Sian’s IBS story – vegan diet with constipation

Welcome to episode 58 of the Inside Knowledge. I’m Anna Mappson. Choosing case studies to share with you is always really good. It gives me a chance to reflect a little bit on What’s gone well and actually how my practice might have changed over the years. And also I know from speaking to people that you enjoy listening to these case study episodes as well.

I often have people contact me saying, Oh, I heard this story that you and I think storytelling is really powerful. So hopefully you will get something out of today. It’s going to be about SIBO, about constipation and bloating. So if any of those are your problems, then listen up. Um, now also just to reiterate that, Obviously I do change some details about all of my case study people so that you won’t be able to tell who it is.

I will change their name, obviously, but I will also change a few other details like their job or anything that is relevant, because I wouldn’t want anybody to be identified. So let’s meet Sian. So Sian was relatively young in terms of people I normally work with, she was in her mid twenties and she had had an episode of food poisoning ten years ago when she was a teenager.

Then, apart from that food poisoning episode, she had no problems for a little while, but then over the years her constipation got worse and worse and worse and the bloating was unbearable. She was passing a bowel movement every two to three days and it was type 1 or 2, on the Bristol stool chart, is very small, hard, pebbly poos, or large, big ones, which required a lot of straining.

She was also eating a, Relatively processed, sort of unhealthy version of a vegan diet. And I say that just, that’s how she described it to me. And like I said in the introduction, when she felt she ate a healthy vegan diet, that’s when her digestive symptoms got 100 percent worse. She had a goal in mind to try and lose some weight, and in order to do that, she was fasting, and missing breakfast most days, so like intermittent fasting, where she was just eating two meals a day.

The meals were a lot of vegan fast foods, or vegan ready meals. So she was having a lot of vegan sausages, vegan sort of pizzas, burgers. for breakfast, if she did eat it, it would be rice krispies, and a lot of vegan biscuits and that sort of thing. She didn’t enjoy cooking, she really didn’t enjoy making food and just wanted things to be better, but didn’t really want to have to engage in the cooking process, which is fine, not everybody likes being in the kitchen.

Before she came to me, She’d already had a SIBO breath test, and she’d had a private stool test, and this was with a company online, so she’d done the tests and then got a quick online consultation from the company that did the tests for her. But they didn’t really leave her with a treatment plan that she felt she could follow, or didn’t really give her anything that would help.

Her SIBO breath test showed that she had high methane producing microbes, especially in the large intestine, as the methane went up quite a lot as it hit the large intestine. Uh, if you don’t know what I’m talking about, do listen to my previous episodes on SIBO, episodes 11 and 12, where I explain a bit more.

What that is and what all the testing involves, so you can go back and listen to that. But just to know that when you have methane producing microbes in your gut, then you’re gonna slow down your digestion because methane affects the nervous system of the gut and just slows down the movement of food.

So It is important to get on top of that. So because she didn’t get anywhere with her previous online nutrition support, she did take her SIBO test to a private doctor. Then she got prescribed some antibiotics to address the SIBO. As soon as she took the antibiotics, which was rifaximin and neomycin, she felt really awful and was unable to finish the course of the treatment.

She just only took it for a few days and then, felt very sick, her stomach was very unsettled and she had pains and the bloating was worse and she just didn’t want to carry on and also she didn’t have any follow up with the doctor to check back in with her so she just stopped taking them and then didn’t know where to go from there so that is how we started.

Sian came to me because she wanted somebody to walk her through what to eat and also how to do it so she’d had Testing done, and an online consultation that wasn’t very helpful. She’d then been to a functional doctor and had antibiotics prescribed, but had a horrible reaction and didn’t then trust to take them or trust what he had recommended.

Because there was no follow up, she felt on her own. So she wanted somebody Who would speak to her each week? And so that is what we did and that is how I work with people in my three month gut reset. I speak to clients weekly for six weeks and then it’s fortnightly for the last few weeks. So you get nine half hour calls with me throughout the three months and during that time that is when you can really explore what’s going on and I can push you a little bit more to make some changes.

So I started off with Sian suggesting that she goes through her basic checks, what I would call the constipation basics, and these weren’t changing anything about her food as yet. So I wanted to see what would happen with her constipation if she just ate three meals a day, because at the moment when she started she was skipping breakfast and then would go to work and then just have lunch and dinner and they were, like I said, mostly fast food type vegan meals. quite low in fibre and vegetables because she felt that they were her biggest triggers for the bloating.

I also encouraged her to start drinking more water and to actually start tracking it. So getting up, drinking a bit of water first thing in the morning, having a little bit of water when she went for her break at lunch in the morning, like trying to use some Key points in the day to hang the water hat on so you say right every time I go to the toilet I’m gonna have a little glass of water or every time I Go and have a meal I’m gonna make sure I’ve had some water in the preceding hour before that just things like that just to really try and Get drinking water a habit because if your stools are hard And, pellety, you may be not drinking enough water because the longer it’s sitting in your digestive tract, the more water is being absorbed, and that is where you can end up with really hard stools.

So, it’s not the only thing that would cause constipation, but it’s one of the basics to just cross off the list. So, eating three meals a day, because every time you eat, it kickstarts constipation. The gastrocolic reflex, which is going to push food through your gut, and you want that. Then making sure there’s water there, so that fibre that you do have can, um, draw water in and create a softer stool.

And then the other basic that she started on was mindful eating. So really chewing her food properly, sitting at the table. This was quite a challenge for her, and she found sitting at the table on her own really difficult. She lived with her mum and dad, but they had different sort of work schedules, so she often ate on her own, and would just make herself really quick meals in the kitchen, but really struggle to sit and eat without distraction or in front of the TV.

So we came up with a compromise of listening to her favourite podcast and trying to fix something funny, something where she could sit up right at the table, but still, get a little bit of concentration on chewing and digestion and food. Sian really wanted to lose some weight as well as part of this, and although weight loss wasn’t a focus of our work, I explained to her that her diet was very low in protein.

Because she was eating a vegan diet, it was mostly carbohydrates that she was eating, and so we talked about how Vegan proteins and what sort of things she could look out for. For example, tofu and beans and pulses in small amounts. And then also vegan alternatives like veggie burgers and things which she was already eating quite a few of.

But I really wanted her to experiment a bit with tofu and she wasn’t mad keen on it, but she did give it a go and introduce things like Scramble tofu, for example, in the mornings instead of scrambled eggs. The thing about eating a vegan diet that is low in protein is that you generally tend to be very high in carbohydrates and particularly, in this case, it was very high in wheat because a lot of things she had were wheat based proteins.

or there was a lot of just carbohydrates like pasta. because that was a lot of the bulk of what she was filling up on. When you eat a lot of wheat, like to that extent, it can be difficult to digest and can, when you’re already constipated, cause a lot more bloating because it’s slowly going through the large intestine and your gut bacteria are going to ferment those fructan molecules that are in the wheat and cause a lot more bloating.

So adjusting the balance and eating more diversity is helpful. The other thing that I thought would help with weight loss was increasing the amount of movement that she did. She was not going to the gym or doing any walking or anything because the bloating had been bad and she just felt really sluggish with the constipation.

She felt slow, like everything was heavy and hurting and she would just felt very full in her stomach and hadn’t wanted to do any movement. But I was explaining that if you can get. Your gut moving through some gentle walking every day, maybe going to the gym and doing a little bit of exercise.

That would not only help with the weight loss, but also would help with digestion. So we agreed on a, you know, a gentle pattern of reintroduction of some movement, as well as increasing her vegan protein sources. For supplements, I advised her to start taking magnesium oxide, which is not a very well absorbed form of magnesium.

This can draw water into the large intestine and create a softer stool. So it makes things mushier, easier to pass and just helps to speed things along a little bit. So she started taking a couple of those at night. There were some other supplements that I suggested that she take that would start to reduce the methane producing microbes.

So remember, methane gas producing bugs will slow down your transit time and we needed to speed it up because often the bloating is down to constipation. When you’re full of stool that can’t come out, not only does gas get trapped and feels much more painful but It’s really hard to keep things moving, so we need to speed things up and try and get the whole digestive tract operating as it should.

 I wanted to see what happened if we reduced down methane producing bugs using allicin, which is a garlic extract, and oregano. She was really, really nervous about taking these because of the bad reaction that she’d had to the antibiotics. These kind of antimicrobials supplements can have a similar effect, to be honest.

They are as effective in some studies as taking antibiotics, although they are much slower working, so you will have to take them for six to eight weeks instead of just two weeks. So she did very gently start taking them, but it was a very slow process.

In fact, The first few weeks she didn’t buy the supplements and I kept saying, How are you feeling about the supplements now? And then she would say, Oh, okay. Yeah, I’ll get them next week. I’ll get them next week. And then she actually got them, she didn’t want to take them. So there was more than just, um, not being sure about the supplements, whether they’re effective, but it was like a fear of bringing back that same experience with the antibiotics, which was so understandable, she’d had a really horrible time of it.

 Eventually, we did managed to talk through how to take them and doing it in such a gentle way and she started to take these supplements which reduce the methane producing microbes. After one month she was having a poo every other day and it was more formed, it was not as pebbly and it was easier to pass, so still straining a bit, and she still had a sense of like incomplete evacuation, but the stools were more formed and easier to pass than before.

So this was really encouraging, and she could see, okay, actually maybe it is working, maybe there is something to all of this, and we carried on increasing up vegetables. At the beginning, she was starting to have raw salads, so she really wanted to eat a healthy vegan diet, but found that eating lots of salads made her feel very bloated.

So I explained that sometimes raw food is more difficult to digest than cooked food. So we increased vegetables, That started off in the low FODMAP vegetables. So really trying to bulk out things that felt safe and eat them in a cooked way to try and increase low FODMAP fiber. Now this actually helped and then she was able to experiment with some higher FODMAP foods like raisins.

And she started taking little boxes of raisins to work with her, which would really help her get looser, softer stools. I also really encouraged her to eat fruit. She was very nervous about this because she felt fruit was too sugary and it might stop her losing weight.

And so I explained again that actually increasing the amount of fruit wouldn’t really have an impact on her energy intake because fruit is quite low calorie and And the rest of her diet was vegan. It wasn’t like she was eating a lot of fatty foods. Adding in some fruit was going to add in essential antioxidants, fiber as well, which is critical for a good, healthy bowel movement.

And just really upping that diversity that would help her with better stools. When we were two months in, she was still only going to the toilet every other day, but the poos were a lot fluffier. less straining, a lot easier to pass, and she’d managed to start at the gym. So she started going back to the gym and she was really loving it.

She was really enjoying moving her body and being able to get into the stuff that she’d wanted to do for a long time. She felt like It was really sort of engaging back with her body after feeling like everything’s broken, nothing’s working, it’s all terrible. Actually to feel like, yeah, I’m building some muscle, like I’m getting stronger.

I’m a bit more active and sort of growing into that person that she wanted to be. Now, remember I said she had been fasting, so skipping breakfast? Interestingly, about two months in, she really noticed that on the days that she thought, actually, I want to go back to losing weight, I’m going to start fasting again.

Those were the days when she struggled to go to the toilet. If she went and had breakfast every day, then she normally went to the toilet within 30 minutes, and then the rest of that day, felt better. She felt less bloated, less painful, and she could move around a lot freer. Um, in her job she did quite a bit of walking and so she was able to move a lot more freely.

That just made a big difference actually noticing when you start to see some changes. And then things go back to how they were. Then you’re like, oh, I remember. This is how it used to be. This is what I used to have to deal with all the time. So it was really great, in a way, that she had those days when she noticed the change and the difference because then she could see, Oh, actually it is working. It does make sense. And it reinforces what it is you’re doing and why you’re doing it. This doesn’t mean it was easy. One of the things she struggled with a lot was eating in the morning. And just because I said she did breakfast doesn’t mean, uh, She found it easy to do. So she did feel a little bit nauseous and she was getting up relatively early for her breakfast as well. So we talked about, you know, is there a way she could eat when she got to work, get there a bit earlier and go to the staff room and eat there?

Or is there a way she could do that? get everything else ready and then eat just before leaving the house. But then there was like an added complication of, Oh, well, will I need the toilet on my journey to work? It is hard to change your routine and hard to change your body, especially when you have got timed deadlines that rely on you leaving the house at certain times or attending work at by a certain time.

This is really challenging when your digestion’s all over the place, but. I felt so proud of her for really sticking with it and trying a lot of these things, but like I said, she did do it relatively slowly in her own time because she was so nervous about the consequences of changing her diet.

The other thing I provide all my clients with is access to the Gut Reset video portal, and in there is a whole series of videos, each one’s quite short. there’s a specific section on constipation, including things about creating a morning routine, how to sit on the toilet more effectively, um, thinking about what to eat for constipation, so it’s all really laid out topic by topic. So my clients can access the bit that they need to learn, but she actually found watching these videos and then returning to them a few months later was sometimes also helpful because she didn’t always take it in on the first time and was sort of skimming them. And then we would chat about it in the one to one sessions and realize, actually, maybe go back and have another look at that video and see if there’s anything else that you might be able to find useful.

At the end of three months, her bowel movements were practically normal.

She was going four to five times a week, so almost every day, but she would still miss a day, They were type 4 on the Bristol Stool Chart, which is a normal stool, easy to pass, and this was just fantastic. Like, she was not getting as bloated as she was, she still did fine. Some meals, particularly, like a vegan burger in a bun, might have increased her bloating.

bloating. But I think that’s relatively normal and a lot of people will get that. But she was just eating so much more and throughout this process she’d learned to cook for herself, learned how to make some simple foods that could be batch cooked and saved and like packed away or frozen so that she could eat them later in the week.

Because when you’ve got to cook for yourself all the time it is quite boring and sometimes you don’t really have the energy or the desire to make a fancy meal. Trying to make some batch cooked foods is really helpful in those kind of situations.

If listening to this story has made you think you would like some one to one help to really target better interventions to get your digestive system working as it should and get you eating a broad range of foods again, then you can email me about applying to work in my three month gut reset with me, where we get lots of time together to talk through your issues and what you need help with.

You can email me on info@goodnessme-nutrition.Com or book a call via my website. I offer a 30 minute free call for anyone who’s interested in working with me just to check if we’re a good fit and you want to work with me and I think I can help you with your issues. So we’ll leave it there for this week, back next week with another podcast episode.

If you’ve got any suggested topics or things that you’d like me to cover, then please do get in touch as well via my email address, or you can reach me on social media. I’m on Instagram, @goodnessme_nutrition. Thanks for listening to this episode of the inside knowledge, better digestion for everyone.