Abigail is a 33 year old marketing manager for a large manufacturer. Abby describes her job as stressful but she said that she thrives on the stress and adrenaline. Some days she worked 9-5, others she worked 9-9, but she rolled with the punches and loves her job. When she came to my office she looked tired but was still bubbly, she apologized for being a bit late and that work got her distracted from her appointment.
When I asked why she wanted to see a nutritionist, she said that she was looking for help with her digestion issues. Her doctor had recently diagnosed her with IBS and offered to prescribe her some tablets to help get her system working. She took the prescription from her doctor, but after reading up on IBS she decided she wanted a more natural solution to her issue.
I explained to her that IBS was not a disease of the intestinal tissue but it was a functional issue with the muscles of the colon. These muscles can spasm, which can give you diarrhea, or the muscles can contract for extended periods of time, causing constipation. When the muscles relax enough for stool to pass you can start a bowel movement with hard constipation and end with diarrhea.
“That’s it”, she yelled excitedly. “That’s what I have!”
Here's the Bristol Stool Chart in relation to the IBS symptoms.
Ok we have a starting point.
When I asked Abby when this began she said she had always had a level of constipation, especially in her teens, but over the past few years it was getting worse. Upon further chatting I learned that she had been in at least three rounds of antibiotics over the past two years for UTI’s. She ate lunch and sometimes dinner at her desk if not in front of her computer every evening. She liked to cook but since her company was launching a new product on the market, she was burning the candle at both ends she had not time to cook. Her meals were heat and eat microwave meals, take-aways, or delivery. And her symptoms of IBS have flared over the past two months that coincided with the launch of a new product.
Abby’s symptoms were typical of Mixed-IBS: worse with stress, constipation for 5-7 days, cramping abdominal pain, bloating and gas, then when she finally goes to the bathroom its hard rabbit pellets that lead into really loose stool. Headaches would accompany the 7 days constipation, during this time her temper was short and her patience was thin.
New symptoms on top of her IBS was, stiffness upon waking in the morning and after sitting for prolonged periods in front of the computer. Once she got up and moving the stiffness seem to abate. Another annoying symptom was small acne around her jawline started to appear. She hadn’t had that issue since high-school.
Since her promotion to Manager, her exercise routine has also taken a back seat. She used to love to jog, hike and do yoga but hasn’t been able to carve out time to get back into it. I confirmed with Abby that her constipation didn’t always coincide with her monthly cycle - as the progesterone half of our monthly cycle can lead to constipation. That’s more about hormone imbalance with a side of IBS. So I can look at that for future but right now I’m concentrating on her Mixed-IBS symptoms.
I asked Abby about what kind of foods does she craved: crackers, chips, soft pretzels, carrots, apples. I noticed a theme, salt, crunchy and carbs. Which to me means: stress, stress and needing energy.
When I asked Abby if she grinds her teeth, she looked at me astonished, ”My dentist just told me I need to get a mouth guard. How did you know?”
I told Abby that cravings for salty foods is usually a sign of adrenal stress and wanting crunchy foods can be a way of reducing stress. The hard crunching action of the teeth is a form of stress release. As for the carb cravings, our stress hormone cortisol, likes to play with our blood sugar and when that happens, we want more energy, usually in simple carbs. She only craved chocolate when she was about a week away from her period and wasn’t a candy kinda person.
When I asked her about sleep, that seemed to still be on track, she could get to sleep and stay asleep. Only the odd night she might have an issue but that was related performance anxiety before a big presentation. Cool, I’ll work on that homeopathically.
After going through a head-to-toe of symptoms with Abby, it was clear to me that stress was the major factor in her IBS, skin and pain symptoms. Coupled with recent, frequent use of antibiotics that has pretty much decimated her good gut microbes in favour of bad gut microbes. This leads to more inflammation in the gut walls and dysbiosis. The acne around her jawline is an indicator of gut dysbiosis that needed to be rebalanced.
I told her I will look into a treatment plan and homeopathic remedy recommendations for her, but first I needed her to do an honest-to-goodness food journal. I also asked her to put down what she was doing before she ate, and what time she ate. It may seem like a lot to ask someone but it’s important stats to know and see patterns in their eating behaviour. After two weeks Abby sent me her food journal.
Her journal came back with what I expected to see.
Quick foods like cold cereals for breakfast, on the mornings she actually ate breakfast. Lunch could be anywhere from 11am to 2pm, and might be a salad with chicken or burritos which is not too bad, then around 3-4pm came the salty snacks from the vending machine along with coffee, dinner was anywhere from 6-8pm or sometimes just a bowl of cold cereal again before bed. She thankfully loved to drink water and wasn’t a big pop drinker. In her food journal I noticed she drank a large glass of ice-cold water with her meals. Coffee was in a large mug with cream and two sugars.
After reviewing her food journal I put together her nutritional plan.
First things first. Eat regular small meals to maintain blood sugar levels to stop the salty, carb binges. I explained to her that no matter what carb your eating you body still processes it as energy IE sugar. And when you are craving carbs, your body is looking for energy. Take a Sunday to prepare your meals for the week. Use Wed to top up what you need to get you through the rest of the week.
Three meals and 2-3 snacks a day, she needed to make time for her meals and snacks, and eat them away from her desk. Her company had a lunchroom, I advised her to go and meet with people and have some fun conversation over her meals. Stress shuts down digestion and shuts away blood from the intestines and we wanted to increase her digestion and absorption of nutrients. If you find you are going to have a stressful day, make sure the meals you have are liquid, smoothies with protein powder, blended soups with bone broth base. This helps your body assimilate nutrients without having to physically chew them. Blended soups using bone broth helps to heal the gut lining, reducing inflammation and leaky gut syndrome.
Second, cut down to 1-2 coffees a day and before noon. Her afternoon coffee was now an organic green or oolong tea with a healthy snack like hummus and carrots, apple and almond butter. Coffee adds to adrenal stress and removing it completely isn't realistic to do at the off but reducing the amount is manageable.
Third, reduce the water you are consuming with her meals to 4oz to aid with digestion and reduce purification in the gut. Keep up the water, but make it room temperature, with consumption between meals. Keep the ice cold water for before bedtime. That helps reduce hunger and the night time boredom snacking.
Fourth, Increase your fibre to increase peristalsis, or the wave like action, that helps move our food through our system. Increase fruits, vegetables, whole grain carbs and legumes. All of these are help our beneficial bacteria in our gut to flourish and starves the bad bacteria that causes inflammation in the gut.
Now, I am not a fan of psyllium husks and frankly, I never recommend them. They maybe effective at bulking stool to get the system to move but it also putrefies in the gut and has a worsening effect on gas and bloating. Instead I recommend my patients get a 500ml glass jar, 250ml of ground chia, 250ml of ground flax seed, two heaping tablespoons of ground cinnamon, a heaping teaspoon of turmeric and a pinch of white pepper. Shake that up and add a tablespoon of that in a smoothie, on top of yogurt, in a soup. Chia is a great Omega 3 source that can reduce inflammation but it also helps stabilize blood sugar, flax is good for hormone regulation and both help to bulk stool without adding gas and bloating. Cinnamon helps stabilize blood sugar and turmeric with the pepper help with inflammation. Plus it helps to feed the good gut microbes that reduce inflammation and improve gut motility, without the gas and bloating.
Fifth, The biggest change in her diet was for her to go off all gluten grains, corn and cow dairy for a month. These are highly allergenic foods that can cause the contraction of the colon that causes IBS symptoms. Yes, her eyes became saucers and her mouth gaped open when I said this. But after explaining the effect allergenic foods can have on her IBS, she was ok with giving it a shot, and it was only for a month. Plus she really wanted to do this as naturally as she could and was determined to remedy her issue.
Instead she could have whole grain cooked: rices, quinoa, millet, oats. And she could have goat dairy. For her cream in her coffee it was going to be either goat milk or alternative milks like almond, rice or coconut for her coffee and cereal. Most people would probably balk at this, but she was so determined to feel better and get her system back running properly.
For her homeopathic remedies I started her on Lycopodium 200C, 3x/wk for a month to help with gut inflammation. And when it came to the presentation anxiety, I gave her a few doses of Gelsemium 200C to take the night before and the day of her presentation.
For her supplements I had her on a strict plan for at least three months and we can re-evaluate her progress on them at that time.
Supplements for IBS
Last but not least, lifestyle.
Stress was a major factor in all of her issues. IBS has a strong mental emotional connection and helping to alleviate her stress was the last piece to the puzzle. She needs to add some calm to her constant storm. Besides getting her to eat in a calm environment and chew her food completely. She needed to get back to some self care.
Wake in the morning with some gentle yoga, just 10min to start and work her way up to 30min. Take a walk at lunch, this helps reduce stress levels which will help her with her cravings too. Have an Epsom salt bath before bed to wind down. Meditate on the days you can’t do yoga. Only three things can reduce cortisol- sleep, mediation and yoga. Being able to add two practices into your weekly routine is a great way to reducing your adrenal stress. You can add more as time goes on or increase the time of your calming practices. I didn't want her to get on the jogging for now, since that can increase cortisol - keeping to walking is a gentle start.
Remove all blue light devices and get back to reading paper under an incandescent bulb. Blue light devices have proven to reduce our body’s ability to produce melatonin, our sleepy time hormone. I also advised her to buy some blue light blocker glasses for the workday, they are inexpensive and help reduce the body’s melatonin interference.
Try to stop eating by 7pm. This is always a hard one for young executives. Our body is like a computer with different systems what work at different times. If we eat at 8pm and go to bed for 10pm, we are mixing our eating/digestion cycle with our shutting down/sleep cycle. Stopping eating by 7pm allows time for the stomach to digest, and allows the gut to start to absorb and uptake nutrients before we have to start our sleep cycle. During our sleep cycle the body can use those nutrients to help regenerate our cells.
Last but not least. Delegate some work or ask for help. I love the saying “A problem shared, is a problem halved”. There is no shame asking for help, yet we all seem to feel we have failed in some way if we do. We cannot be the best at everything, so finding someone to compliment what you need help with, reduces your stress to your core capabilities. Stress levels are reduced, performance is better, you can concentrate on your job without worrying if your going to make a deadline. You are not alone.
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Abby touched base a couple times during the month to ask a few questions, how to eat and what to cook and I sent her more make ahead recipes to help with her meal plan.
First Follow-up
When I saw Abby a month later, I was pleased to see her looking so chipper.
“You know when you gave me that plan I thought I would be hard but it was easier than I thought. Once I got into the groove. I’m still missing my dairy but I’m not missing bread at all!”
In the month she started her IBS symptoms were hard the first week, but then they eased. By the end of the month her symptoms has gone and she was having a good BM every morning after her coffee (coffee increases peristalsis in the gut, that wave like action that moves food through your system). She felt lighter, had more energy and didn’t feel as stressed. Her skin was healing from the acne and there weren't any active breakouts. The stiffness in the morning or when getting up from her desk, was gone.
She was still working on the lifestyle aspect, but her time to shut work down was getting better. She found at work that it was the small projects she spun her wheels on, so she gladly delegated to an intern and is able to concentrate on the larger projects. This also allows her to take more time for meals and snacks throughout the day.
She is much more conscious of what she is eating due to the gluten and dairy restrictions but she has gotten used to planning her meals. Only a few take-aways now but she enjoys the burritos bowls and not big burritos.
The second week on the homeopathic remedy really helped her IBS symptoms. She has yet to use the presentation anxiety remedy as her presentation is still coming up at a company conference.
Bonus to all of this is that Abby lost 5lbs in the month. She was ecstatic over that.
I had Abby continue on her plan for the next month, except we are now going to add in gluten, dairy and gluten with yeast back into her diet and measure her reactions.
Checking for food sensitivity as her trigger for IBS I had her add in dairy for three meals a day for three days and remove it. She was to see how her body reacted to adding it back in over the week. Remove the dairy and do the same with gluten and then the same with gluten and yeast.
For the first part of the gluten introduction she was to consume: wheat berries, barley, kamut, spelt, whole wheat pasta and flat breads.
Then it was yeast based gluten products she was to consume: pizza crust, bread, buns and beer.
This is the best way to find which food you may have a sensitivity to, and it’s a direct test towards her IBS symptoms.
Second Follow-up It was six weeks before Abby was back in for a follow-up. I almost didn’t recognize her when she walked into my office. She was bright and beaming, so happy to be down another 4 pounds. She said she was able to fit back into pants that she thought she would have to donate to charity. Her skin was clear with only one active pimple on her chin. Her body stiffness was completely gone.
She found that the offending foods was the yeast based gluten and ‘sadly’ dairy. But having whole grain flat breads had no effect on her IBS or her skin. When she introduced dairy she almost immediately had a reaction of cramping and diarrhea, not constipation. It went away after she stopped consuming it on day two, she didn’t want to have any other day eating it.
When she introduced whole wheat grain products, she didn’t have a reaction. No IBS, acne breakouts or body stiffness occurred.
When she added gluten breads, buns and beer, her IBS symptoms came back within hours. And so did the acne and stiffness. I did warn her that maybe wine might be out of the question given it’s a yeast based product, but that vodka, gin and tequila mixed with soda would be a substitute for a libation when needed.
I had Abby continue on the supplement routine for at least another month and after that I kept her on the Genestra HMF Probiotic and CanPrev Women’s Multivitamin to help bridge the gap between her diet and what her body needs.
Abby limited her yeast gluten foods knowing the consequences when she consumes them but it’s few and far between. She still has not been able to go back into dairy but enjoys some goat and alternative cheeses when she wants it. I told her to add in Nutritional Yeast for a buttery flavour when she is making sauces, it's loaded with B12 as well, our energy vitamin. Abby was able to go on her way after six months of her dietary changes and only touches base now and again for menu ideas.