Jono (00:01.324)

Welcome back to the bite me nutrition podcast. Today I'm here with Kat. She's back. We're to talk about something a little bit different this time. We've had Kat giving us lots of good menopause advice in particular and some shift work advice, but we're talking, but great segue. We're going to be talking about IBS all things IBS. There's a few different types of IBS. We're to be talking about diagnosis, some management, some treatment, all of those sorts of things. So

Kat (00:18.212)

Yeah.

Jono (00:31.054)

I've realized that I haven't said hello yet or introduced. don't need to introduce you. Everyone knows cat, but say hi cat.

Kat (00:37.1)

Hi everyone. I was actually thinking we need an intro rap when you're like cat is back. We should like wrap me in. Yeah, yeah. It's really set the same. Yeah. That'd be great. Yeah. okay. Yeah. I did see that. Okay.

Jono (00:43.742)

yes. I'll get my toy piano. Well, yeah. All right. No promises, but, we'll see what we can do for next time. cause there's no intro music anymore. Cause someone told me that it was too loud. Hmm. Yep. Which, and like they were right. So I'm not like, not annoyed. so we're straight into it today. But, anyway, just to start with, let's start with an easy question. What is IBS?

Kat (01:07.808)

Yeah, sounds good. IBS, yes. So IBS is Irritable Bowel Syndrome. I'm sure many people, or if you listen to the podcast, either have it or have seen it around or know others who might have Irritable Bowel Syndrome. And what it is and what we refer to it is functional bowel disorder. And what we mean by that is that there isn't necessarily anything physiologically wrong with the bowel, with the small and large intestine.

but rather what is happening there with the function we're seeing those issues. So it's not to discredit by any means the symptoms that an individual is experiencing with IBS. can be very, really variable to really extreme and needing to be by the toilet and extreme pain and discomfort and a lot of anxiety and fear and concern around that to just some battle like.

some constant irregularities in their bowels and some abdominal pain and bloating there. But I guess a piece of mind that we can have around IBS and that functional bowel disorder is that bit of closure around at least physiologically, you know, we're not doing any real harm or damaging though the symptoms that we're experiencing can be very unpleasant. You know, we can really think about then how we can change treatment and intervention and to support the symptoms.

but we're not too concerned in terms of that, like I said, that physiological structure sort of damage and the risks with those types of conditions there with the bowel.

Jono (02:41.286)

Yeah, it's kind of a bit different too. Yeah, I know, tongue in cheek when I asked what is IBS. But I guess it's a little bit different to a lot of things where we're not really trying to cure it, are we? like, we're very much removing the symptoms and removing the triggers to try and alleviate those things. But yes, like you said, I often like to remind people, clients, if they do want to...

Kat (02:41.696)

in a nutshell. Yeah. Yeah.

Jono (03:05.932)

deal with the symptoms, which is their choice. And especially once we've identified what their triggers are, at least they know they're not, it's not like celiac disease and saying like, just have, you can have a bit of gluten and just deal with it. You know, that's causing physical damage as opposed to this. So what, like, how does it, how does it get diagnosed? What's the process there?

Kat (03:18.081)

Yes, yeah.

Kat (03:23.128)

Yes.

Kat (03:29.526)

Yeah. So you've got to sort of kind of then with IBS is, you know, think about those symptoms to sort of watch out for. And that can be things like abdominal pain, bloating, as I mentioned, sort of those changes to your bowels and distension and wind and with the diagnosis. So really we want to think about an exclusion process first off, if we're thinking about it being functional, or we just want to make sure then that there's no, there's more physiological conditions going on because there is

a really large symptom overlap. you're thinking about bowel changes, abdominal pain, gas, wind, that could be a huge amount of other things as well. So you just want to go through that exclusion process and thinking about red flags, as Jono just mentioned, potential for celiac disease. We could also be looking out for things like nutrient deficiencies on our blood tests. Is there any blood in our stores? Are we opening our bowels through the night?

Do we have a really significant family history of anything like bowel pancreas or celiac disease or anything along those sorts of lines? IBD, is, my God, I've drawn a blank. I'm so sorry. IBD, so sorry, everyone. Complete.

Jono (04:37.696)

Inflammatory bowel disease. I'm only quick on the draw because I've done that. I'm like irritable bowel disease? No, that's not right. So yeah, practice.

Kat (04:49.376)

I'm just having a TIA in the middle of my Pro PM where we're recording this. So I probably need my pick me up. yeah. So IVD and then you're thinking, you know, is it potential for Crohn's or ulcerative colitis? So screening around there, we want to exclude those things. first and foremost, so then we can more confidently think about that functional IVS bowel disorder. Then with that, we're looking to something called

Jono (04:54.783)

Yeah, we should have this in the morning. Sorry, that's my bad.

Kat (05:19.02)

the Roanfall criteria and this is to be done with a medical doctor. whether you're GP and they can do the screen using the Roanfall criteria and what it sort of involves is considering your symptoms that you're experiencing over the week and we're needing to see that over that prolonged timeframe. So you need at least one day a week and it needs to be over at least a three month period and it could be anything from you know experiencing pain or bloating when you open your bowels or that you're having that.

change in the frequency or the consistency of your stool, or it's been going, you know, longer than six months. And then from there, we can think about that diagnosis into one of the four types of IBS, which could be IBS, diarrhea, IBS constipation, IBS mixed, which is diarrhea and constipation, or then there is also IBS unclassified as well. So whichever symptoms you predominantly meet and then the doctor would be able to sort of...

diagnose into one of those criteria.

Jono (06:18.272)

Yeah, yeah. Just to reiterate, your doctor, go directly to your doctor. Do not pass go if you are having any of those symptoms we've just mentioned that and they're concerning or there's been a big shift. Don't book in to see us yet, because we'll just send you to your doctor. Don't book in with any dietician or any nutrition professional whatsoever. Get that stuff checked out.

Kat (06:35.968)

Yes.

Kat (06:43.957)

Yeah.

Jono (06:45.932)

Fortunately, lot of it's rare, you know, the instance of those things, but they are quite serious. So we want to at least make sure that we're not dealing with that. We are dealing with IBS and then we can absolutely sort of take it from there and help with that. Right. So in that instance, I've gone to the doctor, they've been diagnosed with one of the, one of the four different subclasses of IBS. What are some of the

Kat (07:00.044)

Yeah. Yeah.

Jono (07:13.196)

treatments, do those treatments vary based on the type of IBS they've been diagnosed with and based on their symptoms?

Kat (07:19.618)

Yes, so exactly you say that you come to us and we know what your predominant IBS may be, then obviously we want to tailor. There is some overlap, depending what treatment path will be appropriate for you, but also then we want to more specifically tailor it to either the type of bowel movements that you are having or it may just be more pain management and bloating as well. So we're on the topic of

today, which we love to talk about still. So yeah, depending on the type of stool consistency and routine that you're having, you're going to be tailoring your needs, dietary and lifestyle needs specifically for that. I guess, you know, to drop the low FODMAP diet, and that's, you know, another diet that everyone is coming really familiar with. And I think it's really important to re -emphasize that it is a tool, it's an intervention tool that's, you know, used by dieticians.

setting to help understand what potential triggers may be for IBS, but it's necessarily always a first result, even though it can be really effective, you know, in a large cohort of those with IBS. But at the same time, it can be, you know, quite restrictive and we, you know, want to be mindful that we're tailing that nutrition appropriately. And you also want to make sure that you're not going through all those three phases of the FODMAP, you know, and potentially

missing bits here and there and not getting that sort of accurate assessment of potential triggers as well. So really guidance around that is quite important and I think there's a lot of steps we can do. So say your low -flood map, say there's a lot we can do at A and B sort of to support symptoms management and IBS as well before sort of going to the low -flood map. So it does depend on the person and what is going on for them but yes.

Jono (09:12.672)

Yeah. Yup. So yeah, like you said, the low FODMAP diet is pretty awesome, but it's also pretty intense. we want to make sure we've got to do it before we, before we do it. are there any kind of big picture? know there's some going to be some very, some things unique to IBSD or IBSC, which actually I'm now not sure if we've, talked about, but IBSD is just IBS diarrhea predominant.

Kat (09:19.79)

Yeah.

Yeah.

Jono (09:39.85)

I think we sort of mentioned there's the different types, but I don't know if we labeled them as IBSD and IBSC just in case, That's basically what IBSD diarrhea, IBSC, constipation, IBSM mixed. Is it IBSU or is it just IBS? Yeah. Okay. Cool. So those are the subtypes. Are there any things that you would just kind of like straight off the bat be like, look, this is kind of a good idea for anybody suffering from potentially any of these four subtypes.

Kat (09:40.556)

Yeah, yeah, we did an acromo. Yeah, short of it. Yes. Yeah.

Kat (09:49.686)

Yeah, yeah.

Obviously, yeah, it is unclassified. Yeah.

Kat (10:07.948)

Yeah, yeah. So I mean, this may benefit for those without IBS as well, if you're just noticing changes in your bowels where you don't have that IBS diagnosis and those red flags that we sort of spoke about there. But it could just be thinking about how you're planning your day, your meal routine instruction around there, eating regularly, thinking about the portion sizes of meals, not having an extremely large meal and then fasting for eight hours.

through your day, so that kind of inconsistency there. So if we want to think about as well things like our food irritants and triggers, so it might be caffeine or spicy foods, particularly fatty foods if we've had any abdominal procedure like mycolisectomy, which is having your gallbladder removed, alcohol, those elements as well. Being mindful of those, we can see symptom improvement.

If you have a female body and you menstruate, just thinking about hormonal changes that can actually affect our bowels as well. And just not reading in necessarily as much that being a food related trigger and maybe just more overshadowing of what's happening with your cycle. Definitely stress management. So if we're really thinking what's going on in IBS is that visceral hypersensitivity. So what we're meaning by that is that the nerves around the bowel are really sensitive.

to the communication between our gut and brain. So we're thinking about being in a fight or flight response. So that's that sympathetic nervous system. What is happening there is blood is essentially shuttling away from our digestive tract and going to our major organs because we're obviously on response, we're on guard in that more stressful state. And that doesn't really facilitate digestion, which is that parasympathetic nervous system and that rest and digest.

So really supporting stress management allows our body to be in that parasympathetic state, support, rest and digest. We get lots of blood flow to our gut and to help with bloating and pain and digestion and symptoms around there. And then on the individual, again, I guess we can look bit more into different supplements and medications that might be out of support as well.

Jono (14:23.67)

Yeah, yeah, yeah. And other medications and supplements, maybe a little bit more specific to those subclasses. Yeah, yeah.

Kat (14:30.378)

Yes, they are. Yeah, yeah, I wouldn't get broadly say everyone must have this supplement or probiotic or

Jono (14:37.599)

What about like the gut healing ones? Not those? What? Yeah, that's...

Kat (14:41.816)

Collagen? Take your collagen. Collagen, don't want to knock collagen because it does do some great things that we're seeing now, yeah, it's all bone broth. It's not going to fix your IVF. Yeah. Yeah.

Jono (14:55.582)

and yeah, definitely. look, hand up anecdotal evidence. don't have like statistics and facts to back this up. My experience with clients, I would say there's a large majority of people who come to me with suspected food intolerances where it's actually a lifestyle related or incredibly exacerbated by the stuff you were talking about of massive meals, long periods of fasting during the day.

Kat (15:18.946)

Yeah.

Jono (15:22.668)

you know, maybe the components of those meals, lots of alcohol or caffeine or spicy foods. Carbonated beverages, I know can be a really big one. Just as a side note, we're not saying any of those things are bad for everyone, right? Like if caffeine doesn't irritate your gut, like go nuts. Well, you know, not really actually, but you know what mean? If you're like, is spicy food bad for my gut? Absolutely not, but it can be a gut irritant for certain people. But yeah, I would...

Kat (15:30.605)

Yeah.

Kat (15:43.136)

Yeah, yeah, yeah.

Jono (15:52.308)

if you're struggling with these symptoms, like we spoke about, doctor first, then, don't immediately jump to, it's the gluten, it's the lactose, or it's it's a FODMAP or something. Yeah. Yep.

Kat (16:02.37)

Yeah, cut words out. Yeah. I mean, I could really emphasize stress management like my clients that I've seen with IBS who have, you know, either done CBTs or cognitive behavioral therapy. They've worked with the Nerva app for the hypnotherapy and support around there have seen really great results in terms of improvement in their symptoms through stress management. know that their anxiety, you know,

Jono (16:10.02)

my goodness, yeah.

Kat (16:29.792)

essentially just brings on their IVS symptoms. So, you know, can really, really emphasize that one as well. Yeah.

Jono (16:34.41)

Yeah, it's huge.

Yeah. Which sucks even more when the IBS symptoms make them anxious, but for understandable reasons, like, yeah, this cycle. yeah, cool. All right. Let's, let's we've alluded to, there's some differences in treatment between say like the, I will pretty much, I imagine just focus on IBSD and IBSC being the most, the diarrhea and the constipation being the most common. Is that right? They're the most common ones.

Kat (16:39.974)

Yeah, yeah, it's unpleasant to have. Yes, of course. Yeah, yeah. Yeah.

Kat (17:01.698)

Yeah.

Yeah, they're definitely the most common that we see through practice coming in between RBSD and C. There is mix, but I would say still even in the mix you do tend to see leaning a bit more towards one of the other sort of store consistency there.

Jono (17:19.584)

Yeah, gotcha. Cool. All right, well, let's go alphabetically. IBSD, talk me through that. What is loosely, what is it touching off on the stuff we've already, loosely. Talk me through that and what we do about it.

Kat (17:30.954)

Yeah, I know. Yeah. Okay, and that's also reversed alphabetically. So we'll go D then C. yeah, C comes with a little D, but that's all right. We're not here for the alphabet.

Jono (17:41.903)

why did I have, I had just had D and in my brain, but no, yeah. It's all, it's firing on all cylinders today. Sorry, everybody. You could start with IBSD if you prefer, whatever you, whatever. Yeah.

Kat (17:56.97)

Yeah. All right. Yeah. Let's go with the, well, we're on it, but yeah. So IVSD as we've mentioned before is, IVS diarrhea. And again, you know, we're classifying it through the room for criteria, but with that, we're specifically looking for bowels. And, if there's any nurse peeps listening today, or I'm sure others may be familiar with the Bristol stool chart, which

We all love to know how our patients and clients stool consistency is, but thinking about that Bristol stool chart, we're wanting to see in IVSD that's, over 25 % of bowel movements are that type six or seven. So that's that real loose, watery, runny type of diarrhea stool consistency. And then I will also see less than 25 % of their bowel movements between that one or two, which is, you know, hard to pass, dry.

pellets kind of stool consistency. it's that stream of constipation is on the low end and diarrhea is on the higher end. So we can classify IBSD there.

Jono (19:07.41)

I mean, be careful Googling, but if you Google Bristol stool chart cakes, there's some pretty awesome cakes that I've seen made. that's fun. yeah, okay. So you've got that extra layer of classification there and diagnosis, not just the frequency of the symptoms, but also that stool type as well. So what are some things that we can do to potentially reduce

Kat (19:14.23)

Yes. Yeah. Yeah.

Jono (19:37.152)

symptoms slash improve symptoms of IBSD.

Kat (19:39.98)

Yeah, I guess we just want to think about, you know, fibres and then more specifically we can play into the amount of fibre. So if we think about fibre, helps us go to the toilet. So if you're eating a huge amount of fibre, which is really great for us, and we definitely want and need fibre in our diet, but you know, you can have too much of good thing for some individuals.

And then also thinking about, as I mentioned, those types of fibers. So a little bit more on the ratio. We have insoluble fibers and we also have our soluble types of fibers. So what that means is our soluble types of fibers are our five viscous fibers. So they suck up fluid and that's like bananas, oats, psyllium husk, legumes.

and then we have our insoluble types of fibres and they are fibres like nuts and seeds, fruit and veggies with skin on, so that little bit more tougher roughage type of fibre. So in IBSD, you know, once we're sort of confident about the amount of fibre that we're having and you know for a female we want at least at 25 grams a day and for a male we want at least 30 grams a day, but then we can also think about

really optimizing that soluble type of fiber, so that sucking up type of fiber. And while we're focusing on that, if you think about diarrhea being watery and loose, that soluble fiber is going to help to suck up excess fluid, help to thicken up stool, and then also help to slow the transit time of that moving through the bowel, through the colon. So here's one side there in terms of focusing on fibers.

Also think a little bit more specifically into FODMAPs that draw water into the large intestine and that is going to be our polyols, so our sugar alcohols. So here we're thinking that sorbitol, mannitol, xylitol, so anything that ends in an O is a nice little easy cheat sheet into thinking that's a sugar alcohol, that's a polyol, easy. And then as well you know excess fructose, so both of those FODMAPs.

Kat (21:50.882)

Like I said, can draw water into the large intestine and then that can obviously then still contribute to loose running stores. So reducing those, then we're thinking about either reducing that fluid being brought into the large bowel.

Jono (21:59.074)

Hmm.

Jono (22:05.056)

Yeah. So getting that balance, I guess, of the right fiber types for you and your symptoms and not overdoing certain ones like those, the oils, thanks chemistry. Yeah. And so I guess with the similar for, is there a role of that visceral hypersensitivity in IBSD as well?

Kat (22:15.341)

Yes.

Kat (22:27.84)

Yes, yeah, again, it's still that stress management. we're thinking about, you know, that fight or flight response, and that, you know, really sensitive nerves on our guts and that communication between our gut and brain, and that's obviously going to have that effect on our digestion and our stool quality and things around there. So stress management, very important. Yeah, and I guess

you know, how we sort of touched on the low FODMAP as well, you know, that's appropriate. Understanding your low FODMAP triggers is also going to be very beneficial and being able to get a bit of control and understanding in terms of what your symptoms may be triggered from.

Jono (23:09.836)

Hmm. Yeah. Yeah. I find it's so easy to go. I feel like you're flinging back and forth in a pendulum. We're certainly not saying that they're that food sensitivities or tolerances aren't real or don't play a part. that's supposed to be me probably sounding like I'm saying that they absolutely are. there's just that kind of, I guess, layer of, order of strategies that we'd kind of work through, Hey, in terms of the structure of your day and a few other things. And then in the case of IBSD, okay, cool. How much fiber?

Kat (23:20.739)

Yeah.

Jono (23:39.008)

What type of fiber, how much of each type of fiber, that distribution and all that kind of stuff, before going cool, all of that sounding pretty good. We're still struggling. There's probably a food sensitivity here. and so knowing full well that unfortunately the magic pill or the magic powder isn't out there apparently anyway. what are some medications or supplements that might be able to support IBSD management?

Kat (23:50.722)

Yeah, yeah.

Kat (24:07.052)

Yeah. So one that I commonly use in practice with my clients is psyllium. As I said, it's that soluble type of fiber. has that gel forming properties. It's going to help to suck up fluid, thicken stool, slow its transit time. So that could be one supplement. It's also non fermenting. So what that means is that it's obviously not fermenting in a bowel and it's not going to increase, you know, gas production and wind and discomfort around there.

Other options as well as like metacellulose, is also a non -fermenting and oat bran as well. And again, they're going to be that viscous type of gel forming fibres that can be helpful in IBSD. And it can depend on the individual and how severe their symptoms may be for them. Medications might be necessary like loperamide, which is gastrostop. There are

those who really just can't even leave the house, they need to be so close to the toilet so that they can really get on top of their symptom management. Medications might be necessary just to relieve that stress and to be able to participate in life. You need to be to leave the house and go to the shops and I don't think that's too much to expect by any means. So if you're to take Gastrostop for that, I think that's important.

Jono (25:27.862)

Yeah, yeah. Well, and especially like we mentioned, if it helps manage the symptoms, which then helps you reduce some of that anxiety around the symptoms, it might be able to break you out of that loop. Again, talk to your doctor for the medication stuff. Yeah. Cool. So contrasting that with something like IBSC going in reverse alphabetical order, like I said, all along.

Kat (25:39.256)

Yeah.

Kat (25:53.228)

Yes.

Jono (25:56.547)

So that's obviously the constipation predominant IVS. What's the difference in diagnosis pathway there?

Kat (26:03.502)

Yep, yeah, with IVSC, similar, yep, the basis of the room for criteria, but then what we're looking there is essentially the reverse with the Bristol store chart. So we're wanting, well, we're not wanting, but what we will see is 20, greater than 25 % of the store consistency is that type one or two. that hard to pass pebbles, dry store.

And then less than 25 % is that six or seven. So that loose watery consistency, that diarrhea type of stuff. That's what we will commonly see in IVSC.

Jono (26:43.318)

Yeah, like you said, the complete opposite. Okay, so it's handy, easy to remember at least. So, and I guess in terms of treatment from outside of the stuff we've sort of already spoken about for high level IBS, what are some more specific things we can do around IBSC?

Kat (26:45.218)

Yes. Yeah.

Kat (26:56.364)

Yeah.

Kat (27:00.078)

Yeah. So there is that overlap, but we're almost thinking a little bit different way in terms of how we are with IBSD. What we're looking at in terms of IBSC is ensuring adequate amounts of fiber. So as I mentioned, those targets, we know we want at least that 25 grams for women and 30 grams for males, you know, more optimally is going to be that 28 grams sort of threshold. So yeah, checking that we're eating.

enough and the right amount of fiber, so plenty of fruit and vegetables. We know across Australia we are all terribly bad at eating enough fruit and vegetables, so I can pretty confidently say that a large amount of us don't eat enough fiber, so I would say that is going to be quite common along a lot of people, yeah definitely.

Jono (27:44.928)

eat more fiber.

Kat (27:49.45)

And then again, thinking about those types of fibers that's soluble and that insoluble, but more so in IVSC with the insoluble. So what insoluble is going to help to do is going to help to speed up movement through the bowel, that kind of roughage. So that's again, like those nuts and seeds, fruit and veggies with skin on, know, raw veggies, things like that is just going to help to move up through the bowel and help to move things, move stool through.

still soluble does also play a role because soluble can help to soften stool which is obviously also really important to help move through the bowel. So still wanting to make sure that we are getting in soluble types of fibers but as well the role that insoluble will also play. And this could even just look like you know adding in two tablespoons of linseed is something that could be quite effective in helping with belief of constipation.

Next we might want to check in with the amount of hydration. So we're thinking about one of the main roles with the large intestine of your colon, it's to reabsorb water. So if your bowel, if your stool is moving through your bowel and your colon is absorbing all the water out of it but you're not drinking enough, that stool is not going to be moving through, it's going to be drying out and you're not moving it through your bowel. So making sure that you're really getting enough fluid and what that really looks like for most individuals is going to be like 30 to 35.

mils per kilo. So you know a rough estimate is you know around that two to two and a half liters to really make sure that we're getting enough fluids in our day. It could even be higher if you train and exercise or you sweat a lot or anything like that.

Jono (29:34.998)

I guess it kind of makes sense, right? If the colon's job is to reabsorb, like if you're not giving your body enough water in the first place, it's going to scavenge everything it possibly can. so does the, just sorry to jump back. I wanted to ask about the insoluble fiber. Does it kind of like stimulate contraction is like the actual muscular movement. Is that, is that kind of what insoluble you said, like how can extra roughage can help increase the transit? Yeah. Move through faster.

Kat (29:45.304)

Yeah. Yeah.

Kat (30:01.194)

move through the bow, increase transit time.

Jono (30:04.618)

Is it? Yeah. Yeah. Cool. There you go. So we need them all, guys. We can't just pick on one type of fiber. They work together.

Kat (30:07.244)

Yeah, yeah. Yeah. There are more fibers, but we're just not going into them as well in terms of, you know, thinking about our pre -botics, which are what FODMAPs are, but it can be another chart as well for another day.

Jono (30:23.338)

Yeah. Yeah. I mean, we could probably do like an eight part lecture series. We're not going to do that, but an eight part lecture series on, on IBS. we had no, I think else to do. what about, like those gut, stimulants and irritants and things like we talked about the polyols for example, and we talked about caffeine and things that do they have a role in IBSC? Do we have to worry about them here? Or are they okay?

Kat (30:32.982)

Yeah. Yeah.

Kat (30:47.83)

Yeah, nope, still thinking about those irritants, but in terms of using them to our advantage. So utilizing Kathleen, Kathleen, that's my name, Kathleen, not utilizing me unless you want to see me as to work with, yeah. Exactly. Utilizing caffeine as a gut stimulant to sort of help move.

Jono (30:53.389)

Okay.

Jono (31:01.718)

Well, I'm sure you can be very helpful in IBSC as well, but yeah, we'll save that for the end.

Kat (31:13.442)

weight the bowel up, get it moving, moving through the stool, moving for a bowel motion there. And what we sort of touched on in IBSD with the excess fructose and the polio sort of monitoring the removing them from the diet to help, you know, thicken stool. We could almost utilize these in IBSC to, you know, help add hydration to the stool essentially and to help get the stool moving and relieve constipation.

if you know that you are able to tolerate those FODMAPs. So I guess an IBSD, they are FODMAPs we are removing. So we know that's not going to obviously contribute to potential symptoms. Whereas an IBSD, if you're adding in the FODMAPs, I guess you want to be mindful that you may see a symptom response with those as well. it can depend. They could possibly contribute to, yeah, IBS symptoms around

Jono (32:02.498)

So they could have the opposite effect, is that what you mean? If we're not.

Jono (32:08.822)

Yeah, OK.

Kat (32:10.09)

if they haven't completed like the low FODMAP diet or if you know you're in phase two or three maybe trial and reintroducing those first or early to see what the symptoms response will be and maybe you can then continue them on in the diet just for the advantage then of supporting your constipation and your bowel health there.

Jono (32:27.71)

Mm, yep, yep.

Kat (32:30.742)

And I guess we didn't touch on to it then as much in that overall general support that everyone can do to help with their bowels, but just, you know, exercise and a bowel routine, you know, so moving your body, getting movement in each day and sort of, you know, getting out, sitting on the toilet or, know, if you need to open your bowels, don't hold it in, go to the bathroom, your bowels. Yeah.

Jono (32:42.764)

Hmm.

Jono (32:54.026)

Yep. Yep. what do mean by bowel routine? Like, do you mean being pretty structured with the timing of that or the, like the timings of that throughout the day?

Kat (33:02.176)

Yeah, yeah, in the like, so if you, you know, you get up in the morning, you might have a coffee and then just go and sit on the toilet, you know, sit with if you've got a little stool, sit with your feet up and just sit there for even if you don't open your bow, but just sort of get into that routine of, know, stimulating that kind of bowel movement in the morning.

Jono (33:22.21)

Yeah, this I have to every time this comes up, I'm I must mention the squatty potty ad. if you haven't seen the squatty potty ad is the best thing on YouTube. Go watch it. Apparently the CEO was like, we're running this ad and everybody else in the company was like, that's a terrible idea. And he was like stuff you were doing it and they like, I don't know, like 15 times their revenue or something. Cause it's phenomenal. So anyway, go watch the squatty potty ad, but there you go.

Kat (33:28.869)

haven't seen it.

Kat (33:48.459)

Great. I'll link it. Yeah, I'll link it in the show notes. Yeah, great. Very great.

Jono (33:50.678)

Bit of homework for rep. Yeah. We'll put it in the show notes, I guess. We so will. That's the best show note ever. But in terms of, to come back to science, in terms of like medications and stuff, once like we've referred to them, some that can be helpful for our IBSD. What about for IBSC? Are there things we can focus on there?

Kat (34:13.686)

Yeah. Again, psyllium, I love psyllium. I don't know if you have the same. just, think it's so great. I'm a big cheerleader for psyllium. Again, though, can help to soften that stool, which is, know, if you're thinking about your stool being a type one or two, you know, dry, hard, pellety, then, you know, softening that is going to help that move through your colon, through your large testisone. And then,

Jono (34:18.902)

What can't it do? What can't it do? Yeah, yeah, I do. It's just throw some psyllium on it basically, right? Yeah.

Kat (34:43.402)

As I mentioned, know, if you're confident in terms of your tolerance with the FODMAPs of Sorbitol, things like prune juice is going to be really effective because it's a high in sorbitol juice and that's going to obviously help that laxation effect. We can also think about two kiwi fruit. So kiwi fruit contains something called actididin. Actididin? Is that how you pronounce it? Actididin? Yeah, which can help.

Jono (35:07.604)

Actinidin. Yeah, yeah, I think that's it. Yeah.

Kat (35:12.318)

be really effective in helping to relieve constipation and promote laxation. And then I guess, you know, depending on the individual, again, we can think a little bit more about laxatives and if that might be appropriate for the person there to help with their bowel routine. And we'll also just kind of mention our review of medications that you may be on. You also want to think about ones that might contribute to constipation. So whether that's opioids like codeine or endone.

the role that they play as well.

Jono (35:44.726)

Yeah. Yeah. Cool. What about some of the like Benefibre? That's another one that I've got a lot of clients who have been prescribed Benefibre by someone else in their treatment team for constipation. that, yeah, could that be helpful?

Kat (35:56.14)

Yeah. So.

Kat (36:01.386)

And Benafibra is wheat dextrin and it's still, the studies are still limited in terms of its support in IBS and it wouldn't be, you know, a first recommendation that I would suggest for your symptoms around IBS. And again, you know, the same Benafibra as well, you want to think about like those fermentable versus non -fermentable types of fibres and those non -fermentable types of fibres are going to be a little bit more easier on the gut because obviously not going to then contribute to...

wind and gas production and things like that. Whereas you might see with those fermentable types of ones like partially hydrogenated, gum or beta -glycan or resistance types, things like that.

Jono (36:43.35)

Yep. Yep. So don't just throw a fiber supplement on it. Is that what you're saying?

Kat (36:48.203)

Yes, because yeah, there's not just going to be bacteria, unless it's psyllium. I feel like you're probably fine. But no, and I think like the dietary posts, like, you know, like the two tablespoons of linseeds, you know, that's going to give you a good increase in insoluble types of fibers. The two kiwifruit, like these are things that are...

Jono (36:53.098)

Yeah, actually, yeah, that's true. That one just reckless abandon. Just go for it.

Kat (37:10.466)

going to give us other benefits for our health and have other nutrient profiles, but also play a role in terms of increasing our fiber and supporting constipation relief. And then we do have like that, you know, the next line of those non fermentable types of fibers, know, trialing them and really giving it a good amount of time. I've had some clients who were just, I tried it for a week or tried it for a couple of days and I didn't really see that relief and you actually need to give it, you know, a good block of time, you know, two, four, six weeks.

to really reassess if it has been beneficial for you.

Jono (37:45.004)

say that's one of the, for a system that is so, I mean, the whole body is so complex, but the gut is one of those very complex systems. like a lot of people try and treat it very casually or very quickly and they'll quickly remove one food or add one supplement and go, or try the low FODMAP diet, which I don't mean to sound negative towards.

Kat (38:02.627)

Yeah.

Jono (38:11.158)

Like that's a really hard diet to just casually do by yourself. So when I've, when clients have come to me and they're like, I've done the low FODMAP diet, I always have to go, cool. Like talk me through it. What did you do? and invariably they haven't done it very well, just like me, you know, working on my car would not be super helpful, right? Because it's complex and I don't have that expertise. So, I'd say that's probably the biggest take home. want anyone who is struggling with these symptoms to have.

Kat (38:14.285)

Correct. Yes.

Jono (38:40.958)

is to like, A, advocate for yourself, make sure you've gone to the doctor, you've been heard, they've done the appropriate tests, you've got the appropriate diagnosis. And then B, please don't just go to the health shop and buy a gut health supplement or a fiber supplement. Because as you've heard with the process that we go through, the steps, all of the different possibilities, the different subtypes,

Like there's a lot of things in moving parts that could be going on. So, if you don't want to come and see us, that's true. That's totally fine. Like we're gonna take it personally. Hopefully you enjoy the podcast. and if you want to go see another dietician, hell's yeah, do so, but that would be silly because Kat's awesome. and she knows lots about this stuff. so definitely if this is something you've been struggling with, and if any of these things have resonated with you.

Kat (39:11.16)

Yeah.

Jono (39:34.708)

or maybe there's been a bunch of things that you hadn't considered before. flick myself or cat a message. you can find her on Instagram very, very easily. She's a caffeine. mean, Kath, I'm definitely calling you caffeine from now on caffeine, Georgia. I mean, nothing is cooler than caffeine. that's fair. but yeah, send either her or myself a message. We've, can answer any questions that you've got. Have a chat through like.

Kat (39:46.935)

Yeah, hashtag Kathleen. Yeah, that's way cooler than Kathleen.

Jono (40:03.532)

what we might do next. We can't treat your symptoms via Instagram just quietly because again, very complicated, but we'd love to at least help you get clear on what the next steps are. we'll throw some things in that like we'll throw absolutely the squatty potty ad in the show notes. I'll send you a, I'll put Kat's Instagram in there as well so you can find her and all the other posts that she does on this sort of stuff as well.

Kat (40:08.663)

Yeah.

Kat (40:19.842)

Yes, thanks.

Jono (40:30.546)

But Kat, thanks so much for all of your time and your expertise and working us through all of that. There's a lot. There's a lot. Every time I revisit it, I'm reminded of like, yeah, this is not just, I'm a bit bloated. Like, there's a lot. So yeah, thank you. Thanks for your time. Thanks for your brain. And we'll have to get you back on soon. Cool. Thanks Kat. Bye. I don't know why I waved. Like that's not going be in the post.

Kat (40:32.334)

Thank you. You're welcome.

Yes. Yep.

Kat (40:43.532)

Yes, there is a lot. Yeah, it's complex. Thank you. Yes. Yeah. Thanks, Johnno. See ya.

Kat (40:59.045)

You