Symptoms associated with the lower GI system are typically gas, bloating, diarrhea, and/or constipation. When these symptoms are chronic and cannot be attributed to disease or physical abnormality, they often get labeled as IBS (irritable bowel syndrome). For the sake of simplicity, this post focuses on the lower GI system. And in particular, calming bowel patterns that are not related to a disease.
A
dietitian that specializes in GI can be helpful in exploring food, behaviors, triggering foods, and intolerances, but please keep in mind that dietitians cannot diagnose a medical condition.A dietitian’s work navigating GI upset is best supported when you either have a diagnosis AND/OR have ruled major medical conditions.
What is “normal?”
The Bristol Stool Chart (see right) is one way to categorize bowel movements in an objective way. But bear in mind that it’s perfectly normal for stool to change AND there can be pretty big variation person to person based on interpretation.
Additionally, it’s hard to define a normal frequency for bowel movements. Bowel movements may happen every 1-3 days. And for some people they may happen multiple times a day. |
Food intolerance are absolutely real and increasingly common! But they are less common than programs like Whole 30 would have you believe. I find many clients haphazardly eliminating foods based on what they read online or following elimination diets that have no scientific evidence. Often food gets blamed before looking at the bigger picture.
Questions to consider…
Any recent changes to your life?Did the symptoms come on sudden or gradual? Did they start after a major life and/or health event such as …
Any one of these events can change the way our bodies metabolize and/or interact with food that have little to do with the food itself.
How often are you eating?I often hear complaints about GI symptoms in the afternoon and evening hours. This also tends to be the time period that people are not eating / drinking and / or experiencing more stress – commutes, family obligations, work meetings.
Going too long without eating and/or getting excessively hungry is a great way to induce bloating and discomfort regardless of what you eat. Combine that with higher levels of stress and it’s a great recipe for stomach upset. |
Are your symptoms clustered or erratic?When I’m talking with clients I’m looking for patterns – are there certain times of day the symptoms are more present than another and what’s happening around those times?
Common patterns clinic include…
These patterns are often situation specific and have less to do with the body not tolerating food and more to do with the situation itself. What’s your stress level?They often refer to our GI system as our second brain (click here for more details). Our emotions are closely linked to the nerves and hormones in our GI system which in turn impacts the speed and comfort of digestion.
Increased stress / anxiety can speed up or slow down peristalsis which result in constipation or diarrhea. If you have a history of anxiety around food or disordered eating, you may experience IBS symptoms that are related to a malnourished / heightened emotional state. Also, stressful times often equate to sudden changes in diet and lifestyle – skipped meals, smaller / bigger portions, different food choices – making some tummies upset. Interestingly enough, research demonstrates that is just as good (if not better) than dietary restriction in IBS. |
Any common behavior / food triggers?
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Have you made any recent changes to your diet?
Here are some common examples I see in clinic:
- “I’m eating healthier” – to many people, this means eating more plant based food (vegetables, beans, fruits, whole grains) which also have more fiber. While high fiber foods have a lot of health properties, they require unique tools compared to lower fiber options. If you make sudden changes, it takes a while for our GI system to “catch up” if you will. Additionally, eating more fiber without getting enough fiber can cause constipation. Ideally fiber is added gradually with sufficient water to keep stool moving.
- “I’m cutting down on sugar” – to many, this means eating more “sugar free” products (eg, sugar alcohols, artificial sweeteners, “sugar free” candy, gum, and ice cream). While these products taste sweet, they can be really challenging for some bodies to digest resulting in bloating and diarrhea – especially when eaten in large quantities.
- “I’m traveling more” – Travel often means eating out more often and erratically. Between heavier meals, long durations between meals, varying meal sizes, irregular sleep, and the stress of traveling, not all bodies adjust easily and sometimes it’s evident in the bathroom.
Some bodies adjust easily to dietary change and others take more time and still others don’t have the capacity for change. That doesn’t mean it’s impossible! But consider the intensity with which you’re changing and if you have introduced any triggering foods.
What if none of these apply to me?
Elimination diets are a process – not a diet. It’s a systematic way of identifying food chemistry that may cause IBS symptoms. You start by carefully identifying a problematic chemistry, removing it for a period of time, and then reintroducing to see if symptoms re-occur. If you find a consistent connection, you may have a trigger! The final list of triggering foods is often quite small so that only a few foods are identified – not entire food groups. Additionally, the foods are often “dose response” – meaning that most people can tolerate a little, but the more they have, the more symptoms they have.
With the exception of Celiac disease, there are few (if any) reliable tests to identify food intolerances (NOT ALLERGIES). Blood tests are often inaccurate (CLICK HERE for a helpful article). Breath tests can give a clue about where to start, but they too are variable and not always available or covered by insurance. So when there’s no test, it’s about experimentation with food chemistry.
There’s a lot to food that common knowledge doesn’t know – it’s best to hire an expert to help guide you and keep you safe. Trying to sort through food without a chemistry degree is like trying to scale Everest without a map, having never walked a mile. You’re better off training and hiring a sherpa to get you there safely.
Kate Scarlata & Lauren Dear
FODMAP dietitians
Moral of the story…
- Check in with your doctor
- Find a local dietitian who specializes in GI (list below) and
- Consider factors that might be causing distress that aren’t about the food