Managing IBS with Jessie Wong, RD

Are you struggling with IBS? I've brought IBS expert Jessie Wong, RD, on to help guide us through managing it. We start by explaining what IBS is, from its different types to the challenges of diagnosis, as well as shed light on unproven "miracle cures" and emphasize the importance of evidence-based treatment.

Diet plays a big role in IBS, and Jessie helps us explore the connection between food, inflammation, and gut health. We also dive into the popular Low FODMAP diet, explaining its purpose and potential pitfalls.

But IBS isn't just about food. Stress can be a major trigger, so this episode provides strategies to manage it. Plus, we explore other effective techniques for improving gut motility and overall well-being.

This episode is your roadmap to take control of your IBS. Tune in and discover how to navigate the twists and turns with confidence!

Resources mentioned:
ibsdietitian.com
poopedia.org
Jessie's Instagram
Jessie's Youtube Channel
Low FODMAP Starter Guide
Symptom Tracker

TOPICS COVERED 👇 
Understanding IBS (06:37)
How to diagnose IBS (08:39)
Finding reliable support (19:14)
Inflammation in IBS (25:01)
The Low-FODMAP Diet (27:39)
Finding your IBS trigger (32:02)
Stress Management for Symptom Relief (42:57)
Constipation and improving motility (46:00)

LEARN MORE
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Transcript

Michelle (00:00:00) -  Welcome back to Nourished and Free the Podcast. This is a show that I host because I really want to help you with creating a healthy relationship with food and with your body and fitness, and I want to make sure that your mindset is in the right place to support that as well. Who am I? I'm Michelle Yates, I'm a registered dietitian. I have my master's in health psychology. And if you're new here, welcome. This is going to be your new favorite show. If any of the things I just said interest you at all. So typically, I really love to talk about disordered eating, especially binge eating and emotional eating and yo yo dieting. Those are really my wheelhouse. And I work with women constantly on how to help them with that. so if you new to my world, be sure you check out my show notes to get more info on how to work with me in those ways. But today I really wanted to talk about IBS or irritable bowel syndrome. And this isn't my wheelhouse.

Michelle (00:00:52) -  It's not my specialty. So I wanted to bring on somebody who does specialize in this, because I think that so many people are struggling with IBS or they think they may be, it might be, and they're not sure what to do about it. Another thing, too, is that so often there is an overlap between disordered eating and chronic dieting and trying to cut out foods as you try to lose weight, and then IBS like symptoms. And so it can be difficult to know if you really have IBS or if you've just restricted foods so much that your gut is kind of messed up as a result. So we're going to dig into this and more. And today I'm bringing on my friend Jesse Wong. She's a registered dietitian and she is so incredibly smart and knowledgeable in the field of gastrointestinal disorders, especially IBS. She is the IBS dietitian on Instagram and she's a great follow. Highly recommend. And I'm also going to put a bunch of links in the show notes for other resources that she has. For anybody who just wants to know more about their gut or their poop or anything like that before we dive in, be sure you're subscribed to the show.

Michelle (00:02:01) -  I'm sure that you are all ready. But just in case, because I've got some really fun episodes on the docket that you're not going to want to miss. And if you haven't taken a moment to do so, please be sure you rate the show or leave a review. I cannot even begin to tell you how helpful it is. We did make it into the top 50 charts recently, which is so exciting. But the thing with these charts is that as more people are writing other shows and those shows are climbing to the top of the charts, my show can get pushed out of the charts. So we do need you to leave a rating or review if you haven't already, so that we can continue to get the good word out about evidence based nutrition and creating a healthy relationship with food. So now that you have heard my plea for leaving a rating, let's dig into this episode. There's a lot of really good info and I don't want to waste another second. Welcome to the show, Jessi.

Jessie (00:02:52) -  Thank you for having me. I'm so happy to have you here.

Michelle (00:02:55) -  We are going to talk all things IBS, and I was actually peeking at your website last night, and I saw that you used to be a CPA, right?

Jessie (00:03:04) -  yes. That is wild.

Michelle (00:03:06) -  So what was.

Jessie (00:03:07) -  The.

Michelle (00:03:08) -  Transition point like? At what point were you like, this isn't for me. I want to go into dietetics.

Jessie (00:03:14) -  Yeah. Thank you for asking that. most people don't know that about me, but I was a public accountant, so working for one of those big, full accounting firms, and it really burns me out. And then one day I just thought, I'm done counting money for the wealthy. I want to do something that can actually make a difference in the world. You know, maybe in one person or two person, two people. And I've always been interested in nutrition and as we know, probably, you know, all of us, when we start, we just look online and learn as much as we can.

Jessie (00:03:46) -  And now, after going to school and actually being a dietitian, we know all of those things are probably in some capacity. They're not quite the truth or the facts about nutrition. So at that time, I just wanted to learn more, and I wanted to really be in a profession where, I can care for people. And I think that's my personality is not counting numbers. It's more I'm a person person. I'm a people person, and I really want to be in a business where I can help people and have a meaningful career. yeah. Instead of doing accounting, sorry, accountants out there who are listening to this, it's it's important work. It's just tedious work. We've had so many accountants in our family. I think there's only one person left who's still in the business of accounting. Well, it was also around the time when I met my husband. Well. And moved to Indiana to study dietetics and then also get my degrees at IU and also had two kids. So it was a good transition for me to also do bearing child and having kids, you know, while I'm in school, which makes life a little bit easier than when you're working.

Jessie (00:04:58) -  Also challenging because. I had to do my internship when I had a second baby, which was really hard.

Michelle (00:05:06) -  You're kidding.

Jessie (00:05:07) -  Yeah. But then, you know, I think for most of us as dietitians, we enjoy everything we learn at the internship. And then it's like seeing all the different things that dietitians can do. In-patient, outpatient, school lunches, breakfast. What else? Long term care? Community. I think it was. It was really fun and I've not regretted at all. Becoming a dietitian. Good. We make significantly less than accountants. I would have to say. I think that might be the only thing that I think you cannot you cannot be as fulfilled as I am right now with my career. If I was doing accounting. So that's the back story.

Michelle (00:05:51) -  I love that you went back to school and took a pay cut, but your heart got bigger. Yes.

Jessie (00:05:58) -  Oh you phrased it summarized it perfectly.

Michelle (00:06:03) -  Well we're happy to have you in the field. And I'm so glad that we got connected to.

Michelle (00:06:06) -  We just got connected not too long ago, and I'm so glad we did, because I feel like I've been looking for somebody who can be a great go to source for me when I, have questions about IBS as I'm helping patients or just to refer patients to or clients to. so I'd love to pick your brain a bit or a lot about all things IBS. Why don't you, for the listeners, just kind of give us an overview of what IBS is.

Jessie (00:06:37) -  so IBS is irritable bowel syndrome. and it is a disorder of the gut brain interaction. And what it means is that you're bringing your guts are not communicating at the right pace. And some of the common symptoms are, motility disturbances. So somebody might be running to the bathroom or maybe not having a bad movement. So it could be, well, let me bring you back a little bit. There can be different types of IBS, IBS, constipation, predominant IBS, diarrhea, predominant IBS, mixed bowel type. So going back and forth between constipation and diarrhea.

Jessie (00:07:15) -  So those are the three most common types. And then there's also unclassified which is when you have all of the symptoms of IBS which could be changes in motility, hyper sensitivity in your domino area or in your GI tract, altered gut microbiota, orchard. central nervous system processing like these are all symptoms. And and a lot of the symptoms that people relate to or complain of are related to defecation. Right. So we talked about different types of IBS and relate it to the changes in frequency of stools and also changes, sometimes in a form or appearance of stool. And people most complained of bloating, pain and sometimes, even spasms in their gut. And we relate those symptoms, that feelings that you have of the symptoms as to hypersensitivity of your gut visceral hypersensitivity. So that is IBS in a nutshell. Now to diagnose IBS is quite challenging because all GI conditions and I really mean all GI conditions have the same symptoms. People may be running to the bathroom, people may not be pooping, people may have, pain, bloating, gas like these are all symptoms of all GI conditions.

Jessie (00:08:39) -  How can we diagnose IBS? And that is by criteria, right? You have to have those symptoms bloating, pain constipation, diarrhea. And it has to be persistent at least once per week. And you have to have the symptoms for at least 3 to 6 months. and also once you have all of these symptoms, your doctor needs to rule out other conditions and other conditions such as celiac disease, which is so hard to diagnose, it can take up to ten years for somebody to get a celiac diagnosis. If you're persistent with, you know, getting the right diagnosis, which is very sad because 80% of celiac patients are not diagnosed, only 20% are diagnosed. And we have a really good treatment options for patients with celiac disease. And that is being adherence to a very strict gluten free diet. Okay. So celiac disease is one that usually your doctor will test you out of. Inflammatory bowel disease is another one that doctors will usually test patients out of before giving them an IBS diagnosis. And of course, there are other conditions such as H.

Jessie (00:09:45) -  Pylori, endometriosis and what else. Oh, bile acid diarrhea, which is not often diagnosed, is usually diagnosed as IBS d or pancreatic insufficiency, exocrine pancreatic insufficiency, and sometimes even some kind of other carbohydrate malabsorption or fat malabsorption conditions that may be misdiagnosed sibs as well. So these are all things we want to test out of before doctors give you an irritable bowel syndrome, diagnosis. And one thing that is very makes it very different, makes all these conditions very different than irritable bowel syndrome, is that within irritable bowel syndrome. There's no structural changes or no organic changes in your gut leading to disease. So it's mostly a coupling interaction issue. So your nervous system problem right. And with all these.

Michelle (00:10:46) -  Or like a lack of enzyme, it's just like, this kind of random. Right.

Jessie (00:10:52) -  A lack of enzymes. No. erosion. Inflammation. So in celiac there's inflammation causing like, shortened villi in the small intestine, whereas in IBS there's ideally your doctor would have ruled out celiac and have done all the bloodwork and scoped for it to rule it out.

Jessie (00:11:11) -  but again, celiac is really difficult to get diagnosed. And one of the things we see too is misdiagnosis of celiac as IBS. That's the next part we can get to about elimination diets. and then with IBD. And celiac and all the other conditions I'm talking about. There are a few ways to test these. There's blood work to test your antibodies for celiac disease. there's blood work to test for inflammatory markers for inflammatory bowel disease. So there's actually inflammation in the gut. Right. And then sometimes, physician will order stool tests to see if there's cow protecting in the stool, if there's inflammatory markers in the stool, because that can be an indication of inflammatory bowel disease. And sometimes if symptoms are really severe and persistent, doctors will order scopes. And it could be colonoscopy and endoscopy. And there are multiple things that physicians are looking for. So they're looking for inflammation that may not be visible to the eyes when they're doing the scopes. So they would do biopsies in the large intestines and in the small intestines.

Jessie (00:12:17) -  This in the small intestine it can rule out celiac. But celiac again is a patchy disease. So which is why may take a few rounds of doing endoscopy to really identify the disease. And then in the large intestine, sometimes they can see microscopic colitis, which is a form of IBD. And sometimes that is closely related to IBS. Like patients may get diagnosed as IBS first before they get the actual IBD diagnosis, which is what microscopic colitis is, and those are done via biopsies. after when they are scoping.

Michelle (00:12:53) -  Yeah. Yeah. So I mean, what a long road to eventually get to a place where it's like it's IBS and I can only I just feel for anybody that struggles with that because it's, I mean, you'd have to feel miserable for so long before you can ever get some sort of label that helps you, helps guide your treatment. Then I guess, of where we go from here, right? Because obviously a label can be helpful. If it's something like celiac disease, then you know the treatment is okay.

Michelle (00:13:24) -  We're going to be avoiding gluten. Gluten for the rest of our life because that makes us miserable. But yeah, to have to wait for so long and be struggling with these symptoms, I can imagine it is just debilitating.

Jessie (00:13:37) -  It is. And on average this is per research. It takes about six years to get an IBS diagnosis. Anything with the GI track diagnosis takes a long time because we don't have good tools for for diagnosis. Right? We have the blood tests we have to test, but there's no specific markers that we're looking for. when it comes to IBS, it really has to be ruling out other conditions. And then depending on whether your healthcare team is familiar with the condition, they might be reluctant to give a patient, IBS diagnosis. And then one of the complaints we hear a lot is patients talking about how they feel that their healthcare provider don't care about them. Once they get the IBS diagnosis and they feel like, you know, there's nothing. That is working for them when trialing it with their health care team.

Jessie (00:14:31) -  Or maybe they just were told live with it is. IBS is a chronic condition that you will have to learn to live with. Take Imodium, take laxative forever. That's it. Goodbye. yeah. It's something we hear all the time. However, you know, you can actually find a provider who are willing to try different things with you. And I'm talking about providers who are actual gastroenterologists and not providers in, in more of the alternative medicine realm where things are a bit and evidence based, and usually we see a lot more harm in that scenario for patients because they are doing tests that are not evidence based, such as the food sensitivity test. and then we also see a lot of GI map, which is to get microbiome test, which and there's a lot of hype these days. Right. And the research right now, we actually I actually just came back from the biggest GI conference in the world is that just disease week. And and one of the present, it was great. It's all about poop.

Michelle (00:15:38) -  But it's not even my specialty. But I'm still a dietitian. I love it, right?

Jessie (00:15:43) -  and one of the talk was talking about the validity of the current stool microbiome test. And then they just talk about all the different kinds of tests out there, and how that we just don't really know enough about normal or optimal gut microbiome to say that, hey, if you have more of this or less of this, that means something is wrong with your gut. And most of the gut microbiome studies are done in North America. And we know that if you live in different regions of the world, you are going to have different gut microbiome. Does that mean you have a less optimal gut that you have to do something to change it? No, we don't know. And the business model with these kind of, gut microbiome tests is usually they sell it directly to consumers, or sometimes the not so evidence based providers will recommend it to their patients. And you do the test at home, collect the stool, put it in a box, send it back to the lab.

Jessie (00:16:44) -  And then they spit out this really fancy report giving you an analysis of what microbes you have different colors, ranges. And then it will usually say, hey, you have, good microbes or bad microbes. They actually label with that when we don't even know what is good or bad or what's optimal. diversity. And then they would recommend regimens or protocols to help you fix your gut. And that would be maybe restrictive diets or a ton of supplements. and we see and then. Right, sometimes some patients are taking like 20 to 30 supplements when they come to us. And the first recommendations we have is like, please stop everything. Well, expensive is one thing, right? It can actually delay actual treatments and it can't cause more harm. And one, sometimes the things we see people deal with is persistent symptoms that won't go away, that might actually be contributed from taking certain types of supplements. And I'll be very brave here and say that probiotics and prebiotics are some things that we do not recommend, and we never recommend it for long term if they're specific.

Jessie (00:17:57) -  but there are few that we recommend to, to be specific that we recommend for specific symptoms. And it's short term. We don't ever recommend anything long term because with probiotics, the research we're never done long term. Right. The longest study might be 8 to 12 weeks. That's it. Like we don't know the long term effects of taking a probiotics long term and how it's going to affect your gut microbiome. Anyways. The business model. So they sell supplements or restrictive diet to say like let's starve out this or let's, you know, feel more of this. Let's take the probiotics, prebiotics, fiber, whatever, or sometimes even antimicrobial. And then after a while people would get tested again, and then they will see if the treatment works or whatever. and then maybe repeated treatments or something else go on. And it's like an endless cycle. And this is a business model for these type of companies. And it's the gut microbiome companies. And sometimes the food sensitivities companies do certain things like that as well, which, you know, if you're listening to this episode, if you're considering, please, you know, don't actually go back to a legitimate physician, your PCP or your GI.

Jessie (00:19:14) -  Now, finding a good GI can be tricky. What I usually recommend is go on to Google and look up GIS in your area, and find a physician that has good reviews.

Michelle (00:19:26) -  Yeah.

Jessie (00:19:27) -  It's so difficult to find the right provider. But, you know, and.

Michelle (00:19:33) -  Something that I hear a lot, too, is that they just have such a long wait list. And I think in the midst of waiting, people are still so desperate for answers that they will then do these other things in an attempt to figure something out in the waiting period. Yeah. Which yeah, I mean, as you alluded to, just isn't it's doing more harm than good potentially than you just waiting it out. Sounds like. Right.

Jessie (00:19:56) -  We actually have a very affordable self-paced program is called IBS freedom. You can find it when you go to IBS. dietician.com/ibs-freedom. It's $49 a month is everything is self-paced. And one thing we want to use that program for is patient education. So you start tracking your symptoms. You start looking at, you know, your bowel movements, learn what is normal, what may not be normal, and learn more about the type of IBS you have so that when you finally go in to see a doctor, you can share the right information.

Jessie (00:20:31) -  Yeah, I'll give you an example.

Michelle (00:20:32) -  Helpful.

Jessie (00:20:34) -  Yes, it will be really helpful to get clarity faster and get the right test and get the right diagnosis faster. I'm going to share maybe an example about bloating because bloating is something that. It's the biggest concern for people. And there are different types of bloat. I think people don't always recognize that. But there are different types of bloating, and different types of bloating can be indication of different areas of your gut having issues or different causes of your gut issues. So with bloating, we always ask, you know, is it above your belly button or below your belly button? do you wake up bloated? So does the bloating occur overnight? Do you bloat right after eating? How long does the bloating last? And how does the bloating correlates to your bowel movements? And do you see like a specific food trigger or maybe lifestyle trigger that contributes to your bloating? So these are things you want to document before going to your physician, because that way they can kind of maybe pinpoint where the problem is, and then they will ask you more specific questions.

Jessie (00:21:39) -  And all of the questions that I just said also apply to pain as well. Where is your pain? When does it happen? How long does it last? How often does it happen? Does the pain correlates to your bowel habits? Are there a specific food triggering your pain? So if you start documenting these things, you will probably get the right test sooner and maybe get to the right diagnosis faster.

Michelle (00:22:03) -  Yeah. Then they have some leads on like, okay, this is where we're probably headed. Yeah. That's good. You know, I'm actually I know we got initially connected because of Doctor Andrea Love. She's going to come back on the show and we're going to talk about the GI map tests and the HDMI or TMA I think is what it is. And the hair.

Jessie (00:22:21) -  Analysis.

Michelle (00:22:22) -  Thing. Yeah.

Jessie (00:22:23) -  Oh my god.

Michelle (00:22:24) -  Yes, Steve Diamond, the host. So I'm excited for that. And if, if you're listening to this episode and you haven't listened to the food sensitivity test episode that I did with Doctor Andrea Love, that is just a couple episodes back.

Michelle (00:22:36) -  So definitely listen to that. If you're interested in the topic of food sensitivities and food allergies and food intolerances, that's a good deep dive episode for sure. So it sounds like with IBD, CRO, which would include ulcerative colitis and Crohn's. Correct. and then celiac, like all of these diagnoses that we need to rule out before we can get to the point of IBS. Am I reading between the lines here that those are all involving some inflammatory element, but IBS doesn't? that's interesting because I feel like with IBS, I mean, inflammation is such a buzzword, but I feel like usually I see those things together, you know, from all the gut health girlies promoting their gummies and stuff like reduce inflammation for your IBS. You know what I mean? So yeah, I mean, speak a little bit more on on that if you can. And the difference is there.

Jessie (00:23:36) -  right. So IBS now with IBS sometimes we do see mild inflammations or maybe white blood cells being, a bit higher in the GI tract.

Jessie (00:23:46) -  and this is where diet, diets can really come in and help. So but before I jump into the diet for IBS and how it can help reduce symptoms, I want to say something about celiac disease. Celiac disease is extremely difficult to diagnose. If you are going through testings, make sure you are eating enough gluten prior to getting your blood work done. Because what we are looking for in celiac disease, bloodwork and endoscopy is the inflammation. If you're not eating enough, gluten, if you're having a little bit but not enough, it's not going to show up positive. This is where people or physicians get into trouble with. When it comes to diagnosing celiac disease, it's really, really difficult to diagnose. You have to be eating. The real research says two slices of bread. So two servings of gluten for 6 to 8 weeks. Now, if your test is coming up sooner than that, you ideally I would recommend doing four servings of gluten every single day, for 2 to 3 weeks prior to your test so that we are inducing an inflammation in your gut so that the test can pick it up and you will get the right diagnosis.

Michelle (00:25:01) -  Sweet. I gotta have four servings of bread today. Yeah. Okay. With how much we demonize it, it's like okay, cool. I gotta prep for my test and have a bunch of bread. Yes.

Jessie (00:25:15) -  It's it's kind of tricky because if a patient do have celiac so celiac is one condition. And then there's also non celiac gluten sensitivity or non wheat sensitivity which is actually a condition we see a lot when they eat gluten. It's just miserable because they are inflamed inside. Now when it comes to IBS right. There are different types of IBS and different causes to IBS. and you were asking the question about inflammation. So no. While most. Cases of IBS don't have inflammation or very, very mild inflammation. Sometimes with the differential diagnosis that may be misdiagnosed as IBS, they can cause some sort of inflammation like, undiagnosed celiac disease or sometimes even known celiac wheat sensitivity. When patients eat gluten, then they will have some, immune system reaction because IBS does involve immune system reaction. Now with IBS, because there's nothing structurally wrong like organically, there's nothing really wrong with the gut, no organic disease.

Jessie (00:26:27) -  And there's a lot we can do to maintain or, how do we say this? Put your symptoms in remission with diet and lifestyle remission is not the right word for IBS because there's nothing wrong. Like with IBD. You can talk about remission, but with IBS, I think you can't maintain or take control of your symptoms with diet and lifestyle. And we know that, per research, the low Fodmap diet is extremely helpful for patients with IBS because FODMAPs are a group of short chain carbohydrates that we don't digest, we don't absorb, we don't break down. It just goes through. Our gut gets to a colon. And for, the carbohydrates are fermented by our gut microbe. So this is actually low Fodmap FODMAPs or higher. Fodmap foods are actually really good for our gut and gut microbes, right? Because they are a source of fuel for our gut microbes. However, for those of us with IBS, the action of having a lot of gas and air in our GI tract that can trigger the hypersensitivity in our guts and causing us to have more symptoms bloating, pain, and distention.

Jessie (00:27:39) -  Now, when it comes to FODMAPs, there are six primary groups of fart maps, and some of the fart maps. We want to try to list it out here as fast as I can. Fructose, lactose, polyols, and mannitol okay, so these four they are water soluble. So they are actually they have an osmotic function or characteristics when they are inside our gut. So when they get into our small intestine they draw fluid into our small intestine. And a lot of IBS patients will be do complain of gurgling and just gushing or their gut making sound. And that's most likely the reason why. And when we have a hypersensitive gut, that feeling of fluids going around your belly, it's just uncomfortable. And people may feel distended when they eat, when they're eating these type of formats and all Fodmap groups are rapidly fermented. So the other two groups of our map is GEOs and for ten. So all of these are short chain carbohydrates. So when they get to the large intestine, like I said earlier, they are rapidly fermented causing a lot of gas, bloating and general discomfort for people with irritable bowel syndrome.

Jessie (00:28:48) -  And we know that for people without IBS when we eat FODMAPs, it still causes the bloating is still causes the fluids to go through your gut. But the difference is we don't have that hypersensitivity and we don't feel the pain. We don't feel the spasms, we don't feel discomfort. Yeah. So that's the big difference between IBS gut and a normal gut. Now, with the low Fodmap diet too, it is a short term elimination diet and ideally should be done with the direction of a dietician with a guidance of a dietician, because there are a lot of nuances when it comes to the diets. And people often do it wrong. Yeah, and that's also the biggest problem we see in the GI space as well, because patients are usually recommended the low Fodmap diet and told to go Google it yourself and try it out, see if it works for you or they're given a one page handout. Let me see if I have anything here. I have a good handout. So if anybody wants a grocery list, we have a free Low-fodmap starter kit on our website.

Jessie (00:29:59) -  So you can go to IBS dietician.com/resources. And we also have a webinar as well to teach you more about the low-fodmap diets and how to actually work through it.

Michelle (00:30:11) -  I'll put all this in the show notes too.

Jessie (00:30:13) -  Sounds good. I need to send you the links. okay. Oh, yeah. But oftentimes, you know, patients get this. Yes and no. Let's be like, okay, you can't eat this. You cannot eat this. That is just wrong because there are specific serving sizes that people can still have. I'll give you an example. For example, with Broccolis, you can still have half a cup of broccoli. And with broccoli the greens.

Michelle (00:30:37) -  That's like all they have anyway in a day. Yeah.

Jessie (00:30:41) -  Yes. And you know, there's so many nuances to it. And a lot of the times what we see is patients become hyper vigilant with their diets, with cutting out food. And when you cut out, yes, all of the fiber, it actually impacts your gut function.

Jessie (00:30:57) -  Right. Our guts really need the fiber. And what we encourage our clients to do is let's make sure you are still getting enough low Fodmap fiber to support proper gut function, because that is key to having good motility. It's key to have better, better bowel movements, and we're always helping our clients get to that. Type three or type four of a bowel movements so that, you know, it feels good to have an evacuation. And yeah, okay. So with low Fodmap it's short term elimination. So once people do low-fodmap usually ideally under the guidance of a dietitian for 2 to 6 weeks, we do a systematic reintroduction of the format foods. And what we do in our clinic is we break down the format groups. So the six primary groups of Fat maps into 12 Fodmap groups and Fodmap subgroups, and reintroduce it group by group to see if anything triggers the symptoms. And we do have specific amounts that we have to reintroduce over three days. and then that way. Right. It is a process.

Jessie (00:32:02) -  And after the reintroduction, we will identify if certain things will trigger more symptoms than the others. And usually after working together, they will be tolerating most of the farmer groups, if not all, at least in the smaller quantities. And we will really encourage our clients to keep eating the small amounts that you can tolerate, and it makes you feel good, because that's gonna feed the microbes that can help you break down that group of FODMAPs. And in the long run, you will improve. Your tolerance will improve. Now that the low-fodmap diets and format tolerance will change according to a person's diets, according to their state of their gut health. And that's one thing we really want to get the word out. Hey, this is not forever. Diets work on a foundation of your gut health. Actually, let's resolve whatever is causing your IBS symptoms. Yeah. And then slowly, and systematically reintroduce the Fodmap foods to identify your triggers and expand your diet.

Michelle (00:33:04) -  Yeah. Something I wanted to say about that. I feel like there's this temptation with any condition or anything diet related to be all or nothing about it.

Michelle (00:33:14) -  And like, let's say somebody gets an IBS diagnosis, they without having the guidance of somebody like yourself, Jesse, they might just go online and start googling it and think, well, I'm just not supposed to have FODMAPs ever again. But it's so refreshing to hear the other side of that from you, a professional in this field where it's like, well, no, we still want you to have them at at the levels that you can tolerate it because they're still good for you. And then my other thought on that too, is that a lot of times we just get so much misinformation, especially on the internet, about nutrition. And people love jumping on different diets because they're, you know, magical for whatever reason. And I feel like sometimes I see people doing the Fodmap diet forever because they just think that FODMAPs are inherently quote unquote bad, which is like, to your point, they're helping your your gut bacteria like we we need it's good for the bacteria and and the microbes. And so it's.

Michelle (00:34:12) -  It's just so crazy how these things get lost in translation, right? Like nobody's saying to cut these out, period. Just because you have an IBS diagnosis. Rather, let's just figure out at what degree these things might be exacerbating your symptoms, which takes some work and it takes some time.

Jessie (00:34:32) -  Yes, I love you. Putting that spotlight on the hyper focus when somebody is, maybe on the low. And sometimes I have a social media presence. Right. And sometimes we get trolls to come in and comment on my posts and talking about the trolls.

Michelle (00:34:50) -  They're great.

Jessie (00:34:51) -  Right? How you know, I'm too relaxed with my format recommendations. Oh, goodness. For a while I took it, you know, as they attacking me in my integrity as a provider. But it's hard not.

Michelle (00:35:04) -  To take it that way.

Jessie (00:35:05) -  Right. And after working with a lot more clients and this is one one of what my, one of my clients said to me, it's either low-fodmap or running to the bathroom ten times a day, you know, you hear that, then, you know, these people are actually struggling.

Jessie (00:35:21) -  They don't know they can expand the diets. But the key is really to understand what is going on with their body, what are causing their IBS symptoms. And if it's okay, I can share a client story. Who who said that? Yeah. So this is a client whom I worked with last year. She actually joined me on one of my podcast episodes as well. That will be airing soon, I don't know when TBD, TBD. Yes, she had the perfect gut. She's actually a small business owner herself, and she was fine until she had Covid and she never quite recovered. So what we call her type of IBS is actually post-infection IBS. So you've gotten an infection, whatever type it is food poisoning, virus, bacterial infection or sometimes even parasites, you know, and then you get treated for that condition. That condition is recovered, right? no more Covid or no more parasites in your gut. Parasites is not a common thing in North America. If you hear provider who is not a legitimate provider talking about parasites, run okay, it's not common as it happens sometimes, but most of the time it is not.

Jessie (00:36:33) -  But anyways, so she had Covid and then her gut was never the same again and she started having nonstop diarrhea. It was terrible. And she went to her doctor and then she was recommended to try out all of my diet. And she has to follow it strictly or else, like she said, is either low-fodmap or running to the bathroom ten times a day. So when we started working together, we do a detailed intake and then to also look at what she's eating, what her symptoms are and what her bowel movement looks like. If you're interested in learning more about bowel movement, we have a website that is purely educational. It's called Poop Pedia or the.

Michelle (00:37:10) -  Best Website ever. I was going to talk about this. I was I was having so much fun going through it yesterday. Oh well, thank.

Jessie (00:37:18) -  You for checking it out. But, so she was having the type six and type seven of stool every single day, no matter what. If she's not eating low-fodmap and it's, you know, like when you have only that one diet to hang on to so that you can have some semblance of a normal life.

Jessie (00:37:36) -  Yeah. It's really hard not to, you know, kind of drill down on it. But that's also when we see the problem is, is people start if they still have a flare up and they start taking out more and more food, even on the low Fodmap list, and they come to us sometimes with just five foods that they feel safe eating, and our job is really to help them expand. So for her case, what I suspected pretty quickly is probably she has what we call non celiac wheat sensitivity or an undiagnosed celiac. So celiac is a genetic autoimmune disease. So when your gene gets turned on you have the condition. Now a lot of people carry the celiac genes. It's hla deka. Two and a Deka. Eight and then there are subvariants of the gene. Only 30% of the people with the genes will develop celiac per research. But then again most celiac patients are not diagnosed. So she lives in a rural area and was not tested for celiac properly. So I can't say for sure she doesn't have celiac.

Jessie (00:38:45) -  We don't know because it wasn't tested properly. And she's not willing to do the gluten challenge again. So eating yeah gluten for 6 to 8 weeks to do the test. Right. But what we saw after looking at what she's eating, her symptoms and her bad habits is we said let's, you know, try out a gluten free diet and let's see how it affects you. Yeah. The gluten free diet is one diet that every time we recommend it, it breaks our hearts a little bit.

Michelle (00:39:12) -  Yeah.

Jessie (00:39:13) -  Because it is so hard. Like, contrary to what people think is just removing food. We're removing bread, pasta, donuts or cupcakes or whatever.

Michelle (00:39:24) -  And it's.

Jessie (00:39:24) -  Hard. It's reading labels intensely, you know, making sure there's no weeds or components of gluten or wheat, barley and rye or derivatives of wheat, barley and rye in a product. And then it's also looking at how people prepare your food for you. There's no cross contact in the kitchen. It's such a difficult eye, so we really don't recommend it lightly.

Jessie (00:39:46) -  But for her case, you know, once she got on the gluten free diet, her symptoms improved. And then we started looking at, okay, where the gluten could be coming from. All right. Did you have a jar of peanut butter that somebody might have double dipped with a regular bread in it? Right. Or is it something else? and then making those adjustments and really getting her symptoms down to baseline. And then we challenge gluten over four days with sourdough bread. And there is a reason why we do that. Because there are other components in wheat that can trigger symptoms. So when we do the challenge, she reacted to it pretty immediately. I think may actually maybe the second day she reacted to it. So a slight delay in reaction. And that's sometimes what we see as well is delay in reaction to wheat or to fog maps now, which is kind of interesting because wheat has FODMAPs, it has the first ten groups. So we want to differentiate it, which is why we use sourdough, which is fermented wheat flour that does not have a map in it and it does not have 80.

Jessie (00:40:53) -  So 80 is another potential irritants for patients with IBS. We don't fully understand it just yet. And and then the other component is of course gluten which is a protein. So ATP and protein above carbohydrates. actually ATP is a protein, but then it gets broken down with the fermentation process. So we want to differentiate the different things and actually challenge only one group of the food, of only one component from weeds to see if she tolerates it or not. And, and we found that she doesn't tolerate it. And what we see in our clinic too is that in these cases, if a person is gluten intolerant, once we remove the gluten from their diet, their tolerance to FODMAPs will improve over time. Because FODMAPs, you know, when it gets into the cut, it does irritate the gut. For those of us who have a more sensitive gut. And if you are gluten intolerance, you you will have a very sensitive gut if you continue to eat gluten, even in trace amounts. But again, you know, you don't want to just cut out gluten and be like, okay, I'm gluten free.

Jessie (00:41:58) -  I'm cutting out gluten forever. That's no fun, right? You never want.

Michelle (00:42:02) -  To do that.

Jessie (00:42:04) -  Right? So you really want to know that for sure. And as of now, we just don't have any test out there to identify gluten intolerance. No, IgG test does not identify it. but the only way to do is eliminate sensitivity test. Yes, yes, eliminate and reintroduce. if you've done those tests, I'm so sorry for you. Toss it away and.

Michelle (00:42:31) -  You know, refund. Oh, I don't.

Jessie (00:42:35) -  Know if that will happen, but.

Michelle (00:42:36) -  Maybe not.

Jessie (00:42:37) -  Probably not.

Michelle (00:42:38) -  Yeah. So I have a question for you. I mean, obviously with each case there's going to be different triggers. There needs to be some investigation. You need to be a bit of a detective when it comes. You mentioned the gut brain interaction there. How much does anxiety play into IBS like symptoms or IBS in general?

Jessie (00:42:57) -  Yes. So anxiety is huge. Now, I would argue that stress did not cause you to have IBS, but stress exacerbates your IBS symptoms and it can be a vicious cycle when it comes to trying to manage your IBS.

Jessie (00:43:15) -  So, when it comes to the gut brain connection part of or the stress part, this is where finding the right routine and maybe making modifications to your lifestyle can be extremely helpful. And that's, in our clinic we have a three step approach. Step one is identifying the food trigger. Step two is actually modifying your lifestyle so that you are managing your stress better. Or we are doing things that improves your gut brain connection, like exercises, like deep diaphragmatic breathing that actually improve your gut brain connection actually help you feel less of the pain or the bloating. It decreases the gut sensitivity. And then also finding a routine that works well for a person, right? To have better evacuations. Right. a lot of the cases we see are also IBS, constipation that may not have any food triggers. But at the end of the day, what we really need to do is improve your evacuations and make sure you are fully evacuating every single day so that you feel good. You don't have to build up gas or build up stool in your colon.

Jessie (00:44:25) -  That's continuously giving you that dull pain or colonic spasms that just are unbearable. But this is a process, right? Improving gut motility is a is a long process even for kids. It can take six months for adults. If you've had constipation all your life, or maybe for years, it's going to take some time for your gut, for your colon to regain that sensitivity and elasticity to help you have a full evacuation. Yeah. But I always have to say, you know, don't be afraid of over-the-counter laxative. They are well studied. They are very safe which is why they are over-the-counter. Like talk to your physician and create a regimen that actually works for you so that you are having that full evacuation every day. Once you have that for patients with ibs-c or even mixed bowel type, you are going to feel so much better. And I would say a lot of the times that's what we start with, a higher dose of over-the-counter laxative to help the clients really clean out and then work on their dietary habits.

Jessie (00:45:29) -  Right. Eating three good meals a day, having a cup of more coffee in the morning, and then also work on other things to make sure they have good evacuations. And then we slowly dose down the laxative. As you know, the other aspect of their life improves. And the big thing is also eating enough fiber. But we don't want to just, you know, shove fiber supplements down somebodies throats because.

Michelle (00:45:52) -  They do either.

Jessie (00:45:53) -  No, because if you're already constipated, you're going to feel so much worse when that happens. And it may send you directly to diarrhea if you are, you know, not already running to the bathroom or if you're not already so distended. So uncomfortable. It's a process. And here's a few things you know I want to share before we wrap up the the conversation on constipation and improving motility. Hydration is extremely important. Fiber intake from a variety of sources is extremely important. Aim for 25 to 35g of fiber daily. 90% of Americans are not hitting their fiber goals on a daily basis, myself included.

Jessie (00:46:33) -  It's difficult, you know, work with dietitians to help you really work on those small lifestyle changes that can help you get there. And I say small because it starts with planning and then grocery shopping and then making sure they available at home, in your fridge, in your freezer. All right. And then other things to think about is hormonal fluctuations, especially for women. Right. The normal hormone fluctuations, right before our menstruation cycle, usually we have more constipated. And that's universal probably to most women because of our hormone progesterone, it slows down the gut. And then when your period starts, there's another hormone like prostaglandin that actually helps helps our uterus contract for our periods to be more, what do you say to extract the things that we need to extract from a uterus? But that hormone can actually cause us to have diarrhea, which is a term we call the period poop. Right? When you have your period, you have more diarrhea. So hormonal fluctuation is a thing, but it's not something you need to change, but more so a thing that you want to understand more.

Jessie (00:47:40) -  So maybe right before your periods you tend to you're more prone to having constipation. It's okay to use some over-the-counter laxative and focus on hydration and focus on getting enough fiber, eating more anti-inflammatory fruits and vegetables, and maybe sleeping more. Work on your stress. Do some more deep diaphragmatic breathing. So these are all things that can help with gut motility. And if none of these works for you, then that's when we think about maybe we want to investigate food intolerance, and that is via maybe the low Fodmap diet or gluten free diets. But remember, it's never a long term diet. We want to challenge to be sure that you are actually intolerance to some of these foods. We don't want to automatically assume you have to cut things out.

Michelle (00:48:28) -  Which yeah, I think is so important here and is probably what we see the most often, is that people just immediately go to eliminating foods, which is not only. Burdensome because that's just like to to remove things from your options of what you can eat is going to be stressful no matter what, but also unnecessary and even harmful at some points or a lot of points, because now your gut is lacking the variety that it really needs and potentially worsening symptoms.

Michelle (00:49:03) -  And I think something to that. You kind of alluded to this earlier, but just that vicious cycle of. Feeling a certain way. So then we eliminate foods and maybe we feel stress about that as well. Now that we're trying to eliminate something like gluten, for example. And that's stressful, right? That's a food that a lot of us love to have, or a component of food that a lot of us want to include in our life. And now you're potentially unnecessarily restricting something, plus adding that stress on top. So that might be exacerbating your symptoms even more. And it's just a vicious cycle. And I think it's like take home message here that I hope people are getting out of. This is like, don't just go eliminating foods hoping something will magically get fixed because that can be more harmful and worsen symptoms. Maybe not initially, but over time for sure. If if it were necessary, maybe by some magical chance. The things you eliminate are genuinely what you needed to eliminate. But to Jessie's point two, you might be okay in some tolerance levels there and some, portion sizes.

Michelle (00:50:12) -  So it's. Yeah, like I just, I think when we're so desperate to feel better, we'll do anything. And usually that's the anything we're told by the internet or the influencers or the coaches or the functional people is to just eliminate, eliminate, eliminate. And it's it's a bummer and it's a shame.

Jessie (00:50:35) -  It really is. and yes, and we're not blaming patients here, but then I think, no, not at all. The, the this is a very vulnerable population with GI disorders because one diagnosis is so hard and the discomfort is just very real. But they're invisible so other people cannot see your struggle. And and that vulnerability led to business opportunity from the predatory businesses to prey on, patients with GI disorders. So, you know, we are really extending, I would say, our sadness, maybe because it's we try to educate as much as we can the evidence based side of things. But I think there's still so much, you know. Bad intentions, people lurking around in the background.

Jessie (00:51:25) -  I don't know if they have really bad intention, because I think sometimes also to these practitioners, they think they're doing the good thing, but they just not well.

Michelle (00:51:33) -  And that's the thing, sometimes it's just poor information. It's not that they had the right information and are straight up neglecting it, which can be the case. But I think a lot of times it's ignorance and which maybe is even more dangerous because the people really do believe in what they're doing, and that's compelling to people, you know. Yeah. Thinking of like chiropractors in particular, they are one of the worst for like quote unquote functional nutrition, quote unquote solutions and a lot of quotation marks here. And it's and they really believe it. They really, really do. And they stand behind their recommendations, which brings the patients confidence in what they're being recommended and and going along with it, which is a shame, you know. Yeah. Again, just bad information. But what do we know. We're just mainstream dietitians right? Well, I.

Jessie (00:52:27) -  Also got to say there are some dietitians that also do these things. I think the analysis one that you mentioned, Andreas jumping onto my podcast tomorrow, and that's one of the ones I want her to debunk. Good good good good good. I'm like, yeah, let's talk about and I'm seeing a dietician promote it a lot.

Michelle (00:52:45) -  And that's really and also the GI map I see a lot of dietitians do those as well.

Jessie (00:52:50) -  Yeah. So it's I hope they will come to the conference with us I think that's yeah. Maybe that's the best we can hope for. but.

Michelle (00:53:01) -  Yeah listen to listen to the podcasts. Well, thank you so much for coming on. I really appreciate your time. I think it's really, really valuable. Just as we were talking about to get the education out there in the information out there about, just the different nuances that are involved here. And again, like take home message is that this doesn't need to be an all or nothing thing. Don't let it be. And also be sure that you actually do need to eliminate something like do your due diligence to address the other areas of your life the lifestyle things, the fiber intake, the hydration, the sleep, the exercise.

Michelle (00:53:41) -  Like do your due diligence to address all of those things first, even your relationship with food. You guys know I'm very passionate about your relationship with food and and really just to have a neutral one and don't make it a big deal. And don't stress about it either, because that can ultimately be exacerbating some IBS symptoms and making things worse. So yeah, then if you're like, no, I really do have something going on here, then you can really start to be a detective and bring on some professionals if you haven't already. So yeah, I, I think this is so good and so valuable, and I'm sure I'll have a lot of questions and feedback on this. So we might have to have you back for some follow up questions anytime. But you will have your own show coming out soon and you've got amazing resources. We kind of quickly touched on poop idiot org, which is incredible. I just poked around at yesterday. There's different photos of real stool that you can compare to and see what type you are.

Michelle (00:54:42) -  There's also a little chart for what the different colors mean of your stool and even odor. I've never heard anybody talk about the different odors and smells and what that might mean. I was like, what? This is so cool, and I'm just totally nerding out about it. So anybody who's interested in knowing what your poop means, that's a great resource. Poopy org. We'll put it in the show notes and then, yeah, Jesse has amazing resources. Even your Instagram is incredible. I was cracking up at your you have a really good reels that are based on memes. Oh, like they're so funny.

Jessie (00:55:19) -  The farting you're paying stomach pink away one.

Michelle (00:55:22) -  Yes, I love that one. So good. Somebody's just running away in the field. It's so, so funny and so relatable. And I know even I don't think I have IBS, but even your memes, I'm like, I can still relate to that. At certain points in my life, I felt that way for whatever reason. So it's just, it's good.

Michelle (00:55:40) -  Sometimes you just gotta laugh about the things that are causing you pain.

Jessie (00:55:44) -  yes. I think a little humor really helps, mitigate or feel better about having an invisible illness.

Michelle (00:55:53) -  Yeah, yeah, absolutely. Anything that I missed in terms of how people can find you or reach out to you or resources that you've got available, anything that I missed, I think.

Jessie (00:56:04) -  We've got it all. And, happy to follow at on Instagram at IBS. Dot dietician.

Michelle (00:56:11) -  Yes, she's awesome. Evidence based. That's what I love. Yes. Because there's a lot of IBS things that are not evidence based. Aced and are pretty predatory. So please follow my friend Jessie because she is and she's the best.

Jessie (00:56:27) -  Thank you Michelle.

Michelle (00:56:29) -  Well, thank you so much for coming on. And, yeah, cheers to all of you with IBS. We're here for you.