and been like, probably should supplement, like I’ve never been like just supplement is going to address your symptoms. It’s just that it’s always been such a strong overlap that I’m like we know that vitamin D supplementation, particularly you’re deficient, it’s not harmful, like if you
Leah
00:20:43 – 00:21:18
Are nowhere near the top end of the healthy range, getting more sunlight or supplementing vitamin D is going to be good for other stuff anyway. It’s going to be good for other stuff. There’s other benefits. So, I’ve always been saying for ages it’s worthwhile, at least checking it, and seeing. Doubling down on that, though, in preparation for this podcast, I did look through all the research on it. Surprisingly little, considering how positive all the research has been done, has been. A 2015 study from Saudi Arabia identified that 82% of people with IBS were deficient in vitamin D, compared to 31% of control participants.
Aidan
00:21:18 – 00:21:39
I’m struck with those statistics because it’s actually lined up with what I’ve said previously in the podcast a while ago, a few episodes back, I said 30% of people had vitamin D deficiency. I just said about 80% of people are deficient in vitamin D if they have IBS so firstly stoked about that. Next one though, that basically, firstly with that’s just doubling down, it’s obviously there’s a clear linkage that is going on,
Aidan
00:21:40 – 00:22:17
but there’s so many other factors with vitamin D. People with low vitamin D see the sun less. If you have IBS or anything mental health related, as we said, there’s a linkage between two. Do you go out in the sun as much? like that is another variable like I don’t know the answer, like it probably shapes it in some way. Um, another study from 2016 o a year later, put that to the test basically, and they got 90 people with IBS, and they got them to supplement with 50,000 international units of vitamin D every fortnight for six months. So, it’s a relatively high dosage. But like when you bring it out over the fortnight, it’s not super high. It’s just kind of high in comparison to relatively low dosages that people normally use.
Aidan
00:22:17 – 00:22:50
There was a significant improvement in almost all symptoms, but it did not completely resolve the IBS symptoms on average. Keep in mind in that study, they didn’t measure deficiency. They didn’t measure the levels to start off with. We make the assumption that like 80% are deficient, but they didn’t actually measure what happens, from my perspective, if you exclude the people who were not deficient, that improves the study odds even further, like it makes it look even more positive just the same as like, there’s this research on calcium supplementation and fractures risk, where they just have a population level and the people who take their supplements do have a slight reduction in risk of fractures.
Aidan
00:22:50 – 00:23:05
What if you just got a bunch of people with really low calcium intake and put them in, like it looks even more positive. So, it’s food for thought. It’s worth testing. That’s my hot take because there’s not that much research on it. But what we have so far is incredibly promising as well.
Leah
00:23:05 – 00:23:46
Okay, so this is something I don’t tend to use a lot in practise, but our next topic is going to be probiotics. So, it’s absolutely not something that I tend to use as a first line approach when someone comes to see me with IBS issues, and that’s because the research on it is so mixed. So, we do have some research to say that particular strains of probiotics can be useful for specific symptoms. Um, but there are a ton of studies that show no significant changes in symptoms when supplementing with a probiotic. Um, but I think it’s at a certain point that it’s worth considering. Um, so we know that particular kinds of probiotics such as
Leah
00:23:46 – 00:24:28
bifidobacteria and lactobacilii seem to be the most effective in reducing some IBS symptoms. Um, so you know, if you’ve tried a few things and you’re really kind of grasping at straws, it makes sense to just try it. There’s no harm in trying a probiotic at some point, um, so these bacteria populations are typically lower in people with IBS. Um, there’s no real clear cut recommendations on how much you should be taking, um, and exactly the kinds of strains or combination of strains. Um, but if you are going for a probiotic, it makes sense to go for something that contains at least one of those strains.
Leah
00:24:28 – 00:25:06
So, we do have a review by the British Dietetic Association that had 29 studies in total, and only 14 of those studies actually showed a positive result from probiotic supplementation using over 10 different kinds of probiotics. Um, so I’d say like 14 out of 29 studies showing a positive result. Like I’d say, that’s very, very mixed. I wouldn’t say it’s like a clear cut thing where, you know, yeah, probiotics are definitely going to help with IBS. Not at all. But I think it’s worth mentioning, and it’s worth a try for some people, in some circumstances.
Aidan
00:25:06 – 00:25:39
For sure. At the moment I’ve got a client who is interested in trying that, and of course I’m going to say yes, every time. But it’s also, as we were saying, if we widen the net, so to speak, in terms of like our recommendations, what supplements we’d recommend if we include that in our net, we’re including a lot of other supplements as well, and then suddenly it’s taking a lot of things when going back to a previous episode is kind of like we are food first people where possible. Like I don’t know. We don’t want to end up taking a whole bunch of supplements and, like that’s what I’m saying, like if somebody’s interested in that there’s nothing really harmful about taking it.
Aidan
00:25:40 – 00:25:51
Only the time to do it. It’s not much time involved in that. And the dollars, the money and it’s not that expensive, so it can be worth a try. But we’re not, like, super passionate about it either.
Leah
00:25:51 – 00:26:22
Yeah, 100%. Um, And if it is something that you do want to try, um, I’d suggest taking it for at least 3 to 4 weeks consistently, um, to really give it a good hot go. But if you don’t see any changes in your symptoms, say, after four weeks, then it’s likely not going to be beneficial for you. And maybe you want to kind of branch out and try other strains of probiotics. But I think at that point, you know, it’s not going to work for you. So, it’s best to move on to the next thing to try.
Leah
00:26:22 – 00:26:34
Yeah, I see people who take who’ve got symptoms for long, long periods of time, taking the same probiotic for a long period of time as well. And they’ve noticed no difference. And I don’t know…
Leah
00:26:34 – 00:27:21
Why you would continue taking it then? Yeah. So, something else that you might want to try, that tends to be even a little bit more effective in some cases than probiotics, would be taking a peppermint oil supplement. Um, so we do know that menthol in peppermint oil can cause the muscles of the large intestine to relax, so this can have a pretty significant impact on abdominal pain. So, if you’re experiencing high amounts of abdominal pain after eating, um and that’s part of your IBS symptoms, it could make sense to try something like a peppermint oil supplement. Um, the only thing is with this is you do need to take it a few times a day, so that can be difficult for a lot of people. So, taking a supplement once a day is one thing.
Leah
00:27:21 – 00:28:04
Doing it multiple times a day is again a whole different ball game. Um, so there is some research to say that it can also help qirh bloating by allowing the trapped gas to pass through the intestine. So, you know, if you are struggling with either bloating or abdominal pain or maybe the combo of the two, it could be well worth a try, particularly if you’ve gone and tried quite a number of other things and you’re still struggling with these symptoms. The most extensive review of peppermint oil that we do have, um, included several studies with over 800 patients, I think it was 12 clinical trials in total. Um, and the review showed that IBS symptoms were
Leah
00:28:05 – 00:28:25
44% less common in the people that took peppermint oil than the people that didn’t. So, I’d say that’s a pretty good statistic in terms of like it’s worth a try at that point. Like if you have tried other things, um, kind of like probiotics. It’s like it might work. It might not, but again, it’s worth a try
Aidan
00:28:25 – 00:28:56
and the standard dosage is 0.2 to 0.4 mls three times per day before meals, probably like half an hour before meals or like just before. It doesn’t really matter too much like I wouldn’t be overly precise with that. Two things touch on that. One, you can just buy it off of something like IHerb online, like just type in IHerb and it’ll come up and, like you don’t have to like the dosages are going to line up with that most likely. Obviously double check, but most likely to line up with that and once again hot take. But something to add on to that is like I don’t think you need to take it three times a day. As in,
Aidan
00:28:56 – 00:29:34
we had this conversation where we like, I don’t know, I personally wouldn’t want to take a supplement three times per day. Like if I had bad enough symptoms. Yes, of course. No brainer, but like if they’re just kind of mild symptoms, but they were annoying, like I probably wouldn’t take it three times a day, but there’s no reason you couldn’t buy it and take it haphazardly. There’s no downside to taking it. If it was so effective that 44% less common symptoms in these patients in those groups, that’s a big enough effect. It’s like, you know, like you could take it and take it sub-optimally like you can still get benefits from it. Wrapping things up now as well, though, there’s two things I wanted to touch on. One of them is that
Aidan
00:29:34 – 00:30:15
I want to go through some constipation specific nutrition stuff in a future episode like we’ve already drawn this out pretty far. I want to leave that for a future episode because there is a lot to go through with that. And there’s some stuff that actually really does move the needle. That isn’t really kind of common advice and we can talk about that. And another thing that we haven’t touched on, that is a massive topic in itself, is the RPH elimination diet, also known as the failsafe diet. I don’t know when we’ll do an episode on that. Probably pretty far down the line, but it deserves a podcast on its own because that can explain a lot of these symptoms as well. And that can be another option if the low FODMAP diet doesn’t work. So basically, wrapping things up
Aidan
00:30:16 – 00:30:21
Thank you for listening to this podcast. This is episode nine and I hope you have all enjoyed it.