{ "version": "1.0.0", "segments": [ { "speaker": "@paulthenutritionist", "startTime": "0.0", "endTime": "45.165", "body": "Before we get started on this episode, I just wanted to say if you want five days of completing free coaching from me, a registered leading nutritionist, for free straight in your inbox, go to tinyurl.com/kickstarter26 and you will get five days of completely free coaching straight in your inbox just by clicking that link. So if you've enjoyed anything that I've ever said, go to tinyurl.com/kickstarter20six. Let's get into the episode. Welcome to No Forking Nonsense, the podcast that slices through the nonsense and serves you straight talking nutrition advice that actually works. I'm Paul, a registered nutritionist and your host." }, { "speaker": "@paulthenutritionist", "startTime": "45.245", "endTime": "84.755005", "body": "And every episode, I'll be debunking diet myths, breaking down confusing food advice and giving you practical science backed tips to help you eat better, feel better and get your edge back. There'll be no fads, no shite, just real talk that makes sense. Let's get stuck in. Hello and welcome to another episode of No Forking Nonsense and today we're talking about IBS, the diagnosis that everybody seems to have but nobody fully understands it. So firstly I want you to think in your mind if you or someone you know has been told they've got IBS." }, { "speaker": "@paulthenutritionist", "startTime": "85.41", "endTime": "144.025", "body": "If everyone was in a room and you all put your hands up, there'd be a lot of hands up. In fact I'd be willing to bet that if you've ever gone to your GP with ongoing stomach issues, bloating, cramping, unpredictable trips to the bathroom, general digestive problems, at some point the words irritable bowel syndrome have come up and then you probably left the appointment with not too much than you walked in with because the truth about IBS is it's one of the most common diagnosis in the world and also one of the most vaguest. It's less of a diagnosis and more of a, I guess a label that says your gut's not very well but we're not quite sure why. It's the equivalent of going to the doctor with some kind of problem, an illness and the doctor going right I ve assessed you and I m concluding that you re ill. So today we going to get into all of it, what IBS is, why the term is so frustratingly broad and why it seems like everyone seems to have it and most importantly what you can do about it." }, { "speaker": "@paulthenutritionist", "startTime": "144.62999", "endTime": "224.975", "body": "So let s start, what is IBS? It stands for irritable bowel syndrome and the first thing to understand is that it s what s called a functional disorder and that means there s no structural damage to the gut that shows up on a scan or a biopsy, your gut will probably look normal, it just doesn't behave normally. The ROAM-four criteria is a clinical framework that doctors use to diagnose IBS and this defines it as a reoccurring abdominal pain occurring at least one day per week over the last three months associated with at least two of the following: pain related, going to the toilet, a change in how often you go, or a change in what your stool perhaps looks like and that's it, that is a diagnosis criteria. And you can see immediately how broad that is, there's no blood test for IBS, there's no scans, there's no definitive marker, it's diagnosed almost entirely by ruling out other things and matching symptoms to a checklist. Then IBS is kind of typically split up into subtypes, there's IBS D which is diarrhoea predominantly, IBS C which is constipation predominantly and IBS M which is like a mix, alternating between the both, and IBS U which is unclassified basically when it doesn't fit into any of the others." }, { "speaker": "@paulthenutritionist", "startTime": "225.215", "endTime": "308.375", "body": "So even within the diagnosis there's enormous variation and two people can both have IBS and have almost completely different symptom profiles. So it gets interesting because it is such a vague term and it can be really frustrating as well because IBS is essentially an umbrella term, it describes a collection of symptoms rather than one single condition with a single cause, which almost certainly isn't one thing at all, Think of it like someone saying I have a sore leg technically accurate but not very helpful because a sore leg could be a muscle strain, stress fracture, nerve pain, even referred pain from your hip or something else entirely and each of those needs a different approach and IBS is very similar. The symptoms might be driven by gut microbiome imbalance or by a visceral hypersensitivity, where the nerve endings basically in the gut are essentially overreacting to quite normal sensations or by the gut brain access being disrupted, is the communication highway between your brain and your digestive system. It can also be via low grade inflammation or via food intolerances or by dysregulated gut motility or most likely by a combination of several of these things." }, { "speaker": "@paulthenutritionist", "startTime": "308.935", "endTime": "371.98", "body": "There was a review in 2021 by Gastroenterology and Hepatology Nature Reviews which described IBS as a disorder of gut brain interaction rather than a purely physical gut condition. Now that's a significant shift in how the medical world thinks about it because it acknowledges that stress, anxiety, sleep and anything that's going on mentally are not just things that happen alongside IBS, they're often what's driving it. And that's why the vague label is a problem because if you just tell somebody they have IBS and send them home, which often happens, you're not helping them understand which of these many possible mechanisms it's relevant to and you're certainly not helping them fix it. The question I get asked a lot is, is IBS actually more common than it used to be or does it just feel like it is? And the honest answer is both because IBS affects somewhere between ten to fifteen percent of the global population according to some current estimate." }, { "speaker": "@paulthenutritionist", "startTime": "372.22", "endTime": "409.41498", "body": "And in The UK it's thought to affect around one to in five people at some point in their lives. It's one of the most common reasons that people see a gastroenterologist. But there are a few reasons it feels like it's everywhere. So first, awareness is obviously higher, people are more willing to talk about digestive systems. Than perhaps a generation ago, gut health has become more mainstream, conversations partly driven by research in the microbiome is more common and partly driven by social media, so more people are identifying symptoms than they might previously have identified them or they would have just put up with it." }, { "speaker": "@paulthenutritionist", "startTime": "409.41498", "endTime": "445.025", "body": "And second diagnosis has got a little bit broader. That roam criteria that I referred to earlier has been revised multiple times and each revision has generally widened the net of what qualifies. Thirdly, and this is the bit that should probably make us think, our lifestyles are genuinely seem to be making gut problems worse. So we spoke about ultra processed food before, we've also spoken about fibre before and fibre intake in The UK is well below recommended levels. The average adult gets anything from ten to eighteen grams a day when you should be in for about thirty grams." }, { "speaker": "@paulthenutritionist", "startTime": "445.38", "endTime": "485.07", "body": "But also chronic stress is higher, so quality is worse, antibiotic use is higher. All of these things affect our gut microbiome and our gut function, so yeah it's probably a little bit more prevalent but it's also being diagnosed more readily. Some of what gets labelled as IBS might actually be a specific food intolerance or other conditions that with better investigation could be more precisely identified and addressed. I want to spend a quick moment on this because it s one of the most fascinating and underappreciated parts of understanding the IBS and that is the gut brain connection. Your gut has its own nervous system." }, { "speaker": "@paulthenutritionist", "startTime": "485.15002", "endTime": "524.215", "body": "Now the best way to think about this is when you get butterflies you feel it in your gut right and that is the gut brain access. It communicates constantly with your brain via what we call the vagus nerve and this is why we call it the gut brain access because it s why stress gives you an upset stomach, s why anxiety and IBS go so frequently in hand. In people with IBS, this communication system seems to be dysregulated. The gut sends more signals to the brain and the brain interprets normal gut sensations as painful or distressing. And this is a visceral hypersensitivity, the gut's alarm system is kind of turned up too high." }, { "speaker": "@paulthenutritionist", "startTime": "524.535", "endTime": "564.46", "body": "A significant body of research now shows that people with IBS have higher rates of anxiety and depression than the general population but crucially it's a two way thing. Gut problems will likely cause anxiety, anxiety causes gut problems and they kind of feed each other. And this is why stress management, sleep and psychological approaches like cognitive behaviour therapy have genuine evidence behind them when it comes to IBS management. It's not because IBS is in your head, because it isn't, but because your head and your gut are in constant conversation and calming one down will absolutely help the other. So some more kind of practical things about what you can actually do about it." }, { "speaker": "@paulthenutritionist", "startTime": "564.46", "endTime": "610.635", "body": "The good news is there s a reasonable amount of evidence behind several approaches. The low FODMAP diet is probably the most researched dietary intervention for the IBS, for the IBS, for IBS, but the problem with the NHS is they don't have the capacity to go through the FODMAP diet because it's a very time consuming approach to trying to fix things and the low FODMAP diet is probably as I say the most researched dietary intervention. FODMAPs are basically a group of fermentable carbohydrates that are poorly observed in the small intestine and get fermented by bacteria in the large intestine. And that can produce gas and draws water in. And for people with IBS, this process can trigger significant problems." }, { "speaker": "@paulthenutritionist", "startTime": "611.76996", "endTime": "658.70496", "body": "There's some research in Australia by Monash University and they developed the low FODMAP approach and suggested it reduced symptoms by up to seventy five percent. The high FODMAP foods include things like onions, garlic, wheat, certain fruits like apples and mangoes, lactose and legumes. But, and this is very important, low FODMAP is not a forever diet. It is a structured elimination and reintroduction process to identify your specific triggers done with an expert. It's not everyone reacts to FODMAPs, the goal is to find your individual threshold and how to eliminate everything slowly a per member reintroduce it as opposed to just eliminating everything permanently." }, { "speaker": "@paulthenutritionist", "startTime": "659.345", "endTime": "704.03", "body": "Fibre is very nuanced with IBS because soluble fibre which is found in oats, psyllium husk, root vegetables, that tends to help both IBS C, the C standing for constipation, and IBS D standing for diarrhoea. And insoluble fibre is found in wheat bran and some vegetables and that can make symptoms worse for some people. So it's not simply just eat more fibre, it's eating the right type of fibre. Gut directed hypnotherapy is also an interesting approach because there's surprisingly strong evidence around it. In 2003 there was a study that showed significant and sustained symptom improvement and it sounds a bit kind of woo woo and a bit left field but the gut brain research supports why it works." }, { "speaker": "@paulthenutritionist", "startTime": "704.19", "endTime": "729.42", "body": "Probiotics have mixed but broadly positive evidence. The strain matters enormously per person. Different strains have different kind of bits of research behind them, but a daily probiotic is a reasonable low risk addition. Stress management, like I can't stress this enough ironically, but it's not optional. If your nervous system is constantly fighting and flying, your gut will reflect that." }, { "speaker": "@paulthenutritionist", "startTime": "729.42", "endTime": "759.96", "body": "As I've said before, you get nervous, your gut plays up, you have butterflies before a presentation or a big event you might feel like you need to go to the toilet. So exercise, sleep, breath work therapy, whatever works for you, it's important that we manage our stress. And unfortunately as boring as it is the food diary work because identifying your personal triggers is genuinely the most powerful thing we can do. IBS is very individual. What wrecks one person's gut might be completely fine for another." }, { "speaker": "@paulthenutritionist", "startTime": "760.04", "endTime": "791.77", "body": "Right, so here's who this next bit is for. If you've been told you've got IBS and you left the appointment with a leaflet and not much else, maybe some medication which is far too common than this bit's for you. If your gut has been a problem for years and you've just accepted it as normal, this is for you. If this goes for your partner, your friend, a family member, this is for you. If you've tried cutting things out, you've gone gluten free on a whim, you've tried every probiotic on the shelf and still don't have answers, this bit's for you." }, { "speaker": "@paulthenutritionist", "startTime": "792.08997", "endTime": "853.36505", "body": "If you, your friend, your family member's digestion's affecting your energy, your confidence, your social life, your relationship with food, this bit is for you. So I want to say something I don't normally do. I have made some time next week in my diary for a free thirty minute call, this is not something I do regularly, schedule doesn't allow it with all my clients and the amount of calls I have and frankly offering free time to this many people at once probably is something I'm going to regret. But I've been getting a lot of questions about gut health, about IBS, about food sensitivities and I want to be useful to people who are genuinely stuck and don't know where to start. So next week I've got a limited amount of slots for a free thirty minute call with me, a registered nutritionist, not a wellness influencer, not a supplement brand, someone who actually knows what they're talking about and can help you start to make sense of what's going on with your gut." }, { "speaker": "@paulthenutritionist", "startTime": "853.525", "endTime": "887.115", "body": "Not just with your gut, if your energy is fucked, if you're finding that you're smashing your head against a wall, you feel like you've tried everything and you can't lose weight, this is for you. It's just a proper conversation about what you're dealing with and what your options are. If that sounds useful to you, the link is the top link in the podcast description. Grab a time next week before they go because there genuinely aren't many. I have tried to get as many as I can this week and well, we'll see." }, { "speaker": "@paulthenutritionist", "startTime": "887.355", "endTime": "938.825", "body": "At the absolute minimum, you're going to leave this call with more clarity than you have right now and that's worth thirty minutes of anyone's time. So just to close here, IBS is absolutely real, it's common in its frustration and the way it gets managed or more accurately not managed by the healthcare system leaves a lot of people stuck with symptoms they're just learnt to live with. You do not have to live with it. If you are someone who is stuck, if you've had enough, if you're fed up of trying everything, whether it's to do with your gut, to do with your energy, to do with how you react to foods, to do with how you're waking up knackered, to do with your waistline, to do with how you feel when you look in the mirror, click the top link and we can have a chat next week. I'm probably not going to be offering this again because I'm going to regret this but put a link below and I shall speak to you next week." }, { "speaker": "@paulthenutritionist", "startTime": "938.985", "endTime": "952.02", "body": "Thanks system. That's it for this episode of No Forking Nonsense where the fluff gets binned and the facts get served. If you found this helpful, share it with someone who could do some clarity from an expert. That's me, by the way. And make sure you hit follow so you don't miss what's coming next." }, { "speaker": "@paulthenutritionist", "startTime": "952.18", "endTime": "965.445", "body": "And if you want more straight talking, no nonsense nutrition advice, come and find me on Instagram at Paul the Nutritionist. Until next time, eat smart, feel human again and stop falling for the Forking Nonsense. See you next time." } ] }