And welcome to episode 36 of the inside knowledge for people with IBS.
This episode is a case study example and I’d love to introduce to you my client Ruth.
This episode could help you if you are interested in women who are perimenopausal with hormones all over the place and digestion out of control. Feeling like you are on a rollercoaster. As well as a growing sense of health anxiety that something bad is happening to you. And you want to get a bit of hope that you can turn this around, then this client story could be the thing that helps you.
Ruth’s problems with IBS and perimenopause
Ruth’s main problems were upper abdominal pain, erratic bowel habits, so sometimes getting constipated, sometimes getting loose stools. Really erratic menstrual cycle, which was shortening as she was getting nearer to menopause. She was getting different sorts of menstrual Irregularity each month.
And she was also really looking for control in terms of a dietary approach. She was using a lot of scattergun techniques and just throwing things out and seeing what happened. Cutting out garlic and onions, for example. Trying a gluten free diet.
Taking advice from anywhere you can
She’d also been to a gym and had a programme of eating recommended to her by a trainer. Which was very high fibre, high protein. Including a lot of protein shakes and this had really set off her bloating. So her main problems were sort of typical IBS like erratic bowel habits. You don’t know what you’re eating that’s kicking off your symptoms. Ranging from constipation to diarrhoea. But also a recurrent pain that was worrying her.
Nocturnal bowel movements – a potential red flag
You will know. It is not normal to get up in the middle of the night to open your bowels.
However, the interesting thing is sometimes when you don’t sleep well and you wake up for a long time at night, your digestion can then kick into action. Especially if you get up to have a wee, maybe you have a little drink. You’re tossing and turning for a few hours trying to get back to sleep.
And if anyone who’s going through that perimenopausal time, you will know that is a really common side effect of changing hormones. To have periods of insomnia.
When you are waking up, sometimes your digestion will get started, but it’s not the digestion that’s woken you up. So it’s not like you’re waking up in order to have a poo, you’re waking up, feeling restless. And then finding that you need to go.
So this was something I could put her mind at rest about as we tracked it, because actually she was thinking, I know it’s bad to get up and have a poo at night.
However, it’s often when I’ve been up for an hour and I’m walking around. Maybe I’ve had a tea. That is when my digestion kicks in and maybe I do need a poo then. And that can be when you’re having very frequent bowel movements that you sometimes do need to go when you’re up and about at night.
Anyway, I’m sort of jumping into the solutions there, but I just wanted to let you know if that’s happening to you that it might not be as much of a red flag as it could be if you’re just waking up with an urgent need for a bowel movement. That is a common sign of inflammatory bowel disease So it’s definitely worth getting checked out if that’s happening to you.
Searching for IBS diet to control symptoms
Now the reason she came to me is she wanted someone who could deal with the IBS.
She wanted a plan, someone to talk things through with and a sense of control. That was one of the biggest things that she wanted is a sense of knowing what was going on with her body.
First step – the low FODMAP diet
So the first couple of things that I suggested that Ruth should try to work on was firstly going low FODMAP. To try and create a baseline where we could assess her diet and assess if there was any foods that were triggering.
I helped her to do that to cut out all the fermentable foods rather than just cutting out onions and garlic and gluten. Like, let’s take out all the things that could be giving you gas and that bubbly feeling. And also the fermentable foods that could be causing loose stools. So she did that for a while.
Now what was really interesting with Ruth is that she had periods where we’d have one or two really good weeks. And think, yeah, okay, we’ve got a good baseline. Now let’s reintroducing the foods, but then suddenly everything just go haywire again.
Impact of hormones on digestion
And we really noticed there was a pattern over the three months of working together where her digestion would go a little bit crazy as she was ovulating, and then again at her period.
There was a real pattern to it. And we only really noticed this through careful tracking, and talking through what had happened at each of the kind of mini flare ups.
Hypervigilance in IBS
We also talked quite a bit about how to calm the gut brain axis. When you are really worried that there’s something seriously wrong with you and you’ve got this hypervigilance about your digestion. Any little tiny symptom can set off the train of thought that, “oh my god, something’s happening. I’m going to get a flare up, it’s all going to go terribly wrong, or there’s something worse that’s wrong with me”.
Even just a bubble of gas can start that train of thought. Then that puts you into a high arousal like sense of dread nervousness, which is basically high cortisol, high adrenaline.
You’re on fight or flight mode. And so it’s really hard to digest your food well. It’s hard to relax your stomach muscles and let the digestion flow and let the blood go to your gut in that situation. And so being a little bit more aware of how your thoughts and feelings interact with your digestion can really help.
Gut directed hypnotherapy
In this instance, sometimes I like to recommend the Nerva app.
If you haven’t seen it, it’s a self paced kind of learning where you practice skills like gut directed hypnotherapy at home on your own as a little bit of reading. I find some clients get on really well with it, although I’ve also had clients who said they didn’t like it.
However, Where people are open to it, I recommend it for my clients sometimes and they can really get on well with the calming element of it. So what you’re doing is you’re learning how to do specific breathing techniques that help your gut and help digestion. As well as learning how to do the mindfulness. How to do calming to talk yourself down from that high stress kind of situation in your brain.
Ginger tea for calming digestion
Other things that she got on really well with and that she enjoyed a lot was ginger tea. Actually any herbal tea, but particularly ginger because it calms down the nausea. She felt it also helped with some reduction in joint pain. Although I’m not sure if that was necessarily linked, but she was certain it was down to the ginger tea and felt like it was really helping.
Yoga for IBS
And the yoga also. I recommended like kickstarting yoga because she enjoyed that but had just let it slide a little bit. So rather than really focusing on like high energy, high impact hit exercise workouts. Trying to move to a little bit slower, some muscle building.
Building muscle in perimenopause
I often recommend upper body muscle building for perimenopausal or aging women. Generally, it’s an overlooked kind of muscle group, so women’s back, shoulders, neck. I really like encouraging women to try to build up their muscle mass, particularly in their upper body. This is really good during perimenopause and there’s actually quite a lot of research that shows that if you have a greater muscle mass, It’s better for you as you age.
Women, as their oestrogen declines, tend to lose bone mass. So the more weight bearing exercise you’re doing, putting stress on your bones through muscle movement is really beneficial for building better bones. Or maintaining your bone density, I should say.
And also in terms of insulin resistance, and managing our blood sugar control. This can become a little bit more disordered as menopause goes on. And again, it’s linked to oestrogen. The more muscle mass that you have, you’re better able to maintain a steady glucose state. It’s really helpful to build more muscle as you age, particularly for women.
Steady weight bearing exercise helps digestion
One of the ways to do that is just through simple yoga, like weight bearing yoga. Positions where you’re putting weight into your body. Doesn’t have to be any hardcore exercises like going to a CrossFit gym or lifting massively heavy weights. Just using your own body weight can be really powerful.
Throughout the programme of working with me, Ruth did actually lose three pounds, which she was happy about. She was wanting to lose a little bit of weight. And I think that some of it came through just being able to engage in gentle exercise, like Yoga again. Rather than feeling like that you have to be all or nothing. Like, doing all the stuff down the gym. Eating loads of protein or you’re not doing any of it. Actually trying to work out what you can manage and what you can build into your daily routine is really helpful.
So those were things that worked really well, which was:
- the FODMAP diet,
- the Nerva app,
- tracking and accountability
- talking with me about the hypervigilance like how to distract yourself from that sense of impending doom about the IBS flare that could be coming
The things that didn’t go so well
Now, a few things that didn’t go as well because I always want to be honest with you in these case studies. It’s not plain sailing, even when you’re working with an IBS nutritionist. There are sometimes things that I try that people don’t like. Or don’t work in the way that I thought they would.
Motility supplement reaction
One instance of this was I suggested Ruth start taking a motility supplement that contained ginger and artichoke and also a few other additional herbal things.
When she took this, she really felt like it increased her bloating and also just like that sensitivity in her digestion which had really reduce prior to taking this supplement. Ginger and artichoke are both kind of motility agents in a terms of a herbal way.
They can help encourage the gut self cleaning, so that migrating motor complex that helps us clean our small intestine, but also just help keep food moving. So it can be really useful.
Gall bladder and bile flow
However, artichoke also encourages bile flow. So this could have been one of the reasons. Ruth did have a scan again on her gallbladder, and it was absolutely fine. There was no issue, which again really helped to put her mind at rest. But they said it potentially could be a little bit sluggish.
As we’re increasing bile flow, what bile does is it is antimicrobial, which is good, but it also is liked by the sulphate reducing bacteria. These are bacteria that produce hydrogen sulphide, which is one of the gases that can contribute to things like really smelly farts, joint pain, bloating and distention and tummy pain.
All of these things could be, partly down to hydrogen sulphide gas.
Now, she hadn’t done a SIBO test, so I don’t know if she had SIBO. She didn’t want to go through the test, uh, at this point, and that is one potential cause. The artichoke encouraging bile flow, which then is enjoyed by the sulphide producing bacteria.
Eating too much fibre?
The other thing that didn’t go 100 percent well was, whilst we were going through the FODMAP reintroductions, she didn’t come up with any food group that was clearly a trigger of her symptoms. So her baseline diet was low FODMAP with these additional introductions of each food group in turn in a really careful way. She followed it really well. However, I kept stressing that we need to make sure we’re having lots of fibre during this time. Lots of low FODMAP fibre and then any other fibres that you can tolerate that you test through the reintroduction process.
If you want more help on the low FODMAP diet, listen to episodes 17 and 18 where I break all this down for you in a lot of detail.
But, the problem was, was that she was actually eating too much fibre. So she found that Some days she was just getting really bloated. And feeling like it wasn’t working as well.
Start tracking fibre to see how much
So she started tracking her fibre intake through MyFitnessPal. This is a free app you can download and you literally just upload, foods that you’re eating.
You do need to start measuring and weighing it, which I know can be triggering for some people. So this would not be suitable for everybody, particularly if you’ve had any disordered eating in your history.
However you can get a sense of how much fibre you’re eating in a normal day. If you just track it for a couple of days. And it can be quite helpful. So she found she was having really good levels of fibre because she was really going for it in terms of variety, lots of different fruits and vegetables, and she really enjoyed eating a healthy diet.
But actually we thought maybe let’s rein this back a little bit. Try to keep your fibre levels around 22 to 25 grams, not really going over that. Keeping it manageable. And then, building it up over time, more slowly.
Impact of her menstrual cycle on digestion
The other kind of spanner in the works was her menstrual cycle, because we did really notice a link to the menstrual cycle.
As I said at the beginning, she’d previously tried HRT and had not gotten well with it at all. But after working with me, she said that she went back to the doctor and tried another type of HRT and felt so much better. And so, what came out of working with me was a good sense of what diet worked for her, how to manage the symptoms.
However, it wasn’t until she got her hormones under control a little bit more through using HRT. that the symptoms really went away.
Diet isn’t everything, says a nutritionist!
There’s sometimes only so much you can do with diet if things are being led and driven by another condition or, um, maybe medication you’re taking. You know, sometimes their diet isn’t going to solve everything and that’s coming from a nutritionist.
Understanding your body during the menopause is hard
I just thought I’d finish with some of the things that she said at the end because it was so heart warming. It’s just that she felt like she really understood her body again and she was so worried about something bad happening. That to have this like weight lifted and to realize what was going on was just, it wasn’t wrong what she was doing. it just didn’t suit her and her diet needed to be a little bit different.
Knowing what works, for YOU
So by adapting it, by personalizing it, she found a way of eating that just allowed her to feel relaxed. She knew that she was hitting all the right kind of targets in terms of getting enough protein in. She’d learnt a lot about how to manage the gut brain connection through deeper breathing, yoga, quiet time. That kind of sense of relaxation and how important that is.
All of those things like added together to make her feel like, she got her body back. And she just felt so much relief that the symptoms were under control. She was able to eat foods that she just couldn’t eat when we started working together.
So that was also really enjoyable for me, was to hear about the things that she was eating.
Freedom of eating out again
Eating just she said she went out for breakfast with her husband and just could choose anything on the menu without having to check it all before you leave. Make sure you know the menu inside out and you’ve chosen what you want before you leave the house.
Just to turn up somewhere and just order whatever’s on the menu and what you fancy on the day gave her such a sense of freedom. And that is one of the things I absolutely love about my job.
It’s helping people enjoy eating again because we all have to eat. And if you are worried about it and anxious and every time you eat it’s sending you into a massive head spin, maybe this is the year you’d like to do something about it.
Work with me – the Gut Reset
If you want to work with me, Then I work with people over three months and I have two ways you can do that, either through the group gut reset where I take people in a group and some of the coaching is done with others, or an individual gut reset where we have more one on one sessions.
But either way you get a personalized nutrition plan. You get meal ideas and recipes, you get a tailored supplement plan. The difference is just how many sessions you get with me one on one and whether you have group sessions or not.
Everyone I work with has IBS, or SIBO, and gut issues.
You don’t need to have a diagnosis of IBS, but you do need to have been to your doctor and made sure that they’ve ruled out other things.
Because there’s no point in me treating you for IBS and talking about diet when actually you’ve got celiac disease and all you need to do is Just avoid gluten, for example.
I’m not saying that that’s what you’ve got. There are lots of things. It’s not just about diet. I work in a holistic way and I like to try and incorporate aspects of your lifestyle that could be adding to your symptoms.
So, It’s not just about food, but obviously it’s mostly about your diet, what you’re eating, but also how you’re eating is a really important part. I hope you’ve enjoyed this little case study about Ruth.
If you have enjoyed it, please like and rate and subscribe to my podcast. I would really appreciate some reviews as well, as I know it helps people to find the podcast.
Thank you very much for listening. I’ll see you next week. Goodbye.