How much money and how many tests do you need in order to reassure yourself that there’s nothing sinister going on with your digestion? When is it time to stop getting these extra tests and focus on food and your lifestyle? This week’s episode of the inside knowledge podcast is about my client. Justin, his main problems were smelly stools, excessive gas.
That was really interfering with his life. And overwhelming worry about his digestion. He’d already had a raft of investigations with his doctors and he came to me at a real loss. Analyzing every bowel movement that he had worrying about, whether it was a healthy stool or not, and obsessing about his food. Let’s hear how Justin got on in the three month gut reset.
Hi, and welcome to episode 84 of the inside knowledge podcast for people with IBS. I’m Anna Mapson. And this is the first episode that I have videoed myself, recording the podcast as well. So you’ll be able to watch on YouTube.
Case study – young man with IBS and smelly gas
Let’s get to know Justin a little bit and his biggest problems.
First of all, I started mentioned in the intro. He had a lot of flatulence. And it was very smelly and it was affecting his confidence being around his friends. It was affecting his confidence to go to the gym as well.
He did work from home, so he had less worries about gas in the office, but it was more socially and also has exercise. He was really interested in the form of his stool. So he felt it was too mushy, it wasn’t healthy. And he just wanted to have a normal poo for once. It was very smelly poo as well, he was very conscious of it every time he went.
It had been like that for around 18 months. When all this started was when he had a stomach infection. Which he needed antibiotics for. He resolved the infection. And then after that, his digestion was never really the same again. You might like to go back and listen to my episode on post-infectious IBS. Because there is some clear correlation between people who have had an upset stomach, like an infection, and then people who go on to have either small intestine, bacterial overgrowth, which is SIBO , or they have just ongoing IBS.
Post-infectious IBS
Sometimes it’s called post-infectious IBS. So there are two conditions. It doesn’t really matter what you name it. And there are some differences between them, but commonly the symptoms are similar. So smelly gas, erratic, stools, just feeling that something is not quite right. And that can be down to the physiology that’s been changed when you have a big infection like that. Plus taking antibiotics can unfortunately also upset the ecology of your large intestine gut bacteria.
Even though it’s essential for getting rid of your acute infection, it can also reduce the good, helpful (sometimes called commensal) bacteria that we want more of.
Case study symptoms – IBS
Those were his two big issues. He was also getting, just the kind of sensitive sensation. He described it as feeling crampy. But it was like a pressure that he was feeding all the time and his stomach that was making him very conscious of his digestion repeatedly. So he was always being reminded of it because there was always a sensation and that can be very common with people who have an enhanced gut brain axis.
Your Vegas nerve from the back of your neck, down to your digestive organs. Is listening to what’s happening in the digestive tract and sending messages back up to the brain. It’s kind of a super highway of information between our thinking brain are feeling in our head plus what’s going on in our torso. That be overly heightened in people who have IBS.
And you can find that you get visceral hypersensitivity. Every small gurgle and pain sensation is like magnified much more than the same sensations would be in somebody else.
That was how we started. He didn’t really know if he had any food triggers. He’d done a food intolerance test, an IgG food test. Which had led him to cut out dairy and a few other things. I didn’t see any improvements in that. He’d also done the Zoe program, which involves a stool test and wearing a blood glucose monitor for several weeks in order to get some suggestions. If you want more information about the food intolerance test, then you need to go back and listen to the episode that I did all about the science of the food intolerance tests and why they aren’t really helpful.
That is episode 75 and that will give you all the information about why I don’t recommend anybody should take a food intolerance test for IBS. Or for any other reason, actually,
Also, he had done the Zoe program. A lot of my clients come to me with this information. But unfortunately, as a nutritionist, There’s very little in in the results I get that actually help me.
So even though you have had a stool sample analyzed, you have had a test, it doesn’t really give us the clinical information that we need in order to make recommendations. Even though it’s a big investment.
The cost of managing IBS
One of the things about this client is he had spent somewhere in the region of three to 4,000 pounds on private health care. I know in the UK, we are very lucky to have our NHS. And have access to free healthcare but. There are long waiting lists. And when people have got so much worry often, going private is really the only way to get on top of your worry.
A SIBO test that was negative.
He’d had a celiac disease test, also negative, checked for blood in the stools that was normal. There was a small amount of raised inflammation. Calprotectin was very slightly raised. You can listen to the episode about inflammation in the gut. If you want to hear about that, but it can be normal in IBS if especially only just out of range. but he also had an endoscopy. And full blood count. Looking at all his markers and they were all normal. That is the picture of where Justin was when I started to work with him.
What did he change?
If we move to think about the kind of work that I did with him and what we changed. One of the main things was to trial the low FODMAP diet. This is removing the fermentable fibres which can reduce the gas. Sometimes when people are very health conscious and have done a lot of research then going on the low FODMAP diet can feel like you’re eating less variety, more simply than you would want to.
Especially people who have done the Zoe program, because there’s a lot in there about getting your 30 plants a week. And really trying to get fibre diversity. Now, if you’ve heard my podcast before I am all for that, I love the idea of people eating a whole range of different plant foods every week.
That is great. But when you are trying to do the low FODMAP diet, You need to be simplified. You need to just focus on basic kind of bland foods for a while. In order to get the FODMAP diet, right. So this was my advice to him because he was eating quite a lot of different fibres and vegetables. and he was quite busy as well, so he needed something very simple.
So we did a very simplified, low FODMAP diet. I also advised him to eat three meals a day because he was fasting and skipping breakfast a lot of the time. He would have a protein shake, go to the gym or go for a very long walk. Because he worked from home and he had his own business. He could really be in charge of his own time.
Intermittent fasting doesn’t always work in IBS
This was something I wanted to work with him on as well is the regular meals. Now, most people who’ve had my podcast before. Again, this is something I really suggest is helpful in IBS because. When you’re trying to cram a whole day’s worth of food into two meals. You can easily overload your gut so you can either eat too much fibre in one setting, you have to eat a lot of protein in one go in order to meet your targets.
Otherwise you’re not going to be getting enough protein in your day. You’re not going to be getting your five fruits and veggies a day. It’s really hard to get that 30 grams of fibre. Because you’re eating very big meals. And your digestive system has to then cope with a lot of fermentation. So by splitting his food into three meals, having some of it at breakfast. Then keeping it very simple and low FODMAP.
And also I wanted to suggest to him to have an overnight fast of around 12 to 14 hours. Again, this is something I do recommend to quite a lot of clients. And it’s about allowing your digestion time to to do its job, be still be quiet over your sleep. When we’re sleeping, it’s not great if we have just eaten a big meal, because that’s going to sit quite heavy in your stomach. Now, some of your digestion will continue, but a lot of it just goes to sleep for a little while when you’re going to sleep. And so that can be to more fermentation for your gut microbes. So I suggest. That you try and eat around three hours before you go to bed, then that means most of your food will have left your stomach by that phase, which is more comfortable when you want to lie down. can reduce the risk of getting reflux and like upper belching coming back up.
When you lie down to go to bed. He was very happy to do the fast because he’d already been trying to do like a longer, fast of at least 16 hours.
Some days he was skipping lunch as well, and some days he would skip breakfast. So by inputting three meals a day, I worked with him through how to create some simple, protein, rich meals that he could just eat something at lunchtime to keep him going, because then there’s less chance of nibbling and grazing all through the afternoon.
Gut directed hypnotherapy for IBS
Cause actually then that’s when you are getting hungry. order to work on the gas production, he was having a fast overnight. And going on the FODMAP diet. And then I also thought he would get on well with some gut directed hypnotherapy. There is an app called NERVA. Which some of my clients get on well with, and every day there’s like small pieces of information to understand as well as a guided relaxation. This was really helping overcome the nervousness and the worry. And that feeling like, trying to say to yourself all as well with my digestion. Things are going to be okay.
I am going to get better. And that is very powerful for some people. So that was the kind of approach that we started off with.
Anxiety about testing
Despite. Knowing that all the previous tests were clear, because he was still getting these ongoing symptoms, Justin was really worried about the colonoscopy that was also planned.
And he was pretty much convinced that he was getting bowel cancer. Because he’d been doing so much research and reading that there are higher rates of bowel cancer in younger people now than ever before. And he was just convinced that this was going to be him. However. It was all clear.
And so once he’d had that final. Recognition that there was no physical changes in any part of his body that could be tested. He started to relax a little bit and that actually. Had a very big impact on his symptoms. In conjunction with working through the gut directed hypnotherapy program. So practicing relaxation, consciously trying to slow down to eat chewing your food really well, but also just sitting with your body. Because it can be very, very difficult when you feel anxious and you feel so much worry. So there’s that as well as actually seeing another result that said you That really did have a big impact on his symptoms and his feelings of hope.
Seeing positive changes
He started to get firmer stools. As the low FODMAP diets kicked in. So normally when I work with people, it takes a couple of weeks for people to get the hang of the low FODMAP diet. Once he’d got the hang of it and worked out some clean, clear meals that he could repeat and just, you know, fall back on. Then he started to notice that his stools were getting more from. And. He wasn’t someone who was getting diarrhea in the first place, but they were just mushy.
They weren’t formed stools and they started to get a bit firmer. , we also talked about a couple of supplements that would be helpful for him. So one of them is partially hydrolyzed, guar gum, or pH GG. Now this is a prebiotic. That is low FODMAP. So it’s suitable for people who are sensitive to other prebiotics, like inulin, fos gos, et cetera. So he was taking that alongside the low FODMAP restriction phase.
And sometimes I do put this prebiotic in at that time, because your restricting on a lot of other types of fibre and it can be quite helpful for. Supporting bowel consistency, getting a well-formed stool, but also feeding the good bacteria through the restriction phase. I also suggested that he take Saccharomyces boulardii I, which is a beneficial yeast. Which is known to slow down gut transit time and help. With loose stools.
So again, he wasn’t having diarrhoea, but he was getting mushy stools and he wanted them to farm up a little bit. The other thing about Saccharomyces boulardii that’s good, is that it can take up a bit space. It kind of crowds out pathogens that sometimes are more associated with very smelly gas. So it’s helpful to take. But it’s not suitable for everyone. Like if you’re immunocompromised, for example, you definitely shouldn’t be taking that or any other live bacteria, for example.
Half way through the Gut Reset
Working with Justin for six weeks. He found he was no longer getting smelly gas and that was incredible. He just said it was such a huge relief. He was overwhelmed with With relief to not be getting the gas. And his bowel movements to be firmer as well, more formed. So they were easy to pass and didn’t smell.
And that was the only goals that he really wanted apart from his problem with his poo and gas, the rest of his body was very He was all good. He was so relieved to have this change. We cut the saccharomyces boulardii down to one a day instead of two. kept in the PHGG because he did feel that helped. And also, I think he was taking ginger and also reduce that down a little bit as well.
Reducing gut supplements as you start to feel better
So as soon as people start to get some relief from their symptoms, And start to get a good new baseline. I always think it’s time to try and remove some of the supplements and see how you’re doing without them, because they are supplemental to your diet. They are not the be-all and end-all of a good nutrition program. In terms of the diet. He actually ended up going on holiday around halfway through, and he just found it so impossible to stick to the low FODMAP diet. That he started to reintroduce foods without going through the proper FODMAP reintroduction process. Now, normally I would be dead against this because I think what was the point of doing the restriction phase? And actually cutting all of those few doubts so carefully from your diet. If you’re just going to go back to eating them all without doing any of the learning about whether any of the foods are an issue for you or not. But in this case, her symptoms just didn’t come back.
Even though he started eating pasta, he was having pizza. He was having burger and chips. Like a lot of foods that were not necessarily in his normal eating plan that I’d been given to him. He was feeling ok on it. So he did find that reducing fibre down to probably the bad minimum. Having a lot less fruit and vegetables and more chips and burgers and stuff like that. On holiday made him a little bit more constipated. That then set him off to worrying again, like, oh, actually, is there something bad? All he had to do was just to start introducing some more vegetables.
Remember, like go and get a banana with your breakfast or have a little side salad with your dinner. And actually that really helped. Him straight away. Even when he was on holiday and eating foods that he wouldn’t necessarily eat every day at home. As long as he added to it, by having some fruits and vegetables, he managed.
Okay. And that was a really good learning point, I think for him that, um, Firstly, he doesn’t have to be low FODMAP. That was not the cause of his issues. And he managed. With the gas and everything else alright. But if you cut out fruits and vegetables and you don’t adhere to any sort of fibre in your diet, You are likely to get constipated. So that was one of the learning points. And then it also, he ended up finishing, working with me earlier than three months because he just felt things were so contained, so secure.
Distancing yourself from intrusive thoughts about digestion
He knew what he was doing. And he also understood the FODMAP process. So well, And he knew he could go back to it. If he needed to in the future. One final technique that I wanted to share with you that I use sometimes suggest with my clients and definitely use with Justin. Was when you have intrusive thoughts about your health, that, ‘oh my God, something’s going wrong’. Panicking about the symptoms and what they might mean. That is helpful to acknowledge the thought in your brain and think, okay. Thank you brain for letting me know this is a danger or this is a worry, something that I worry about. However. I’m choosing not to do anything about it.
Like I’m going to let it go. So almost thinking. Thank you brain for alerting me to this symptom. I hear what you’re saying. And I’m choosing to move on and not dwell on it because when you’ve got a mind that loves to work and go over bad things constantly. It’s really difficult to move on with your day.
If those fleeting thoughts, they just go through your mind. Tells you that you need to be on high alert puts you back into that fight or flight mode. And then it’s really hard to carry on with your day, like chatting to your work colleague or. To have to going back to thinking about what shopping needs to be done. Like logical thoughts are really hard to have when we’re in that distressed state.
So that’s something that you can try as well is when you feel that you’re a real warrior about your digestion. It’s really difficult to control the thoughts. It’s just first of all, to notice that you’re even having them. , , oh, we’re notice I’m having a thought about my digestion.
That’s maybe not helpful. Okay, thank you. And then you can take a big breath. And just let it go and try to practice putting space between you and the thought that’s not particularly helpful.
So that is how Justin resolved his smelly, recurrent gas. And. It sorts of things he did that doesn’t necessarily mean it is a prescription for you to follow the same approach. Everybody does have a different sort of digestion. However, that kind of advice might be something that I could give to you.
If you are struggling with your IBS and digestion. I work with people over three months. And I would love to hear from you, if you have a problem that you need some help with. You want to get better digestion, but you don’t know where to start. I can help you. So I can work with you over three months and give you a diet plan and supplement advice and lifestyle changes that will help you get better digestion.
So please do get in touch if you need some help.
I’m going to leave it there for this week and I’ll be back next week with some more information about IBS and how you can help your guts. But thank you for listening to this episode of the inside knowledge podcast, better digestion for everyone.
