The Gut Health Podcast

Part 2 of The IBS-C series: Mind Your Gut: Diet and Lifestyle Solutions for Constipation

• Kate Scarlata and Megan Riehl • Episode 15

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Join Dr. Riehl and Kate as they share practical lifestyle strategies for managing IBS with constipation. Studies show that up to 84% of IBS patients experience GI distress related to eating, with most triggers linked to carbohydrate intake—particularly highly fermentable ones like FODMAPs. Learn how the low FODMAP diet, the most extensively researched dietary approach for IBS, stacks up against traditional therapies and medications. Kate also explores other researched diet options for IBS, including the Mediterranean diet and the UK NICE IBS diet guidelines.

Dr. Riehl discusses the intricate gut-brain connection and presents evidence-based therapies for managing IBS symptoms. She provides an in-depth review of a range of treatments, including mindfulness techniques, gut-directed hypnosis, and other effective interventions, offering a comprehensive approach to symptom relief.

Finally, we explore simple, holistic lifestyle changes that can complement IBS management. From the benefits of eating a wide array of colorful plants, engaging in mindful eating, to stress reduction and healthy living techniques. By the end of this episode, you'll be equipped with a variety of self-care and nurturing practices that align with your personal values, helping you find joy, reduce stress, and better manage your IBS symptoms.

Diaphragmatic breathing demonstration

Book: Real Self-Care: A Transformative Program for Redefining Wellness (Crystals, Cleanses, and Bubble Baths Not Includes)

References:

Nutrition:

Efficacy of a low FODMAP diet in irritable bowel syndrome: systematic review and network meta-analysis.

The Association Between a Mediterranean Diet and Symptoms of Irritable Bowel Syndrome

Clinical Trial: A Mediterranean diet is feasible and improves gastrointestinal and psychological symptoms in irritable bowel syndrome

UK Nice Guidelines IBS

CAM & Sleep:

Complementary and Alternative Therapies for Chronic Constipation

Sleep Duration in Constipation

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.

Kate Scarlata, MPH, RDN:

This podcast has been sponsored by Ardelyx. Maintaining a healthy gut is key for overall physical and mental well-being. Whether you're a health-conscious advocate, an individual navigating the complexities of living with GI issues, 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 all things related to your gut and well-being. I'm Kate Scarlata, a GI dietitian.

Dr. Megan Riehl:

And I'm Dr Riehl, a GI health psychologist, and today's episode Mind Your Gut: Diet and Lifestyle Solutions for Constipation is part two of our three-part IBS series. I hope that you listened to part one with Dr. Justin Brandler, because he is a true wealth of information and enthusiasm and we had such a great time. So please make sure you've checked out part one. And now we get to dive into part two.

Kate Scarlata, MPH, RDN:

Absolutely, and Megan and I really love talking about diet, behavioral therapies, lifestyle and how that can really play a role in IBS symptom management, and you know we wrote Mind Your Gut for that reason, because we know these therapies can be extraordinarily helpful if you're living with irritable bowel syndrome. So certainly, as a GI dietitian, I'm going to delve right into my favorite topic and that's nutrition. I'm really grateful to see the interest in nutrition and how it intersects with IBS. Finally, because I've been doing this for over 30 years and really for years we had nothing to say to patients other than hey, try to increase your fiber. And often that just really failed and made their symptoms worse, and often that just really failed and made their symptoms worse.

Kate Scarlata, MPH, RDN:

So now we know a lot more and people are interested, researchers are interested in really looking at this, and so, although we're in the beginning stages of understanding nutrition and IBS, and we all know that individuals with IBS have somewhat of a different individual experience, we need to personalize nutrition, but there are some general takeaways that can be applied to most people living with this condition and I really wanted to talk a little bit about, just in general, ibs and how patients experience eating. There was a great survey study of about 200 IBS patients and 84% said just eating any food triggered their symptoms. That's quite a lot of people, and that's not surprising to me, because I certainly hear that from patients that I intersect with on a regular basis.

Dr. Megan Riehl:

And I think even the ears that you are listening to this podcast with even if you don't have an IBS diagnosis, some of us are going to have occasional bouts of constipation, some people are going to have more chronic IBS with constipation, but I personally love hearing your wealth of information, because occasionally things are going to slow down a bit, and so what are some of the foods that we need to be thinking of when our tummy is upset or when we're not having complete evacuation in the bathroom? So I think that that's just important for us to be thinking of as we move through this conversation about food and mood. And you kick it off, kate.

Kate Scarlata, MPH, RDN:

Yeah, absolutely agree with you. You know, when we think about how food intersects with the gut, all of us are going to be affected at some point, and constipation is a hard one, because most people living with constipation, especially with IBS, they're the ones that tend to be a little bit more symptomatic. They're more likely to have bloating associated with their symptoms. So let's get into a little bit about diet. So the survey study that I mentioned earlier 84% felt that eating anything triggered their symptoms, but the vast majority of them pinpointed actually fermentable carbohydrates as their top trigger and the low FODMAP diet that is, a diet specifically for reduction of fermentable carbohydrates shown to be the most beneficial diet, the most researched diet for IBS. It's really no surprise. I mean, these patients know what's bothering them, they identified them and now we have a diet therapy that really addresses how we can reduce some of these fermentable carbohydrates. So we've got the most research on IBS.

Kate Scarlata, MPH, RDN:

The vast majority of studies show efficacy or the ability for the diet to manage symptoms in about 50 to 80% of people. There was a recent study in The Lancet journal that suggested efficacy around 76. So it's in that range. Not everyone's going to benefit from reducing fermentable fibers, but at least half will. That's pretty amazing. It's better than any medication that's out there for IBS. So diet is, and can be, very therapeutic.

Dr. Megan Riehl:

It's comparable to our behavioral therapy outcomes.

Kate Scarlata, MPH, RDN:

Yes, and we are going to dive into those with Dr Riehl, who is the expert in all of those behavioral therapies, which I can't wait to just dive into that in just a moment. I'm talking FODMAPs, I'm talking about the fermentable carbohydrates it's really an acronym and I don't want you to get caught up in these sciency terms, don't ask me to say this.

Kate Scarlata, MPH, RDN:

Okay, you have to. No. So fermentable oligosaccharides, disaccharides, monosaccharides and polyols and in general, just so what you really need to know. They're small carbohydrates that are commonly malabsorbed. They pull water into the gut and or are rapidly fermented by our gut microbes, creating a lot of gas. That water in the gut, the gas in the gut kind of stretches the gut, makes us feel a little bit uncomfortable, makes us gassy, right? So all of those symptoms that can be problematic when experiencing IBS, but also sometimes just all of us, it can be really uncomfortable.

Kate Scarlata, MPH, RDN:

So common FODMAP foods dairy, but it's not all dairy. It's the dairy that's rich in lactose and that's the wet part of milk. So think of milk and ice creams as wet, not a hard cheese (that's dairy) or butter. Those are very low in lactose, but those that have a lot of like fluid consistency to them tend to be higher in lactose. Also, big FODMAP rich foods are your onion, your garlic, your wheat. Those are big triggers for a lot of different people. And then there's some fruits like stone fruits, peaches, plums, prunes. We know we use them for constipation a lot of times and part of the reason we do is because of their FODMAP activity, pulling a lot of water into the gut. It does soften the stool but it can be a little bit gassy for people with IBS, so sometimes those prunes or prune juice doesn't work as well in that sensitive gut that we see in IBS. So additionally, when it comes to FODMAPs, there's been some really interesting research out of UMichigan and this has been led by Dr. Prashant Singh, and what they've looked at in animal studies and in a small subset of humans, that in humans, particularly when they respond to the low FODMAP diet, when they give them high FODMAP foods, a cascade of effects occur in the gut and what happens is that there's more of a dysbiosis, so more sort of pathogenic potential microbes in the gut, or what we call bad microbes, versus health-promoting microbes, and this leads to immune activation as well as colonic permeability, an increase in colonic permeability. And this is just giving us insights into some of the mechanisms why FODMAPs may trigger pain in some of these IBS symptoms. So very, very interesting. Love seeing this head in a direction where we're understanding not just like oh, this makes you better, but why it might make you better. I love that because you know we like science, right, dr Real? That's right. That's right.

Kate Scarlata, MPH, RDN:

First, let me just tell you that the low FODMAP diet is typically done in a three-phase approach. So you eliminate FODMAPs. This is the beginning of the diet. You don't stay here, okay. So reminder to my listeners, our listeners out here this is the beginning of the diet. We're reducing FODMAPs. Seeing how you do? You stay there about six weeks. Then we do a reintroduction protocol, which we systematically add FODMAPs back to really understand which FODMAP subtypes whether that's lactose or fructans these are all different types of carbohydrates that are commonly malabsorbed which ones are triggering you. And then the last phase is the personalization phase, when we add back the foods that you can tolerate, because there's no reason to restrict all FODMAPs long-term. In fact, studies have shown us that the average amount of FODMAPs that are problematic for IBS patients it runs about two to three of the groups. So not everyone has issues with the polyols or everyone has issues with the monosaccharides. It's really variable person to person and we want you to have a liberal diet and enjoy food. So that's really important.

Dr. Megan Riehl:

And this is why, if you've ever Googled a dietary therapy and you've used the low FODMAP diet, you picked up one of Kate's books and you have gotten some relief, but you have never resumed the reintroduction phase. This is key. We don't want you staying on the low FODMAP diet long-term. So if you're still on that diet, you're still in the restriction phase, work with a GI dietician or experiment yourself, knowing that it's normal to have maybe some slight increases in your GI symptoms when you're going through reintroduction. Your body will get used to those foods that you've been missing for a little while and that maybe you avoid. The foods that really, if they do cause you a big flare of symptoms or more severe symptoms, there you go, ding, ding, ding. That's the group that you want to stray away from. Absolutely.

Kate Scarlata, MPH, RDN:

And I think that's a really important point, Megan, is that you know a little gas bubble, a little distention after you add FODMAPs back, totally normal. It's really when you're triggering like a major IBS flare and you're feeling the pain and you're like, oh, this was really bad, then you know that would sort of warrant a trigger, not necessarily a little gas. We all get gas when we eat FODMAP, so you're not alone out there. And then, briefly, I'm going to just talk about a couple other diets that have been studied for IBS. One of them is the Mediterranean diet and, to be honest, there's been three studies. Two showed favorable results. The third was very mixed and not definitive on that. For me personally, I do think a Mediterranean diet which is rich in things like lots of plants, legumes, nuts, seeds, olive oil, a little bit of fish, a little bit of yogurt, healthy, has a lot of evidence for just general health cardiovascular risk, diabetes risk, so many health benefits. So eating like that, great, if you can. Mental health, mental health too, and even in the IBS studies mental health was noted as a benefit. So yeah, give it a go. There's some evidence, not as strong as a low FODMAP because there's not as much studies right. So the weight of the studies out there, it's just less but interesting could be beneficial. And then the other diet I often kind of go to and we'd kind of morphed it and used it as part of our Mind Your Gut Gentle Diet Cleanup is the UK NICE guidelines for IBS and in general this is really a cleanup. It's like don't skip your meals, eat in a relaxed setting, don't have a bunch of junk food. Limit your fruits, because fruits tend to have a lot of these fermentable sugars that are problematic. Don't overdo it with alcohol. None of us should be, by the way. Keep caffeine at bay if it triggers your symptoms. More of a problem for those with diarrhea-predominant IBS, for those with constipation. I find my patients tend to benefit from the caffeine. It stimulates colonic motility. That's not a bad thing when you have a sluggish gut. So those are really the three main diets that I look at. There are some studies looking at very, very low-carbohydrate diets. I'm not a huge fan for that because, quite honestly, fiber is a carbohydrate, so we need fiber. We know that fiber is beneficial for our gut microbiome, so I don't know that we have to go that low, right? Yep.

Dr. Megan Riehl:

So that is all a really nice overview of some considerations with our nutrition and IBS, and let's also talk about this mind-gut connection that is at play. This is a very complex interaction between the brain and the gut, but guess what? We all have it. It's complex, but we all have it, and many, many different factors can impact your mind-gut connection. Kate just covered a big one food, but also our environment, stress, mood, genetics, medications and really a lot more. And so you know, as we think about putting all of these pieces together in powerful ways that we can address our overall GI health. Knowing that the brain and the gut communicate and can produce symptoms that are very real is important, and that communication pathway, your brain-gut access, includes your vagus nerve as well as different neurotransmitters that are produced in your brain and your gut. And when we see changes in this communication pathway that can affect your gut motility, the sensations that you feel, and it can potentially then lead to IBS-like symptoms, can potentially then lead to IBS-like symptoms. And so, given this intersection between brain-gut behaviors, we utilize brain-gut behavioral therapies that have now really become a gold standard as part of treatment for patients living with IBS. And also today, I want you to be thinking about ways that you might incorporate some of these suggestions that you might receive in therapy. But also, maybe you might receive in therapy, but also maybe you're not in therapy and you're just again. Just like we would do a gentle diet cleanup, we want to kind of think about doing a gentle, mindful lifestyle cleanup as well. So some of the science-backed interventions that we use that come from this brain-gut behavioral therapy world, or also known as gastropsychology, include cognitive behavioral therapy that's specific to GI conditions and concepts, gut-directed hypnotherapy, mindfulness-based stress reduction techniques and relaxation training. These are all aspects of treatment that you may receive if you're working with a GI psychologist, and there are many, many studies out there that support the efficacy of utilizing these strategies, and I'll use hypnosis as one example where patients that have been refractory to pretty much every other medical treatment that's available for IBS. Those patients have response rates of over 60% when they are using a protocolized, evidence-based gut-directed hypnotherapy program.

Dr. Megan Riehl:

So it's really exciting that we have so many different targets and ways to get at helping you live a better life if you're somebody that's affected by IBS, and these psychological interventions are going to be tailored to your needs. So when you're working with somebody like myself. We're going to be looking at what's your mood like anxiety, stress Do we need to really hone in and build some additional coping strategies for when your symptoms are unpredictable and can feel uncomfortable and uncontrollable? And a GI psychologist is going to help you gain insights into how you respond to uncomfortable sensations in your body. Sometimes those uncomfortable sensations are going to activate your body's sympathetic system, which is the fight, flight or freeze response, and that alone can trigger more neurotransmitters that can exacerbate your GI distress. So a lot of work is done for almost every patient that I work with to have some early, tangible strategies you can turn to. So we've got things like proper pooping position, making sure that you are using a squatty potty and your knees are elevated above your hips with a toileting stool, diaphragmatic breathing We'll link a quick YouTube clip to make sure that you're aware of how to do this technique and also making sure not to sit on the toilet for too long. I believe it was Dr. Darren Brenner in one of our previous episodes who really highlighted you should not be sitting on the toilet longer than five to 10 minutes. So if you find that you're struggling with things like this, seek support. Sometimes lifestyle changes can be really critical in terms of making some long-term changes for your overall gut health, and there are certainly providers out there that can help you with this.

Dr. Megan Riehl:

Another type of therapy that I'll mention is something called biofeedback.

Dr. Megan Riehl:

So sometimes when you Google therapies for constipation, you'll find biofeedback comes up, and this is usually not a type of therapy that's delivered by a mental health provider, though sometimes in the context of a holistic practice, together with a physician, you might receive this type of training, but usually you receive biofeedback, which is a type of therapy where you're using an electronic device to help you gain some awareness and control over your physiological functions, and in the constipation world, this is to help you better coordinate your pelvic floor muscles, and so a pelvic floor physical therapist is usually somebody that you will work with, and you can't talk about constipation management without mentioning pelvic floor PT.

Dr. Megan Riehl:

This can be a really life-changing type of therapy for somebody that has constipation. If you've ever been diagnosed with something called dyssynergic defecation, definitely talk with your provider about how this fits into your treatment plan, and what I've seen in collaboratively working with pelvic floor physical therapists is that either they have already taught their patient diaphragmatic breathing or some type of massage. That again similar to how I treat and teach everybody diaphragmatic breathing, so do they. So this is something that, even if you haven't formally worked with a pelvic floor physical therapist yet, it's something you can get started with, just like something like abdominal massage, and we discuss a massage called the I Love U Massage. In Mind Your Gut. You can easily find this on the internet, too, which can really be helpful for somebody that's either struggling with chronic or occasional bowel problems.

Ardelyx:

When it comes to irritable bowel syndrome with constipation or IBS-C, there's no one-size-fits-all treatment. If you're not satisfied with your current IBS-C medication, it may be time to try something different. Ibsrela (tenapenor) is a prescription medicine used to treat adults with IBS-C. Ibsrela works differently to help relieve the constipation and abdominal symptoms of IBS-C and could be the right option for you. Ready to try something different for your IBS-C symptoms? Ask your doctor about Ibsrela. Do not give Ibsrela to children less than 6. You should not give Ibsrela to patients 6 to less than 18 years. It may harm them. The most common side effect is diarrhea, sometimes severe, and your child could get severe dehydration. Stop taking Ibsrela and call your doctor if you develop severe diarrhea. Do not take Ibsrela if you have a bowel blockage. Tell your doctor if you are pregnant or breastfeeding and about the medicines you take. Other common side effects include swelling or a feeling of fullness or pressure in your abdomen, gas or dizziness.

Ardelyx:

Learn more at Ibsrela. com/ PI or call 1-844-IBSRELA and press option 4.

Dr. Megan Riehl:

The last therapy that I'll mention has growing interest in the world of kind of complementary and alternative therapies, and this is acupuncture.

Dr. Megan Riehl:

So we know that acupuncture has been around for literally centuries but in terms of using it for therapy, there have been several systematic reviews, including meta-analyses, that have shown the effectiveness of acupuncture for chronic constipation and in this type of treatment, an acupuncturist will use acupoints on the skin that are manually stimulated with needles and very specific points, and we won't get into the nitty gritty details, but what I will say is that back in 2023, we hired an acupuncturist in our GI division at the University of Michigan and his clinic was full within a very short period of time and there's some really cool research that people like Dr Borko Nojkov is doing with our acupuncturist, Henry Buchtel, and it's, I think, going to help further the interest of this type of therapy that you know our division chief, Dr Chey, has really promoted as getting outside of the traditional therapies for constipation and IBS and really thinking broadly about what we can learn from other types of medicine.

Dr. Megan Riehl:

So this is exciting stuff and we know that now there is a place certainly for medication, but I think also there are a lot of people that are interested in other ways to address their health. That hit some of the tips and tricks that we're going to give you right now.

Kate Scarlata, MPH, RDN:

Absolutely, and you know I'm glad you brought that up because I do think, and it's been shown in the research, that people that are living with IBS are very interested in more of these holistic approaches. And I certainly don't want to discount medication either, because I would say the vast majority, or at least 50% of the patients that I've interfaced with have required some level of medication, whether it's a laxative or a neuromodulator or something to manage their IBS. No shame there. If you need a medication, you need a medication. You want to feel better to live the best life you could live right. But this growing arsenal of holistic therapies is really exciting to see because it's meeting a need that many patients are truly interested in.

Dr. Megan Riehl:

That's right. Let's say, the medication is the thing that allows you to leave the bathroom right, but now you have the rest of your life to live. You still have to eat, you still want to feel fulfilled, you want to have joy in your life, and so when you can choose foods that you know also nourish your gut, when you can choose activities that are good for you, such as yoga, it kind of kills two birds with one stone. Right when you're approaching your lifestyle from a healthy perspective, that includes whatever strategies help to let you have complete bowel movements, exactly, exactly. So, kate, what are your tips? Give us some nutrition takeaways that I'm going to be thinking of when I'm at the grocery store and are going to help the Riehl family to have healthy guts and butts.

Kate Scarlata, MPH, RDN:

Healthy guts and butts? Okay, well, you know. My first thing is to eat regular meals, don't skip. A lot of people living with IBS think, well, if I don't eat, I won't have symptoms and that'll be great for my work day. Or fall into the habit of rushing and eating standing, or with working on the computer and inhaling a sandwich and not even tasting it. None of that really works well, if you're skipping meals, you're going to overeat. You're going to come home you're going to indulge in getting rid of those hunger pains that you're experiencing. It's too much food for your gut. At once, it impacts your sleep. So many downstream effects to that.

Kate Scarlata, MPH, RDN:

Just learn what you can tolerate for breakfast so that you can start your day, to nourish your brain, to take on the day and you have the strength and energy to face all that comes our way, because we all have different things coming our way. Right, I'm dealing with a lab right now, a chocolate lab puppy, and she's keeping me on my toes over here. So wherever you are in, you know we're always up against something. So the other thing I think that's really important with eating and something that we've done with our kids as they've grown up. Light, music, a candle, if you're into it, just to kind of set the tone also for relaxing. Once your body's relaxed you're ready to take in the food. So you're in more of that parasympathetic mode rest and digest. So if you need some external cues, that can also be helpful. The other thing, just for eating breakfast, really important because you have this reflex called the gastrocolic reflex. It's most active in the morning and that's stimulated. It stimulates colonic activity when you're eating. So if you're doing that in the morning, it's more active in the morning. You're more likely to have a cleansing bowel movement in the morning. So again, for those constipation predominant listeners out there, pay attention certainly to that. So the other thing I think is really important is to eat a variety of different colored plants. Eat the rainbow and that helps fuel a healthy gut microbiome. Your rainbow may look a little different than mine and that's okay, but think about getting different colors into your diet.

Kate Scarlata, MPH, RDN:

I think the other thing that's really important is what you can go easy on and that's the booze, the alcohol, really limiting to no more than one drink if you're a woman, two drinks for men and just keeping that in check. Caffeine, if your diarrhea predominant. Keep a button up on that one. Get your fiber on and I talked about that with the different types of plants, but it's really important to have a wide range of fibers. We're going to get that in our plant foods.

Kate Scarlata, MPH, RDN:

But find things that are a little bit more gentle on your gut If you have the sensitive gut, which you do if you have IBS. So things like kiwi, fruit, blueberries I love wild blueberries, they're rich in polyphenols, better for your gut microbiome. Chia seeds, white potatoes eat the skin oats and things of that nature. Start there, those tend to be a little bit easier on the gut. And then reducing FODMAPs if you find a lot of gas, a lot of bloating, and work with a GI dietitian to make sure you're appropriate for that diet and to make sure you have the right guidance to do it. So those are kind of my top tricks and tips, Dr Riehl, and how about you? All right.

Dr. Megan Riehl:

So I really thought about five lifestyle recommendations for everybody, and the first thing is thinking about stress. So stress affects the chemicals in your body, and when we also think about constipation specifically, you're tense, you're irritated, you're seeking release, and so the more stress you have in your life, the more you're just going to kind of wind yourself up, and so what I want you to do is be really intentional about finding some time in the near future to sit and reflect. Think about what are some of your occasional stressors, like vacations or travel or the family coming into town, as well as your daily stressors, and these are going to be things like your family morning routine or your nighttime routine. Assess how that's going, assess if your blood pressure shoots up during those periods of time, and come up with a new plan. Recognize that there can be some kinks to work out as you make some changes and develop new routines, but these usually stabilize within a couple days or weeks, and if you find that you need a little help to make some changes in your routines, then seek that support with, typically, a mental health provider can be very helpful in coming up with exactly what you need. I always say that everything is harder if you're not sleeping, and so that's the other side of this is to create consistency in your sleep, and not sleeping enough or sleeping too much can have really adverse health effects, and in fact, in one study it was found that short sleep duration posed a higher risk of constipation in men, whereas sleeping too much correlated with higher constipation risks in women.

Dr. Megan Riehl:

So this is really important for all of us to think about in terms of adopting a routine for your bedtime that you can be consistent with, and this doesn't mean it has to be some million-dollar facial routine like you're at the spa or use of a Vegas nerve pillow spray those exist. What it really means is teaching your body that it's time to wind down. You can give yourself an ideal bedtime and really work backwards from that. So whatever will get you eight hours of sleep, work backwards. And then we've talked about this in the past where you want to keep the bedroom for sleep and sex, and that is it. Turn off screens a couple hours before you plan to close your eyes and then come up with things that are tangible, like having a cup of tea before you brush your teeth, turning off the lights and doing some gentle muscle relaxation. I also think it can be really powerful to end your day with constructive and self-affirming talk. So it could be as simple as today. I did my best and that's it. That's it. Aim to do this routine every single night.

Dr. Megan Riehl:

We also want to work and think about how we can reduce the physical effects of stress that builds up throughout our day, and this can come in the form of what I call a breath check and a body scan. So as you move through your day, we're dealing with whatever life throws at us. Our breathing can change and really be reflective of where we're at from a stress and anxiety perspective. So the more busy we are, the shorter and the shallower our breath can become. You might even catch yourself holding your breath, and so I recommend setting an alarm, as you're getting used to doing these types of check-ins three times a day. So I kind of think to anchor it next to things that you do all the time Drive to work, midday, drive home. Waking up, lunchtime, going to bed. And this can be when you stop, you deepen your breath, you notice how your breathing is. Could it be a little deeper into the belly? What does that feel like? Does it make you naturally drop your shoulders. And if you pair this with a body scan where you ask yourself, where do you carry your tension? And usually people have a pretty good idea about this oh, it's in my shoulders, or my jaw, or my gut, my stomach. Start there, take a couple deep breaths, kind of focusing your attention to that space, noticing what it feels like when you do release tension there, and then kind of do a quick scan of the body from head to toe, relax the forehead, the jaw, pull the shoulders down, wiggle around a little bit, notice how that feels and then, onward with the day, this can be done in 60 seconds or less, also having an idea of when you're going to do this.

Dr. Megan Riehl:

So, as I was saying, anchoring this into things that you already do goes along with my next tip, and this is organizing life via a planner.

Dr. Megan Riehl:

My friends and family know that I have been using a planner diligently since I was in fifth grade and, in fact, if you ever need to know what I was doing on a particular date or time, I can tell you what it was because I have it documented in my planners.

Dr. Megan Riehl:

And so, having some way to organize and know what you're doing on a day, in a week in a month. Also, having vacations planned or times off gives us little sparks of endorphins to think about that vacation that we're going on in a couple of months. But also we can do something called time blocking, where you dedicate specific slots of time for specific tasks, and this can be so that you know where are the family activities. How does that fit in with your work schedule? When are you exercising, when is your specific time for relaxation? And also how does self-care fit in? Now, this brings us to kind of we're getting ready to wrap up, and I think that self-care and wellness can be really triggering words, and so I'm going to give you some tangible tips on self-care. So, Kate, how much do you think the wellness industry is worth?

Kate Scarlata, MPH, RDN:

I'm going to say $2 billion,

Dr. Megan Riehl:

$2 billion.

Dr. Megan Riehl:

Well, the Global Wellness Institute found that this wellness industry, which is mostly targeted at us women, was worth $4.4 trillion Trillion with a T.

Kate Scarlata, MPH, RDN:

Wowza.

Dr. Megan Riehl:

So I think that this can be an area where we can get taken advantage of, and that's why I loved the book called Real Self-Care by Dr Pooja Lakshman, who is a psychiatrist and she wrote this book, and this book came out by her last year, and what I just want to highlight for people is that we have to be on the lookout for faux self-care and this is a noun typically describing a product or an activity that's prescribed by somebody else. And real self-care this is the stuff that originates within you, what you value. It's a verb describing an invisible internal decision-making about how you're going to spend your time, to bring yourself joy. And she writes and I'll just read this directly because I think it's beautiful, "real self-care requires treating yourself with humanity and being in tune with what you need and want at any given moment, and so, when you're practicing real self-care, self-compassion is the lens through which you view yourself" and so figuring out for yourself what self-care means.

Dr. Megan Riehl:

And that might mean that you, from a guilt-free perspective, stop every single day and you time block 20 minutes or an hour on Peloton, or going for a walk, or being out in nature to fill your cup, and you do this without guilt, and so I think I'll leave you with that. We hope that you will allow yourself the time to reflect on what this all really means for you and what your needs are, and as we put all of this together, we recognize true constipation and IBS management requires nourishing your gut as well as your mind and your body.

Kate Scarlata, MPH, RDN:

Thanks for listening, friends, please subscribe to The Gut Health Podcast. We appreciate your support, friends.

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.

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Kate Scarlata

Host
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Megan Riehl

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