Where To Start With IBS & Chronic Gut Issues

In this episode, Tisha is taking a deep dive into Irritable Bowel Syndrome (IBS). She unpacks what IBS is (and isn’t), the importance of getting a proper diagnosis, and practical strategies for managing symptoms. 

Tisha explores the gut-brain connection, the role of stress, and how foundational habits like mindful eating, hydration, and fibre intake can make a difference. She also discusses the low FODMAP diet, common trigger foods, and the importance of personalizing your approach to gut health.

Tisha shares actionable tips for tracking symptoms, understanding dietary triggers, and when to seek professional help. The episode wraps up with a look at supplements, herbal support, and the value of stress management in overall gut wellness.

Episode Breakdown

02:17  What is IBS? Symptoms, types, and who it affects
06:46  Why diagnosis matters: ruling out other conditions
10:07  The low FODMAP diet: what it is and how to use it
17:27  Gut health foundations: meals, portions, hydration, fibre
24:26  Common trigger foods: coffee, spicy foods, fat, gluten, dairy
29:26  Underlying causes: SIBO, dysbiosis, bile acid malabsorption, gut-brain axis
39:24  Stress and IBS: the mind-gut connection
43:44  Supplements and herbal support for IBS
47:38  Key takeaways and actionable tips

Connect with Tisha
Website: nourishedwithtish.com
Instagram: @nourishedwithtish
TikTok: @nourishedwithtish
Email: hello@nourishwithtish.com

References

Altomare, A., Rosa, C. D., Imperia, E., Emerenziani, S., Cicala, M., & Guarino, M. P. L. (2021). Diarrhea predominant-irritable bowel syndrome (IBS-D): Effects of different nutritional patterns on intestinal dysbiosis and symptoms. Nutrients, 13(5), 1506. https://doi.org/10.3390/nu13051506

Chae, Y.-R., Lee, Y. R., Kim, Y.-S., & Park, H.-Y. (2024). Diet-induced gut dysbiosis and leaky gut syndrome. Journal of Microbiology and Biotechnology, 34(4), 747–756. https://doi.org/10.4014/jmb.2312.12031

Chiarioni, G., Popa, S. L., Ismaiel, A., Pop, C., Dumitrascu, D. I., Brata, V. D., Duse, T. A., Incze, V., & Surdea-Blaga, T. (2023). Herbal remedies for constipation-predominant irritable bowel syndrome: A systematic review of randomized controlled trials. Nutrients, 15(19), 4216. https://doi.org/10.3390/nu15194216

Lacy, B. E., Pimentel, M., Brenner, D. M., Chey, W. D., Keefer, L. A., Long, M. D., & Moshiree, B. (2021). ACG clinical guideline: Management of irritable bowel syndrome. American Journal of Gastroenterology, 116(1), 17–44. https://doi.org/10.14309/ajg.0000000000001036

Manza, F., Lungaro, L., Costanzini, A., Caputo, F., Volta, U., De Giorgio, R., & Caio, G. (2024). Gluten and wheat in women’s health: Beyond the gut. Nutrients, 16(2), 322. https://doi.org/10.3390/nu16020322

The gut‐brain axis in irritable bowel syndrome: Implementing the role of microbiota and neuroimmune interaction in personalized prevention—A narrative review. (n.d.). ProQuest. Retrieved August 13, 2025, from https://www.proquest.com/docview/3195393387?pq-origsite=primo&accountid=13631&searchKeywords=irritable%20bowel%20syndrome&sourcetype=Scholarly%20Journals
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Transcript

 Welcome to Wellness Unpacked. I'm your host, Tisha your gut and hormone nutritionist and TMI bestie. I help people like you to improve their hormones, gut health, and their relationship to food and their bodies using an inclusive and anti-D diet lens. Join me as we deep dive in a conversation about diet, culture, hormonal health.

Sexual health, and let's be honest, the topics that maybe we're too shy to bring up anywhere else, follow me on Instagram at Nourish with Tish and make sure to subscribe to the podcast so you'd never miss an episode. Let's dive in. Welcome back to another episode of Wellness Unpacked. Today we are going to be diving into IBS.

So if you struggle with any gut health issues and you wanna know where to start in your gut health journey, this episode will be for you. So in this episode, we're gonna be specifically looking at IBS, but we're also gonna be talking about foundational things that you can do to support your overall gut health and.

Kind of go over some of the key signs that you're dealing with IBS versus something else, and really look at dietary strategies and how we can manage symptoms with what we eat. This has been an episode that I've been wanting to do for a while now but I'm not going to lie, it's a really daunting episode to do just because there is so much that you can talk about when we're talking about gut health and specifically around IBS.

So. It's definitely going to be a education knowledge packed episode, so definitely a good one to take notes and yeah, this just felt like a really. Really important episode to do because I feel like so many people that I work with struggle with gut health issues. They struggle with constipation or diarrhea and they don't really know where to go with that.

So if you're listening and you're like, yeah, that's me, then hopefully this episode will help you out a little bit. So with that said, I think we're just gonna dive right into it. And yeah, let's get started. So first things first, let's talk a little bit about what IBS is and what it isn't. So when I say IBS, I'm talking about irritable bowel syndrome, and this is now defined as a disorder of the gut brain interaction.

So it used to be defined as a functional gastrointestinal disorder, but now we know there's a lot of research to show that it's really an issue between the gut and the brain. And we're gonna talk a little bit about that and talk a little bit about how. Stress and how mental health can really impact overall gut health.

But essentially that is what it is. And one of the key signs that is IBS versus something else is that it is characterized by abdominal pain that's associated with going to the bathroom or with change in bowel habits. So either. You're going more often than you used to, less often than you used to.

Or having like major changes in the consistency and the. Form of your stools. And actually that reminds me this episode we are gonna be talking a lot about poop. So brace yourself, lock in. Yeah, so about five to 15% of the population of the Western population struggles with IBS. This predominantly affects women, but it really can affect anybody.

We just tend to see it a lot in women, and in fact, I see this a lot with people that come to work with me for hormone related issues that they're also struggling with IBS with gas and bloating and issues going to the bathroom and having regular bowel movements. There are four different types of IBS based on the Rome four criteria which is the gold standard for the gold standard criteria for assessing and diagnosing IBS.

So there's IBSC, which is constipation predominant, so that's when you're mostly having constipation. There's IBSD, which is diarrhea predominant, so that's where we're mostly having diarrhea. There's IBSM, which is. IBS mixed, which is where you're having both. And then there's IBS unclassified. So this is like you're having both, but maybe you're having less than IBS mixed.

So according to the room four criteria with IBS mixed, you're having over 25% loose stools and over 25% hard stools. And with IBS unclassified, it's less than 25% for both. So, as I mentioned, it's essentially a condition where you're having abdominal pain at least one day a week. And that's paired with, you know, either needing to go to the bathroom more frequently or having.

Issues going to the bathroom and having issues with the change and form of your stools. And alongside this, you can also experience a lot of gas and bloating and distention. So overall, just it feels really uncomfortable and for a lot of people it creates a lot of anxiety around going to the bathroom or a lot of anxiety around food.

There's a lot of fear that if you eat a certain food that it's going to trigger a reaction. And yeah, this is not a fun place to be for anybody. So we're gonna dive in a little bit about what the causes are, the main causes of IBS. But as a general overview, some of the big root causes are the stress and brain gut connection.

So we're definitely gonna be talking about the role of stress and how that impacts our gut. Dietary triggers are also really big. So whether that be FODMAPs or high fat or spicy foods. And it could also involve some other mechanisms that we're not really sure. How they work or what their role is.

So it could be something like alter GI motility so you're not having food move through your digestive system as effectively as it could be. It might be visceral hypersensitivity, so you're more reactive to certain things that you're eating. It could be something related to dysbiosis, so whether that be sibo, which is small intestinal bacterial overgrowth, and we'll talk.

About that in a little bit or maybe just general dysbiosis. So there, that's changes in the gut microbiome. Which could be related sometimes to food poisoning sometimes just to foods that we're already eating. And essentially we have an overgrowth of bad bacteria that can be impacting overall gut health.

And it could also just be related to dietary habits and environmental factors. So there's a lot of different things that can happen that can potentially trigger IBS in individuals. And something we really wanna talk about right away is if you don't have an IBS diagnosis. It can be really beneficial just to go see a doctor to confirm that that's what you have.

'cause there are a lot of other conditions that can cause these same symptoms, and you just wanna make sure that you're treating them effectively because they'll have different strategies depending on what you have. So for example, if you're dealing with something like dysbiosis, if you're dealing with gut bacteria or an infection, for example. You probably wanna treat that with antibiotics, but if you're dealing with IBS specifically, we really wanna focus on removing trigger foods and improving overall gut function. Right? And. So we definitely wanna make sure that we are ruling out any other potential gut issues.

So that could be celiac disease, so maybe it's gluten that's the issue for you. Or inflammatory bowel disease. It could be food intolerances or any gut microbiome imbalances. And some of the red flags to look for that might tell you that this is not IBS is if you have blood in your stool that could be indicative of something else.

Similarly, if you have anemia that points to potential blood loss. So again, that's probably not related to IBS. If you're experiencing unintentional weight loss or if you have a family history of colon cancer, celiac disease you're. Inflammatory bowel disease or any other GI disorder, it might be worth just getting it checked out and ruling out those other conditions because unfortunately, IVS is often a diagnosis.

Via exclusion. So we often come to the conclusion that it's IBS when we've ruled out everything else that it might be, or most of other things that it might be. And with this said, if you're unsure, if you have IBS, maybe you know you have IBS, but if you're listening to this and you're like, I just have gut health issues and I don't know what, this is something that can be really beneficial right now, is keeping a journal to track your symptoms.

And if you're also able to track food, I. Find that really helpful 'cause you can kind of look for patterns for triggers. You can bring this to a dietician to work with. I know not everybody's comfortable tracking their food, so if that's you, that's totally fine. But it could still be really beneficial to track overall symptoms.

'cause a lot of the times, you know, someone. Might think they're like, well, I think I have pretty healthy gut. You know, like, I think I'm going to the bathroom pretty regularly. I just have gas and bloating. And when you start to actually look at it and write it down, you're like, wait, I'm only going to the bathroom once a week, or I'm going multiple times a day.

And I didn't realize that it's, you know, right after I have my morning yogurt, it becomes an urgent situation. Right. So. It can be really beneficial to just write things down and keep track of what's going on. And this will give evidence that will definitely help you out in the future when you decide if you decide to work with the healthcare practitioner.

It just provides more context, more information, which will ultimately help you in the end. So with that said, let's assume that you have IBS, you know, you have IBS, and you're really not sure on where to start to manage your symptoms. I think one of the first tools that will probably be offered to you, and in fact maybe you're already familiar with it if you have IBS is a low FODMAP diet, and the reason this is often given to clients and patients with IBS is because there's a lot of evidence to support its effectiveness for managing symptoms.

So if you've never heard of a low FODMAP diet. It's essentially a diet that is low in fermentable fibers that cause these symptoms related to gut health. So it stands for fermentable, oligosaccharides, disaccharides, monosaccharides, and polyols. But essentially what we're talking about is fiber foods.

But specifically fibers that ferment in the gut. And so this can cause gas and bloating and abdominal pain, and it can cause urgency and constipation. So this was developed by Monash University and in fact, if you want to learn more about how to incorporate a lo thumb map diet into your life, they have an app.

I think it's. Just called Monash University is the app and it walks you through what foods are low fodmap, what foods are high fodmap, and how to start and navigate this diet because I'm not gonna lie, this diet is a pretty intense strategy. If you struggle with gut health, if you struggle with IBS because you have to remove a lot of food.

And there's also a lot of confusion around this diet. I think a lot of people have the experience where they go to a doctor, the doctor says they have IBS and they give them a handout of high FODMAP foods and they're like, don't eat these. And that's the end of it. And that is not at all how the low FODMAP diet is meant to work.

In fact, you are not meant to be on a low FOD MA diet forever. And I think this is a huge. The thing that happens when people are told they have to go on a low FODMAP diet is they assume that this is their new normal and they can never have any foods at all that are higher in FODMAPs. And that's actually not the goal.

And in fact, it's not recommended by anybody to do this long term because as I mentioned. FODMAPs are these high fiber foods. So essentially when you cut them out, you are effectively restricting how much fiber you're intaking. And we know that fiber is good for gut health. Of course, it's good for regularity.

It is, you know, to make sure that you're going to the bathroom regularly. To bulk up stool, but also fermentable fibers specifically are what we call prebiotics. So these are the foods that feed the healthy gut bacteria in our digestive system. So if you are not eating these prebiotic foods, you're essentially starving the good bacteria in your gut over the long term.

You can imagine. That this will have negative consequences for gut health. So we definitely don't want people going on a low FODMAP diet and thinking that this is their new normal, and from this point forward, they can never have high FODMAP foods. And I also do wanna mention too, that with FODMAPs, the dose really is the poison.

And so you'll see if you go on the Monash University website or the app. You will see that certain foods are only high FODMAP if you eat a certain amount. And so that's also important too, right? If you were trying to navigate symptoms, it can be really beneficial to know that sometimes it just matters how much of that food that you're consuming.

And if you're eating a little bit, you know, here and there, it might not trigger symptoms in you. But essentially the way this diet is meant to work is that you are initially meant to cut out all these high FODMAP foods, all these potential trigger foods for a short period of time. So this might depend on yourself, your practitioner what feels best for you.

And as I mentioned, it's a pretty restrictive diet, so not everybody feels comfortable just. Removing all of these foods at once, but essentially you're supposed to restrict these foods and then slowly you're supposed to introduce the different groups. So you start with maybe the oligosaccharides, and then you introduce the disaccharides and then the monosaccharides.

And what you're looking for is to see, are there any. Foods that act as a trigger for you specifically because you might find out that not all of these FODMAPs bother you. It might just be one or two, for example. A lot of individuals with IBS seem really sensitive to onions and garlic. That is often a really big trigger.

So you might do this and realize that that's a trigger for you, but other foods are totally fine and there's no reason to cut them out. So as I mentioned, this is a pretty good place to start for most in individuals with IBS because it's really just helping to manage symptoms. That's the goal of the low FODMAP diet.

It is there to mitigate the symptoms that you're having, right? But it doesn't really get to the root cause of what is going on. It's just taking out the potential trigger foods. And for some individuals, maybe there are foods that you're like, I just don't do well with this. And that is something I know and that's fine.

But I think it's also worth digging in deeper. If you notice that there are a lot of trigger foods, there might be some additional gut support work that needs to be done. Right. And before we move on for the low FODMAP diet, I will say there are some individuals where maybe this diet would not be super appropriate.

So if you are somebody who has a history of disordered eating if you actively struggle with an eating disorder. This is probably not where I would recommend you start just because it can be really triggering to restrict so many options at once. And I also find that for a lot of people. This is not always a realistic thing to do because sometimes this can last weeks months of trial and error and seeing what foods work versus don't work.

And so something that can again be really, really helpful with a low FODMAP diet is if you're keeping track of your symptoms and your foods. You can start to notice patterns especially if you're working with a healthcare practitioner a nutritionist or a dietician, to really go through your food journal and notice if there are certain foods that are potentially causing a reaction in you.

And then maybe it's just easier to start there instead of restricting everything. Maybe we just start with the trigger foods and see how that goes. So those are my thoughts on the low FODMAP diet. I feel like this could be an entire podcast episode just going in how to do this how to make it work for you and tips and tricks.

But for today's purpose, I will leave it there and just remind you that if you decide to go on a low FODMAP diet, please know it's not meant to be forever. I feel like there are people that go on this diet for years and years and. Suddenly become very sensitive to any fiber foods, which makes sense because your fiber tolerance has gone down and then all of a sudden they feel super reactive to everything and it feels like they can't eat anything, and that is never the goal.

The goal with gut health should always be, in my opinion, the goal should always be to make sure that you can eat as many foods as possible with minimal to no reaction. Right? So beyond a low FODMAP diet, what should you be doing for gut health? For IBS, the truth is a lot of what you do for IBS is what contributes to good gut health overall.

So the recommendations don't really shift too, too much. You really wanna start with the foundations of. Gut supportive eating. And so what I mean by this is eating regular meals with moderate portion sizes. So you wanna make sure that you are eating breakfast, lunch, and dinner, and you really wanna avoid undereating and overeating.

So what I mean by this is you wanna make sure that you're not skipping. Breakfast or lunch. These are the meals that people usually skip, so that's why I'm emphasizing we wanna make sure we're eating breakfast, lunch, and dinner. But also you wanna make sure that your portion sizes aren't too big because that can also trigger symptoms, especially for, this is really common in individuals who maybe.

Don't eat breakfast, eat a really light lunch, like maybe it's just a bagel, cream cheese or something, and then have a big dinner and then snack late in the evening. And so essentially what this does is it causes stress on your digestive symptoms. And so it can be much more likely to experience gas, bloating, constipation, and diarrhea.

So you really wanna make sure that you're balancing out your meals and practicing mindful eating. So you wanna make sure that you are eating when you are feeling minimally stressed. So you wanna make sure you're not distracted and you wanna chew your food well. And these are the things that just don't sound super sexy.

You're like, okay, I already know this, but honestly, these steps are. Always, almost always guaranteed to make a huge difference. So really get real with yourself and ask, are you, you know, slowing down? Are you eating your food with awareness to how full you are, to how sated you are? Are you chewing your food properly?

Because that's going to make a big, big difference. And then beyond that, you also wanna make sure that you are hydrating well. So make sure you're getting enough water and we're gonna be talking about this in a second 'cause we're also gonna talk about fiber and the importance of making sure you're getting enough water when you have fiber.

Um, but whether you are struggling with diarrhea or constipation. Both are indicative that you probably need more water, so definitely making sure that you're getting enough water. Aiming for about two liters a day. Coffee does count towards your water intake. I know, I feel like there's a myth that coffee dehydrates you, and while it's true that caffeine.

Is a diuretic, you're getting much more water from your coffee than you're losing, so it is still hydrating. But that being said, for some individuals, coffee can very much be a trigger for symptoms. So it also might be worth it to cut back on how much coffee you're drinking. You wanna keep it under three cups.

And for some individuals they might find that, you just have to remove it temporarily. Maybe it's just not going well. I also know that for some individuals, especially individuals with constipation, that sometimes coffee is the only thing that gets the needle moving and gets you going to the washroom.

And if that's the case, let's just let's keep that it's working. Keep what works, but especially for individuals who have diarrhea, who find that they immediately have an urgent need to go after having coffee. Especially if you're someone who puts cream in your coffee and you notice that, you know, all of a sudden it's a dire situation, you're running to the bathroom.

It might be worth it to take a look at your morning coffee and either reduce it or eliminate it. And you could also see if it's like, maybe it's just the dairy that has to come out. Maybe it's the coffee entirely. Really finding what works for you.  And then the final thing I wanna say is that we really wanna make sure that we are emphasizing fiber, specifically soluble fiber.

So as I mentioned, if you're eating a low FODMAP diet, you're already removing a lot of these prebiotic foods. So as much as possible, we wanna be supporting our gut with good fiber intake and soluble fiber seems to be the most beneficial. So insoluble fiber specifically I think brand is a really big one that people tend to gravitate towards, can actually make IVS worse.

So we want to minimize insoluble fiber. Again, it really depends on the individual. Somebody might have bran, they might have raw vegetables, they might be fine. And then other people it might trigger symptoms. So again, let's go back to that symptom journal. But soluble fiber. Can be really beneficial for both IBSC and IBSD.

So examples of soluble fiber include cilium and Gugu, and these are two that I think are really beneficial to take as a supplement. You know, as much. As much as possible, we wanna be eating Whole Foods. But when it comes to symptom management, I think a, I think a supplement like Cilium or GU Gum can be great.

There's just a good amount of evidence to show that it can help with symptom management for, again, for both constipation and diarrhea. Other sources of soluble fiber that can help include flax seeds and whole foods like fruits, vegetables, and legumes and nuts and seeds, and. A lot of the time it can help to cook these foods because by cooking it, you help to reduce the insoluble fiber that's a little harder to digest, and you increase that soluble fiber that helps to manage symptoms.

And when it comes to fiber intake, we wanna be aiming around 25 grams of fiber for women and 38 grams of fiber for men. And when it comes to fiber intake, you wanna start low and slow. So I know Fiber Maxine is all the rage right now. But believe me, this is something you wanna, like, start slowly and increase over time.

Even when it comes to taking a supplement like cilium, it can be really, you know, you wanna start small, so maybe a teaspoon every day, and then increasing slowly to a tablespoon or 2.5 teaspoons as tolerated. Same thing with water gum. I feel like it's often recommended to just take the full scoop, which I think is five grams a day.

But I think that can be really, that can be really aggressive. So, you know, start with half of that, see how that goes, and slowly increase. I am kind of partial if you were trying to pick between the two of them. I'm a little bit more partial to GU Gum just because you can add it into your beverages without noticing it.

So I find it's a little bit easier to take. That being said, there's so much research behind cilium. Both are really great options and I know Cilium does have flavored, like, you know, Metamucil does have flavors that you can drink. So it really just depends on what is the most effective for you. Some people find one work better than the other, so it really just depends.

And then in thinking about foods that we want to avoid, certain trigger foods. So as I mentioned, coffee can often be a really big trigger food, but so can spicy foods and high fat foods so you don't have to go on a low fat diet if you have IBS. But it might be worth noticing specifically if you have diarrhea that IBSD, that it might be worth it to notice if it's linked at all to higher fat foods, because that could potentially be a trigger.

And then also sugar alcohols can be a big one. So a lot of sugar alcohol. So when we're talking about FODMAPs, sugar alcohols fall into that category as a high FODMAP food. But specifically I want to mention things like sorbitol. That can cause a lot of symptoms and that can be found in like gums and foods that you wouldn't really expect.

So it's always worth it to pay attention to your sugar alcohols. But there are other sugar alcohols that might not cause problems. So xylitol, for example, that's also found in gum and rool, which I feel like is found in a lot of keto baked goods. Those might not cause symptoms for individuals.

So if you're someone who you know, uses sugar alcohols and you're not ready to remove them, potentially consider which ones you're consuming and. See if that's causing any kind of symptoms. And then, yeah, I wanted to also just talk about gluten because I think that's something, when people have gut health issues, the first thing they'd want to do is cut out.

Usually gluten and dairy. And it kind of depends on the individual whether or not that's required. So when it comes to gluten, oftentimes what people are reacting to you in gluten is the FODMAPs. In gluten. So the fiber in gluten, not the protein. So gluten is a protein found in wheat, but a lot of times people are reacting to the fiber in wheat that's causing symptoms.

So a good way to tell. If you are struggling with gluten specifically or if you're struggling with fod, Mavs is to cut out all gluten. And then when you're ready to introduce your gluten, start with low fodmap gluten foods. So specifically sourdough felt bread is a great example because it is still contains gluten, but it's low.

In that fiber, in that FODMAP that can cause symptoms. And if that still causes a reaction in you, then that might be really a, that would be a good sign to me that, okay. Maybe gluten specifically is an issue for you. But if you find you can eat that, no problem, then chances are it's actually the FODMAPs that are bothering you.

And if that's the case, then it's also, again worth another reminder that the dose kinda makes the poison. So even if you are eating a low FODMAP diet, you can still have wheat-based products just in smaller amounts. So maybe one slice of bread, you know, that's cons. Like one slice of wheat bread would be considered a low FODMAP food, or half a cup of cooked pasta.

And if you're like, well, should I just cut out gluten anyways? If, you know, if I am reacting to FODMAPs, like shouldn't I just remove it And. Honestly, it's a personal call, but I would say that I wouldn't, I don't recommend people go gluten-free if they don't need to be, unless there's an underlying issue, unless there's good solid evidence that they would do better without it, just because there is good research to show that over time, eating a gluten-free, gluten-free diet can have a negative impact on good bacteria.

And also a lot of fiber rich foods are found in gluten products, right. Whole grain pasta, whole grain breads, et cetera. And so a lot of times when we eat gluten-free, we are inherently cutting out all this fiber and replacing it with refined sugar. And then the other big one that people tend to cut out when they're dealing with IBS symptoms is dairy and.

I would say that if you're struggling, especially with diarrhea again, it could be really beneficial to go on a low fad, low FODMAP diet. Lactose is high in FODMAPs and lactose is found in, it's a sugar found in milk, so potentially having lactose free dairy might be a better option for you. And it does seem like maybe people with IBSD are more sensitive to dairy, so, and that might not be all dairy either.

You might notice that maybe it's yogurt or ice cream or cream cheese, those specifically can be triggers for you. And if that's case, then yeah, it might be beneficial to remove those foods. So yeah, overall, I guess that's my message, that if a food isn't bothering you. You definitely wanna keep it in because I, I feel like dairy is so beneficial gluten.

Filled foods are so beneficial. So overall, we wanna keep those foods if we're not reacting to them. Okay. So now that we've talked about general nutrition support for IBS, let's dive in to some of the root causes of IBS, and then we're gonna end it by talking about supplement and herbal support, because I think that can also be really beneficial for individuals who are struggling with IBS.

So first things first. Let's talk about some of the key underlying issues that could be contributing to IBS. I think the first one we should talk about is probably sibo. So SIBO is small intestinal bacterial overgrowth, and it essentially occurs when bacteria that normally live in the large intestine move up into the small intestine and cause a lot of fermentation there.

So it can also have symptoms like bloating, diarrhea, and abdominal. And a lot of the symptoms with SIBO are very similar to IBS. So it is really common to have, you know, constipation, diarrhea, alternating patterns, and gas and bloating. And it's worth noting that it's estimated that there's a good chunk of people with IBS that.

Have SIBO as an underlying cause, and there are some estimates that say that's as high as 60% of people, so it could be worth it to get tested for that to rule out sibo. Unfortunately, SIBO is a little bit difficult to test for, so the most common diagnostic tool is a lactulose or glucose breath test, and that measures the hydrogen and methane gases produced by bacteria in the small intestine.

However, I feel like these. Tools often have false positives and so it can be a little bit tricky to navigate and they're not, it's not an easy test to do. And so because of that, I have seen some dieticians who say, if it presents sibo, we'll act as though it is SIBO and see if that helps. And then I've seen other dieticians who say, you really want to make sure you get tested for first for that.

So it kind of depends on the practitioner, I think. But the reason it matters is because the treatment, the. The route you go to manage your symptoms is going to be different for SIBO than it is for IBS. So with SIBO it's typically managed with diet, with stress management, and then maybe medications that target symptoms.

But with sibo, the treatment is largely focused on addressing this back. Arterial overgrowth that's happening in the small intestine. And that's often used, that's often treated with antibiotics. So something like rifaximin is typically used or depending on the practitioner that you work with herbal antimicrobials can also be used.

So something like candibactin oregano oil or berberine, something like that. And then also there's a heavy emphasis on prokinetic to support gut motility. And there's also a lot of emphasis on. Spacing out meals to help with that gut motility. So avoiding, you know, eating your meals. Meals too close together, avoiding snacking because that can cause food to sit where we don't want it to sit and allow that fermentation to happen in the small intestine.

So they present very similarly. But it's really important to make sure that, you know, if you're dealing with IBS or sibo, so you can have a plan that is tailored to you. And in the same vein gut dysbiosis or essentially having bad bacteria or an imbalance of bacteria in the microbiome can also contribute to IVS, but also can present as IV.

S. So there is good research to show that individuals with IBS often have reduced microbiome, microbiome diversity, so they don't have as much variation in the types of microbes in their gut. They also tend to have lower levels of beneficial bacteria, so specifically lactobacillus and bifidobacterium.

And they have higher levels of pro-inflammatory microbes and gas producing bacteria that are linked to bloating and pain. And they also have lower levels of butyrate producing bacteria. And butyrate is a small chain fatty acid. Nope. It's a short chain fatty acid. But it is typically produced by these prebiotic foods that we consume.

So if you're not eating those foods, it makes sense that you would have less of the chfa and less butyrate. And butyrate is important because it actually feeds colonocytes, so it feeds cells in the colon to promote colon health. So one potential cause of gut dysbiosis is food poisoning. So post-infectious IBS.

So essentially what happens is there's this introduction of bad bacteria, so something like bactes or e coli. That is introduced to the gut microbiome, and it can cause problems by releasing toxins, triggering inflammation, or causing damage to the gut barrier, which in turn can increase gut permeability and make us more sensitive to the foods that we're consuming.

So with dysbiosis, this can be a really great time to introduce something like probiotics or fermented foods and herbal formulas to help support the gut microbiome. So we still wanna be focusing on some of these. Gut health foundations that I mentioned earlier. So making sure to eat regular meals, get enough fiber.

I think there could also be a conversation about getting enough antioxidants and decreasing inflammation, but it could also be a really good time to introduce something like a probiotic. And again, probiotics might not be, I think sometimes people think if you're, they're dealing with IBS, we want to jump right to a probiotic, but.

If you're dealing with IBS related to stress and related to our gut-brain connection, a probiotic might not be very effective. And also similarly, if you're dealing with something like sibo, you really wanna prioritize eliminating. Certain bacteria before you focus on introducing beneficial bacteria. So something like an antibiotic would be more effective than immediately diving into a probiotic, which is why a probiotic is not always suitable for all individuals.

But that being said, I always feel like a probiotic never hurts. I think a good rule of thumb if you are interested in trying a probiotic, is take it and notice. I would say take it for a couple weeks, see if it does anything. And if you don't notice any changes, I would essentially remove it. Try again later, maybe.

But if it's not doing anything for you, it's probably not the issue that you're having and so there's no point taking it. And if you're looking for a good probiotic to try, I would probably recommend Bio. Kay. Their IBS Pro, it has lactobacillus in it, it has three different strains, so that one can be really helpful.

Potentially also taking something like Saccharomyces bii. So bui can be really helpful, specifically if you've had food poisoning, if you have any kind of traveler's diarrhea or diarrhea in general or antibiotic associated diarrhea. That might be a good time to maybe try bui. And if you're in Canada, the brand I would probably recommend for that is Flora Store.

Flo Astor. So I think they have their, the Flo store daily and that one is just bui. So that's probably where I would start. So now that we've talked about SIBO and gut dysbiosis, let's talk a little bit about bile acid malabsorption as a potential contributor or, underlying cause of IBS. So bam, as it's known sometimes it's called bile acid diarrhea is essentially a condition where bile acids.

Aren't being recycled properly. So typically bile acids are reabsorbed into the small intestine, but with bam, this recycling process isn't happening. And so these excess bile acids spill into the colon and that can irritate it and cause diarrhea. And I think there's actually a good chunk of individuals who have this and don't realize it.

And by a good chunk, I mean up to 30% of people diagnosed with IBSD may actually have bile acid mal absorption. So typically BAM is diagnosed by a bile acid test, or in some cases clinicians will just give a therapeutic trial of bile acid binders. So these essentially bind to the bile acid so they're not making their way into the colon and causing diarrhea.

And if this makes a difference, then that's a pretty good sign that BAM is the underlying cause. And so again, the reason this matters is because if you're dealing with bile acid malabsorption, your treatment's going to look a little bit different than if it's IBS. 'cause with IBS, again, we're focusing on diet, we're focusing on fiber, maybe some antispasmodics, both.

Bam, we're really focusing on binding these bile acids and reducing the impact that they have, right? So, and that's, that's typically where a medication might come into play. So a good sign that you're dealing with bio acid diarrhea as opposed to IBS, is that a low FODMAP diet just isn't working for you.

So you've implemented it and you still feel like you're going to the bathroom nonstop. Some other key signs are that your symptoms are worse when you have a higher fat intake or that your stools are often very. Malodor, so they're very smelly, or there's an oil slick. Or even if you've previously had your gallbladder removed, that could potentially be a sign that you're dealing with.

Bam, instead of IBS. And if that's the case, like I said. It'll probably be resolved by taking bile acid sequestering. So these bind to the bile acids. And then some other things that can be done is to eat more small frequent meals, which again, is very interesting. 'cause as I said, with sibo, you wanna do the opposite where you wanna have less frequent meals because you want to improve gut motility.

So understanding what kind of gut health issue you're dealing with is. Super important but also limiting high fat foods and taking a soluble fiber supplement. So like we said before, cilium or Gugu can be really helpful with managing bile acid diarrhea. And then the last potential root cause that I'm gonna talk about today is the gut brain access.

So potentially having stress as a root cause to IBS. So as I mentioned previously, our gut and brain communicate with one another. We have something called the vagus nerve, and it's a pathway where not only can the brain communicate with. The gut, but the gut can communicate with the brain. So your stomach can tell your brain you're hungry and your brain can signal to the gut that it is a stressful time.

And digestion is not a primary focus. And as I mentioned previously, whereas before IBS was treated as a functional gut disorder, now we're really viewing it through the lens of how our stress, how our mental health affects overall gut function. So research shows that. Individuals with IBS often have higher rates of anxiety and depression and stress can actually worsen IBS symptoms.

So it can alter motility. So it can either speed up or slow down digestion and it can increase visceral hypersensitivity. And this is how sensitive your gut is to pain. So it can make you more reactive to the foods that you're eating and it can also influence your micro. Microbiome balance and contribute to gut inflammation.

So again, this can go back to increasing permeability in the gut. This can impact our gut barrier which can make us more sensitive to the foods that we're consuming. So, anxiety, depression, stress, and trauma can all contribute to IBS. And I also wanna mention that. So can the medications that are used to treat.

Anxiety and depression. So these can also affect gut motility and can impact symptoms. And unfortunately, IBS can create a bit of a vicious cycle when it comes to stress because it's very common with people who experience IBS to have a lot of stress around eating, knowing that it might worsen those symptoms.

And so. It can almost act as a self-fulfilling prophecy where you feel a lot of stress and anxiety around eating certain foods, and then that stress worsens your symptoms. So not only are you having the impact of the food you're eating, but you're having this additional stressor in which you're anticipating a negative consequence to eating this food.

Right. And stress is also a little hard. For people to pinpoint as a root cause because a lot of times when we're experiencing stress, we don't feel stressed. It's very, very common to normalize your situation and a lot of people who are actually experiencing a lot of stress in the moment are like, no, I don't think I'm that stressed.

And so it can be really challenging to pinpoint. Stress as a contributor to IBS, but some things that can potentially work is including more nervous system regulation. So whether that is cognitive behavioral therapy or working with a healthcare practitioner, or therapist to focus on regulating your nervous system even practicing more mindfulness, yoga anything to manage stress.

I think this would be beneficial regardless of whether or not you think stress is potentially at the root cause of IBS. Just because I feel like most people are dealing with some kind of stress, and again, as I mentioned, sometimes there's just a lot of stress and anxiety around the foods that you're eating.

So sometimes that stress component, even if maybe it wasn't what initially. Was the root cause for your IBS, it might still be an underlying component. And there's also research to show that gut directed hypnotherapy is just as effective as a low FODMAP diet for reducing symptoms in IBS. So it is worth noting that if you're struggling with IBS symptoms, that working on stress levels and on regulating your nervous system, and again, that could look very different for different individuals.

So. It might look like psychotherapy. It might look like acupuncture or meditation or yoga, but just finding ways to invite more calm, and again, when we're sitting down to eat a meal, really trying to make sure that we're not distracted, that we're not feeling stressed, that we're not feeling overwhelmed, and that you're feeling as present and calm as possible to help with overall digestion.

Okay. And then I think the last thing we're gonna talk about today is herbal support and supplements that can help with symptom management. So the first one I'm gonna mention is peppermint oil, just because there is a lot of good research to show that peppermint oil can help specifically with diarrhea because it acts as an anti-spasmodic.

And while you can take it as an herbal tea, it's going to be most effective as an enteric coated capsule, and it is worth mentioning that. Peppermint oil is not recommended for individuals with heartburn or GERD because it can exacerbate symptoms and peppermint oil can just be a really great tool in your tool belt to help with abdominal pain and discomfort.

So it can help to reduce some of that and some of the urgency that's often experienced, that cramping that happens before you have to go to the bathroom. So pepper peppermint oil could be great for that. Okay. Another supplement that can be really helpful is ginger. So typically it's been studied for nausea, but it is anti-inflammatory.

It works as a pro kinetic, meaning it helps to improve gut motility, and it's just good for overall digestion. So it can help with bloating. So for that reason, I think ginger as a tea can be really beneficial. And for individuals who are struggling with constipation, magnesium can be a great supplement to use.

It can be really beneficial to take at night because it acts as a natural laxative. So when you're looking for magnesium, you wanna prioritize something like magnesium citrate, which has a laxative quality to it. Something else that has been researched is eating two Kiwis at night before bed. That can help to encourage a bowel movement in the morning.

So if you struggle with constipation, you know, beyond the usual, increasing your fiber, you know, consuming, chia seeds, flax seeds, cilium or gorg gum potentially eating kiwis and adding magnesium can be really helpful tools in your tool belt. And so lastly, I'm gonna talk about two herbal formulas, which might be beneficial if you have IBS.

So the first one is a burga, and I don't think this was always available in Canada, but it is now, and it's an herbal extract that has a bunch of different herbs, including peppermint, caraway, and licorice, which are all good digestive aids. And it has been shown to be effective in managing IVS symptoms, so specifically bloating, pain, and irregular bowel movements.

So I think that can be a really great one for people to use. And then the second one that I'm going to mention is GI Revive, and this one has not been looked at specifically for IBS. It's used more for overall gut support. But the reason I like it is because it has slippery elm and marshmallow root in it, which are two mucilaginous herbs.

These herbs are really soothing to the intestinal lining, which can be really important if you're dealing with any kind of inflammation. So I like that it also has l-glutamine in it which can be very effective for individuals with diarrhea. So it helps to support the gut barrier and to improve gut integrity.

So I think it can be really helpful for that, and it still has licorice in it and some additional botanicals, like chamomile that can help to support overall digestion. So those are two, if you're trying to think of like where to go with a supplement blend. Those are two additional ones. I will say a barrel gas is just a capsule, which is great.

GI Revive, although I'm a big fan of it, it is a powder formula and it does not taste very great. It is peach flavored and it's something that I recommend you drink, like maybe with juice or something to kind of cover up the taste. It's just my personal opinion. Okay. And I think I'm going to leave it there for today 'cause that felt like a lot of information.

But to kind of summarize what we've talked about today, if you're like, where do I start in my IBS journey? I would say first and foremost. If you can start by tracking your symptoms and the foods that you're eating, this is just going to give you a lot of good insight. It's going to give you a resource to share with your healthcare practitioner, and I think that can be a game changer.

A low FODMAP diet is definitely a great tool to eliminate potential trigger foods, and so if you're looking for symptom management, that can be an awesome place to start, as well as just starting with some good overall. Gut supportive tips. So things like eating regular meals, being mindful of portion sizes and consuming soluble fiber.

And a supplement like cilium or GU gum can be really beneficial. And then of course, you know, potentially ruling out any other underlying causes of IBS. And this is where working with a healthcare practitioner can be really beneficial. To just to make sure that you're getting the right treatment for you and what you need.

And then beyond that, supporting with herbals and supplements as needed. So depending on the individual, I don't always think this is the first line of defense, but it can be, right? Like something like peppermint oil can really help because of that anti-spasmodic quality. It can be a great thing to just be taking right outta the gate.

And similarly with things that are just supporting overall gut health. So something like L-Glutamine or GI Revive, like I mentioned, that's not necessarily getting to the root cause, it's just providing some additional support. Which is great and we love that. So if you have any questions, if there's anything I didn't cover, please feel free to reach out to me.

You can either email me at hello@nourishwithtisch.com or you can DM me on Instagram at Nourish with Tisch and if you'd like to work together to get to the root cause of your gut health issues I'm now working with clients who wanna under one and I'll leave that information in the show notes below.

And yeah, I think that's all she wrote. Enjoy the rest of your day and I look forward to our next episode together.