Hello, welcome to episode 65 of the Inside Knowledge podcast for people with IBS. I’m Anna. Welcome back to another case study episode where I tell you a little bit about somebody I’ve worked with in the past. What we did together to help them improve their digestive symptoms and start eating a better diet that was more tailored to them.
Let’s meet our case study
This week is all about Liz. I worked with her a little while ago. She came to me because she’d had some blood in her stool and it had really upset her and sort of worried her.
She’d gone off, had a colonoscopy with the doctors, they couldn’t find any problems. But she was still getting quite a lot of constipation. Really a lot of bloating and sometimes occasionally she would get diarrhoea.
It was like a weekly bout of diarrhoea but then the rest of the time would be constipated. She was also getting a noisy very gurgly digestion. She’d really tried changing her diet but had just never been able to stick to it.
So she thought, oh I just need to start eating more healthy and would do that for a few days Then give it up. Then she might say, Oh, maybe I need to go gluten free and try that for a week. No improvement. So give it up. And so she was just sort of launching from one thing to the next, not really knowing what to try in order to make the symptoms better.
Battling a busy life and bad digestion
She had a very busy life. She had her own business. Working with somebody else and they had a really busy company, so she didn’t have much time. You know, she was often traveling, sometimes going up to London and she also had a family which was obviously busy, it takes up a lot of time.
She didn’t have much headspace spare, but the worry was really starting to encroach into daily life. It was taking up space and then making her feel all sort of muddled at work and a bit forgetful. Although she had had a clear colonoscopy, she still worried that there was something else wrong because she didn’t feel good.
Clear set of digestive tests
Her symptoms were that she was feeling rubbish. Even though the tests that she’d had with the doctor were clear.
She didn’t have celiac disease, she didn’t have IBD, those had all been cleared. And a colonoscopy was clear.
She’d had a good set of tests that the doctor thought were appropriate and they said it is just IBS. Now, we all know if you have got IBS that just IBS doesn’t mean that you don’t have severe symptoms.
It’s more that, they just weren’t going to do any more tests and they weren’t going to offer her any medication. The reason she wanted some help from me is that she tried adjusting her diet already and she just couldn’t stick to it. And so with that and the fact that the worry was now starting to take over a little bit, she really wanted somebody to guide her. And she thought that, I’d be able to help her.
Using medication
She’d started taking an SSRI, like an antidepressant, around six months before working with me, which was also really helping with stress and anxiety management. She just wanted to do something more practical to try and get on top of it.
One of the first things that I talked to Liz about changing was increasing variety in her diet in order to try and get better, more regular bowel movements. I also advised her to start taking a laxative in the short term, just to try and get things moving.
Laxatives can help get things moving
Because if you are quite backed up and you’ve got a lot of hard stool inside your colon, it’s really difficult to know if you actually have any food intolerances because almost everything you eat is going to be sitting there for a long time.
Think about how your digestion works. Your food waste goes through the small intestine and there a lot of the nutrients are getting absorbed. Then it’s in the large intestine, water is being reabsorbed. And, you know, some other stuff is happening too. But generally that is where your water is being reabsorbed.
Dry hard stools
So if it’s sitting there for a long time, it could potentially end up with quite hard stools that are difficult to pass. And this can lead to pebbly poos that which are like type one on the Bristol stool chart. So if you get those then you know that your stool has been sitting there for quite a long time and you could be dehydrated or it could just be that it’s such slow movement that more water has been reabsorbed.
Bloating improves when the constipation eases
I suggested taking a laxative in the short term in order just to try and get things more regular and try create a little bit more softer stools and then once you get that then often the bloating does go down. The ongoing bloating is really difficult to get on top of if you can’t have regular bowel movement.
That is often the first place that I will start. Now, some people already take laxatives and still are constipated. So that means maybe there’s other things that you need to do But if you haven’t tried taking laxatives, I would recommend.
It’s nothing to to avoid, like it’s okay to use them in the short term because what it does is it just gets the bowel moving and gets it cleared.
Struggling to make new meals
After the first few weeks of working together, it took a little while for her to try out the recipes. She looked at the menu and was like, yeah, these all look great, I’m happy to make them all, but actually finding some time to do the cooking and to try new foods and new meals took a little while, but once she had started doing that, she started to feel a little bit better.
Worry about laxative use
But she didn’t try the laxatives straight away because she’d had an experience with another family member trying laxatives and they had ended up taking a little bit too much and getting a bit of leakage, a bit of incontinence, and she was really worried about that happening to her, which is completely understandable.
It took a little while to actually get the confidence up to start the laxatives. But, another week later, once she’d actually tried that and got on with it, then she started to notice that the bloating was going down.
And then that gave her a lot more scope to try and play around with the dietary changes that I was advising.
Changing up your fibre variety
Even though you might feel like you have a good healthy diet, eating lots of fruits and vegetables, You may find that you’re only eating the same types of fibres. So this is where getting a good diet diversity can really help. So with this particular client, I didn’t advise that she would cut anything out.
It was more about adding foods in and trying to create a bit more diversity and variety in the types of foods that she was eating. This doesn’t have to involve eating different meals necessarily. It can just be about adding to the current family meals that you’re already cooking. It’s maybe like adding one extra piece of vegetable to your plate.
Small steps count
Maybe having an extra piece of fruit after lunch. It’s just thinking about the small steps that you can take throughout the day, rather than. Trying to completely overhaul your diet. This is where I was trying to get a long term solution for her.
Because as I said at the beginning she’d already tried quite a lot of things tried going on different and various elimination diets. And hadn’t seen much change.
But partly because she was doing it on her own and it’s tricky to know exactly how to implement those sort of changes, but also because she was going all in and changing everything all at once and it was just so overwhelming.
Stack small changes to see progress
Sometimes your progress can be a bit slower when you make small changes, but when you’re kind of building up, stacking these small changes bit by bit by bit, then this also really helps to cement it in your life. It doesn’t become like a diet that you’re on or off It’s like just developing a new way of eating and I don’t think you can do that overnight It is a slow and steady change and that is what My process is all about.
That’s why I work with people over three months It’s not just throwing you in and giving you some changes and see you in six weeks and hope you’ve made the best of it.
Testing eating beans & pulses
After about three weeks working together Liz was really keen to try some pulses and lentils because she loved them. But she’d never been able to eat them because they always gave her so much gas and bloating So she started off with a really small amount.
now what if you haven’t eaten pulses for a really long time, but you want to include them a good portion to start off with is around two tablespoons. Whether it’s chickpeas or lentils black beans, whatever this is not too much.
Increase your tolerance
And this is what’s still considered a low FODMAP amount for most beans and pulses So, just a really small amount, adding it to your plate.
That would be a good first day challenge to see if you can tolerate some beans and pulses. If you get on okay with that, then you could start with a bigger portion the next day. And see if you can get on okay with it like that.
Once she was getting regular bowel movements and wasn’t constipated anymore. Then actually she found she could do lentils and chickpeas. It did give her some gas, but if the gas is not getting trapped and it’s not particularly smelly, then I tend to not to worry about it. Most people will get a bit more gassy when they eat a bean heavy diet.
Some level of gas is normal
And it’s actually okay. As long as the gas is not causing you any pain, it’s not really smelly and like offending your family members. Then actually, you don’t necessarily need to worry about it. It’s a sign of fermentation and actually feeding your good gut bacteria. Beans and pulses is a very good source of the galacto-oligosaccharides. Which is like one of the prebiotics that really helps to feed them and create a good diverse gut microbiome.
So, getting a little bit of gas is not something that you need to avoid at all costs. It can be quite normal. It’s just where that causes you significant pain, and that can sometimes then lead to sleep loss if it keeps you awake at night. And that is, much more in keeping with people who have IBS rather than somebody who just gets a bit gassy after having a few more beans.
“I feel like a new woman”
One of the things that this client said to me halfway through the process of working together is, I feel like a new woman. And this was really amazing. She felt such a weight lifted that it really had cleared a lot of the mental anxiety and the burden that was just like a black cloud sitting over her.
Partly worrying that she had a significant illness.
Health anxiety
Not that IBS isn’t significant, but that she had something else that was going to be more serious. That was still a worry, but also just feeling so tired. Like once she was able to eat a better diet with more variety, actually some of her energy came back.
And once she had got more confidence in cooking and eating more variety, it lifted some of the worry. When you are going out with work for lunch. Or like if you’re going to different offices around the place. And you don’t know what you’re going to be able to get.
Choosing food is easier when you have a choice!
Actually having the freedom to eat more of those foods just is such a weight off people’s shoulders.
If you’re thinking, Oh my God, I can only have these five types of lunches. And I don’t know if there’s going to be a cafe nearby that will do this. And it just creates quite a lot more worry. Whereas when you can just eat all of these little things and feel okay with them, then it’s just one less thing to worry about in your day.
Freedom to eat
And that in itself was just really lifting. So halfway through the process, she actually said, I want to come off antidepressants. I feel like everything’s just clicking into place. And I really want to start. Looking at my other medication as well. So she made an appointment with the doctor to have a discussion about that.
By this time she was not seeing any blood in her stools at all and 5 days out of 7 she was having a normal bowel movement. So like a normal Bristol stool type 4 poo with no straining. No gas, no pain. Some days she was still getting a slightly pellety poo, like a little bit harder. And then that was two days out of seven.
Setbacks can keep you on track
So majority of the time it was normal, easy, and those two days a week in a way, just serve to remind her why she needed to keep up with the small changes. And actually sometimes that is helpful. Just to have some kind of setback or something that reminds you why all these things are still important to keep you going.
Because the other days when it doesn’t happen, it’s like oh such a relief. She also said it felt like it was easy to slip into the old ways.
Slipping back to old habits
It was easy to go back to snacking on sweets or like eating out a lot for lunch without thinking too much about fibre and different fruits and vegetable intake. Once you have those like new thought patterns, it does take a long time for it to become a bit more normal or that you even notice that you’re doing things in the old way.
So, for example, if she had a lot of lunches out, it would generally be like a sandwich or something that you can get in a cafe. That didn’t really leave as much room for eating fruits and vegetables. So we talked about how to bring things with you, like take. Food along for snacks that you can add to your basic meal that you’re buying out and about when you’re having lunch.
Maintaining the basics
And it just means that you’re starting to get that five a day as your minimum, like five fruits and vegetables as a minimum. That’s your baseline, you just don’t deviate from that because it’s normal for you to add things to each of the meals that you’re having.
Supplements to support constipation
In terms of, supplements and things as well as changing her diet, I did, advise Liz on a couple of supplements to take.
One of them was magnesium oxide, which is very good at drawing water in to soften the stool. It’s not a well absorbed form of magnesium, so it’s pretty useless if you take magnesium oxide and you’re hoping to absorb the magnesium. And it’s mostly in the cheapest sort of supermarket brands of magnesium, you’ll find it’s magnesium oxide.
So it’s good, it’s relatively cheap. Easy to get hold of. But because it’s not very well absorbed, it tends to, by osmosis, draw water into the colon and loosen the stools. There was a few other supplements that she took as well alongside the work on her diet. But essentially I felt like I wanted to share this case study because it was a relatively simple case.
Simple changes can be effective
It’s a relatively simple set of changes that she made and had such a dramatic result for her.
I guess following on from the podcast last week where I was saying some of the things that are holding you back from getting improvements with your IBS is going down rabbit holes of very specific niche rare conditions. Researching them and taking tons of supplements. And really going hard into internet research territory.
Support to change is really important
Whereas actually, sometimes some of the basic kind of changes being supported to do it, to give you the confidence that this is the right thing to do, can have very dramatic improvement results.
Sometimes you might feel like I’ve tried all of these things, I’ve tried this basic approach of just eating more variety, but what I find is that Some people with IBS can say that they have done that, given it a go.
But because the symptoms don’t change either quick enough or you don’t really understand why and how they’re changing, you might then give up on certain dietary interventions such as increasing your fibre.
Constipation – start with low FODMAP fibres
So where I would suggest people with constipation start if you were looking to how to do this, would be to start with low FODMAP fibres that are less likely to create more fermentation and that sort of thing.
So, whilst I’m not saying go on the low FODMAP diet, but if you’re just looking for places to start, foods to include, that would be helpful.
Fruits for constipation
You might also think about fruits like kiwi, pineapple, and papaya. Papaya and pineapple are also very good because they contain some enzymes in them which naturally help us digest our food.
So there’s papain in papaya and bromelain in pineapple. They’re just naturally in the fruit, plus, they’re tasty, they’re quite sweet fruits and nice to eat.
You can add those kind of things to your diet and in terms of vegetables, it’s things like carrots, parsnips, spinach, green beans. Just start with those ones.
If you don’t feel confident about eating more highly fermentable foods, like, I don’t know, cauliflower or lentils, don’t start there. Start with the lower fermentable foods.
Support for the FODMAP diet
And if you’re not sure about which ones those are, you can listen to my episodes on the FODMAP diet. That’s episodes 17 and 18, which is an introduction to the FODMAP diet.
Then episodes 25 to 29, which is a summary of each individual FODMAP kind of grouping. And what you might find if you have a fructose intolerance or maybe you have an issue with sorbitol. So it kind of goes into each one of those, what are the foods to look out for, and how might you go about reintroducing them.
And I’ve also got episode 37, which is what can you eat on the low FODMAP diet. And that is where you’ll find more discussion about low FODMAP foods. So if you were looking for fibre types that you wanted to try and include, that would be a good place for you to start.
Your next steps
If you feel like you need help with your individual diet and support in order to change things in your life to try and get a better diet and digestion, then you can work with me wherever you are in the world.
I have a three month gut reset program. And over those three months, It’s working together very closely with me. We start off speaking weekly and really trying to dig into where you need to make some changes. Also critically how to make the changes so that you feel supported.
You know what you’re doing and you have all the resources to do it. Like meal plans and ideas for foods as well as a supplement plan.
Learning as you change your gut health
A lot of gut health information and education that I have in my video portal. So I have a whole set of videos that you can just watch in your own time and then you can use the calls with me to ask me questions or to, check anything.
I always have a discovery call with people ahead of working with them and that’s really important part of my process to work out if it’s a good fit.
Most people I feel like I can work with, but I just want to make sure that you’ve had the relevant involvement with your doctor for example, that you have actually got IBS or SIBO and that actually you like me as well, that we’re a good fit to work together, that you feel like you can tell me all your health history, you can tell me all about your diet and your bowel movements.
It starts with a discovery call
You have to feel comfortable with it. Some people just don’t come back to me and that’s completely fine. Some people will think about it for a couple of months and then come back to me and that’s also fine. So if you feel like it could be worth investigating, you can set up that discovery call. It’s 30 minutes over zoom.
Where we just have a quick chat about what you need help with.
So I’m going to leave it there for this week. Thank you very much for listening to this episode.