IBS, FODMAPS, and Leaky Gut Syndrome
IC You Podcast Episode 24
Hosted By: Callie Krajcir
Featuring: Crystal Austin
Callie: Today I have another registered dietician with me coming all the way from Australia, this is Crystal Austin! Do you want to just give my listeners a brief introduction on what you specialize in?
Crystal : I'm the equivalent of a registered dietician. So we call it accredited practicing dietician here in Australia, and essentially my interest area lies in IBS and other digestive disorders. So I really help people who are struggling with abdominal pain, constipation, diarrhea and help to feel better, to get rid of those symptoms. At the same time, try not to restrict their diet too much. My goal really is to show them how to do that without having to stay on these restrictive diets for the rest of their life. I myself have IBS and I never had much support from my doctors or my medical system, I just thought there's so many people out there that need this information and need this help. I have so many clients that they're scared to leave the house. They're scared to go grocery shopping because they need to know where the bathroom is at all times. It takes over their life essentially, and people just start staying home more and more. They start working from home and eventually they don't have much left because their IBS is so all consuming. So essentially there's three main sub subcategories of IBS. So IBS C is constipation dominant, this means that people are more constipated and they tend to have bloating, pain, excessive gas, constipation. IBS D is similar so bloating, pain, gas and diarrhea. IBS M is when people tend to swing between the two. So they'll have constipation some days, diarrhea some days, sometimes both in the day.
Callie: About a third of people living with interstitial cystitis also have IBS and we know that the organs do talk to one another. So if somebody's living with both conditions and they have a flare up of their IBS, that could also trigger a flare up of their IC. So can you explain to me your stance on just food sensitivity testing in general?
Crystal: They're not something that I practice or that I recommend my clients to do for a few reasons. Number one, they're not evidence based. A lot of the time they're not causing an immune reaction, so there's nothing to necessarily test or find in the blood or find in the hair sample because they're not actually activating anything around their body. They might just be picking up the fact you've eaten that food, not necessarily your intolerant to that food. The other main reason that I don't recommend them is I've just seen some damage done with them. They develop food fears. They don't know what to eat. They become so scared to eat. They get further away from their answers. I prefer to work much more in a structured manner where we do a structured elimination diet, structured food challenges and reintroduction.
Callie: I completely agree with the lack of evidence supporting these tests. It also confuses people because there are people out there who don't understand the difference between food allergies and food sensitivities and that those are different things.
Crystal: I think these companies are simply taking advantage of people because they're not evidence based. They make lives harder and they don't give you the answers that you're looking for. So I know people want a shortcut and I know people want a quick answer, but it's not it, unfortunately.
Callie: I wanna take a step back and have you explain what you said earlier? So FODMAPS, can you explain what that stands for?
Crystal: So the acronym itself stands for Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polys. So It's a group of carbohydrates in our diet that people with IBS may be sensitive to. They've found that essentially 50 to 80% of people with IBS find relief with this diet, probably closer to that 80 to 90% success rate. It's evidence based, we have studies that show how they break down the body, why they are triggering symptoms, and we have a process to go through with it. So one of the most confusing things about the diet is that it comes down to portions. It's not simply black or white, it also comes down to food processing and ripeness of foods.
Callie: So what would an elimination diet look like for somebody who is working with you?
Crystal: So we go through a bit of a process. So the steps we do are actually before the elimination diet. The first step I always like to do is make sure they're eating regularly, they're eating enough, they're eating mindfully. If we then move into an elimination diet, which is usually between two and six weeks. Essentially what we do is go through their current diet, highlight those foods that are high FODMAP, and we make swaps for them for other foods. So for example, one of the FODMAP groups is lactose, so if they're drinking full lactose milk to swap them to lactose free. That key of making swaps rather than just cutting things out is so important. We catch up every two weeks to see how they're doing and if their symptoms improve, then we move into some structured challenges. Typically over three days, day one is a small portion, day two is a moderate portion, day three is a larger portion. So I'm testing not only can they tolerate the food at all, we're tolerating how much they can have. I think long term that also helps with having less restriction, because if you can tolerate even one day of this food, then that gives us so many foods we can add back into the diet rather than saying no lactose for the rest of my life. This phase takes between four and 12 weeks, depending on how quickly or slowly people will move through it. The goal is really to have clarity around exactly which foods trigger their symptoms, which ones don't, and we move forward from there. People realize they are avoiding foods they don't need to.
Callie: I've noticed so many of my clients have histories of eating disorders or disordered eating, and that increases the risk of triggering them and with IC and IBS stress is a really big trigger. Do you see a lot of exacerbation of symptoms with stress?
Crystal: Yeah, definitely. So essentially with stress your digestion mode is slowed down, it's almost switched off because your body is in that fight or flight mode. So when digestion slows down, a lot of those symptoms are exacerbated. I also have a gut hypnotherapy program as a part of the program that I work with where clients do that as well. Gut hemotherapy is another evidence based treatment. It really helps in calming the digestive system, calming the nervous system, improving communication between the gut and the brain and overall reducing symptoms.
Callie: That's exactly what I have my clients do. It's important to understand our limits with food, it's really helpful to know those things so that you can indulge occasionally with confidence. I was trying to figure out can somebody do an elimination diet for both IBS and IC at the same time? I'll usually ask them, at this moment in time, what is the thing that is bothering you the most, what is the thing that's getting in the way of nourishment for you right now, and the most and whatever that may be, that would be the avenue to take. I don't know if you have any stance on that.
Crystal: I think that that's quite common. I'll either pull them off it or I'll just clean it up. So I'll add more variety and more options in there or I'd say what's your priority and what's the most bothersome and I think as well, taking into account the weight loss and the food anxiety. That's where a dietician comes in. It's our job to be able to make that assessment and look at the diet and let you know that this is what's going on. It's not someone's job to know all of this, so the medical team is so important in that area.
Callie: Yes exactly. What is your dietician stance on leaky gut?
Crystal: Leaky gut is an overdiagnosed condition from a lot of alternative health practitioners. Leaky gut can be a side effect of other things that are going on, so we can have an increased intestinal permeability or increased gaps in the gut. It's not necessarily the root cause of what's actually going on. It's not the diagnosis. It's not necessarily the target for treatment. Usually they try to sell you a bunch of supplements to help with leaky gut. You shouldn't need a bunch of supplements. There's fiber supplements I'll definitely use with my IBS patients, and then there's definitely a few small digestive enzymes or other things that I will use at the end of the program. They're not the answer or the treatment. People are selling you problems to sell you their solution when there's other things we can do. We just need more research before we can make those recommendations.
Callie: Do you see any common myths or misconceptions in the IBS community that you wanna address?
Crystal: Not relying on supplements, not doing food sensitivity tests, not taking leaky gut as a diagnosis. I think most people tend to try and cut out dairy and gluten as a first step, and don't automatically cut them out. Don't start an elimination diet on your own as well.
Callie: What would the steps to getting diagnosed with IBS look like?
Crystal: First step I always say is just see your general practitioner. Write down your symptoms, how often they're happening, what your bowels are doing, and just say, you know, this is what's going on. It's based on your symptom criteria and it's also based on elimination of other things, rule out other conditions. People will get a colonoscopy, but that's not necessary for everyone. Have at least a celiac test run before you cut out anything in the diet, see what other tests that they recommend, and then book in with a dietician.