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Ep6. IBS tracker – the data you need about digestion
26 Jun, 2023

Episode Intro

When my clients start working with me, I ask them all to complete a diet diary. Some people wonder whether it's worth the effort and feel like it's a bit of an inconvenience, which I totally get. We are all busy and it's just another thing to do. However... After even just one week of tracking your food and digestive symptoms, we can start to see patterns and useful data about your diet that can help shape a nutrition plan. In this episode of the Inside Knowledge, I'm going to give you a better understanding of diet and symptom tracking for IBS. So you can try it for yourself at home, and you can also download my actual template that I use with my clients to give it a go for yourself.

Podcast transcript

Hello, welcome to episode 6 of the Inside Knowledge. I am Anna Mapson. I’m a registered nutritional therapist working with people who’ve got IBS.

Today, we’re talking about diet diaries and what you can track in order to try to find some patterns. It’s something I do with all my clients and I find it really important part of getting a better understanding about where you are. What you’re eating on a day to day basis and any pattern in your symptoms.

It’s not just looking at your food and writing it down, although at a basic level, that is a good place to start.

Get the template I use 

In this episode, I’m going to go through some things that you could track and I will also give you access to the template that I use with my clients. and I’m happy to share it with you, loyal listeners of my podcast, so that you can try some of these things at home and see.

Now when we talk about diet diary, there are lots of templates out there. You know, you can get apps.

What I do is a Google spreadsheet with my clients, but it doesn’t really matter what the format is, as long as you’re tracking the right information.

IBS Tracker Essentials

One of the things I’m looking at is patterns around eating. Like what time you’re eating, how often do you eat, do you snack? All of these things give us really important information. If you haven’t yet listened to the other episodes that I’ve previously done, then go back and listen to the one about when to eat, which was episode three.

Meal timing

It’s really focusing on timing of meals, regularity of three meals a day. And when and how you could snack because that’s really important. For this, what I’m looking at is how often you’re eating. What you’re eating in those snacks, if you do snack, and also is there huge gaps between the food intake.

I’ll also be looking at your symptoms against the food intake. And looking at timing of when those symptoms occur.

So, as you will know, if you think about episode one, where I talked about normal digestion, when you eat something, it’s not always that particular food that comes out of you. If you get an quick reaction to food and you find you’re rushing to the toilet after meals, it’s rarely that particular food which is actually giving you problems.

What we’re looking at is a lag of like 24 to 48 hours for it to come through. That is interesting information as well. So how long does it take for the symptoms to hit you?

Those things are really key as part of the diet diary tracking.

Looking at your diet macros

And I’m also really looking at, quantities of protein, fats and carbs, particularly fibre. Like, are you anywhere near getting 30 grams of fibre a day? Maybe you’re eating too much fibre. Are you not eating protein for breakfast and lunch?

Which I have to say is very common. These things can be really apparent when you write it all out and you see everything laid out.

The other thing you could probably do at home is to look for repetition. So often people might eat a lot more wheat than they think, whether it’s in breakfast cereals, sandwiches, pasta for dinner.

You know, just thinking about how much of that fermentable carbohydrates that you are eating on a daily basis.

And are you eating a lot of the same foods? We also might see lots of common vegetables repeated again and again and again. And this is particularly if you’ve got a very restrictive diet because you’ve had to eliminate lots of foods due to your IBS symptoms.

So, if we now look at the template that I use, and you can download this so you can follow along. Or you can just write out the categories that I’m talking about in your own notebook and, do it offline. so the first thing I’m asking is the day. Obviously you just need to record what day it is.

Recording the timing of meals

But also the first bite that you have of the day and the last bite.

And this is giving me an idea of your eating window. So if you go back to episode three, you can hear a lot about time restricted feeding. And whether it’s a good idea to have long periods of time without food. But what I’m looking for here is, are you eating a lot during the day, or are you eating in a shortened time period?

There’s no set answer for what this has to be. It’s just interesting information. There’s no correct answer. But I think it’s useful to look at whether there’s regularity across five or seven days. See whether you’re eating at regular times during the day. Or perhaps you’re a shift worker and you have to do irregular eating patterns.

Tracking your IBS diet

And coming on to the food, I ask people to write down breakfast, lunch and dinner, snacks and drinks. Again, writing down the time that you eat the foods. Just writing literally what you’ve had for breakfast. Porridge with raisins and seeds. And lunch, cheese sandwich, whatever. And then dinner, you had stir fry with some brown rice. Then write down the types of snacks that you had as well.

I don’t ask people to weigh out the food. I don’t find it necessary. I’m not specifically working with people on their weight most of the time. So we’re not trying to control for energy intake.

Sometimes if I feel like people might be under eating, I will ask them to send me pictures of the food so I can get a sense of portion sizing.

Especially making sure that they’re eating enough, because that can be a real trigger of IBS symptoms. Now the one thing that is really important to think about here.

Appetite tracking for IBS

And I asked my clients to track is how hungry they were before and after each meal. This comes from appetite retraining that I have borrowed from Dr. Helen McCarthy.

She is a health psychologist who’s written a book called How to Retrain Your Appetite. And she’s Come up with a great appetite pendulum. Which thinks about swinging from minus five when you’re extremely hungry. To plus five when you’re very, very full. Now, I like to use this with my clients to get a sense of when you actually have hunger in the day.

And when you eat, are you eating to the point that you’re full, that you’re satisfied? Or are you still actually hungry after your meals? I find it really interesting.

Tracking hunger in IBS

A lot of people with IBS maybe override some of their hunger or fullness signals. And that can be down to dysregulation in the hunger hormone production. Or it can just be down to behaviours and learned ways of eating. That you’ve had to do over the years to manage your symptoms. It’s really interesting to think about when you get hungry, and do you get to the point where you’re absolutely starving. Or do you just get mild hunger and actually you never feel hungry because you’re always nibbling? All of those things, are really interesting and useful information.

So before each meal, I ask you to rate whether you’re hungry on a scale of minus five to plus five, and then after the meal, how hungry were you?

And again, this can just give you some really good pictures of your patterns of hunger and satiety for each day as well.

Tracking your poo for IBS

I also want to know about your bowel movements, of course, people with IBS, this is really, really key.

I want to know how many poos you’ve had and also what type were they on the Bristol stool chart. In episode one, when we talked about normal digestion, I talked about the Bristol stool chart but essentially it’s just a pictorial way of looking at poo. Type one is really hard pebbly constipated type poos, type seven really loose watery diarrhea.

I want you to rank the poos on that scale every time you go.

Sometimes people are going multiple times a day so you can write that down as well what type it was and how many you had per day. This is also really important information when you’re thinking about patterns. Is it that case that you always go at the same time every day or is it really erratic?

And you could go throughout the day, whenever it is, you never know what’s happening. This is helpful information for me. And I think it can be helpful for you as well, just to get a sense of tracking it. Because it can feel erratic, but then perhaps when you track it, it’s not as bad as you think. Or it’s not as, ‘unpatterned’, as you think.

Personalising your IBS tracker

Now, the next section is moving on to, three specific symptoms that you can come up with yourself. So for you, it might be the fact that you get really, really bad gas. That is your main symptom, or maybe it’s that you get nausea.

And that’s something else you want to track. I have a space for three symptoms, and you can write those in and track them over those five or seven days. And that gives us a good idea of any fluctuations in the symptoms. For example, with say it’s bloating, like, is it bad every day, all day?

Is it the case that it just comes and goes? Is it related to the amount of bowel movements that you have? Like trying to connect the dots and see if there’s any patterns.

Tracking lifestyle factors in IBS

I’m also going to ask about your sleep. So what time did you go to bed? What time did you wake up? And then to rate and rank the quality of your sleep.

This is also really important. Getting enough sleep and making sure we are well rested is such a key way to help us feel more resilient. To reduce anxiety, which strengthens that brain gut connection.

So we want to try and give ourselves the opportunity for sleep. What I can see here from this element, and you’ll be able to notice as well, is how many hours did you actually spend in bed?

You know, if you don’t spend eight hours in bed, then there’s no way you’re going to get eight hours sleep.

So you need to look at the opportunity for sleep and work out whether you can go to bed any earlier. Like, are you going to bed at a consistent time as well? This can be a really important part of just better understanding your own health practices like outside of digestion.

Daylight hours need measuring

And then other lifestyle things I’m also really interested in is how much daylight you’ve been exposed to per day. now that might seem a little bit strange But when we are going outside more it’s easier for us to set our circadian rhythms You know, we tend to spend a lot of time indoors nowadays.

You might work inside drive to work sit in the office all day. Drive home again and then sit inside majority of the time. Of course in the summer we might spend a little bit more time outside.

But we really are not exposed to the elements as we used to be. Now when we have access to daylight time it helps to set that wake sleep cycle. Which can get you better sleep but also it’s just really good for mood. There’s special light that comes from the sun, even on a cloudy day. That you just can’t replicate with a bright indoor bulb inside your house or office.

So, getting outside, I want you to think about whether you’re getting

  • less than 30 minutes a day.
  • Are you getting one hour a day or more?
  • one to three hours
  • or even four hours?

And that would be, like, the maximum, probably, that most people will get in a day.

What exercise are you doing?

And then… Thinking about other lifestyle factors, I want you to track up well how much exercise you did.

Have you, been for a walk, for example? Have you been to the gym? Thinking about how much exercise you did. A description of it, maybe you went to Zumba class or CrossFit or something.

And then how intense was that exercise, because that is also really key. When you do really intensive exercise, sometimes that can trigger IBS symptoms, or it might make you feel a little bit ill the next day or something.

So again, we’re looking for patterns. You had a really intense workout one day. The next morning, you were a bit hungry. Maybe you had breakfast a bit late, then you’ve got a flare up.

These are the kind of patterns that we might be able to pick up.

Tracking the impact of stress on your IBS

And then also, just on the lifestyle, I’m just asking people to rate their stress so that I can see their stress levels per day.

And again, is it constantly that your eight out of 10 stressed or does it fluctuate? And does that have any impact on your digestion?

Tracking your menstrual cycle

And then for women, I also ask about which day of your menstrual cycle you are on. It’s a really key factor for so many women. you can find additional bloating around your time of your period that might not be digestion related, it might be hormonal.

Sometimes people will find they get, constipated in the run up to their period and then get diarrhea when their bleeding actually starts. These kind of patterns are really important.

What I have found over the last year or so of using this particular template is that people are noticing patterns around ovulation more. And that is often to do with the peak in oestrogen that can be as triggering for IBS symptoms as the actual bleed.

So just getting a sense of where you are in your menstrual cycle and what effect that might have on your digestion is also important.

Going deeper in a conversation

So that is what I use with my clients, before they start to work with me in my three month gut reset. And it gives me an idea of what they’re eating, how they’re eating, their stress levels, their exercise levels.

But the majority of it, I also gather through a conversation as we have our initial consultation.

But the purpose of this podcast episode was to give you some things to think about. And once you can start tracking, Some of these individual factors, you might find some of the things that I’m talking about in the podcast. Like around timing of eating around diversity of your diet, those kind of things start to become a bit more apparent. And that’s where you could start to make some positive changes. 

Are there any downsides to tracking?

Now, I also wanted to finish just really thinking about if there’s any negative consequences to diet tracking.

And we see this quite a lot in terms of weight loss. Where people are maybe tracking their macros, using something like MyFitnessPal. Really trying to better understand how much energy they’re intaking, and can start to get a little bit obsessed with the data and tracking.

And lose touch a little bit with their body.  Now I don’t see that as much using this kind of approach because like I said at the beginning, I don’t ask people to weigh their food and to measure it. I’m not so interested in your energy intake unless I think that might be a problem.

The purpose of tracking IBS is to look for patterns. If you’re tracking using something like MyFitnessPal, you can get quite obsessed with the data, is what I’ve found. You think I’m not going to eat that chocolate. Because then I’ll have to track it and log it and I can’t be bothered to log it.

Now for some people, That provides them with a momentary pause before eating that stops them eating the snack foods. And that can be helpful in terms of weight loss.

What’s measured starts to improve

The other thing I wanted to talk about is that once you start tracking something, there is this phenomenon called the Hawthorne effect. As soon as you start tracking something, it starts to improve.

That is because subconsciously we are trying to maybe put our best selves into the tracker. Literally writing down the good stuff and wanting to it to look overall impressive. Even if it’s just for yourself and you’re not going to show it to anyone. But you can actually just get some improvements.

Just from measuring things rather than, even starting to make any of those changes. So that’s something else to look out for.

Is this actually normal? And that’s why if you do it for like two weeks or more, you probably will revert back to your normal patterns instead of thinking, Oh, I’ll try and be healthy just because I’m tracking it. And I want to put in a good tracker.

Tracking your IBS honestly

The other thing is just trying to be really honest with yourself. Literally write down everything that you’re eating instead of just thinking. “Oh, I won’t write down the biscuits that I had at work” “or a little bit of my children’s food that I finished up for them.” Those things could be the triggers.

So we just need to get a really good picture. Make sure that you are actually writing down everything that you’ve eaten.

That’s it for this week. Give it a go, download the tracker from my website.

There’s a link in the show notes, get tracking, see what patterns you recognize.

Want a bit of feedback on your tracker? 

And I’ve got an idea to potentially do a little workshop or webinar where if you’ve downloaded it, I’ll get in touch with you and ask you if you’d like to be part of it. Maybe we can review people’s diet diaries as a group and see where we go. Let me know if you’d be up for that.

And just finally to finish, please, subscribe, ‘like’ my podcast and leave me a little review.

If you’re finding some of these things helpful. I’d love to be able to reach a wider audience.

Thank you so much for the support, though, for people who have been listening. It’s been great getting your feedback.

Thank you for listening. See you next week.

 

 

 

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