Leah:
Hello and welcome to the Ideal Nutrition Podcast. I’m Leah Higl and I’m here with my co-host Aidan Muir. And today’s episode is going to be all about underrated tips for IBS. So IBS is something that I do personally deal with in my own life. And it’s something that a lot of my clients definitely have issues with. I’d say they’re probably around a third of my clients are like IBS related. I think just working in that plant-based space, it comes up a lot.
So obviously we have talked previously about things like FODMAPS and kind of all that gold standard practice stuff that we have other episodes about. But I think today we really want to go over those other kinds of tips that we can layer onto maybe that other, those like main strategies that you can use for IBS management that I myself have found very helpful and in practice have been very helpful and of course, evidence based.
So, we can definitely start off with things like I said, looking at the FODMAP elimination diet and doing other things like avoiding common triggers like high fat meals and spicy foods and alcohol. And we’re going to talk about a lot of those other things today that are not necessarily always talked about.
Aidan:
The first one I want to start with is Metamucil slash psyllium husk because Metamucil is based on psyllium husk. And this one is not a secret or anything like that. So it’s not like it’s something we never talk about or anything like that, but I put it into the category of being underrated for quite a few reasons. One of them is simply that it is one of the most effective non-medical options for managing constipation. A lot of research comes back showing as much as around a 50% improvement in all symptoms on average. So that’s pretty powerful for something that’s a non-medical option and something that’s just something simple that you can just kind of add in.
Many people haven’t tried it. That’s why I say it’s underrated. A lot of people who have tried it may or may not have done it for consistently enough, long enough or used high enough dosages as well. That being said, obviously there people who won’t get benefit from it, but just looking at the statistics, a lot of people can benefit from it. It can also help with mild diarrhoea as well. This is partly just because it is a water-soluble form of fibre, which can absorb water on the way through. So it can help with both ends of the spectrum with IBS.
And sometimes constipation contributes to diarrhoea as well. And you want to address the constipation first, which makes it even more important to look at this as a potential option, which is why I like it.
Leah:
Yeah, definitely an underutilised one. I think a lot of people pass it by going like, it’s just like, it’s so often recommended. Like maybe it’s not even worth trying, but it definitely is in a lot of circumstances.
Aidan:
There’s a story I tell that I don’t think I’ve told on the podcast. where it’s a dietitian colleague of mine, not somebody I know well, she tells this story about how she had constipation herself and she went to see a doctor and she wanted to get some medication and the doctor’s like, have you tried Metamucil? And she’s like, I haven’t tried it. And it’s like, go away, try Metamucil, then come back. She went home and she spoke to her partner about her experience and they kind of came to the conclusion that they’re like, he didn’t listen to you. Like he didn’t listen to her she is an expert in this space. She knows what she should be doing and getting and receiving and her case is quite severe and not something that could be solved by something so simple. She went back and she’s like, can I get medication? And he’s like, have you tried Metamucil? She’s like, no, I have not tried Metamucil, but I think this is something more serious than that. And he’s like, go away, try Metamucil and then come back and we can speak after. And she tried Metamucil and it worked.
Leah:
No, that’s like a positive anachronism.
Aidan:
Obviously, really like embarrassing experience and stuff like that. But like I love sharing that story with clients and stuff like that who feel like Metamucil is like such an obvious thing. Too simple. But it’s like that person who I’m talking about is a very smart person. Yeah. And just kind of I don’t want to say overlooked, but like they were like, it’s going to be more than this. It’s always like a first line thing that I consider trying.
Leah:
Yeah. And from my perspective, working in that plant based arena, people usually come back and say, well, I haven’t tried that because I already eat so much fibre. But I think even in the case that we have adequate fibre coming in our diet, having this kind of high dose soluble fibr esupplement, it has a very functional purpose. So it’s less to do with, I guess, upping your overall fibre intake and more its functional purpose. I think that’s worth mentioning. The next thing we are going to touch on that I feel is definitely underutilised in a lot of circumstances is digestive enzymes.
So this can be a range of different products. A really common one is your lactase enzyme to break down lactose for those that can’t tolerate lactose that well. A really common example of that product would be lactease, something you can find literally in the supermarket. There are things that you can also get for the breakdown of galacto-oligosaccharides, so commonly found in a lot of your legumes and that’s called Bean Assist. So very on the nose there with what that is trying to get what it’s targeting.
Then in terms of other FODMAPs, you can utilise things like Intolerant is a really great brand in Australia that has a wide range of digestive enzymes. I often recommend Quartrace if someone has an issue just kind of widely with a lot of different FODMAP groups because it’s a range of different digestive enzymes all in the one capsule that can be taken alongside food to help with the breakdown of those FODMAPs. Therefore, hopefully reduce IBS like symptoms. Then we’ve also got things like Fodzyme, which has recently come on the market like in the last what couple of years ish. And that’s again, FODMAP related and something you can sprinkle over your food.
I think for the purposes of making life a lot more bearable and like not being so restricted in regards to eliminating specific FODMAPs all of the time. Digestive enzymes can be a great way to just be normal and eat normally.
Aidan:
Yeah, the best food is like eating out. Like if you’re in a routine at home where you’re not having these foods or you’re limiting them, etc., it’s really not a big deal. But then if you feel like every time you eat out either you feel super restricted or you’re just like, no, screw it, I’m going to eat this stuff anyway. Like particularly that latter category is where it’s like, but this is actually really helpful.
Leah:
As someone with IBS, like I know I do that all the time. I know my clients do that all the time. And how good if you can just take something alongside that meal to reduce symptoms.
Aidan:
Yeah. For the third one, I’m going to talk about gut directed hypnotherapy slash specifically Nerva, which is an app. I would have previously talked about this on a podcast we would done really early on, like what to do if FODMAPS doesn’t work. I think it was one of our early episodes.
Gut-directed hypnotherapy. Why is it underrated? And it’s simply because it just sounds like alternative medicine.
Leah:
It sounds very like hippie-dippy.
Aidan:
The way I would loosely describe alternative medicine is alternative medicine is stuff that either has not been proven to work or has been proven not to work and is not commonly accepted in the mainstream, in Western medicine, etc.
But gut directed hypnotherapy has nearly 10 randomised control trials looking at it and almost all of them have found significant benefits. That’s getting up there as pretty much a gold standard treatment alongside stuff like FODMAPs. That’s why I consider it underrated because a lot of people look at the success rate of a low FODMAP diet which helps about 50 to 80% of people and be like, that’s a gold standard treatment. That still leaves 20 to 50% of people where that didn’t significantly benefit. Gut directed hypnotherapies look at similar type of numbers.
It is kind of a gold standard option as well. The reason why I specifically talk about Nerva is simply just because it’s an app that you could just use every day. I believe it costs about $200 to use for a six week period. But imagine trying to get a practitioner and paying per session. That’s the reason why I’d recommend Nerva as an app. Cause it’s something you can just do at minimum. It gives you an opportunity to like chill out for like 15 minutes. That could obviously have like a benefit by itself. But there are some specific benefits of gut -directed hypnotherapy specifically.
Leah:
Yeah. Worst case scenario, you’re doing some meditation, which is going to be likely beneficial. Yeah, it’s definitely something that I use a lot in practice. And whenever I’m talking to clients about it, we’re introducing it. I’m just like, bear with me. We’ll go through some of the research. I know it seems weird. And then we go through like the mechanisms, highly under-rated.
Aidan:
There’s a chart I pull up for every client when I’m talking through this which literally just shows the success rate of a low FODMAP diet and the success rate of gut directed hypnotherapy. Just to be like, even if you’re skeptical, like based on the stats, it’s worth a crack.
Leah:
Yeah. And I’m like, I was skeptical and I’ve tried it. The next thing we will talk about is something that I, guess in the last six to 12 months have integrated more so into my practice and have found really beneficial and that’s bowel retraining.
So essentially bowel retraining can be useful for both chronic constipation and that’s realistically where I use it most. But it can also be useful when there is like frequent loss of bowel control or kind of constant loose bowel movements. It can be somewhat or occasionally useful in those circumstances as well. So what it is, is it’s essentially trying to or aiming to have a bowel movement at the same time every day in an attempt to somewhat train the bowel to have regular movements that are a bit more predictable.
For a lot of people like that is the norm. Like a lot of people without IBS will be like, yeah, I go and do a bowel movement at 10am every morning after breakfast. And that’s just my routine. For someone who does have IBS, that’s not commonly the norm, but it’s bowel retraining is trying to get back to that.
And to do this, I usually suggest sitting on the toilet for five to 10 minutes each morning after breakfast. Having a coffee prior is usually a good one as well, being a stimulant on the gut. The reason I suggest in the morning is because that’s when our gastro-colic reflex is the most effective or the most strong. And what that is, is basically this increase in gut motility when our stomach is expanded.
So when we eat food, our stomach expands and then in the lower gastrointestinal tract, there’s an increase in the motility that’s essentially trying to push through a bowel movement, push waste products out. so that can be a really effective mechanism to utilise in the morning. so yeah, having sitting on the toilet five to 10 minutes after breakfast and then just trying to have a bowel movement, but it’s important to note that it’s not you like sitting there straining.
It’s really important not to strain where essentially just sitting there trying to be calm and hopefully a bowel movement happens. And the more that you do this, likely the more regular it becomes to have a bowel movement at that time. A couple of things that I like to add onto this is we’re going to talk about these a little bit later, but I like to recommend using a poop stool to prop your feet up and doing some diaphragmatic breathing during this bowel retraining phase.
So yeah, it’s something that probably seems a little bit weird, like trying to retrain your bowel, but can be highly effective, particularly for that chronic constipation group.
Aidan:
In my first job, one of the supervisors was like really big on just like IBS type stuff. And they were talking about literally all of those things. I remember like when I was like a real new grad dietitian being like, thinking like everything I said had to be like specifically about nutrition, specifically like inside my scope of practice. And like, whose scope of practice is this to start off with? And just being like, it’s just like a really helpful tool that is not that far away from nutrition.
Leah:
100% not that far away from like, and it’s not something that’s going to cause harm either. Like as long as like where you say, obviously don’t strain on the toilet, but just telling someone to sit on the toilet for five to 10 minutes, relax and do deep breaths.. It’s not going to cause any harm.
Aidan:
100% and so effective. The next one is underrated just because it’s boring, but it is chewing well. Just chewing your food super well, digestion starts in the mouth, etc, etc. If you do chew your food well, it makes the digestive process a lot easier. I try to view myself as super evidence-based and trying to find evidence to back everything up. Because sometimes you’ve got to question and be like, is this something that I just say because everybody else says it? Or is this something that we can find a legitimate percentage improvement and stuff like that?
And with this one, it’s so obvious that there’s not a lot of research on it, but trying to find any research to kind of back it up. What I did find was stuff just looking at the alternative. So there’s a study that I’ve just added in the show notes kind of looking at this, and there’s plenty on this topic, basically saying that chewing insufficiency, as in people not chewing enough, was significantly linked with IBS symptoms. So rather than looking at the other way and going like, people chew their food really well, are unlikely to have IBS symptoms.
There’s heaps of research of the upper end of spectrum being like, you don’t chew your food well, very likely to have IBS symptoms. And all of this research, you can see how far afield I’ve gone with this, but like a lot of this research was on people who have like missing teeth and stuff like that. It’s like really easy to find that research looking at that. So something that’s super simple, but it is obviously very effective. If you chew your food more thoroughly, it should help with this.
Leah:
Yeah. A lot of the time for bloating, this is my first slide approach. Yeah. Because it can be so effective. Yeah. The next thing we’re going to touch on, I briefly mentioned talking about in the bowel retraining stuff is the toilet stool. So a poop stool or also known as like a squatty potty is a great way to simulate a more natural position to pass a bowel movement. So ideally, like, I mean, we are designed to pass a bowel movement in that kind of squatting position. So well before toilets were their kind of traditional design.
I wish I could show you a picture because I think that really sends this home. But essentially by being in that position where you have your feet elevated and your knees are above your hips, just have your lower large bowel is a lot more open so that a bowel movement can pass through a lot more effectively and without running into like a kink that has to kind of go around.
And research does consistently show that passing a bowel movement in that position does result in a more complete bowel movement. And there is a reduced risk of haemorrhoids because there’s a reduced amount of straining that is needed to pass a bowel movement. So it’s one of those things that again, it’s pretty cost effective. You can get them for like 10 to 15 dollars on like Amazon. It’s not something that takes a dietary restriction and you ideally should already be pooping. So it’s just about elevating the feet. I just think it’s such an easy win.
Aidan:
The next one I’m going to talk about is glutamine. I mentioned this on a previous podcast, but part of the reason why I think it’s underrated is because even amongst health professionals, I’d say not many people are like looking into this super closely because it’s still considered to be something that’s like a bit on the fringes, not much evidence for it, etc. And where I would say it’s underrated is that there’s now four from four randomised control trials that are showing significant benefits. So every randomised control trial that has been done so far has found very significant benefits.
What makes this kind of a touchy area for me personally is that that’s not enough to be super confident. I don’t want to be out here being like, yeah, glutamine definitely helps. I want this to be a position where it’s like, hey, it looks pretty promising so far based on the research. There’s some theory behind it. Kind of makes sense. If five randomised control trials come out showing the opposite, I’m going to change my mind very quickly.
Leah:
100%. It’s for me, it’s definitely one of those things that I’ll like layer in, especially if someone wants that kind of approach that’s like, come in all guns blazing, let’s do everything. It’s a good thing to just tack on. The final thing we’re going to have a chat about is diaphragmatic breathing. So again, this is something that I do recommend a lot because it is such an easy win. It doesn’t require any extra tools or devices that you need to purchase. It doesn’t require anything dietary, like in regards to changes. But essentially what it is, is this kind of deep controlled belly breathing, I will put a link to a video in the show notes that runs you through how to do it if it’s something that you are interested in.
But the pros of this kind of breathing is twofold. So the first thing is it can bring you more into that parasympathetic nervous system. So very similar to the breathing you do during meditation and things like that. So that’s our rest and digest mode. A lot of the time, a huge part of IBS can be stress and anxiety related which puts us more into that fight and flight mode where digestion is not necessarily being prioritised and can enhance the severity of symptoms.
So being able to bring that diaphragmatic breathing in to your life and bring you more into that rest and digest mode several times throughout the day even can be really beneficial to reducing symptoms, particularly when they are stress and anxiety related. So like I said, I use this a lot during bowel retraining, so whilst you’re actually sitting on the toilet. But I also utilise it a lot with my clients before and after meals, especially when there’s been quite a lot of anxiety around consuming certain foods.
Like even when we go through the FODMAP elimination diet, we’re starting to do the reintroduction. Even doing some, like if someone has a lot of anxiety about reintroducing certain food or FODMAP then we don’t want that to necessarily interfere with the results.
So sometimes utilising this diaphragmatic breathing can, I guess, take that component more out of the scope and it can be more of a clear result. So definitely something I utilise a lot. And then the second reason why it can be beneficial is essentially when we have this like deep belly breathing, we’re pulling a lot of air into like the stomach cavity. And this can almost give us like, our intestines like a little massage and can help the gut, overall gut motility and help push through trapped gas. So it also has a very functional purpose.
Aidan:
One of the things I love about everything we’ve kind of talked about today is none of it actually requires you to change what you’re eating. Yeah. There’s a lot of things in the IBS space that do require you to change what you’re eating. And there’s many cases where that is kind of required, but that’s what’s kind of handy about this stuff that it’s a little bit underrated because it’s like, what if you did some of these things and it was really beneficial?
And then you no longer needed to change those things. won’t work out like that in every case, but I think it’s just an interesting way to think about it. And it could be beneficial in lot of cases.
Leah:
Absolutely. So this has been episode 136 of the Ideal Nutrition podcast. If you haven’t yet left a rating or review, it would be so greatly appreciated for you to do so. But otherwise, thanks for tuning in.