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
Living with IBS: How to Manage Symptoms Without a Major Diet Overhaul
Join us as we discuss effective non-diet focused methods for IBS relief. In this episode, Kate and Dr. Riehl review key factors on how gender can influence common symptoms of IBS.
Hormones significantly influence IBS symptoms, with women being diagnosed 2.5 times more often than men, in part due to differences in gut function and pain perception.
This episode features the following key discussion areas:
• Women's fluctuating estrogen and progesterone levels affect gut motility and pain sensitivity throughout the menstrual cycle
• Visceral hypersensitivity causes normal digestive sensations to be interpreted as pain - like a car alarm going off unnecessarily
• The "microgenderome" refers to gender differences in gut microbiome that may contribute to women's higher rates of IBS and autoimmune conditions
• Gut-directed hypnotherapy helps reprogram the subconscious mind to interpret gut sensations more accurately, with 70-80% improvement rates
• Pelvic floor physical therapy can help address muscle tension that contributes to both constipation and diarrhea symptoms
• Non-diet approaches including medications, supplements like enteric-coated peppermint, and lifestyle factors are effective IBS management tools
• Regular exercise (especially in nature), adequate sleep, and stress management techniques complement other treatments
For more information on IBS-C treatments, check out our dedicated three-part series in episodes 14, 15, and 16.
This podcast has been sponsored by Ardelyx and Nerva by Mindset Health.
References:
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 Ardelyx and Nerva by Mindset Health.
Kate Scarlata: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.
Dr. Megan Riehl: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. I'm Dr Megan Riehl, a GI psychologist.
Kate Scarlata:Hello, and I'm Kate Scarlata, a GI dietitian, and April is IBS Awareness Month. In today's podcast we're going to cover some non-diet related treatments for IBS and really expand on factors that contribute to symptoms outside of diet. But of course, before we delve into non-diet approaches, it's important, especially as a GI dietitian, for me to acknowledge that many people prefer dietary therapies for IBS. But there are occasions when you know a strict food elimination diet really isn't appropriate or may not even be effective for certain patients. Reducing dietary intake can really pose risks for malnutrition and, for some people, even amp disordered eating, which is not ideal, so no. So today we'll focus on other tools and factors that impact IBS.
Dr. Megan Riehl:Yeah, you know so many of our patients, I think, sometimes with diet can feel overwhelmed and, as you mentioned, we do see a high prevalence rate of disordered eating and eating disorders in the IBS patient population. So today's episode is for all of you listeners out there that might want to think a little bit broadly in terms of treatment approaches. But, as we said, we're going to start by learning a little bit more about the gender differences in IBS and we haven't delved into this before and so the role of hormones and symptom fluctuations and why some people experienced heightened pain in their gut and it may not be surprising, but IBS is more common in women compared to men, lucky us. And research suggests that 60 to 70 percent of people diagnosed with IBS are female, or a prevalence ratio of I always love these the 2.5 to 1, so the half of a woman. So why is this?
Kate Scarlata:So really there's a couple reasons. There's probably more than a couple, but we're going to delve a little bit into these couple of reasons, and one of the first big reasons is difference in primary sex hormones. So women have a different hormone profile than men and this can affect gut motility and even pain sensations. So women's primary hormones are estrogen and progesterone, and you might know that estrogen regulates the menstrual cycle. It also promotes breast development and supports bone health. It's important for mood and cognition and also our skin elasticity, which we of course want to prevent those wrinkles.
Kate Scarlata:We won't talk about it though, not today, not today, all right. The other hormone, progesterone, is also involved in regulating the menstrual cycle and supporting pregnancy. It also affects mood and has a calming effect, which we love on the brain. For men, testosterone is the primary male sex hormone, and when I say these are primary, you know, keep in mind women have testosterone too, but these are, you know, the more prominent hormones based on gender, and so, testosterone being the primary male sex hormone, it's responsible for development of male characteristics such as a deep voice, muscle mass, facial hair. We don't really want that as women, I guess. Well, we want the muscle.
Dr. Megan Riehl:We want the muscle. Muscle mass is important. Look, that's got to lift those weights?
Kate Scarlata:Exactly yes. So women, don't forget, you're losing about a 1% decline in muscle mass from 35 years old and older, so make sure you're lifting. That's really important. So research indicates that the male sex hormone, testosterone, might have a protective effect against IBS and maybe that explains why men are less likely to experience this disorder. For women, progesterone and estrogen can influence how the digestive system functions, so they play a big role here in motility. They interfere with smooth muscle contraction in the gut and, again, may play a big role in why women have more IBS, particularly IBS-C, than men, and men are more, you know, at risk for IBS-D or diarrhea predominance, so IBS-C being constipation predominant men are more at risk for IBS-D.
Dr. Megan Riehl:So like we're not saying that, you know both sexes can't have either one, but we do see that constipation predominant IBS a bit more frequently in our female patients.
Kate Scarlata:Absolutely, and so I'm not going to dive deep into the menstrual cycle. In all the different phases it gets complicated and the hormone fluctuations are quite significant. But let's talk a little bit about some of these changes. So in the pre-menses phase or the luteal phase we'll focus on, progesterone is dominant and if an egg is infertilized we have a rapid decline in estrogen and progesterone and this can lead to exacerbation of bowel symptoms. It can be constipation or diarrhea sort of dependent on the hormone profile. But we tend to notice an increase in bloating here and probably related to progesterone. During menstruation, this is the lowest levels of estrogen and progesterone and this can exacerbate bowel symptoms in susceptible people and we often see an increased amount in some of these hormone interactions. There are other hormones that are related as well, with lower progesterone levels really leading to bowel symptoms, often with diarrhea alongside the pain. In menopause there's a decline in sex hormones and this lines up interestingly with the decline in IBS incidence. So less incidence of IBS in the menopause phase, but we do see a higher incidence of constipation. So if you are an IBS-C patient and you've gone through menopause, you may find that your constipation is a little bit exacerbated. So we know this. Estrogen and progesterone really fluctuate through the cycle and can really impact our gut function. Those pesky sex hormones, and progesterone in particular, slows gut motility and can lead to constipation and bloating and worsening, as I mentioned, of IBS symptoms. During menstruation IBS symptoms may worsen and cause softer bowel movements in some people, more severe bloating and abdominal pain. Estrogen, as I mentioned earlier, can really impact that gut-brain access, which is that communication system between your gut and your brain, and when estrogen is high it can make people more sensitive to pain. So this might explain why some women feel increased discomfort or bloating around their cycle. And it's not just in your head, it's your hormones, right Megan ?
Dr. Megan Riehl:That's right. That's right, and I've had so many patients that will say what is going on with my IBS symptoms during my cycle. And this, as we've just highlighted, is exactly what's happening. You're having a lot of hormone fluctuations. Your behaviors may also be changing. When you're in a lot of pain, you might not be moving around as much, so you might forego your exercise a bit, and so some of these changes can lead us to opportunities to keep going. Maybe you don't do a heavy workout on the first couple of days of your cycle, but if you can get a walk in, that's important, certainly nourishing your body but also give yourself rest. Taking a couple of days, a couple of times a month, to do what's best for you emotionally is really key here too, because obviously we know those hormones aren't just affecting our IBS symptoms physically, but emotionally it can be a bit taxing as well. So we want to be gentle.
Kate Scarlata:Absolutely!
Dr. Megan Riehl:So you know, another factor where gender can impact our IBS symptoms is our gut sensitivity.
Dr. Megan Riehl:Hopefully we're going to give you some validation here in terms of how this gut sensitivity impacts our functioning. So I want you to imagine this as we start to talk about this concept. Think about your gut like a car alarm that's extra sensitive, and for most people, a little bump in the road doesn't set it off. So you're driving down, you hit a pothole, car alarm doesn't go off. Unfortunately, though, for people that are living with IBS or many other GI conditions, even a small sensation like a gas bubble, or even the normal digestive process, some mild bloating, you're going to feel this way more intensely. Your gut nerves way more intensely. Your gut nerves, all those nerves that line your intestinal tract, are more reactive, and they send stronger pain signals up to your brain, and therefore the alarm is going off way too often, and this is unfortunate. This is not helpful for us as we're going through our day-to-day activities, and women are generally more at an increased gut sensitivity compared to men, and so this can, I think, again lead to some of the higher likelihood of developing IBS, and studies have suggested that women may have more pronounced visceral hypersensitivity. So the car alarm is this concept, and we're going to dive a little bit into this.
Dr. Megan Riehl:Heightened sensitivity to pain or discomfort in your gut is called visceral hypersensitivity, so these are real pain symptoms. This is not in your head, and so any of our listeners out there that have ever experienced being told you know it's just IBS. And with it being IBS Awareness Month, we want to highlight it is never just IBS. It is something that's happening in your brain, but it's because of the brain, gut, access, this bidirectional communication pathway and a very real sensation called visceral hypersensitivity. And so, in addition to women experiencing this, men, you're not immune either, but we experience this typically at a higher prevalence in women, and again, it can contribute to all kinds of additional IBS symptoms. And other factors that can contribute include our genetics and stress, and so there are a lot of factors that can contribute to how one may be susceptible to visceral hypersensitivity and how some of this kind of bidirectional communication pathway between your brain and your gut gets a little bit out of whack. And, as we've talked about, there are a lot of factors here.
Kate Scarlata:You know, I love when you say, and I'd love you to give our audience, our listeners, a little Dr Megan Riel information, and that is, you kind of talk about the gut and brain screaming at each other, because that's visceral hypersensitivity.
Dr. Megan Riehl:That's a good example right, it's a perfect example. And so you know, when you're going through the normal digestive process and let's say you and I both go out to lunch and I have IBS but you do not, and so as we're having our lunch, we're eating very similar things I feel the gurgle in my stomach and now my brain is in tune with what's happening down there and those sensations that are normal, benign sensations, are sending signals up to the brain and in a way it's kind of yelling hey, did you feel that? Feel that one, feel that one. And what happens with visceral hypersensitivity is the brain has a very hard time downregulating those signals. So what may be a normal conversation in your body?
Dr. Megan Riehl:So you're having your lunch, you're feeling a little gurgle, you may even toot and just pass that gas, not think about it at all, and your gut is saying, hey, did you feel that? And your brain is saying, yeah, I did, don't worry about it. Onward we go and you don't think about it anymore, whereas, poor me, I'm sitting here feeling it, my pain is starting to increase, the sensations are starting to cause more discomfort and my brain is amplifying this experience, saying, yeah, this is a really bad idea. We shouldn't have even come to lunch. You know, now you're really feeling this. Oh, good job, you've gotten yourself into this predicament and that's where we see increased levels of anxiety and stress.
Dr. Megan Riehl:That comes along with, you know, a good old lunch with two friends, and so visceral hypersensitivity is a very real experience.
Dr. Megan Riehl:That is happening because, you're right, my gut is screaming up to my brain and my brain is not turning down the amplification of what's going on down there. This is a very significant factor and goal for treatment in working with somebody like myself is we can utilize our brain-gut behavioral therapies to actually calm down and turn down the volume on that communication. And that's a very unique thing that, yes, some medications can do. Some of our neuromodulators that we've talked about in other episodes, certain medications can help with this, but sometimes we need to also add the behavioral therapy to maybe calm down the anxiety that associates with these sensations, to have you experience a pleasant lunch with friends, to not let that lunch become a trigger for anxiety which might even ramp up that visceral hypersensitivity before you even put an ounce of food in your mouth. So this is all. Obviously I get excited about this and really a true target of therapy, that when people understand this concept, they feel validated and then they also feel hopeful that there are treatments that can be beneficial to turn down that communication pathway.
Kate Scarlata:Absolutely. It's just having that awareness is so important, like my gut and brain are screaming at each other. I'm always kind of talking through this with patients that it's okay if you have a gas bubble, it's okay if there's a little gurgling.
Dr. Megan Riehl:That happens.
Kate Scarlata:It's normal.
Kate Scarlata:Yeah, People pass up to 14 times gas a day and so just kind of having that barometer just like leaning into these normal digestive processes, especially like through a reintroduction phase of a diet where you're adding back FODMAPs. It's like FODMAPs produce gas, so be prepared, there's going to be a little more gas. Just don't get ramped about it, because that ramping can really make a difference. So we've talked about hormones and visceral hypersensitivity.
Kate Scarlata:As you know, these key sort of differences we often see in gender area which is so close to my heart because I love gut microbiome science is that we're learning that men and women have different gut microbes and that these microbes can respond to things like stress and hormones and nutrition differently or in unique ways.
Kate Scarlata:So men typically have a more diverse microbiome, although the research shows that as we age that seems to level out a little bit. But, very interestingly, research shows that women are more likely to suffer from autoimmune diseases and these conditions are often linked to the gut microbiome and gut microbiome changes. So there's a new term and it's called microgenderome and it refers to the concept of sex-specific differences in the microbiome and its interactions with hormones, our immune system and even disease risk. And the concept of the microgenderome is relevant because many diseases really show these sex-specific prevalences, such as IBS and, as I mentioned, many autoimmune diseases. So, because there's gender differences in the microbiome that may contribute to disease susceptibility, this really can help explain why women are more susceptible to bloating, more susceptible to pain as well, and maybe even why women may report their IBS-related issues more frequently.
Dr. Megan Riehl:And you know I get asked this all the time and that's do you see women in your practice more than men? And the honest answer is yes, but we still see a lot of men too, and a big part of this may be that women are a little bit more proactive in terms of seeking answers for their symptoms, and I think that's an amazing thing. We have to be our self-advocates and we don't want anybody out there suffering, and I think sometimes women might be a little bit more open to working with a psychologist, especially if their referring provider has done a really good job at explaining that the psychologist that they are referring the patient to is, you know, somebody that specializes in this health condition. So all of our listeners out there that are clinicians and medical providers, when you make that referral, highlight that you know these are experts. GI psychologists are experts in brain- gut behavioral therapies that are going to target these physical symptoms that you have, and so that's why, then, when we do get men through the door, we can help you too, and really even the research shows that men and women benefit just as much from our treatments. So let's take gut-directed hypnotherapy as an example, and we're going to dive into this a little bit more obviously close to my heart, and the research has shown that gender doesn't determine who is a good candidate for this type of therapy. So we just want to highlight that to all of our fellows out there. If you're struggling with your IBS, I'm talking to you too. There's a lot that we can do to help.
Dr. Megan Riehl:Now, all of this talk about how us women, women who we have babies, we have menstrual cycles you know we deal with so much. Our human body is so remarkably resilient and obviously, because of the hormones that we're born with, it's stacked against us a little bit more. While, unfortunately, there's no definitive answers on how pain is perceived differently in the sexes, we do know that we are just more susceptible to more severe, more frequent, more long-lasting pain compared to men and, as we've highlighted, hormones is the answer here in many ways and that that estrogen and progesterone can actually amplify our pain sensitivity, while men have higher levels of androgens. Those are those sex hormones like testosterone, and we've seen in experimental studies how testosterone has been shown to act as a natural painkiller. So men actually have these natural born painkillers in their bodies that are helping them. So imagine if we had some of these, with childbirth and our menstrual cycle. Gosh, we would be ruling the world. I think,
Kate Scarlata:I agree, I agree,
Dr. Megan Riehl:and even without them, we can rule the world.
Kate Scarlata:That's right, that's right.
Dr. Megan Riehl:No shortage of women empowerment here on The Gut Health Podcast.
Kate Scarlata:Exactly so. We know hormones, visceral hypersensitivity, the microbiome, really shedding the light on so many different factors that impact the pain we feel and how our gut moves, and how these hormones actually can really impact our brain and well-being and sense of calm even so, very interesting stuff here today.
Dr. Megan Riehl:Yeah, and I hope that in understanding visceral hypersensitivity, you really do feel that validation and that hope and there's reason and you know how that is a specific treatment target for some of the medications that we use, for our lifestyle suggestions, for our brain-gut behavioral therapies like gut directed hypnosis and with this greater understanding of that, it really does then open up some of the remedies that we may suggest. And certainly on our podcast we talk about the science-based remedies. So everything that we're talking about are very specific to what science has shown us.
Kate Scarlata:I think it's also really an interesting factor that women's health really hasn't been studied as significantly as men's health. And I don't want to get political here, but there are some limitations because we really haven't delved into the female body as much as we have studied the male body, and so the reality is that some of this science really needs to be expanded, and our hope is that that will be happening, you know, sooner than later, and there's a lot of women out there in the scientific community really pushing for this Gynecologists, pelvic floor physical therapists and reconstruction pelvic surgeons and colorectal surgeons so there is going to be a movement here. But I think the reality is that there's more research to be done to really help women, and I just want to make that point.
Speaker 3: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. 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.
Speaker 3:Do not give Ibsrela to children less than six. You should not give Ibsrela to patients six 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. Learn more at Ibsrela. com/ PI or call 1-844-IBSRELA and press option 4.
Dr. Megan Riehl:In my practice I see so many patients struggling with IBS and one thing is clear, managing IBS with diet and medication alone doesn't work for everyone. As a GI psychologist, I know that the brain-gut connection plays a crucial role in IBS symptom management. I refer my patients to Nerva, a gut-directed hypnotherapy program designed to retrain the way the brain and gut communicate. Many of my patients have never heard of this approach, but once they try it they find it's easy to incorporate into their routine. Most importantly, it delivers lasting results. Nerva is easy to access via an app on your smartphone and takes just 15 minutes a day.
Dr. Megan Riehl:Beyond IBS symptom relief, they love that Nerva helps with stress and overall well-being, giving patients a tool they can use for life. With GI specialist wait times often long, a research-backed and accessible tool like Nerva can provide meaningful support. It is referred by thousands of healthcare practitioners and has helped hundreds of thousands of IBS patients worldwide. If you're a patient, you can download the Nerva app today with a seven-day free trial. If you're a healthcare provider, you can request free clinician access, request a lunch and learn for your clinic, or even offer your patients 25% off via their online referral form. Just visit nervahealth. com/ clinicians to learn more.
Kate Scarlata:So let's talk a little bit about some of the evidence-based treatments we have today. And, of course, for IBS there's a number of prescription drugs that really can target those specific symptoms whether it be bloating or abdominal pain or diarrhea, constipation and really selecting a medication that can help target those specific symptoms. And that's how we typically do treat IBS. And we've really delved into the role of hormones and we don't want to discount that. So if you feel that hormones are playing a bigger role, there are physicians that you can speak with. There's a number of different hormones. So the sex hormones you might see a gynecologist. You might see an endocrinologist as well. There's thyroid hormones that can affect the gut as well. Women are more prone to thyroid fluctuations and autoimmune thyroid conditions. So these are all different physicians that you can see for the targeted IBS treatments. Primary care doctors are great or a gastroenterologist can help you select the medications to target. And we also want to really emphasize that just because you try one medication and it doesn't work say you have a particular drug that's working for constipation or diarrhea that's not really doing its job let the doctor know you're not where you want to be. It's important that you feel like you are living your best life despite having a chronic condition right. So work with a good team. Expand the team if you need to, if you really think these sex hormones are a big line item for you, and move from there.
Kate Scarlata:Other supplements that one can try would be enteric coated peppermint can really target abdominal pain, relaxes the smooth muscle. Fiber supplements can work, targeting the right fiber supplement. In IBS. The one with the best evidence really is psyllium husk. Sugarcane fiber also has good data but it's a little difficult to get here in the US but for those listeners in Australia, sugarcane fiber has evidence as well to work with IBS in helping manage constipation. Psyllium also works well with diarrhea, so it can actually soak up some of the liquids in the gut and soften, kind of make a more formed stool. Laxative therapies whether they be osmotic laxatives that pull water into the gut or a stimulant laxative that helps kind of propel the gut in movement those can be used along with the guidance of your health professional. There's antidiarrheal medications such as loperamide, and that can help control diarrhea. Again, run these ideas through your health professional. And then we also have neuromodulator medications, and these are prescribed again either by your gastroenterologist, your primary care doctor or even a psychiatrist could recommend these. These can be targeted to help with some of the anxiety and depression, but for IBS they're really targeting those pain sensations, that visceral hypersensitivity in the gut, and so these might be tricyclic antidepressants or selective serotonin reuptake inhibitors or SSRIs, so managing some of the potential psychological manifestations that often co-occur with IBS, but often significantly the pain. Probiotics have mixed data for IBS, but certainly worth a try, generally very safe.
Kate Scarlata:Align, for instance, has some evidence to help with global IBS symptoms, so something you can explore with your healthcare team. And those are just some of the treatments that you can have in your toolbox that are non-diet related, because, again, we have plenty episodes on diet. Feel free to listen to those. But these are really targeted to the discussion points that we wanted to talk about today and, in line with that, we do have an IBS-C Series. So, if you're interested, check out episode 14, 15, and 16, where we really identify a lot of the different treatments, from diet, behavioral to medications, as well as exploring really an interesting conversation with Erin Judge, who is an IBS-C patient. So take a listen to those as well.
Dr. Megan Riehl:Those episodes are great and really dive a little deeper into what you've mentioned here. And just to highlight that, a lot of times with medication and supplements, it's a ever-evolving conversation. Unfortunately, a lot of times you don't start on something at diagnosis and remain on that for the rest of your life, and so if you are somebody that has been just kind of trucking along, getting minimal improvements but still suffering with some of the other symptoms, please talk with your team, because oftentimes with a little bit of work and good communication, we can get even better improvements, and some of that may include working with somebody like me and incorporating some of our brain gut behavioral therapies. So let me talk a little bit about that, and while there are a number of brain gut behavioral therapies that you've probably heard of, like GI-specific cognitive behavioral therapy, mindfulness-based interventions, I'm going to really highlight gut-directed hypnotherapy today because it tends to be the treatment that I start with when somebody is bringing up their pain, when they are somebody that is experiencing a lot of physiological tension, and I'll tell you why. Visceral hypersensitivity is a big piece of this. But I do want to highlight that there was a really fascinating study that if you've ever heard me talk, I bring this study up a lot because it highlights the effectiveness of both the low FODMAP diet and gut-directed hypnotherapy, but I think with benefit moving toward the gut-directed hypnotherapy piece, because it doesn't involve any dietary restriction. And so, Dr. Simone Peters, any dietary restriction. And so Dr Simone Peters, who is really a trailblazer in the world of GI psychology, she conducted this study comparing the low FODMAP diet to gut-directed hypnotherapy and found that 70 to 80% of the participants had improvements in their symptoms of IBS. But notably, the gut-directed hypnotherapy provided lasting benefits, again without the dietary restrictions, and so this is a really valuable alternative for patients, especially those that may have a history of disordered eating or who really again draw that connection between their stress and their symptoms.
Dr. Megan Riehl:So when I see a patient for treatment we do a nice long initial consultation and I'm learning a little bit more about them. And when I have a patient that acknowledges I have a really hard time relaxing. In a lot of my patients I can predict I bet you have IBS-C, because when we think about constipation and holding in and the bearing down in the bathroom that they describe and that the stool is backed up and maybe they've had a recent abdominal x-ray and they're like yeah, my study showed that I'm full of beep, and I highlight that, Yeah, I bet you're living with a level of tension that is just your baseline. And my other trick that I love to do is I'll tell them drop your shoulders for me right now. Do this to listeners too, because I bet they were up. We just kind of live in this state of fight or flight. We're ready to go, and when we're sitting here having a conversation there's no need for our body to be holding such tension.
Dr. Megan Riehl:And hypnotherapy can really be beneficial over time at helping patients to get their body back to a baseline that is actually kind of relaxed. And so many times this is so satisfying as a therapist to you know, have somebody that has never felt deep relaxation or has released a lot of physical tension that they've been carrying for years, to have them say you know, now I feel relaxed. I can say that like I've learned how to relax, and it is. It is certainly a intervention that takes time and practice and commitment over the course of a couple months, but what you can gain from it is pretty remarkable. So I wanted to illustrate a little bit about what hypnosis does and how it works. And so to do that, Kate, do you remember your childhood best friend's phone number?
Kate Scarlata:I do, Lisa P.
Dr. Megan Riehl:All right. So when's the last time you would have thought about that phone number?
Kate Scarlata:You know, a long, long time ago, at least 20 years.
Dr. Megan Riehl:Okay, you know a long, long time ago, at least 20 years. Okay, so your brain helped to retain and store that information from the past, and that's your subconscious mind working. So the subconscious mind holds our memories, our habits, our learned patterns, without conscious awareness. This is why, you know, when I drive by my elementary school and my kids make mention of hey, did you go there? And I say yes, and then I can start to recite the school song that I haven't said in 20 plus years as well. We are the kids from Keewahdin School. I mean, I could go through the whole thing and as I'm singing I have no idea how my brain is putting these words out of my mouth.
Dr. Megan Riehl:That's because of my subconscious mind, and it plays a really key role in gut-directed hypnotherapy because our subconscious controls a lot of the automatic processes in our body, things that we don't have to consciously think about, like digestion, pain perception, muscle function. And in IBS the subconscious mind really becomes kind of a misfire. So again, that car alarm going off when we don't need it to, and that misfire in IBS is how it processes the signals that are coming from the gut. And so, for example, when your gut sends a signal that's supposed to be a mild sensation, the subconscious mind may interpret that as intense pain and this is why in IBS we have that visceral hypersensitivity, that heightened pain perception and discomfort that comes with the normal digestive process. So a lot of people are very curious about this type of intervention and it used to be far more difficult to get access to it and that's why I think a lot of people just didn't even know about it. But this is a type of intervention that's been around since the 90s, the very early 90s, and has at this point many, many, many randomized controlled trials and research showing the effectiveness of this therapy.
Dr. Megan Riehl:So this type of therapy, you know you're going to work with a trained mental health provider to access that subconscious mind and this is not like stage hypnosis, in no way are you losing control, but we do call it a trance-like state, and in that trance-like state you're very deeply relaxed. And then we use very targeted suggestions and visualization techniques to help in a way kind of reprogram. Or I like to talk about how it's re-kind of doing that brain-gut connection and doing so in a way where the subconscious really starts to respond differently to the gut sensations. So that goal is to reduce the brain's hyper alert response to the gut and then helping to interpret those signals more calmly and more accurately. And so during a hypnosis session we guide you through this. You know, very pleasant. It usually takes anywhere between 15 to 30 minutes depending on what program you're using.
Dr. Megan Riehl:And the key here is just patient openness. So a lot of times patients will ask me you know well I don't truly believe that I'm hypnotizable, and that's okay. Research has actually shown that just being open to trying this and going through and completing the program. So during this program it's about four months and you meet with me once every other week and in between you get audio recordings that you'll use at home. And really the key here is that you're really getting into a habit. You're practicing this intervention at home and it's painless.
Dr. Megan Riehl:In fact a lot of people like that.
Dr. Megan Riehl:They're able to tell their family like, well, doctor's orders, I have to go into my quiet space and practice my relaxation interventions and I'd say usually, by about two months we're seeing improvements in symptoms and the stats are really remarkable that even patients that have not had adequate response to medications, to diet therapy, to the other things that they've tried, they still get response from the gut-directed hypnosis and also results are very comparable whether you're doing this with a digital program or something in person.
Dr. Megan Riehl:There are even groups out there that are doing group gut-directed hypnotherapy again to increase access. So talk to your doctors about this as an option, especially if you're somebody that has those amplified sensations of bloating and cramping and bowel fluctuations. I even like this a lot as an intervention to do either before having a meal or after having a meal. So there's a lot of ways that we can help you incorporate this type of intervention into your day-to-day living, but also knowing that the actual target is again working at that subconscious mind. So this is not an intervention where you're going to do it once and then you're going to just be IBS-free for the rest of your life. The expectation is that it's going to take some time and effort and application, but oftentimes for so many people that is a huge benefit in the long run.
Kate Scarlata:Yeah, I love it and I think the key here, just for our listeners, this is a specific gut-directed hypnosis. This is not just hypnosis. This is a specific targeted program for your gut-brain connection. So I think, just as a reminder and you know, Megan, you mentioned tension and I think about that even for people just as sort of as another non-diet therapy dimension, and that's pelvic floor physical therapy. So a lot of people have a lot of tension in their pelvic floor and this can derive from a number of different factors. You've had a really bad norovirus with a lot of sort of post-infectious IBS diarrhea predominant and you're constantly clenching to make it to the bathroom and then you start kind of almost learning to tighten your pelvic floor. Or it may be, you know, damage from a pregnancy or delivery that has really affected your pelvic floor. So there's a number. Those are just a couple different factors, but really having a tense and often weak. So you're tense but you're weak and pelvic floor physical therapy can really help. So that's another tool in your toolbox to consider for both diarrhea and constipation. I would see mostly my constipation patients are the ones I'm referring, but it can also help with diarrhea as well.
Kate Scarlata:So I wanted to kind of wrap up with a few more lifestyle interventions. And you know I did mention that this is a non-diet, but I was really focusing and I'm not gonna get into diet today, I promise, except for a couple of little things. So when I say non-diet interventions, I'm really suggesting non-food elimination diets. But there's a lot of things that you can do simply to your lifestyle around diet and that is not skipping meals, eating a balanced plate, not just eating a big, huge piece of fish and rice. Where's the vegetable, where's the produce, where's the healthy fat? Looking at that balance and color and variety, that can also really balance.
Kate Scarlata:I always say balanced plate, balanced gut. You know where is that balance? Adding things like two green kiwi fruit if you're prone to constipation can be very helpful. So diet can be beneficial, not just with restricting but thinking about adequate fiber, balanced diet, balanced plate, etc. Adding some positive, good, nutritious foods to your plate. But also things like regular exercise. And if you follow me on Instagram, you know I am a believer of getting out in nature and just getting that really brisk walk. I don't care if it's raining, if it's freezing, I'm out there and I love it and it gives me calm and there's great evidence that it helps with sleeping and stress management and so many other things. And nature, if you get out, it actually can help boost your immune system or add to your ability to keep a strong immune system. I should say.
Dr. Megan Riehl:And your endorphins.
Kate Scarlata:And your endorphins.
Dr. Megan Riehl:Boosting those endorphins, those feel-good neurotransmitters, it goes a long way.
Kate Scarlata:Absolutely so. It doesn't have to be get on a treadmill if you need to get on a treadmill, but it can be a simple walk, you know, in a park. That can really just be wonderful. I just was in New York and we spent two days and I was in Central Park most of the time. I mean, that's where I find just relaxation and beauty and so even on vacation you can get out in nature. So I encourage that.
Kate Scarlata:We did an episode on sleep and both Megan and I really focused this, prioritized the rest when we can. We both have busy lives, but it's important to get shut eye and to let your body just relax and regroup. It's good for your brain, it's good for stress. It's good for your brain, it's good for stress, it's good for weight management. Even If you don't get enough sleep, we tend to go for the food, the sweets, the treats to try to energize our body. So try to get a good seven to nine hours and have a good sleep routine. That can be really helpful. And then, of course, stress management, and I think Dr Riehl is the queen here. What are your just three top stress management tips for our audience today?
Dr. Megan Riehl:Yeah, so you know, I think organization like, don't try to put too much on your day, pick the top priority. Sometimes maybe it's one thing that you know in your work day you really need to do and be gentle and kind to yourself. A cognitive reframe that I always like, that I think can be really helpful for stress management, is if you are putting the expectations that you're putting on yourself onto a loved one, how would you talk to them? How would you help them get through the stressor?
Dr. Megan Riehl:Oftentimes we are way harder on ourselves than we are on somebody that we love, and so then you know, take that person away and ask yourself you know how far away from that conversation were you with yourself?
Dr. Megan Riehl:And again, have your tribe of people for stress management. Reach out, be vulnerable if you need to, to say to your girlfriends or your significant other you know I'm going through a lot. There's a lot on the proverbial plate right now. A lot of times just talking about that can start to lift the load a little bit You're not carrying so much alone and that can have a big impact on then, you know, kind of putting one foot in front of the other again and grounding yourself back into the present moment. A lot of times, with stress, we're starting to think about what's tomorrow and the next day, and the next day and two months from now and a year. And you know, unfortunately we can't go up and live there. We can only live in the moment that we're in. And trying to get yourself in that space to then deal with whatever that moment is can be humbling and then also empowering.
Kate Scarlata:Absolutely. Stress reduction. I think it's the fear and we're worrying and we're in worry land, which is things we have no control over in the very moment sometimes, and it just really can add such a layer of stress.
Dr. Megan Riehl:Yep.
Dr. Megan Riehl:So you know, obviously stress can impact those hormones and, as we've learned today, that's a big factor here in our gut health and we hope that you'll consider some of our strategies and suggestions. For everybody listening, Kate, it's been a pleasure. Happy IBS Awareness Month. Let's continue to support our friends and patients living with this condition. I look forward to doing that with you
Kate Scarlata:Absolutely!
Dr. Megan Riehl:Our goal here is to live the best life possible, regardless of what else is going on in your health. So we hope that you will subscribe, follow and like The Gut Health Podcast. Your support means the world, 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 @the gut health podcast, where we'd love for you to share your thoughts, questions and experiences. Thanks for tuning in, friends.
