81: Gut Health and Elimination Diets
"A stressed out person often has a stressed out gut."
In this episode, Paige invited her good friend Marci Evans, MS, CEDRD-S. LDN, cPT to join her on Nutrition Matters Podcast to talk about gut health and the dangers of elimination diets.
Bloating, constipation, gas, and many other GI symptoms are often met with recommendations of elimination diets as the standard protocol and intervention for gut health. Many people in our society right now are removing entire food groups and/or common allergens in order to try to understand what is causing the digestive problems.
Many people with a long-standing chaotic relationship with food and many with eating disorders find that these protocols are causing more harm than good. There's so much to learn about gut health and it's a topic that science is only beginning to scratch the surface in understanding. Tune in to hear an in-depth conversation about how to have a healthy gut without letting that pursuit lead to you to yet another diet trap.
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Paige: Hello and welcome to another episode of Nutrition Matters Podcast. My name is Paige Smathers and I am your host. Today, I have the fabulous Marci Evans discussing a very important topic that is near and dear to my heart as a Registered Dietitian. The topic is Digestive Health. Marci is an expert in this. She’s been giving talks throughout the last few months about the intersection of digestive health and eating disorders. She has gathered all these amazing resources and information together to be super helpful as we navigate this current trend in our world, which a lot of people are talking about digestive health. A lot of people are encouraging others to just willy-nilly cut things out of their diet. In this episode, we really dive into that and talk about the pros and cons of that approach and also some other things to look at as well. So, you won’t want to miss this episode! We talk about the Squatty Potty®, probiotics, bloating and gas. We will talk about, sort of, recovering from chronic dieting and what that might look like in our digestive system. We talk about the brain-gut connection. This is fascinating stuff! It’s really kind of cutting edge and new in the research. There is so much more we have to learn about these things. There are fascinating things to learn about gut health. I am really excited you are joining me for this episode. Before we do that, I want to make sure you all know a few things. First, is my online course, [Educate, Embrace, Empower]. If you like what you hear in this podcast I would really encourage you to check out the course. If you would like to take healing your relationship with food to the next level you might enjoy this 10 week, in-depth look at how to bridge the gap from dieting over into intuitive eating, gentle approach to nutrition and health that we talk about in this podcast. I take you through the stepping stones on how to get there. So, this is a 10 week online course and if you would like to check it out it’s www.paigesmathersrd.com/course. Also, join us over in the facebook group for the podcast. Search “Nutrition Matters Podcast” on Facebook.com or the Facebook app. Simply click “request” to join. As always, if you are willing to go to iTunes and leave a review for the Nutrition Matters Podcast that is always appreciated. With that, let’s get into our conversation with Marci Evans, MS, CEDRD-S. LDN, cPt. She is a Registered Dietitian in private practice in Boston, Ma.
Paige: Hi Marci and welcome to Nutrition Matters Podcast for the third time!
Marci: Thanks, Paige! It’s so nice to be here!
Paige: It’s always great talking with you. When I saw you starting to do these presentations about this particular topic that we are going to talk about today, I knew at some point that I wanted to get some of your time to talk about this super important topic on my podcast. So, I am grateful you are here! I know that this topic is so relevant to so many people.
Marci: Oh my gosh. This is so cool for me to be able to come here and talk about it. It’s amazing! When I started presenting on the topic of looking at disordered eating and GI disorders. Even though I saw it all the time in my clinical practice, I was actually really surprised by the number of people who wanted to engage in this conversation. The number of those who reached out and said “this is my experience” or clinicians who said “this is my experience”. It’s just been validated over and over what an issue this is. It’s not something that is making headlines but now that I’ve started talking about it, it has been amazing how many people really resonate with it. So, I’m really glad to be able to talk about it here.
Paige: Yeah, it’s so important and sometimes people in the world of GI disorders don’t really connect or don’t really maybe have training in eating disorders and disordered eating and then vice versa. But, they totally intersect and I feel like this is a growing trend right now too. If we want to take a giant big picture look at this, the way I see it, and I would love to hear your thoughts on this, Marci. But the way I see it is, back a few decades ago it was totally, socially acceptable to be on some really restrictive diet and it was normal to talk about that and do that. Maybe all your friends were doing it. And, then slowly there has been this move toward, I think for awhile with social media, it seemed like it was a move toward, “clean eating” as the focus or goal. Not really calling it dieting anymore but it is sort of dieting in disguise, right. And then we moved, I feel, beyond “clean eating” and now we are seeing a lot of [people saying] “oh, I’m only cutting this out because I’m allergic to it or “I have an intolerance” or “it gives me brain fog” some of these vague, obviously an allergy is not a vague thing if it is diagnosed properly, but vague symptoms that you are relating to particular foods. A lot of DIY digestive health conversation going on. Obviously, I didn’t do a great job talking through every trend that has happened. But this is sort of what I see what is going on, currently. We don’t really admit to dieting. It’s sort of taboo to say “I’m on a diet”. But it is sort of taking some of these different forms, some DIY digestive health investigating.
Marci: I absolutely see that as well. What use to be socially acceptable in the dieting world has become a bit less socially acceptable. So much so that dieting companies are changing their marketing strategies and co-opting language from the anti-dieting movement and body positive movement. And then people get smart and figure it out and they are able to talk about “clean eating”, identify ways in which that is another diet undercover. But, we are so in the habit, I think as a culture unfortunately, trying to work out so many of our problems unconsciously through managing our bodies. Specifically, managing our food. It shows up in all these different shapes. I think the level of discomfort that we have with ourselves to have a concrete solution is very appealing. So, if somebody notices they are feeling bloated it is completely socially acceptable to say, “well, why don’t you try going off gluten”. It’s this open door for people to try to fix themselves and it kind of gets covered up in the language of digestive health and trying to be as healthy as possible.
Paige: It is important to say, Marci we are not anti-health. We are not saying you are not allowed to be gently concerned about your health or to focus on that in a gentle way that is right for you. One of the criticisms I get of this podcast is that I am saying, “throw health out the window. It doesn’t matter.” That’s definitely not where I’m coming from on this.
Marci: Yeah, it’s good to know that’s some of the feedback you have gotten. I laugh only a little bit, in that, I’m a dietitian. My two degrees are in Nutritional Science. I’m certified as a Personal Trainer. My background is in health and wellness. I think that that criticism speaks to how hard it is for individuals and us as a culture to figure out the line between what is a reasonable pursuit of taking care of one's physical body and when that becomes an agenda or a vehicle to attend to other parts of our well-being. Whether it is a way to feel a sense of control or stability in one’s life. Whether it’s a way to feel esteem and confidence. Whether it’s a way to channel anxiety. That of course it is wonderful to take care of your physical health, your mental health, emotional health. I absolutely want that! That is what my career is dedicated towards. Where it gets sticky is when it is unconsciously used to manage something else. That can be very hard to parse out. Just like it can be very hard to parse out what is happening in one’s body when a person is not feeling well in their digestion. That is a real thing. I don’t ever want minimize my client’s experience. If they say they are having pain in their stomach, they are having pain in their stomach, right, and I want to talk about that. Rather than keep launching forward, I will put a pause there so we can see where we want this conversation to go.
Paige: I think that is beautifully said Marci and I completely agree. Whenever we are talking about a semi-controversial issue I like to acknowledge what someone listening might be thinking. Like, “are they going to tell me that because I have this, this and this intolerance that I am a bad person or I should feel ashamed of myself.” The obvious answer there is, absolutely not! Our goal with this conversation is to kind of shed light on some of the problematic ways that type of approach to your health can go. Maybe some other angels to take. Other ways to view or to look at your health and to maybe not always blame your stomach ache, your brain fog or your whatever symptom on food. Maybe take a look at what else could be going on. I think what I am trying to do here is say there are some other things you might want to look at too.
Marci: Absolutely! When it comes to what is happening in our gut it is a very complicated process because there are so many different facets to consider. The reason is because our entire digestive system is innervated by your nervous system. So, your whole nervous system goes and feeds into your gut. What that means is that what is happening for you mentally and emotionally is literally getting transmitted down into your stomach, your intestines. So the reality is your emotions are deeply impacting your physical health. Really, right down into your center, the core of your body. When we are having a problem with digestion, often we’re just thinking about the food that we have put into our body. Literally that pipeline from mouth to stomach and how that is impacting things. That is relevant and not to be ignored, but you have this other pipeline coming from your brain that goes right down into your gut. That is equally valid to consider and to wonder about and to hold in mind.
Paige: Yes, very well said again. I love that. So, to set the stage here. Marci, you have spent months and months, maybe even years, research this topic and preparing to tour the country, from what I understand. The topic you have been hitting on at conferences and in your talk is the intersection of digestive health with eating disorders. Now, I kind of hesitate using the word eating disorders, even though I use it a lot on this podcast, but I hate to use it because I hate to lose the person thinking, “gosh they are talking about eating disorders again and that is not me.” Then they turn off the episode. This whole do it yourself, digestive health, thing is happening all around us. It definitely intersects with eating disorders but also all the current trends and our current culture as well. You have spent a lot of time researching this and recommended a book that I ended up reading and I was shocked while reading it.
Marcie: oh you read, “Gut” [Gut: The Inside Story of our Body’s most Underrated Organ by Giulia Enders]. . It’s so good!
Paige: Yes, I read it. It was so good.It was so good! I learned so much. I am not sure how to focus this conversation because there is the book, there is the intersection between eating disorders and digestive health, there is this trend I am seeing that I am concerned about. I think it is all super important, but we only have a limited amount of time. So, what do you think is most important to spend our time on today in regards to this huge, broad topic you have been researching extensively?
Marcie: Sure, it is a broad topic. I’ll share some thoughts and things I feel are important. You feel free as the Master of Ceremonies to interrupt me at any time. Let me backup a little bit. Yes, I am an eating disorder specialist but don’t hang up this podcast because we will talk about how it makes sense and is important more broadly. My interest in this topic happened out of my clinical experience. Nearly all my clients with eating disorders and eating disordered histories were having unremitting GI issues that we could not seem to get to the bottom of. All kinds of bloating, constipation, irritable bowel syndrome, all kind of symptoms that were bothersome. We were feeling stuck because the last thing you want to do with someone who is in recovery from an eating disorder is put them on an elimination diet. Often an elimination diet is kind of like the first protocol, first line of defense against any sort of GI issue.
Pagie: Marci, just in case someone doesn't know what an elimination diet is. Will you define that real quick?
Marci: Sure. The standard protocol [for an elimination diet] is you keep a food journal, which I don’t do with most of my clients. You study all the symptoms and then depending on the protocol, there are a lot of different protocols, you are taking out a large amount of food and food groups. Removing all these foods that are common allergens, common irritants, commonly intolerated. That doesn’t mean it happens all the time, but when it does happen these are the most likely candidates. You take them out of your diet and then slowly and systematically add one thing in at a time to determine what is causing the problem. That intervention for anyone with an eating disorder history or someone who has a long-term diet history or chaotic, fraught relationship with food [means] an elimination diet can be a disaster. It can be really harmful. I’m not saying it is harmful all of the time. I would never say that! I’m sure there are some people listening who have done an elimination diet and learned a lot and it was helpful. But in my clinical experience, I just felt like it was causing more harm than good. While trying to determine the other options, I ended up reaching out to a colleague of mine, a dietitian in the Boston area. Her name is Lauren Dear. She is a fantastic digestive health dietitian. We ended up swapping supervision. As a digestive health dietitian she was seeing all these clients who had developed disordered eating or had eating disorder histories. So, we were seeing it on both sides. She was sharing a ton of information and really opening up my eyes into the digestive health world. I then started digging into the research and told her we have to speak on this. So, we developed a proposal together. Which when you develop a proposal to give a talk you are then really forced to get into the details of the research and organize your thoughts and ideas. I learned a ton in this process. We have given a couple of talks together. I’ve given a couple of talks on my own and done some interviews on podcast. So, that is a little bit of the background to where we’ve gotten. But where I think the conversation, I could give you a ton of fascinating information on digestive health and the intersection between digestive health issues and eating disorders.
Paige: Maybe we can do that conversation at another time.
Marci:That specific content is absolutely mind blowingly fascinating.
Paige: It is. I can attest to that. I heard you speak in January. It is so fascinating.
Marci: When you start uncovering this stuff you are like, “Oh my gosh! This makes so much sense.” But where this really applies, I think to more people, not just people who have a history of eating disorder is a couple of places. One, is related to the connection that I was talking about earlier between your head brain and your gut brain. That connection is really having to do with your emotional well-being. What we see is that people who are really at risk and more vulnerable to developing issues with their digestion that seem impossible to diagnose… they don’t have celiac disease, they don’t have crohn's disease, they don’t have a specific disease that can be diagnosed, they just have a cluster of frustrating symptoms. A common denominator is that that person also tends to struggle with anxiety and depression. Not always, but a lot of the time. So, It’s certainly possible that you have someone who doesn’t maybe have an eating disorder but maybe they are emotionally and temperamentally at risk. They are someone who, like myself, tends to feel stress stronger. I am by nature, my wiring is as a highly anxious person. I am someone who is at risk of having a highly anxious gut. So that really plays into it. The other thing that plays into it is this unconscious, I do believe it happens for people very unconsciously, way in which we sort through our problems by managing our food. One of the things where this gets so slippery is we live in a culture where we are praised for doing so. So, somebody runs a 10K race, posts it on facebook and they get a ton of likes. There is nothing wrong with running a 10K. There is no judgement . It’s not necessarily a bad thing. But the point being, we live in a culture where there are so many secondary gains to managing your body. So you get the gain of saying, “I ate more fruits and vegetables. That is healthy for my body. I got vitamins and minerals and fiber. Fantastic!” But then you also get this self-esteem gain by someone saying, “good job! That’s awesome! You’re doing right!”That is what gives you a boost to your mental and emotional well-being temporarily . So, if you go on a “clean eating” diet that takes all this stuff out of your diet there is an increased likelihood that you are going to perhaps temporarily feel better for a variety of reasons including the emotional benefit that you feel you are doing something right and good. That is giving you a thumbs up from them people around you.
Paige: That is so true. You can’t underestimate how much that will affect your mental and emotional wellbeing, that praise you get from people around you.
Marci: Yeah, and whether or not it is overt praise or imagined praise inside of your mind, that self praise. “I’m doing good” That produces literal, physiological changes inside your body and it is impossible to unravel the difference between what is a physical improvement due to those changes, subjective changes that perhaps you made to your nutrition, taking something out, removing an entire food group versus this pride you feel you are “getting things under control”.
Paige; When this comes up in practice for me with my clients, when and if, there is sort of this question, “Okay, this symptom you are describing I am going to dig into that. Is this a food thing? Or perhaps could this be your association to that food? Or the way you relate to that food? You are really anxious about bread, you eat it and then get a stomach ache. Is it the anxiety about the bread? Is it it the gluten? Who knows what aspect of the bread is causing those symptoms for you. It is a very delicate thing to bring up with people because there is this tendency of people to say, “oh, so you’re just telling me it’s all in my head. Great.” So I anticipate someone listening, thinking, “so they are saying this physical symptom I am experiencing is just all in my head. So I just need to not think that way?
Marci: Oh yeah, and the reality is thoughts that we have in our head create real physical experiences, right.
Paige: So, we are not saying the physical experiences are false.
Marci: No, the physical experience isn’t false. It’s not made up. It’s absolutely not. If someone took that message away I would feel really badly about that. Actually, unfortunately, a lot of the messages some of my clients have received from certain gastroenterologist, who say “if you have an eating disorder that means it’s all in your head. This is all sort of made up.” But, we are really saying the exact opposite. That is, the incredible capacity to have a thought or experience an emotion and that lives in our body in a very real way. That deserves acknowledging, exploring and trying to understand. There are very real instances in which certain foods don’t work for certain bodies. There are a fair number of people who are legitimately lactose intolerant. Every single time they have yogurt, a glass of milk, a piece of pizza they are sick. That’s a real thing, of course it’s a real thing. It can be complex trying to figure out how much of it is a specific food versus how much is one’s relationship to food and the fears associated with it. It often takes, I think, trust in working with someone to sort that out and get to the bottom. I do coaching with a lot of people and sometimes we learn, wow as it turns out every time you eat eggs that is a clear symptom. Let’s experiment and play around with that.
Paige: So true and that book we were mentioning in the beginning she talked about some interesting and emerging research about our gut flora and how that perhaps might affect our mood. There are so many elements of our gut that we still are barely scratching the surface in understanding. I think it is useful as we are navigating our health and our bodies, the way that we feel, to question that little thought “oh, maybe I should just cut out that food” Maybe that is something you need to do, but also I personally prefer to explore as many other options as possible beforehand. We all know what happens when you restrict a food. It’s no different if you have an intolerance or symptom associated with it. You are still going to have the problem of now I think about that food all the time. Now when I am around that food I have no idea how to behave because it’s so off limits. We create a bizarre and unhealthy relationship with it.
Marci: Yes, it can become a bit of a vicious cycle. That is one thing I have observed with clients who have taken something out, then another thing and another. It takes on a life of its own. The way that I approach any type of investigated work with my clients in terms of foods that might not be tolerated, is that I want to have a multi-faceted approach and the goal is to remove as few foods as possible. And by multi-faceted, what I mean by that is taking an inventory of all the potential things that impact digestion. So, for instance I have a client who I worked with for a long period of time, in recovery from bulimia and doing really well. She was no longer using eating disordered behaviours. What she noticed was that she started really having some pretty bad stomach pain, a lot of bloating, she was constipated. She really, genuinely, for the best of intentions wanted to figure it out. She was in pain. She wasn’t doing well. At that point, we had stopped working together because she was doing really well on her recovery. I didn’t know about the digestive stuff. It sort of occured after our work together. She went and did a consultation with a specialist. This specialist ask her to go onto an elimination diet. She said “well I’m pretty nervous because I’m recovered from bulimia”. He didn’t seem to understand what that meant, put her on a full elimination diet, she then reached out to me and relapsed pretty significantly back into her bulimia. What she and I ended up doing together was challenging. What she found was when she removed all these things from her diet her physical symptoms, her GI symptoms, went away and she felt better. So, we were in this bind. It was unsustainable. She was restricting, then binging, she was all over the place. She couldn't sustain it, but also wanted to be out of GI pain. What we ended up finding out together, is that when we really took an approach that looked at all the different areas we were able to help her find a pattern of eating that was thoughtful. That worked for her but wasn’t nearly as restrictive. For instance, we made sure that she was eating every 3-4 hours. She noticed when she went longer stretches of time her GI symptoms were far worse. Well, as it turns out, the digestive tract prefers, during waking hours, to be on rhythm of eating approximately every 4 hours give or take. When you are working with your body’s natural rhythm it’s going to feel better. So we were able to integrate that. We also found that when she ate really balanced meals and snacks, meaning she had multiple food groups going on, she also felt physically better. So, if she had a meal that was a big salad she felt really terrible or when she had a meal that was all starch she also didn’t feel well. But, when she ate in a balanced way that helped her. The other thing we discovered was different types of food preparation. For Instance, for someone with a sensitive system raw fruits and vegetables can really take a toll. So, we shifted away from a lot of raw stuff, apples and raw kale, and got creative about less difficult to digest produce. Things more cooked and a bit more prepared. That made a big difference.
It also makes a big difference in terms of regulating movement and making sure you’re not moving to either extreme with over exercise. Also sitting at one's desk all day long is not good for digestion. You don’t need to be narcotic about it, but taking a moment where you are standing up or taking a walk around the office or the block periodically.
She also needed to invest time into working on her stress reduction. She was extremely stressed out. I often say, a stressed out person has a stressed out gut.
And the other thing that we did was integrated a couple of supplements. A supplement often helpful with IBS and a probiotic. So we did all these different things, tweaked it in such a way that we can help manage her symptoms. We did a couple other things. We got her a Squatty Potty®, which we can talk about if it’s interesting you think. We sort of pulled in as many different tools as we could and helped her to find a way of eating that was really manageable, enjoyable and didn’t fuel the obsessive type of thinking. The way of eating that wouldn’t be sustainable for her.
Paige: That’s such a great story. I am so glad you shared that. Just to summarize what I am hearing. I am thinking of the person listening who has dabbled in this digestive health world and maybe wondering what are some things to try in addition, maybe, understanding what is going on with their food. What else can a person do? I heard you mention stress management. Making sure that is something you working towards and actively engaged in trying to manage. And, I also heard movement. Moving your body. Not to either extreme, too much or too little just somewhere in the middle that is right for you. What are some other things, just so someone listening can kind of say “before I try cutting out entire food groups here are some other tools I can work on”.
Marci: Another thing is utilizing a Squatty Potty® or stool to go to the bathroom if they find they are having trapped gas or constipation. The way that our body's physiology works, and this is a little hard to describe just verbally without a visual but I’m going to try to do my best.
The very bottom of the digestive tract is where your recturm and anus are. To be able to go to the bathroom. What happens is, we have this muscle that ropes around our recturm so that when we are standing up, sitting down, that rope of muscle kinks that recturm to help hold your poop inside of you. When we sit down to go to the bathroom, in and ideal world, people would be positioned like people were positioned hundreds of thousands of years before we developed the very sophisticated porcelain thrown. So they were in a deep squat. When you are in a deep squat to go to the bathroom, that muscle that loops around the recturm actually loosens up and it is much easier to go to the bathroom. So the Squatty Potty® is just a stool, and it doesn’t have to be a Squatty Potty®, that goes at the front of the toilet that you can prop your feet up on to get your knees high enough for the muscle to disengage, making it easier to go to the bathroom. We find actually far fewer rates of digestive problems, including constipation, diverticulosis and hemorrhoids in non-western countries.
Paige: Fascinating! I studied abroad in Thailand and I had to learn how to squat. It was quite the adjustment. Now, hearing the science behind it and learning about that it’s just fascinating how it’s like of course we would have evolved to go to the bathroom that way. It makes total sense.
Maci: The other thing I would recommend is also talking to your PCP [Primary Care Physician] and asking about getting a referral to a gastroenterologist. Or for the women here, talk to a gynecologist or OBGYN if you are having trouble with a lot of bloating or gas. If you are having trouble going to the bathroom normally, whether it’s diarrhea or constipation, because sometimes this can be tied up in your physical anatomy. These are problems related to the pelvic floor. It’s known as pelvic floor dyssynergia or pelvic floor dysfunction. When there is a problem with the muscles and the nerves in the pelvic floor it can create problems with digestion. And, I can promise you there is not a single food you can take out of your diet that is going to fix that issue. So, if you find that you get really bloated, you're not going to the bathroom normally. If you feel your stomach pouches out where you almost look pregnant those are possible symptoms of problems going on with your pelvic floor, but they need to be properly assessed and treated by a pelvic floor specialist or physical therapist. So, that is something else to consider. So, advocating and asking questions.
Paige: You want to see if something is going on physically with your anatomy. You want to explore if maybe a different position in going to the bathroom could help various issues, perhaps. We mentioned managing stress and movement. Another thing I would add is, this is something some people don't think about, is if you are a recovering chronic dieter and or recovering from a full blown eating disorder you will have some GI distress as your body gets use to eating again. If you don’t use it you lose it. Or if you are constantly eating more than you need to, there will be an adjustment in feeding your body appropriately as well. On every end of the spectrum, changing your eating you are going to feel it in your body. Don’t you think?
Marci: I totally think that. A couple more points I would like to make that I think are important, that you are reminding me to emphasize. One thing that is really important is that our digestion really likes routine. Now some people are more sensitive and some are less sensitive. The less sensitive people really aren’t listening to this podcast episode and thinking, “what are you crazy ladies talking about. It is no problem” But for those of you who feel like digestion is a problem, you are likely a person who is overall a very sensing person, a highly feeling person, you experience things in a stronger way and that has its advantages. That can be a wonderful gift in many ways. The downside is that you require, in general, being a little bit more in routine for things to go smoothly. That is also true for your digestion. A sensitive person is likely to have a sensitive gut. The hard reality is that sensitive gut needs care meaning you just have to prioritize eating every few hours. You have to prioritize having balanced meals and snacks. You have to prioritize utilizing ways to try to bring your stress levels down through using mindfulness, using psychotherapy, using deep breathing. It’s similar to someone who is taking insulin for their diabetes, they have to be more mindful than the average person of how they structure their eating. It’s the same for somebody who is more prone to having problems with their digestion. It just takes a bit more care compared to the average person. It’s shifting your mindset that if you have a hectic day, as we all do, and it’s been eight hours since your last meal don’t be surprised if your stomach hurts.
Paige: Then maybe try to avoid associating, oh it must be because I ate this food I vilified.
Marci: Oh yes, we had pasta for dinner and then my stomach hurt...and then we’ll hold that pasta in context... what was your day like, how long had it been since you'd eaten before that. I know for me, my biggest recipie for having stomach pain is if I get really hungry, I’m not able to eat and I go way past hunger. What happens is I have a lot of pain in my stomach and I get filled up with air and it’s quite painful. So I know for me, that patterning is very important. That is very, very ,very common for people who have more sensitive guts. So really focusing on that timing. Another thing to consider is whether or not trying a couple of supplements might help, it might not help. There is some research to support the use of [supplements], but some of the research isn’t the strongest. People often ask me, I don’t know if you get asked this question Paige, “oh, should I be taking a probiotic.” Do you ever get that question?
Paige: Oh yeah, totally. Talk about that a little bit.
Marci: I will tell people that we, right now, do not have the research to say everybody should be taking a probiotic. Probiotics are relatively expensive. They are about a dollar a pill. For some people that is not a lot of money, but for others it really adds up and is a lot of money. So, I don't like recommending things just for the sake of recommending them. The thing I like to explain about probiotics is research on probiotics are done on specific bacterial strains, in specific dosages, to treat specific symptoms. So you might pick up a probiotic and be taking it because you get bloated but for all we know that probiotic has only been researched to treat something else entirely. And so, who knows whether or not it is helpful. I don’t necessarily say everybody go on a probiotic; however there is a really great app that I think is worth checking out if somebody is interested in looking at this a little bit more. It’s called the Clinical Guide to Probiotics. Where you can go and search under a symptom and see what brands are recommended and look at the strength of the research and can at least be thoughtful about why you are taking it.
Paige: That’s good to know. I will add a link to that [in the show notes]
Marci: It’s a great resource.
Paige: It’s kind of a trendy topic too. That’s one of those things people like to throw out there, “oh you have this aliment, here take a probiotic”
Marci: Often another one you hear is digestive enzyme. I don’t think there is any harm in trying a digestive enzyme. You can buy a broad-spectrum digestive enzyme, try taking it with your meals and just observe whether it helps. Essentially enzymes help break down your food. So if for some reason you have lower digestive enzymes, supplementing could be like a little boost, it could help. But, it is pretty difficult to figure out whether or not you are actually having low enzymes or whether the cause is something else. It can be a little bit like whack-a-mole. Another supplement I think is great is one used to treat IBS. It’s called Iberogast. Will link information in the show notes. It’s an herbal supplements with a few different herbals combined together to treat the symptoms of IBS. One note about IBS, be careful to not self-diagnose IBS. It is considered a diagnosis of exclusion, meaning you have excluded every other possibility of your digestive issues being attributable to something else. The last thing that we can categorize it as, when all other options are exhausted, is IBS. So, be careful it’s not due to possible overgrowth of bacteria in your small intestines, lactose intolerance, celiac disease or to a motility issue that a gastroenterologist would pickup, or an anatomically issue in your pelvic floor. You want to rule out these other things before placing band-aids on what seem like difficult to treat symptoms.
Paige: Yes, that is a really, really important point. Any other supplements you wanted to talk about? I think that is a good rounded thing, but want to see if you have any other.
Marci: No. there wasn’t anything else specifically. We could detail out a few others but those to me are the ones that are most important to talk about and tend to be the most common.
Paige: yeah, I like that. I do want to talk about one thing in particular. One symptom that I think people read into a bunch, that I want to talk about since I know you will have a lot of interesting things to say about it. The symptom is bloating. What is bloating? What is gas? What’s normal? Let’s talk about that.
Marci: Bloating is a nebulous thing. Because bloating is very individual, depending on how a person is experiencing it and it can be caused by a lot of different things. It can be air building up in your system that should not be there. It can be located in your stomach, your small intestine, your large intestine. But, it is also accompanied by fluid. So, it is a combination of air and fluid. To some extent some bloating can be normal, right. You eat a meal, your stomach is filled up , you want to be careful that isn’t be misinterpreted as bloating. That’s just a natural experience of having food in your stomach, right.
Paige: Right. That is an important thing to say. Because it is a nebulous term people might say, “oh well, I got to the point of fullness”, which is appropriate and fine, and say “Oh I’m so bloated” and maybe start blaming things for that.
Marci: I want for my clients to feel full after a meal. That’s the goal. That your stomach is full, not that you are in pain or stuffed to the brim. But, there is also a sense of fullness and heaviness. That typically last, depending on the size of the meal, 20-30 minutes that you feel full. Bloating is almost a sensation that you have been pumped full of air. You imagine, if I could just stick a hole in my stomach I would be so relieved because I could feel all this air coming out. I feel this is a different sensation than simply having food in one's stomach. So when I am assessing, I am asking my clients to point where they are experiencing that sensation of bloating. Is it up high, in the middle, down low, to the side? I am also asking whether or not it is associated with any pain and what elevates it. Appreciate that having a little burping or farting is normal. Make sure we are not getting too worried about what can be normal body processes.
Paige: It is so interesting, Marci. I have actually had clients who develop such an awareness and sensitivity to what is going on in the GI system that they are aware of feelings that most people would never even know are going on. There can be a dysfunctional, too strong of a connection that you can have with the feelings in your body. Is that a controversial thing to say? What do you think about that?
Marci: The way that I think about it is that some people, this correlates with the theory of IBS and what IBS is, it is an increased sensitivity and an increase awareness of what is happening in ones digestive system. It is also experienced as painful. So, for some people, their body is over communicating the details of the digestive process to the brain.
Paige: Right, that is a better way to say it. That’s kind of what I meant.
Marci: Yeah, and the brain is then interpreting it as a problem. So, one of the really difficult things about working with someone with IBS is that they have this system that is an over-communicator. It’s not that anything wrong or bad is happening, the body is just experiencing it as wrong or bad. Sometimes removing one or two foods might help. Someone might notice, “every time I eat apples I am doubled over in pain” okay, maybe we don’t do raw apples. Then we are utilizing some of the other techniques we talked about to help manage it. That’s when you also want to work with a specialist. Because for some people utilizing medication is really helpful. We didn’t talk about prescribing medication but for some people that becomes quite necessary. It is a real thing, it’s a hyper sensitivity. Which is really tough. Oh my gosh, that’s tough.
Paige: Another thing I wanted to mention about bloating is there is such a thing as too many vegetables. And, like you mentioned earlier, raw vegetables can for some people be a bit more difficult for them to digest. You might notice that in the way that you feel. Some of the people that complain the most about bloating, in my experience, have been once we dig deep and take a look at what they are eating it’s just an inordinate amount of vegetables. So, that’s an important thing to keep in mind too as someone is navigating the symptoms they are having. Make sure you are eating adequate amounts of food as chronically under eating can manifest itself in these nebulous symptoms. But also overdoing it on these things that are “good for you” can also produce symptoms that are not fun.
Marci: Oh, yes. Well said. Absolutely! Again, I know I am sounding a bit like a broken record. That’s where it really can be helpful to work with a professional to help you sort out what the right balance is for you. Certainly we want to get enough nutrition but also the right balance. Often people say, “I’m constipated. I need more fiber” but the type of fiber they are getting in is actually making it worse. It is heightening and worsening their constipation. It can get a little bit tricky. Often one of the things that goes undetected is when people maybe have a long term dieting history and they are not eating enough. It’s no wonder why they don’t have regular bowel movements. They are not having big enough meals to move it through.
Paige: So true, that is so important.
Marci: You are having this problem not because something is wrong with your body but because we need to increase your nutrition. We need to have the right balance of nutrients.
Paige: And the regular eating you mentioned earlier too. Where your body is on a schedule with eating. So it knows, okay, we are going to get food every 4-ish hours and it will be all good.
Marcie: Yes, and one thing I should add, that I think is interesting, is that there are two phenomena that happen within the body. Technical names are not worth mentioning. But, what I've learned is that the digestion process really goes much better when you are feeding yourself full meals. If you are having problems with your digestion the grazing pattern, this is not always, this is not all of the time, it’s not black and white, but some problems are worsened by grazing. Because it is not actually signalling to your body the process of moving things down. If you have ever had the experience of waking up in the morning, you don't need to go to the bathroom, but then you eat breakfast and need to go to the bathroom. What has been stimulated is the gastrocoloic reflex. It’s basically telling your system, “Here comes your nutrition. Make room for it.” Without that meal, if you are just doing little nibbles, that reflex isn’t actually stimulated.
Paige: That is another one that I just love because I feel like in our world we glorify this idea of small frequent meals. Not that it’s necessarily bad, some people that works great for. But for me, that does not work. I like feeling satisfied and full after a meal. I do not like feeling half way and neutral all day. I do feel sick to my stomach when I do that grazing pattern. It’s very interesting to understand what my intuition tells me about how to feed myself when you look at the things you are talking about, like with that sweeping mechanism that happens in the small intestine that doesn't get triggered until we’ve spent a few hours not eating something.
Marci: Yes, that is exactly right and that’s my personal preference as well. That I do much better, get hungry, have a really solid meal that makes me full and I feel satisfied and then I don’t have to think about food or deal with food. I physically and mentally feel better for a couple hours and then I am ready for more. I don’t feel well when I don’t actually get to that phase of feeling like I’ve been fully nourished and noticed for my own self, sort of anecdotally, that physically I feel better as well.
Paige: Yes, me too. So, one more question for you. If there is someone listening who says, “okay, this is great information. I love learning about all these other things to look at, but at the end of the day I do have this intolerance or food that doesn’t agree with my body.” I feel like that in and of itself it such a tough issue to have something you know you can’t tolerate very well. How do you navigate this idea of emotional eating and being at peace with your food? How do you do that when you know there is something you can’t do?
Marci: Yeah, it is very, very difficulty bind to be in. My sister-in law has celiac disease. There is no way around it. She has celiac disease and cannot eat gluten and that sucks. It totally sucks. I have an uncle who has type 1 diabetes and he has to manage his nutrition is a very specific way to manage his blood sugars. So, there are certainly times in which a person can not tolerate something and can’t have it as part of their diet. In short, what I recommend is making sure that you are regularly incorporating things that you love to eat. That feel so genuinely enjoyable and deeply satisfying. That you are meeting that need in a regular way, on a regular basis as best as you can. I was working with a client previously who had a long list of food allergies, that had been diagnosed by a food allergist. She had a long history with an eating disorder. We really had to spend some time parsing out the difference between an allergy versus a restriction that she had followed from her eating disorder. Another client with crohn's disease and we were able to have some frank conversations that she had been avoiding, that had more to do with rules she had constructed in her mind and had nothing to do with her crohn's. So, our work together was on trying to create as much flexibility and as much variety with the foods her body could tolerate and get rid of those dieting rules. She hadn’t eaten a hamburger in years but there was no reason because of her crohn's not to have a hamburger. So we had to really work on giving permission to a wide variety of foods and pay close attention to that since the natural consequence of removing other foods out due to a medical condition becomes really necessary. It’s a really tough thing to navigate.
Paige: Yes, tough. And it requires so much honesty and introspection and awareness and curiosity to figure it out. It can be totally wrapped up in some type of,” I’m trying to manipulate my body” or “oh, how convenient. I have this diagnosis that helps me to wrap things neatly up into this package so people don’t question my restriction” So, in order to untangle that and take a deep, hard look at it, it requires a lot of that work of introspection and honest. It’s doable, definitely doable. You are not unable to participate in the idea of being at peace with food, the idea of loving your body and treating it well, intuitive eating and all that stuff. You can do that and still have celiac disease or whatever it may be
Marci: You are not doomed.
Paige: Yes, exactly
Marci: And, it is legitimately challenging.
Paige: Yes,I love it! That is such a great way to say it. Marci, you are just fantastic! This has been so fascinating. Do you have anything that is just huge that we should hit on or do you think we did an okay job?
Marci: I think we covered it! Of course, we can talk for hours and hours and hours. I hope it was clear. I hope it felt useful. This conversation is a challenging one, by nature, because the subject matter is challenging. It’s nuance, it’s multi-faceted, it’s hard to get your hands around. If anything, I hope I’ve given your listeners a new way to think about it. Things to allow them to percolate, to pay attention to, to be aware of and be opening to exploring their experience that is maybe coming at it from a different angle than they were before.
Paige: Perfect! That beautifully summarizes my intention here too. Again, I think this is another popular, trendy thing that is out there in the world. Something to talk about and help each other navigatie. It’s tricky when it’s disguised as, “Oh, it’s gut health” or “Oh, it’s just clean eating”. It can get really, really confusing so I am grateful for your time today in helping us talk about this really important subject.
Marci: Awesome. It’s been a total pleasure to chat with you, as always.
Paige: Thanks, Marci. So, take a minute to tell people about how to keep in touch with you and also anything that is new on the horizons for you with your business and your work.
Maric: Thank you! Please connect with me on my website, www.MarciRD.com. I am super excited because my brand new site just launched. Come check it out! One thing I love about my new site is I now have a resources page. Scroll down to the bottom of the site, on the bottom left hand side you can click on “resources” and I have some freebies there. I have a couple mindfulness meditations you can download. A couple of resources for Dietitians that could be interesting. I have an online training that teaches dietitians how to counsel people with eating disorders. My new and improved 2.0 version, if all goes well, will be launching on October 1, 2017. Stay tuned for those details. Connect with me on social media, my handle on all things social media is @MarciRD. I love hearing from people who have listened to me talk. Send me questions. Tell me what you want to hear more about.
Paige: I love the work you do and grateful you spent some time with us today talking about this really important topic. I know this will resonate with people.
Marci; thanks again. Take care!
Paige: I sincerely hope you enjoyed this conversation. If you haven't already, please leave a review on iTunes. Thanks again so much for listening. We’ll see you soon for another episode.