The Gut Health Podcast
The Gut Health Podcast explores the scientific connection between the gut, food, mood, microbes and well-being. Kate Scarlata is a world-renowned GI dietitian and Dr. Megan Riehl is a prominent GI psychologist at the University of Michigan and both are the co-authors of Mind Your Gut: The Science-based, Whole-body Guide to Living Well with IBS. Their unique lens with which they approach holistic conversations with leading experts in the field of gastroenterology will appeal to the millions of individuals impacted by gut health.
As leaders in their field, Kate and Megan dynamically plow through the common myths surrounding gut health and share evidence-backed information on navigating medical management, nutrition, behavioral interventions and more for those living with or without a GI condition.
The Gut Health Podcast is where science, expertise, and two enthusiastic advocates for wellness come together to help you live your best life.
Learn more about Kate and Megan at www.katescarlata.com and www.drriehl.com
Instagram: @Theguthealthpodcast
The Gut Health Podcast
Part 1 of the IBS-C series: Pathways to Relief: Understanding Medications for Constipation with Dr. Justin Brandler
This episode launches the first part of a 3-part mini-series on IBS-C, shedding light on the complexities of this widespread condition that affects millions of people across the U.S. It stresses the importance of a holistic, patient-centered approach to managing IBS-C. We explore the various medications used to treat IBS-C, including both over-the-counter options and prescription drugs, offering a comprehensive review. Our expert guest, Dr. Justin Brandler, a neurogastroenterologist at Virginia Mason Franciscan Health, provides valuable insights into the mechanisms and effectiveness of these treatments.
Dr. Brandler simplifies the intricate science and treatment of IBS into easy-to-understand concepts. He likens his role in treating IBS to that of both a plumber and an electrician. As a disorder of gut-brain interaction (DGBI), IBS affects how the brain and spinal cord process signals, influencing gastrointestinal symptoms.
Different patients respond to different treatment approaches. Dr. Brandler discusses medications that target the "plumbing" aspect of IBS, including pharmaceutical options like linaclotide, tenapanor, and lubiprostone, as well as over-the-counter treatments such as magnesium oxide, senna, and bisacodyl. He also covers treatments that address the altered brain-gut connection in IBS, highlighting various neuromodulators, including selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs), and their role in adjusting the nervous system to help alleviate IBS symptoms.
We explore essential tips for making the most of your medical appointments, such as organizing a concise summary of your medical history and symptoms to ensure clear and effective communication, including outlining your goals. Preparing ahead of time can help your healthcare providers deliver the best possible care and make the right referrals for your needs.
This podcast was sponsored by Ardelyx.
Resources:
Mechanisms of Action Considerations in the Management of IBS-C
Learn more about Kate and Dr. Riehl:
Website: www.katescarlata.com and www.drriehl.com
Instagram: @katescarlata @drriehl and @theguthealthpodcast
Order Kate and Dr. Riehl's book, Mind Your Gut: The Science-Based, Whole-body Guide to Living Well with IBS.
The information included in this podcast is not a substitute for professional medical advice, examination, diagnosis or treatment. Always seek the advice of your physician or other qualified health care provider before starting any new treatment or making changes to existing treatment.
This podcast has been sponsored by Ardelix, or a healthcare provider, you are in the right place. The Gut Health Podcast will empower you with a fascinating scientific connection between your brain, food and the gut. Come join us. We welcome you. Hello, friends, and welcome to the Gut Health Podcast, where we talk about all things related to your gut and well-being. We are your hosts.
Kate Scarlata MPH, RDN:I'm Kate Scarlata, a GI dietitian, and I'm Dr Megan Riehl, a GI health psychologist.
Kate Scarlata MPH, RDN:So we have a new format that we're sharing with you today, and this is a podcast series. It's a mini -series with three episodes. We're going to take a deeper dive into the diagnosis and treatment of constipation-predominant irritable bowel syndrome.
Dr. Megan Riehl:That's right, Kate, and I really put some thought and effort into bringing you experts, including our expert. Today we're going to dive into the subject matter of our book Mind your Gut and in this first part of this IBS series we're going to talk about the pathways to relief. So, really understanding medications for the symptom of constipation, we will be exploring the options from pharmaceutical to over-the-counter medications and how they work.
Kate Scarlata MPH, RDN:Awesome. So let's get to it. Let's introduce our incredible expert guest. He's a good friend and just an amazing clinician that we really appreciate his approach to care in IBS. So, Dr Justin Brandler, is a motility expert from Virginia Mason Franciscan Health in Seattle Washington. Dr Brandler cares for his patients with GI conditions, both complex and general, through evidence-based medicine and comprehensive personalized care plans developed through a strong patient-physician partnership. He desires to empower patients with tools for hope and healing. In addition to using medications to treat disease, Dr Brandler thoughtfully harnesses therapeutic tools from nutrition yay, psychology, double yay, integrative medicine and spiritual care. He strives to earn his patients' trust and we know the trust relationship is so huge, especially in IBS and seeks to provide a safe and welcoming space through empathetic listening, humor and compassionate care.
Dr. Megan Riehl:Welcome, Dr Brandler.
Dr. Justin Brandler:Thanks you guys so much for having me. It's like bucket list be on Gut Health Podcast check, so what an accomplishment. So thank you so much for having me.
Kate Scarlata MPH, RDN:We're happy to have you.
Dr. Megan Riehl:Yes, we were both thrilled as we were thinking about, like who do we want to speak on this topic? And while the point of today is to talk about some of the pathways to recovery here and to care, you really approach this. You walk this with your patients and, while medication can be such an important part of the treatment plan, you certainly bring the holistic to multidisciplinary care that we can appreciate from the physician lens.
Kate Scarlata MPH, RDN:And I'll say that Megan mentioned your name and I was like yes, yes and yes. He is perfect for this episode. I was so psyched, so we're thrilled to have you here beyond. Yeah, really happy.
Dr. Megan Riehl:So we're going to dive in. We're going to start with an easy one, a nice little softball for a complex disorder. So I especially love, probably, the way you describe this to people to humanize this diagnosis. So tell us what IBS is, how common is it and how do we treat it?
Dr. Justin Brandler:How common is it and how do we treat it?
Dr. Justin Brandler:Yeah, so IBS is incredibly common, albeit complex, and I think that's the uniqueness of it is that every patient that comes to me so I am a neurogastroenterologist, motility specialist, brain-gut connection doctor of which IBS, or irritable bowel syndrome, is under the umbrella of these DGBIs or disorders of gut-brain interaction.
Dr. Justin Brandler:So that's kind of a large umbrella term, but underneath that is irritable bowel syndrome, of which there can be a lot of different what we say pathophysiological, or basically how your body works and how it's not working well, processes that can contribute to this. As far as prevalence, actually, there was a global prevalence study published in 2020 by the Rome Foundation that showed that up to 40% of the US population has a functional GI disease or a DGBI in general, of which there have been different estimates, but around 6% to 8% of the US population has irritable bowel syndrome, which is a huge number when you think about that. I mean that's almost 10%, so like one out of 10. And if you see people lined up at the supermarket waiting for their self-checkout and there's 10 people, one of them probably has IBS and one of them may be you. So it's incredibly common, but incredibly complex and, I think, needs to be respected as such when we're approaching these patients.
Dr. Megan Riehl:That study you were mentioning. I love that study and I use that a lot to highlight and normalize, and I think, even taking that 40% a little further, that group was at a risk of about 30%. So all of the people that have one DGBI 30% have two DGBIs. So it really then encompasses upper and lower. And, just as a kind of FYI for our listeners, the beauty of many of the things that we're going to talk about over the course of this series medications included, but lifestyle and nutrition is that many of these interventions have been studied for lower GI, but they can apply to upper GI conditions as well. So I'll use hypnosis as one example. It's just that how we use hypnosis for lower DGBIs urinal bowel syndrome it can be very effective for upper GI. So not to dive into that too far today, but just again to highlight, people are suffering from mouth to anus.
Kate Scarlata MPH, RDN:They are, and I would say you know, same with diet. There's applications that we use for IBS that may help with functional dyspepsia. That overlap is significant.
Dr. Megan Riehl:So what's your elevator pitch, real quick, for patients that have been newly diagnosed with IBS. What do you tell them off the bat?
Dr. Justin Brandler:Yeah, I definitely have so many elevator pitches. As you guys know, that's kind of my shtick, and I actually teach a class called Brain Gut Coaching Class via Zoom. That's billable to their insurance, because it is so hard to really do a deeper dive with these patients in clinic. We just don't have time and so we kind of outsource it that way. But from a high-level view, what I say is as a brain gut specialist.
Dr. Justin Brandler:I'm basically a glorified plumber and electrician, so I think about it from a plumbing standpoint, being a gastroenterologist. So the mouth to anus, like how the bowels, the stomach, the small bowel, large bowel, those types of things, and sometimes we target treatments based off plumbing alone, depending upon the situation. But there also can be a connection with the electricity. So that's where the neuro fits in, or the neurological nervous system, and what a deep connection there is between our brain and our gut, both within the brain's nervous system, both within the gut's nervous system, called the enteric nervous system, which is kind of felt to be maybe a second brain, and then there's also the connection in between, which is often the vagus nerve, if you've heard of the vagus nerve as well as some other nerve pathways.
Dr. Justin Brandler:So that's kind of a high level view of the physiology, but from an emotional standpoint, I guess even before that, I just sit and look at them and I tell them I believe you. I mean honestly, that's the first step, or at least I present that non-verbally, because these conditions are so challenging, because a lot of the testing that we have currently, or biomarkers, what we say can't really capture it. A lot of times it's the patient where their lab studies are normal, their CT scan is normal, they're shuttled out the door saying there's nothing wrong with you, and the patient is left feeling like nobody believes me. They think it's all in my head, whereas I say an elevator speech would be it's not all in your head, but part of it is in your brain and spinal cord within your nervous system. Because I think if we do totally take away the head piece, we take off the table so many helpful tools that people like Dr Megan Riehl and others can use in the psychological realm, as well as medications, which we'll talk about.
Kate Scarlata MPH, RDN:Well, I got the chills. First of all, you know I started a campaign, "I Believe in your Story and so it is so vital and provides just such trust in that relationship. When you feel like you're believed, I mean that should be normal, right, and with a lack of biomarkers and not having something objective to sink your teeth in, it does leave patients feeling a little bit like what the heck do I have and do I really have this? So I'm really glad you said that lots of little chills in your little elevator speech for Kate Scarlata.
Kate Scarlata MPH, RDN:So let's get into medical treatments a little bit, because we know that at least I've been doing this for 30 years and the majority of people that I work with they don't just require diet alone. Some do, some benefit from gut-directed hypnosis and that's all they need. But I feel like the majority need like a full toolbox and medications can, I think, they're stigmatized a little bit like it's a cop-out, but these medications can really be life-changing and really address the plumbing issue in many cases in constipation. So can you just go into a deep dive between pharmaceutical medications as well as some of the over-the-counter medications that people might grab to alleviate some of the constipation and symptoms associated with that.
Dr. Justin Brandler:Totally. So diving into a few more metaphors I use here a bit. So as far as the toolkit, I love the toolkit concept. I actually use that because it's a lot of specialists. I say I specialize in making a lot of friends and maintaining them because I need their help. So I think of it as the team concept and at Virginia Mason we're team medicine, so sometimes there are team members that will be on the field. So those will be tools that we will use. We'll refer to GI dietitians, we'll refer to GI psychologists, but maybe that's for a time and maybe they'll go off the field for a while and we bring in the pelvic floor physical therapist, for example. Take them off the bench for a season because you're a human being who has a life. You can't be going to visits all the time. So I think the overarching team metaphor is really helpful when approaching the toolkit and then when we dive into the toolkit for constipation in particular, I'm actually going to steal a metaphor from both Dr. Riehl and my mentor, Bill Chey, who taught me about the toothpaste metaphor for constipation. So I use this all the time, especially before I'm doing a rectal exam.
Dr. Justin Brandler:So when you think about it, think about a toothpaste tube with a cap on the bottom. The cap is the anus and you want it to loosen well enough to let the poop out. You want it to loosen well enough to let the poop out. You want it to tighten well enough to keep the poop in. So when we focus on the cap level of management, that can be a pelvic floor physical therapist not even necessarily medication management. And a lot of times these patients are like I just want to get better and be done and no meds and no whatever. And I'm like okay, well, we do have to. There's no magic wand. That's not a good pitch because that's not true. But if anybody was a magic wand, it would be a pelvic floor physical therapist, because they can really help guide you through a lot of helpful non-medicine tools. But if we go upstream, in the toothpaste tube metaphor, we can think of it both from the paste standpoint as well as from the tube standpoint.
Dr. Justin Brandler:So from a paste standpoint, soluble fiber can be very helpful. However, it's a double-edged sword, so we want to start low and go slow. If we're doing fiber management, the most evidence-based would be psyllium fiber or metamucil, which is the bright orange container in the stores, and you can go week by week, increase teaspoon by teaspoon to get to that soft banana stool. Alternatively, albeit less evidence-based but helpful for the bloaters, is citricil. So it's metabolized a little bit differently but a little less bloaty. So that can be a dietary management. And also you reach out to your friendly GI dietician, bring them on the field for your dietary fiber options, especially maybe lower bloaty fiber options, such as two green kiwis, which has been studied in randomized control trials to be beneficial. So that's part of the paste management.
Dr. Justin Brandler:Now going up a little level to more medication management, and we'll start with over-the-counters. So one medication that can be really helpful and people feel more as kind of a natural option is magnesium oxide or really any magnesium product. I use this all the time now and there was actually a recent randomized control trial comparing it to Senna and it was equivalent. We'll talk about Senna in a second. But magnesium oxide can be helpful for a few reasons. It's called an osmotic laxative, so it can help to kind of soften that paste a little bit. Also, to a certain degree the magnesium can have a muscle relaxant effect as well, as a lot of my patients have benefit with sleep if they take it at night, so it can kind of serve a lot of different modalities. You want to get it from a reputable company that's been third-party tested so it has the right amount of magnesium, and you want to avoid it if you have chronic kidney disease, but for the vast majority of people it's incredibly safe and effective.
Kate Scarlata MPH, RDN:Can I just interject like where do you start with magnesium? Do you start at a certain dose?
Dr. Justin Brandler:So what I tell them is magnesium oxide, 400 milligrams, because that's how it's been most studied and I started at one a day and oftentimes I advise them at night because of that sleep benefit and then we can increase each week. We say at night and then maybe in the morning, and then it's even been studied up to three times a day. 1,200 milligrams is perfectly safe for people. Now there are so many magnesium products and it is insanely confusing. I kind of try to center them on oxide because it's a little bit more of a nice balance between absorption by the GI tract and getting those blood levels higher which can help the sleep medicine. But it also stays within the bowel to help that stool softening effect, as opposed to like magnesium citrate which theoretically maybe stays more in the bowel and has a bit more cramping effect for some people not always but some and then on the other end is like magnesium glycinate, for example. That's absorbed more by the GI tract and has a bit more evidence for like headaches and sleep and stuff like that but may not have as much constipation benefit. But it really unfortunately is a bit of trial and error and I have patients along the spectrum and we just kind of go with what works. So as far as other paste options, miralax, you know, is a tried and true. That's usually in a white container with a purple cap at the store over the counter, you know, generally relatively safe. You know, there is some evidence that's starting to develop in terms of long-term side effects when you've been on it for a long time, potentially from a neuropsychiatric standpoint. That evidence still has to evolve more and especially in my little old lady who's like 70 or 80, that I'm like that is a long-term consequence. I don't care about that for you, I just want you to be feeling better. And the other trick here is it's recommended as a full capful. Sometimes that's too much and that gets you too liquidy. You can always break the rules a little bit and go to a half capful. It's not against the law, nobody's going to come and get you so and that can actually be all that's needed.
Dr. Justin Brandler:And then there are a few other ones, you know docusate, which is like a stool softener. Actually pretty minimal evidence there one of my friends when I was at Mayo, Allison Yang, who's now in the Harvard system, I believe, she described it as all mush, no push. So it really just softens the stool, which can be really helpful for somebody who doesn't have motility issues, but it's more of a you know, they have an anal fissure, for example, and they just really want to get something smooth by that anal fissure. That can be a helpful tool. So you know, that's kind of a bird's eye view. I think of the paste type of interventions where we can help soften the stool. That's more in the osmotic laxative category. I guess.
Dr. Justin Brandler:Another one if we're going to go in prescriptions and we're going to stay in the paste world now we're going to enter into the prescription medicines. So that's something like linaclotide, for example, or Linzess. Another one is lubiprostone or amitiza. I actually don't like that one as much because it has a high risk of nausea, although insurance loves to force you to go through that because it's cheaper. And then another one is placanotide or trulence. Basically all three of those work in a very similar mechanism.
Dr. Justin Brandler:Lubiprostone's a little different but essentially it helps to secrete fluid from the small bowel into the large bowel and out.
Dr. Justin Brandler:And especially linaclotide and placanotide and I guess lubiprostone to a certain extent are indicated for both chronic idiopathic constipation so that's constipation without the pain as well as IBS with constipation, which is constipation with the pain, and how we think that works maybe is through affecting the pain receptors and helping those numb those down a bit.
Dr. Justin Brandler:So those are some prescription options in that realm. Another new kid on the block which is pretty exciting is tenapanor or Ibsrela, so that one is indicated for IBS with constipation predominance, and it actually is a totally new mechanism of action that we kind of think is almost a retainagogue. So as opposed to secretagogues where they secrete fluid, this one actually blocks a certain receptor to keep fluid or retain the fluid within the small bowel so that it comes out and in some ways maybe a little less diarrhea side effect with this guy as well, as if you hang on to it for six to eight weeks or so that's how it was studied where we get some bloating and pain benefit but you can start to get the stool consistency benefit off the bat. So that's a lot of paced stuff both from OTCs over the counters as well as to prescription. Now going out to the tube itself tube itself.
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Dr. Justin Brandler:Okay. So we're going to talk about things that can squeeze the tube, so we think about them like stimulant laxatives. We'll start at over-the-counter level. So over-the-counter level would be something like your senna or Senok ot, so senna is actually derived from plants and actually can be very helpful in terms of stimulating the bowels. Sometimes there can be a bit of cramping here, though, so I would start at just like one tab and test it out. You can go up to even two tabs twice a day. Another fun little trick is for those tea drinkers out there is smooth move tea actually, so you can steep a tea bag at night, have some of that stimulation happening over the nighttime, so hopefully avoiding some of the cramping, and then ideal world is wake up with a beautiful banana bowel movement.
Dr. Justin Brandler:That is definitely ideal, yeah, that is always the goal, doesn't necessarily always happen, but I think a reasonable strategy, especially for people looking for that natural option. Another one in the realm of the squeezers is bisacodyl or Dulcolax. I will tell you this is insanely confusing when you're going to the store because there are Docusate, which is the stool softener, the all mush, no push, and the Dulcolax, which is actually the brand name that makes the bisacodyl. I think they also do docusate. So it's insanely confusing. But if you're looking for the true ingredient, when you're looking on the back, look for bisacodyl B-I-S-A-C-O-D-Y-L. Now that's actually a little bit more effective stimulant laxative and I do advise it to start with five milligrams. But this can be really effective, especially for our patients. Without the pain component. It's more the constipation because the stimulation isn't going to bother them as much. I don't use it as much for my IBS-C patients because until we get that turned down in terms of the pain, we may not have as much benefit and more side effect.
Dr. Megan Riehl:That's a good point. Just to make that, you know, a tenant of IBS is abdominal pain plus these bowel fluctuations. But there are lots of types of constipation too, so you can have constipation without abdominal pain and, to your point, talking about that with your gastroenterologist or primary care physician is really going to help inform many of the treatment suggestions that they make you got it.
Dr. Justin Brandler:It's all pain, no gain of IBS diagnosis. So it's a little different flavor there and different strategies. And then finally another somewhat newer kid on the block for a stimul. Block for a prokinetic we would say, is prucalopride or Motegrity, so that one can stimulate the bowels, albeit in a more gentle fashion. However, it's technically indicated more for chronic idiopathic constipation, so kind of avoiding it with those with pain. So that's really we're diving into all the plumbing stuff. I don't know how much we want to go into the electricity stuff as far as neuromodulators, but in general for an IBS-C patient I'm going to focus on the plumbing first actually, because sometimes getting the plumbing in order, whatever that looks like, you know paste, tube or cap strategies that may help the pain just secondarily and we don't even need to go into the electricity realm of the neuromodulators where we're adjusting the nervous system. That's kind of a bird's eye view of the pharmaceutical approaches.
Kate Scarlata MPH, RDN:That's awesome. I learned a lot, you know, and I feel like I knew the drugs pretty well, but the way you worded it is just so simple. That was great, thank you.
Dr. Megan Riehl:Dr Brandler just very briefly tell us a little bit about what neuromodulators mean and what a patient that's struggling with constipation might get in terms of a prescription.
Dr. Justin Brandler:Totally. As I said, we'll focus a bit more on plumbing first, but this is in the electricity. So neuromodulator means change or modulate the nervous system. And yes, these drugs originally were antidepressants, anti-anxiety, but a lot of times we use them in different ways with these conditions. So, for an example, SSRIs can sometimes be used for patients that have predominant anxiety and depression features, and actually it's because we leverage the side effects to a certain extent. A lot of times diarrhea can be a side effect which we can totally leverage for a constipated patient, right. So something like a sertraline, for example, Zoloft we can get by with low dose for that and that can help calm or settle down the nervous system to a certain extent.
Dr. Justin Brandler:Now, with our bigger pain people, I would actually recommend more a SNRI for my constipated pain patients. So that's serotonin and norepinephrine. The one I love the most by far is duloxetine or Cymbalta. It can be incredibly effective and treats so many different things, including the pain for a lot of conditions depression and anxiety and has less of a side effect profile, especially constipation. Finally, tricyclics or tricyclic antidepressants actually have the most evidence and we use them in much lower doses. This is like amitriptyline or nortriptyline I would use in a constipated patient because it doesn't pass the blood-brain barrier as much. But that does have a constipating side effect. So I'd want to get the plumbing down under control first, and then we move into the tricyclics.
Kate Scarlata MPH, RDN:Thanks for that. You know, I think of people. They hear neuromodulation (and think)... this is used for depression. My doctor thinks I have depression. What is your elevator speech about that?
Dr. Justin Brandler:I go back to. It's not all in your head, but part of it is in your nervous system and in your brain and spinal cord and the way that we know these work actually and through the class I'm able to teach this more but we are understanding more about these pathways and actually how it can help to control those overactive gut to brain signaling. And the other thing is we can actually get by with lower doses for brain gut conditions than we actually do for full-blown mental health conditions. So that's also why in some ways I'm like, hey, whatever, I'm not even going to put anxiety depression in your chart, because I actually don't even think you're anxious or depressed, I just think your nervous system's all out of whack and let's turn it down. So you know, that's also sometimes how it can be framed too.
Dr. Megan Riehl:Perfect, and people aren't going to be usually on these for the rest of their life too, and therefore having these additional follow-up appointments with you to talk about their hopefully improvements can help them inform future treatment. So, from that kind of transition, tell us what is the most beneficial information that a patient can prepare to make the most of their time with a neurogastroenterologist or somebody like you.
Dr. Justin Brandler:Yeah, I mean, I think first of all is they're probably not going to see a neurogastroenterologist, right? They're going to see a general gastroenterologist, a general GI, nurse practitioner or PA that also probably really care, but they're very limited on time. So one of the best advice I can give you is really go in with a good sense of what your goals and expectations are for the appointment, Because, inadvertently, what often happens is you're suffering, right, you don't, you just want to feel better and that's all you want to feel. But that's very hard for the person on the other end of the exam room to address without really understanding what you're looking at, what your goals are, because there's only so much time to cover, I will say, actually a shameless plug for a talk I gave a few years ago with the IFFGD or International Foundation for GI Disorders, which you can still find online actually, I saw is I gave a talk called Living Your Best IBS Life and in that I give you a guide of an IBS snapshot, so a one-page summary of the key points that you can give to your provider that you're seeing, and I will tell you if you can summarize in a page your basic history of your predominant stool habits, if you're speaking the Bristol stool chart, for example, if you're identifying some of your triggers, if you're doing those types of things, if you can give a one-page summary, as opposed to a giant binder or a giga download of your tracker's PDF or whatever, that's going to go so much farther and that provider is going to feel so much more empowered themselves to empower you with guidance as to next steps.
Dr. Justin Brandler:So key goals and expectations for that visit and then organizing your thoughts and history into a one-page summary, if at all possible, is really, really ideal.
Kate Scarlata MPH, RDN:Yeah, I often say like of all the symptoms you're experiencing, try to kind of like qualify those... Like bloating is the most difficult, or pain is the most difficult, or I'm in the toilet for 14 hours every morning is the most difficult. So the physician can kind of prioritize right and you're on the same page.
Dr. Justin Brandler:And quality of life too, like what of these constellation of symptoms most affects your quality of life, and that we can more precision target, because from there a lot of other things will fall in place, because a lot of this these aren't quantity of life conditions, these are quality of life conditions, and so if we can really focus on and pinpoint the takeaway from that, then that can really lead to high-yield visits.
Dr. Megan Riehl:And Kate and I will talk more about this in part two, but just off the top of our head again, if this is a plumbing issue and you're trying a bunch of different medications over the counter and you're just not sure and you want some clarity, then having that medical provider conversation is so important. If you are avoiding going to things with your family, if you're at home, your avoidance behaviors, your stress, your anxiety, you are depressed because of your symptoms, that's going to key in our physician colleague to make that consult to a GI mental health provider. Or if you're afraid to eat, you don't know what to eat, you are avoiding meals again it's going to trigger that referral to a GI dietician. So it's really important again to be organized and to be open with your physician so that they can help guide where to go next.
Kate Scarlata MPH, RDN:And I would add you know, sometimes you try a treatment, you see the doctor and you say I feel better, but the doctor doesn't understand necessarily like how better? Like sometimes you try a treatment, you see the doctor and you say I feel better, but the doctor doesn't understand necessarily like how better, like are you at 80% of where you want to be, or is it you were zero and now you're 10?
Dr. Justin Brandler:So sometimes making sure you kind of qualify the benefits that you received, Actually, in my practice now we're collecting IBS symptom severity scores so objective scores at the beginning, and then we see that progress. And it's actually so rewarding for myself that we just talked about this yesterday with a patient. She went from like 330 to like 20 or something. It was amazing. So rewarding for our team members too. Sometimes we do mental health scores as well to objectively see those changes. Sometimes we do mental health scores as well to objectively see those changes. So you can work with your provider on how to do that, maybe even do that beforehand for them so that they know where things are at.
Kate Scarlata MPH, RDN:Well, this was amazing, and no surprise, because you're amazing. I couldn't have wanted a better scenario for this episode... you covered, from A to Z and really understanding medications better and the complexity of IBS, and I love the plumbing, electrical sort of system alterations that are associated in very simplistic terms for our listeners. So thanks for your time.
Dr. Justin Brandler:Yeah, thank you guys so much for having me. I mean, I just like, blow up, Mind Your Gut with patients, I mean as they're waiting to see me. I'm like, okay, this is something you can read before seeing me. Like it's, it's promoted in the classes, like it's just, you guys provided such a powerful tool that I've read myself that, as you know, that is very patient, accessible and myth busty, which is also incredibly important, and a side conversation. So, thank you guys so much for what you're doing for patients everywhere.
Dr. Megan Riehl:Well, we look forward to ongoing collaboration with such a rock star in the motility space and everybody out there listening. Please make sure that you subscribe, like and follow The Gut Health Podcast. Your support means the world to us, our friends.
Kate Scarlata MPH, RDN:Thanks everyone.
Dr. Megan Riehl:Thank you for joining us as we grow this gut health community. We hope you enjoyed this episode and don't forget to subscribe, rate and leave us a comment. You can also follow us on social media at The Gut Health Podcast, where we'd love for you to share your thoughts, questions and experiences. Thanks for tuning in, friends.
