“So what we need to understand about IBS is that it's a multifactorial disorder. And what that means is that there are different things that can trigger these symptoms.”
Details
Transcript
Resources
In this episode, we welcome Antonella Dewell. We’ll discuss her experience helping clients with relief from IBS, the role of nutrition in IBS, and effective methods to manage gut health.
Antonella is a Registered Dietitian passionate about helping people with IBS find relief from uncomfortable gut symptoms and pinpoint the foods that are triggering them, so they can stop being anxious around food, eat with confidence, and live a full, vibrant life.
Shireen [0:33]: In today’s episode, we welcome registered dietitian Antonella Dewell. We’ll discuss her experience helping clients with relief from IBS, the role of nutrition in managing IBS and effective methods to manage gut health overall, stay tuned. Antonella is a registered dietitian passionate about helping people with IBS find relief from uncomfortable gut syndromes and pinpoint the foods that are triggering them so they can stop being anxious around food, eat with confidence and live a full vibrant life. Welcome Antonella.
Antonella [1:15]: Thank you Shireen!
Shireen [1:16]: such a pleasure having you on so Antonella lets start with your Why, could you share a little bit more about what drew you to specifically look at IBS and gut health?
Antonella [1:27]: I’d be happy to. When I started counseling people one on one, I was doing that for a variety of reasons. So I would see people who had either diabetes or heart disease, high cholesterol, and it slowly became more and more evident how many people were actually suffering with gut issues, and especially irritable bowel syndrome. But it was really the experience of one client that really drew me to specialize in this area. It was a one woman who was referred to me because she was suffering with IBS. And our predominant symptom was a really severe diarrhea. And it was so severe that she literally couldn’t leave the house unless she took several doses of an anti diarrheal medication, because she needed to be close to the bathrooms at all times that she couldn’t go to college classes to a part time job. It was very debilitating. And this is the issue that can drastically worse than people’s quality of life. So at that time, I was already you know, by coincidence, looking at some research on irritable bowel symptoms to comply with those continuing education units that all of us dietitians need to do every few years. And I had come across some research from Monash University in Australia, that had sort of pinpointed a diet of strategies to help people with IBS and I applied these principles with my client. And within two weeks, she was no longer suffering from diarrhea, she could discontinue all of her medications. She was free to go about and live her life. And that was so rewarding. And it was so amazing to see firsthand that I decided this is a group of people who really needs help. And this is where I could be helping them and helping them really quickly really turn around their life.
Shireen [3:23]: How interesting, let’s maybe take a step back Antonella and help us understand a little bit more about what is IBS? Let’s start with the definition around it because it seems like such a broad term in terms of everything it encompasses help us define it.
Antonella [3:38]: Yeah, this is really important. So IBS is a syndrome, so if not a disease. And what that means is that structurally, there’s nothing wrong with a gut as seen in the results of blood tests or imaging or even after doing an endoscopy, colonoscopy, all these tests come out to speak negative, but it’s the gut is not functioning the way it’s supposed to the way it should. And it’s called a disorder of the gut brain interaction. And what’s happening is that the gut and the brain are always talking, but in the case of IBS, so to brain can misinterpret the signals from the gut. And this leads to the brain thinking that some normal stimuli, like the movement of food, or the production of cough, or even like a stressful event, are actually more than normal people. And so they’re more severe and then manifests as pain and as irregularity of the gut and bloating and gas. And so it’s really a constellation of syndrome, and it characterized mainly by recurring abdominal pain, alter bowel habits, it could be diarrhea, constipation, or a mix of the two and for most people, also, painful bloating. A way to visualize it is I like to think of the gut as a stereo system. And that has speakers that are tuned too loud. And so instead of talking to the brain, its screaming and that manifests as pain. And all of these others symptoms. So it’s a matter of actually turning down the symptoms and re- learning for the gut and the brain how to speak to each other.
Shireen [5:30]: Yeah, so what you’re saying is physically, everything looks fine. You know, you go to your GI doctor, they look, they examine, they do- and you mentioned doing an endoscopy, they’re doing all of those things, physically, everything’s looking fine. It’s more of this connection between the mind the gut where the gut is screaming something or signaling something much more profoundly than it needs to, which is causing this to happen to where the symptoms happen. How does one even understand that they have IBS?
Antonella [5:59]: Yeah, so it’s a good question, because I hear from a lot of my clients that sometimes they’ve had it their whole life, and they didn’t even know because that they thought that that was the normal. So you know, they either talk to somebody and they realize that that’s, you know, it’s not normal to feel bloated or gassy all the time, or do you have this irregular bowel movements? And you know, that turns around, you will ask really good questions regarding the symptoms. And the classic pattern is that there needs to be, you know, recurring pain with, you know, either diarrhea or constipation, that have been happening consistently, for at least three months. And so it’s not really the occasion or within all experiences on an occasional basis. But isn’t the recurring matter, and it happens to a point that they really disrupts the quality of your life.
Shireen [6:50]: And that’s really the key there, right? It’s the quality of life that it can impact, like you mentioned, for this patient, do the symptoms and causes vary from person to person?
Antonella [6:69]: Oh, yeah, absolutely. Now, unfortunately, we don’t really know what causes IBS. But we do know some of the drivers like we talked gut brain miscommunication, the list of what we call visceral hypersensitivity. So it’s super sensitive. Literally, the nerves around the gut are so sensitive that a little bit of this tension or bloating can be interpreted as pain, then there can be imbalance in the makeup of the gut bacteria in our gut. And it also runs in families. So there is a genetic component. And for some people, it can come from an infection, about our gastroenteritis. So experiencing food poisoning, from which, you know, they don’t fully recover. Whereas most people, you know, just suffer for a few days, and then it’s gone. You know, for some people, these symptoms can linger on and then become chronic. Now, the symptoms do present differently. In fact, we actually talk about IBS subtype. For some people diarrhea, like, you know, the client I just mentioned, is the predominant feature. So we call that IBS D. Diarrhea predominant. Or there is IBS, constipation predominant, are they can actually occur, you know, and alternate, so you will be constipated for many days, and then all of a sudden you have diarrhea. And even within this classifications for some people, you know, the pain is what are the words from others is really severe bloating and gas, it does present differently. No two people are alike,
Shireen [8:42]: Mhm, which makes it all the more complicated to try to understand exactly what is going on. What are some common misconceptions about IBS? I also hear there’s some taboo around discussing symptoms. And can you help us understand that?
Antonella [8:56]: Yeah, absolutely. So for the longest time, IBS was, you know, dismissed. And luckily, we’re getting away from this, but it’s all in your head. And so even doctors would dismiss is just so patient, that’s all due to stress, and they should stress less. Or maybe just try and eat more fiber if they’re constipated. But we know from the research now, that’s not going on, there’s really, you know, changes in how the brain and the gut interact. We know that IBS is real, and these symptoms really affect people’s quality of life. Nonetheless, there’s, I still hear from my clients, sometimes their doctors will tell them that there’s nothing they can do for them. And that’s the other misconception, too, is so much you can do to manage, you know, although it’s not a disease that can be cured. There’s so much you can manage the symptoms so much that, you know, you could come to the point where you no longer to meet those diagnostic criteria, and so you can really live a life without the symptoms. A full, vibrant life and do all the things that you can do.
Shireen [10:09]: It’s really good to know. Could you explain the strategies you’ve developed to help clients get relief from IBS? You mentioned the success story as well. What are some of those things associated with relief?
Antonella [10:22]: Yeah, absolutely. So what we need to understand about IBS is that it’s a multifactorial disorder. And what that means is that there are different things that can trigger these symptoms. And that that’s also another misconception about IBS, that diet is the only thing that affects your symptoms. Well, diet is a really important part, it’s really crucial. But we cannot disregard other things like stress. I think it’s on par after with diet, and your whole lifestyle, you know, how and whether you exercise, how well you sleep, how well you manage your stress. And how you talk to yourself good, what goes on in your mind, whether you’re continuously telling yourself and talking negatively, like beating yourself up, or you’re talking to yourself with self compassion. So all of these things I haven’t, you know, put them together in into my program, so that we can, so to speak, attack IBS, on all fronts. And also make sure that the changes and are long lasting, you know, that you can manage IBS for the long term, not just you know, for a few weeks or a few months, but really, that my clients have all the tools that they can incorporate into their life,
Shireen [11:49]: you know, you mentioned its just not about diet and nutrition. That’s certainly an element of it. Can you help us understand what is the role that diet nutrition plays in relieving or easing the symptoms?
Antonella [12:02]: Absolutely. And that’s where my passion lies, because I am a dietitian, after all. So what really revolutionized this field was some research from Monash University in Australia did quite a while ago, now that but only has, you know, become to the front row to the knowledge even most dietitians in the past five to 10 years. And what I discovered, there are certain dietary factors, certain sugars and fibers that seem to really trigger the symptoms of pain, bloating and gas. And so they developed a protocol where you temporarily, you know, eliminate these foods. And, you know, they came up with a name that you may have heard was called the FODMAP diet or FODMAP protocol. And it’s a complicated, you know, acronym that stands for fermentable, oligosaccharides, disaccharides, and polyols. But what it means is really, if certain sugars and certain fibers and certain foods, that if you eliminate them for a short period of time, and notice that your symptoms have really improved, then you can reintroduce them one by one to really figure out which one is triggering your symptoms, because no two people are alike. So not everyone will react to all of these foods. But everybody has one or two or you know, multiple ones that are triggering their own symptoms. And at the end of this protocol, you really figure out what are the foods that are triggering your symptoms, so that they, you can make informed choices when you are, you know, eating, and whether to maybe, you know, not completely eliminate it. And it’s rarely really somebody will have to completely eliminate a group of food, but at least minimize them, or decrease the portion sizes in a way that will allow you to eat a wider variety of foods, and at the same time, not experience these painful symptoms. And I’ve wanted to just add to that as that is sort of like the core principle that really allows people to find the biggest relief, but we cannot neglect other factors in diet. So it’s not just what you eat, but also how you eat that’s also very important whether you skipped meals or your graze all day or you have some regular meals, whether you eat quickly and don’t chew your food well, and the environment when you’re eating. Are you in a hurry? Are you eating in front of the computer working under stress, as well as other non FODMAP dietary triggers that we’ve known for a long time can irritate the gut like alcohol or caffeine. And again, not that everybody needs to, you know, do all of these things, but we need to figure out what’s important for that one person so that then they can know what works For them, in sum, there’s like no one size fits all. So dietary solutions for everybody, but everybody needs to go into investigative, you know, process to really find out the diet that works the best for them.
Shireen [15:16]: You know, you brought up a very interesting point, which is, you know, just going back a little bit, which was it’s not only about what you are eating, but how you are eating. Why is that how so important when it comes to IBS?
Antonella [15:27]: Well, part of it is that, you know, our gut likes regularity, and likes consistency. And so, you know, one common mistake is to either skip meals or graze all day. And so our that seems to prefer some regular meals and balanced meals to so that you can actually nourish the gut and gives them all the energy and nutrients that they need to flourish. And then as far as the IBS symptoms, because there’s so much driven by stress to and think about our modern visualize that we’re jumping from meeting to meeting from work to family, we’re always operating into the, you know, fight or flight response, even if we’re not really feeling you know, it’s stress. That’s the mode that we’re operating on. So to switch from that to the rest and digest mode, where the parasympathetic system is more active. And so what that means is that in that mode, the stress hormones are dysregulated, being produced by the gut, more blood flows towards the gut. And that was allows to have the best digestion you can have. And if you’re digesting your food, well, then you’re less likely to experience symptoms like bloating, or pain, or gas. So all of these things that, you know, some of us take for granted, or we’re not paying too much attention to, like, you know, eating in front of the computer really quickly, and not chewing really well. You know, when we chew? Well, our digestion starts in the mouth already. So we start digesting, you know, the food. So our digestive system down the track, that less work to do, and again, allows for that optimal digestion.
Shireen [17:24]: You know, if there’s a listener out there today who’s seeming like they may have IBS, or know that they have IBS? What are some quick things that you could tell them to sort of reset, either be slowing down or looking at their foods or how they’re eating, what they’re eating? What are some things that you would impart on them to- what they can do to manage their symptoms better today?
Antonella [17:44]: Yeah, well, I would really start from the how you’re eating right now. So look, you know, your meal pattern? Are you skipping any meal and try to have more regular meals, and are you grazing all day, trying to have more meals that are spaced out so that they’ve got had that time to rest in between meal, there’s a lot that goes on in that recipe to to maximize digestion, and my save, there’s really, no one meal time comes, try to slow down, have a set time for you to have that breakfast or lunch or dinner. And start by taking three deep breaths and breathing is so easy to do. And so under valued sometimes that we don’t think about it, because we can do it without thinking about it. But taking some deep diaphragmatic breathing can really switch us from that, you know, fight or flight response into to that rest and digest mode, and really set us up for that good digestion. And at the same time, you know, eat as slowly as you can, or at least eat not as quickly as you’re used to. So you have a chance to chew your food well. So those would be the first thing to really start with if you’re not already doing. And one thing I would add is stop doing what a lot of people are doing, which is go down this rabbit hole of just looking at food and start eliminating foods. This is so common, and I hear from so many of my clients that they come to me. And they basically come down to just a handful of foods they eat over and over again, because they’re too afraid of eating some foods just because they associated that food with you know about the symptoms on one day. Just because you eats something and like you maybe, you know, two hours later, you have diarrhea, that doesn’t mean it was that one food. And so there’s a little bit more of an investigative process that goes into really figuring out which foods are triggering your symptoms by just eliminating foods or random actually can you know First, you know, take away a lot of the joy of eating and take out a lot of really great nutrition for you. So it’s completely unnecessary. And second, you know, it doesn’t really help you in identifying what foods are triggering those symptoms. And then the long term can actually make your symptoms worse.
Shireen [20:20]: Which actually takes me to my next question, if IBS goes untreated for a while, what happens are the ramifications on that?
Antonella [20:30]: The only ramification is you’re continuing to suffer with a symptom, so you’re not really damaging your gut. As I was saying before, it’s not a disease, the fact that you eat something that makes you feel bloated, or gassy, or gives you pain doesn’t damage the gut. But it certainly you know, disrupts the quality of your life, you know, prevents people from enjoying meals with other people with their family and friends going out to eat is a big issue. For people, they end up avoiding, you know, get togethers birthday parties, just because they’re afraid that would be something that they haven’t prepared themselves. And they don’t know how they’re going to react. So the biggest repercussion is really on your quality of life and your mental health, because then you even start isolating yourself. And that has been shown that people with IBS are more prone to suffering with depression, for example. So it can have repercussions down the line
Shireen [21:34]: for sure. In I know the experience that you’ve had working with individuals who’ve had IBS, through your own work, was there anything that has either surprised you or inspired you?
Antonella [21:45]: Yeah, what surprised me at first, because I wasn’t, you know, so aware of where what how different, you know, every single client is how I really have now met two people after, you know, six years, I’ve seen people with IBS, who either react to the same foods, you know, or ended up with the same, you know, diet. So it’s really an individual disorder, and the recommendations need to be individualized. Also, you know, what inspires me is all the work that all my clients, you know, they get to a point where they really can’t live with this anymore. And so they’re really, you know, this protocol is not hard, but it does take some commitment to eliminate some foods that’s first, and then to do that, you know, detective work of figuring out your trigger foods. And what inspired me is really the great results that people have after completing this process. And really, you know, the people who are really committed, and that also have a much more nutritious diet, and much healthier diet, one that’s gonna help them actually would a lot of other aspects of our health.
Shireen [23:01]: How helpful. And I’m going to try to squeeze in one more question here. But what are some useful ways for people to maintain long term gut health? You talked about having a healthy gut? What does that look like?
Antonella [23:12]: Yeah, so this is really the end goal of this game, or now this process that we want to really figure out what our triggers are, so that we can, you know, expand our diet as much as possible, and only like, minimize maybe certain foods or once we know what our triggers are, if there is an enzyme that can help us digest that food better than we know, we can utilize that. So what I always tell all my clients, the best thing you can do is to make sure you keep expanding out your diet, and especially, you know, have a variety of plant based foods, the vegetables, the fruits, a whole grain to let us know really, you know, eliminate any of those from your diet, even if you can only have two tablespoons of beans, you know, or lentils keep incorporating those because the research has shown really that for our long term health health, we need to feed these gut bacteria that are living in our large intestine. And we’re finding out more and more from the research how important they are to maintain our gut health, but also our overall health. And so to continue to feed those bacteria, their favorite foods are fibers and fibers come from plants. So the wider variety, the bigger, you know, Rainbow you can put on your plate, as far as different colors of fruits and vegetables. That’s really the key to long lasting gut health.
Shireen [24:43]: So fascinating. Thank you so much Antonella for your time here today. Can you tell our listeners how they can connect with you and learn more about your work?
Antonella [24:51]: Yeah, absolutely. So I have a website, and it’s just my name Antonelladewell.com And I’m also active on Instagram and Facebook. I am @IBS.nutritionist.rd. That’s right.
Shireen [25:08]: Lovely, and we’ll link up everything in the show notes. Antpnella thank you so very much for your time. For our listeners today. Thank you for joining us on another episode of the English podcast. You know what time it is head over to her social media and answer this quick question. How do you manage your relationship with your gut? Pretty simple, right, especially after this episode. So head over to at young lash on Facebook on Instagram. Find this podcast post, comment below to tell us again, how do you manage your relationship with your gut? We will continue the conversation there, Antonella, Thank you.
Antonella [25:41]: Thank you so much for having me. It was my pleasure.