Practical strategies for gut health IBS, bloating and constipation with Dena Norton, RD

This week on The Less Stressed Life Podcast, I speak with guest Dena Norton, MS, RD.  We discuss all things gut health, IBS, and all the symptoms that come with it. Dena shares her strategies for those looking for the basics of good gut health and also those with long-term gut problems in search of symptom relief.

KEY TAKEAWAYS:

• Foundations for gut health
• Defining IBS- irritable bowel syndrome (diagnosis of exclusion)
• Common IBS symptoms
• Root cause approach to better gut health
• Food gut health connection
• Conventional vs Functional approach to IBS
• Role of stress on the gut

SHARED HELPFUL TIPS FOR GUT HEALTH:

• Managing the Brain-Gut connection
• Ensuring good digestion
• Self-awareness
• 10 practical strategies for gut health (how do you eat, bitter foods/teas, gut rest, breathing/stretching exercises, abdominal massage,  toilet stool)
• Advanced strategies after trying basics- root cause approach for supporting good motility long term
• Gut imbalances these tips will not fix
• Finding a provider to really look at the whole picture- labs and symptoms alike

ABOUT DENA NORTON:

Dena Norton, MS, RD is a registered dietitian and Holistic Nutrition Coach with Back To The Book Nutrition, a web site and virtual practice dedicated to helping clients find and fix the root causes of their gut and hormone symptoms so they can get back to life! Dena holds bachelor's and master's degrees in nutrition, and is currently finishing up her functional medicine certification.

When Dena faced HPA Axis Dysfunction, hormone imbalance, and IBS symptoms that traditional medicine couldn't explain or fix, she found answers in the world of holistic nutrition and functional medicine. Her own dramatic recovery opened her eyes to a whole new approach to health and gave her a passion to help others find healing as well.

With over 15 years of experience in both the traditional medical system and the holistic health sphere, Dena now combines all she's learned to leverage the best research-backed and results-driven approaches to help her clients optimize their health. Her work has been featured on Dr. Axe, Prevention Magazine, Fitness Magazine, The Huffington Post, and many others.

WHERE TO FIND DENA NORTON:

https://www.backtothebooknutrition.com/

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https://www.instagram.com/backtothebooknutrition/

WHERE TO FIND CHRISTA BIEGLER:

https://www.christabiegler.com/

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instagram.com/anti.inflammatory.nutritionist/

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Transcript

Dena: (00:00)
But you're manually breaking down the food and that's reducing the burden on that stomach acid on the rest of the digestion so that it has less work to do so you're lowering the burden of digestion, especially if you're in a position where you have disrupted gut function, everything you can do in these ways is helping your body work less. When its burden

Christa: (00:20)
Stress is the inflammation that robs us of life, energy, and happiness. Our typical solutions for gut health and hormone balance have let a lot of us down we're overmedicated and underserved at the Less Stressed Life. We are a community of health savvy women exploring solutions outside of our traditional Western medicine, toolbox and training to raise the bar and change our stories each week. Our hope is that you leave our sessions inspired to learn, grow, and share these stories to raise the bar in your life and home

Christa: (01:02)
Access to functional or specialized medicine testing and standard blood work is a big piece of personalizing care plans to help our clients succeed by getting accounts with multiple labs and ordering and tracking results from many different web portals slows efficiency by bogging us down in admin work. This is why I'm completely obsessed with our podcast sponsor at Ruba health. It's a single portal that allows you to order from over 20 specialty labs in one incredibly simple dashboard, I'm talking less than 30 seconds to set up your free account in about 30 seconds to order the labs you need. All the results are in one place, and I can securely send clients their results with a click of a button. A big advantage for our clients is that standard blood work can be ordered for almost two thirds, less than other direct to consumer lab sites.

Christa: (01:48)
Rupa is a lab concierge. So they send the lab invoices on your behalf of a client pays for their own labs. They help them get set up with a lab, draw, navigate testing questions, and they provide the requisition forms. It's literally a dream. Go sign up for free to help streamline your practice and simplify ordering labs for your [email protected]. That's Rupa health.com and let them know I sent you when you sign up, you can also check out the show notes for this episode for a short video walkthrough of how I use Reba health in my own practice. All right, today, we're gonna talk about this little topic that sometimes is not super popular, but what does it look like if we're not pooping every day? And so Dean Norton has so kindly said, I would love to talk about this topic. And so Gina is a registered dietician and holistic nutrition coach with back to the book nutrition.

Christa: (02:39)
And she works with gotten hormone issues. She has a bachelor's in master's degree in nutrition and is currently finishing up her functional medicine certification. She faced HPA access dysfunction, otherwise more commonly known as burnout, right? Hormone, imbalance, and IBS symptoms that traditional medicine couldn't help her fix. So she found answers in the world of holistic and functional medicine and her own dramatic recovery opened her eyes to a whole new approach of health and gave her a passion to help others find healing as well. She has 15 years of experience in both traditional medical system and holistic health. And she now combines all she's learned to leverage the best of research back and results, different approaches to help her clients optimize their health. She's been featured on Dr. A prevention magazine, fitness magazine, Huff post, and others. Welcome Dina.

Dena: (03:22)
Thank you. Glad to be

Christa: (03:23)
Here. Yeah. So we don't know what the title of this episode will be, but we feel like it's really practical strategies. And like you were saying offline, this is the basics that need to be in place kind of before we get into advanced stuff. Right?

Dena: (03:36)
Yeah. Honestly, I think it's for anyone and everyone truly, because what we're gonna talk about today is the foundations for long term gut health for optimizing digestive function. So whether you're like early days in your IBS or gut symptoms, or whether you're deep in the ditch and doing all the advanced stuff, the things we're gonna talk about today are cheap, easy. You can do 'em today and they matter, they will get you more out of everything else you're trying to do to fix your gut.

Christa: (04:02)
Yeah. Okay, cool. So practical strategies for gut health, which affects everyone. So on that note, since we've already given lip service to the term IBS, let's go ahead and just define that for clarity, because I think if we, if we define it, people may say, oh, well, I might have that garbage disposal. Yeah. Criteria that may apply to me as well. So let's define IBS

Dena: (04:22)
First, right? Yeah. So IBS is irritable, irritable bowel syndrome. It is considered a diagnosis of exclusion. So anytime you hear the word syndrome tacked on the end of something, it's a diagnosis of exclusion, meaning it's a cluster of symptoms. We don't really call it some other definitive diagnosis. It's sort of once we've ruled out everything else, we just call it this because you look like these symptoms, maybe we don't know much else about it. Typically there's not a whole lot. We can do to effectively manage it and fix the root causes from a conventional standpoint. So they kind of like stamp this on you and send you out the door, maybe with an anti-spasmodic maybe telling you take some MiraLax, but there's not a lot of clarity on what causes it, what it really, really is or how to fix it from a conventional perspective.

Christa: (05:08)
All right. So there are, I mean, let's just kind of back up and say, people get this diagnosis, or maybe they don't get this diagnosis because I think there is common, but not normal symptoms. And so therefore someone may not realize that only having bowel moment every three days, one week or the really Mor defined one every two weeks is not normal. I think maybe, I don't know. I'm just probably, if you're listening to this podcast, you're gonna be the more self-aware person. That's the, uh, understanding. So share this with a friend who you may have found out is only pooping every once, every two weeks. But the point is, is that, like you said, this could, uh, impact everyone. So if we think about people who either have the diagnosis or do not, but are having experiencing lack of regular motility, what do you think? Some of the questions that we get the most before we kind of dig into the meat? Like, what are people thinking is the problem, or what are they looking for as like, Hey, I've tried this, but you know, do you have any advice on this? Like what do people ask you as a dietician? Or what kind of messages do you get online from people that are dealing with gut issues first?

Dena: (06:13)
Well, I think the obvious ones are around how to fix the symptoms. Cause that's, what's popping up above the surface, you know, I'm bothering people, I'm constipated. I have diarrhea. I have a lot of pain. I have all this gas I can't get rid of. So a lot of it's about like, how do you fix the constipation? Or how do you slow down the diarrhea? Or how do you fix the gas? And so those are the like symptoms you see on the surface and you know, you and I are more interested in like, yeah, let's put some bandaids on that and make you feel better, but let's look under the hood and like, try to figure out how this happened in the first place what's going on with stomach acid. What's going on with your stress levels. What's going on with all these other things that were brewing under the surface to push you over into these symptoms of, you know, IBS.

Dena: (06:53)
And then I think the next kind of the other group of questions are around foods, right? The obvious mm-hmm thoughts, you know, where people go usually is something's wrong with what I'm eating. I'm either not eating enough of something or I'm eating too much of something that's triggering all these symptoms. And so they start to focus on what they can do with their food to fix the symptoms. I think these are like totally logical responses. Right? Right. We're like dealing with symptoms where that are bugging us every day. And we know that we eat food every day and we, a lot of times see symptoms following foods. So it makes sense that people go here first. And I actually am like one of those practitioners, who's all for it. Like, Hey, do the obvious do a good Google search, try some things boots on the ground every day. Makes sense. Do the 1 0 1 things on your own. But if you're not getting traction, that's when it's time to like look a little deeper and try something more.

Christa: (07:37)
Sure. Yeah, no, I would agree. And I would say what I, that was kind of like the answer I was a bit rooting around for is that people will kind of come to us because the term is dietician. But I think sometimes there is more than what meets the eye there. Like there's gonna be a little more, we offer besides diet changes. Now on that note, I think maybe it might be useful. I don't think this fits, I think this will get lost when we get into the rest of the content. So I think maybe we should actually address what is the conventional approach to IBS or constipation versus the holistic approach. And then the holistic approach will allow us to dive in. So let's just like preface, what does it conventionally look like? Mm-hmm um, if someone ex has experienced this, they may have experienced it already. But if you haven't, we'd like to save you some time.

Dena: (08:17)
Yeah. The conventional approach. This is from my own personal experience and what I hear clients being told by their doctors when they come to me is typically take some sort of over the counter product, usually first to fix your diarrhea or your constipation. So like just take some MiraLax. This is probably just IBS, good luck. Sometimes they might prescribe something like an antispasmodic or a prescription level antidiarrhea to help you even, I guess, more in their minds. And then the other thing that has become more mainstream with conventional recommendations in the last several years is like recommending a low FODMAP diet. That seems to be the kind of the golden boy right now of what should you do with your diet based on conventional medicine advice. So that's what I'm seeing dolled out to people as first line recommendations when they have IBS,

Christa: (09:04)
How do we feel? I know. How do we feel about,

Dena: (09:06)
Yeah. How do we

Dena: (09:09)
I, I, um, you know, I can't argue with the literature, honestly. There's great research showing that you get results when you bring in a low fat diet with a lot of people. Okay. Both diet. Yeah. Yeah. I mean, the research is behind it, short term mm-hmm um, so I'm very, like, I'm very moderate when I talk with people, I'm like, let's talk about the pros and cons, you know, there's probably like some value in this and some value in that, but let's like put it on the table and really decide like what makes sense for you. So the deal with low FODMAP or really most are all other like quote unquote gut healing diets of any kind is that they're very focused on short term symptom resolution mm-hmm and that's great. Like, you might need a dash of that, but it can't be your only strategy and it can't be your forever plan.

Dena: (09:48)
Mm-hmm so that's all fine. And good. If you're gonna do it for a couple of weeks, just to sort of test the waters and see if you get symptom improvement, but at the same time, you need to be figuring out how to get under the hood and see what caused this and how do I reverse that as well? Because the, you know, now we're getting publications, research, publications that confirm what we've been seeing as practitioners all along is that the longer and longer you persist on these restrictive diets, the more and more dysfunction you're, you're really just cutting your nose, spite your face. Basically you're kicking the can down the road and you're getting immediate relief for the sake of long term, like setting yourself back. Yes. So I, I have strong concern with really making that your primary game plan. I don't think that's smart. I think it can be used in the right dose for a short period while you're exploring deeper causes.

Christa: (10:31)
Right. So if you've been doing low map and you saw benefits at the beginning, and now you realize that that it's one too restrictive two, it's not a long term approach. Like we are immediate gratification people. And so, you know, this is getting dolled out pretty commonly, but it's not like you said, a long term solution. And what it's creating is dysfunction, which creates immune dysfunction and, and food sensitivities that are more severe.

Dena: (10:53)
So just, it really breeds that

Christa: (10:54)
Stuff. Yeah. It that's,

Dena: (10:55)
It totally does what it does. Yeah.

Christa: (10:57)
And on that note, so setting the stage, when we're thinking about holistic strategies, we have maybe some diet changes and that may not look like restriction. It might look like stool testing. It might look like different supplement protocols to overcome, you know, as essentially we'll call them shortcuts to the outcomes that we want. So we can talk about all of those things or like all those things in general, but what we were just describing with people getting more and more restrictive really reminds me of this like stress and gut connection. And I think that might be where we should actually start is that's where I see things really getting spiraling out of control is that you do some food changes, you see relief, and then it really spirals out of control. And we just wanna continue to think that food is gonna be the answer. The restriction of food is only gonna be the answer. So let's talk about what happens next with like stress nervous system, nervous system imbalances, and what's going on in the gut and how big of a part does that really play in the overall gut dysfunction, gut health, IBS, bloating, constipation picture

Dena: (11:59)
Mm-hmm , it's huge. It is a part of it for every single person dealing with gut issues, hands down. I think there are some people for whom it's a bigger part, honestly. And usually these people are somewhat aware of this, right? Like, oh, when work stress ramps up, my gut just gets really bad. You know, a lot of people can make this connection at whatever level they can make it, but it's a part for everyone, whether they realize it or not. And so I would say it's not even like important to look at the longer and longer you go with symptoms or when diet hasn't worked. I mean, this has been going on as a piece of it from the very beginning. And that's why I say the stuff we're, you know, gonna talk about today is stuff that everybody with gut symptoms needs to be tending to because if you're not, you're skip jumping over foundations and you're kind of setting yourself back.

Dena: (12:43)
You're not gonna get as much benefit out of the other things that you're trying to do. So the brain gut connection is strong. Obviously that's something that's widely accepted even by conventional medicine at this point. And a lot, a lot of what the brain is doing for digestion has to do with its perception, incoming of what's stressful, what's needed. What's being felt at the moment. The brain is the, you know, receiver of all these signals from our physical senses, as well as from things that we're perceiving with, you know, in other ways. And so it is kind of like sifting through all this and deciding what's needed. Are we needing to send a stress response? Are we needing digestive juices? What are we needing at the moment? And then it dictates down to all these components of our digestive track. Like we need you, or we don't need you.

Dena: (13:30)
We need you to this degree, we need less, we need more. And so if your, you know, brain is busy sifting through things that it perceives as high importance, things like stress of whatever type, um, things like I'm just really busy. And I have a lot of task I need to fire off right now. It is going to downgrade digestive juices. And we have, you know, definitely animal data and some human data confirming this, that stomach acid, digestive enzyme production, bio acid production, all of those drops significantly when we're under chronic stress. For sure. That's very clear in the literature. And then under acute stress, like in the moment right now, today, there appears to be this like variation person to person. There could be an excessive stomach acid in those situations, or there could be a reduction in stomach acid, but for sure the brain is actively affecting digestive juices and is also affecting the muscular motility, the nerve endings that are like signaling to the gut, move things along or don't move things along.

Dena: (14:26)
So there's a lot of input. Chronic stress is also very, very involved in immune regulation. So that definitely comes in as far as, can you fight off stuff in the gut that you should be fighting off parasites and pathogens and whatnot, or can you not? And are you overreacting to things that you shouldn't react to like certain foods? So the brain is key in everything you want the gut to do for you. And if your gut is messed up, in whatever way you really need to be going upstream and really working top down on the brain and on the stress inputs and how it's, you know, responding to all of those.

Christa: (15:05)
So to add onto that, if we have stress in this moment, it's going to suppress how we digest stomach acid, digestive enzymes file, basically how we process and digest food, despite what it looks like on the other end, whether it looks like loose stool, whether it looks like constipation, whether you can even tell or not, because we don't have x-ray vision, as I like to say to clients. And so lack of digestion, as I think one of the most foundational pillars that is essential for long term, good gut health, because lack of digestion equals fermentation overgrowth of things, gas and bloating, et cetera. Like if there's gas and bloating after meals, there's fermentation happening instead of digestion and absorption of nutrients. And once we have less digestion absorption of nutrients, which is part of why we eat and digest and absorb nutrients, the less we have of that. And then coupled with the fact that stress depletes certain nutrients, the less resources when this happens over a long period of time, the fewer resources we have for all functions in the body to work properly. And so it's just like a slow breakdown of, yeah,

Dena: (16:01)
It's a down spiral for sure.

Christa: (16:02)
And usually I would say, you know, the best case situation is when someone comes into our spear and has pretty good self awareness of when symptoms began and very commonly, well, first of all, I've never ever, ever seen an autoimmune flare up or diagnosis that wasn't prefaced by some sort of stressful time of life, but also get dysfunction in general. I very commonly see it happen after college, after certain times of life that are more, we really glamorize stress in our current world is sometimes I've gotten away from even using that term because we have so much unrealized, nervous system dysfunction, you know, even myself, when I've gotten lab data back, I'm like, oh, I should change how I'm doing things regardless. So anyway,

Dena: (16:46)
Yeah, I thought I was managing well, I'm a high functioning stress. Yeah.

Christa: (16:50)
Well, and that actually is, that is a great way to say it. Those have been some of the hardest clients, because if it's unrealized, then you can't address something that's unrealized or someone doesn't think is a problem. So

Dena: (17:02)
Usually those folks are very unaware of the internal dialogue, the constant stress input that's coming from within, from the way that they, you know, actively interact with themselves and their thoughts when you have external stress inputs, a lot of times we can remove ourselves from those or turn things off at certain times, but our internal dialogue and the way we process the world, it's huge for some people mm-hmm . Yeah.

Christa: (17:23)
So we can come back a little bit to, after we get through some of these foundational principles, which I think we'll jump into now, because we wanna go over practical strategies that we should be considering as foundations before you get into that advanced stuff. And then we can give a little lip service to if these things, if you have dried all of these, actually, which doubtful , whenever someone says I've tried everything, I'm like, I doubt it. Let's talk about it. I think it's admirable that you think you've tried everything and that's okay. You know, but there is probably, I, my mantra is that we always have options. So let's get into some practical strategies for gut health or IBS. That can be really helpful.

Dena: (17:58)
Yeah. And there are so many, I have 10 on the list. I cut it down to 10, but there are so many more, but I think simple things, the first few are really geared around, not what you eat, because again, there's a lot of that out there. That could be important too, but we're talking about how, how do you even approach food? How do you eat when it's time to eat? Cuz all of this is signaling to your brain. Are we digesting or are we responding to stress? So I think even before you eat, taking a moment, I mean, I try to tell clients, even if it's 30 seconds, like we all have 30 seconds to take a moment and do some deep belly breathing. And so what this is doing, especially if we're really focusing on letting the abdomen expand and having long slow exhales, even a few cycles of that is what it's doing is it's urging the body, nudging it out of fight or flight or sympathetic dominance and into rest and digest.

Dena: (18:48)
It's just signaling to the brain we're done with that. We're setting it aside for now. We need digestion all hands on deck. And that will start to signal down to these glands, to the musculature, to everything that we are gonna digest now. So you taking a few moments to do deep belly breathing is a great way to set the stage for good digestion. I think number two would be to, don't just jump right into eating after you've done your breathing, take a moment to observe the food and to smell the food. And this all sounds like so small, right? Like eye roll. What's that gonna do? But really when you take in the food visually when you smell the food that does, you know, quote unquote, get the juices flowing. I mean, that's an old phrase, but it's very physiologically accurate. And if you, you know, think of a time where you like walk into your favorite restaurant or bakery or home when dinner's being cooked and just that moment where you're like, ah, it just all hits you and it just smells so good.

Dena: (19:38)
And it kind of takes you in. And if you really listen into your body, you'll, you'll notice there's excess saliva being produced. Your, your mouth will actually be watering. And that is part of your body signaling digestive juices. The saliva itself, you know, has these enzymes that break down carbs and fats. It's getting the ball rolling, ready for. What's about to come in. So you intentionally, even sitting down to a quick lunch, you know, can take a minute to observe the food, to think through it visually and to smell it and to sort of take it in with other senses before you start to eat. So that would be number two. And then the third would be when you're actually eating, taking your first bite, thinking slow down. I mean, most of us are wolfing food without realizing it. You know, we give the obligatory like three chews and a swallow and onto the next bite and we really need to be, I tell my kids all the time, I'm forever saying like half bites, double choose, half bites, double choose.

Dena: (20:28)
You know, we really need like smaller bites, lots and lots and lots of chewing set your fork down, push your plate away, recline a bit, take a moment to chew that until it's pureed. Like everything you eat should be pureed or nearly so before you swallow it. And I, I bet you're not doing that. cause I have a hard time doing it, you know, but chewing slowly and thoroughly. So this manual digestion by the teeth, again, no longer it's in the mouth, the more saliva's being secreted, that's gonna start some of the enzyme breakdown, but you're manually breaking down the food and that's reducing the burden on that stomach acid on the rest of the digestion so that it has less work to do so you're lowering the burden of digestion, especially if you're in a position where you have disrupted gut function, everything you can do in these ways is helping your body work less when it's burdened.

Dena: (21:17)
So chewing well, eating slowly, I think number four would be limiting the fluid that you drink with meals. This would be kind of a small way to, you know, let your body have max potency of its stomach acid. So if we're drinking gobs and gobs of water, we're diluting the pH of our stomach acid a little bit. And that potency of acid, especially if you're someone who has suppressed stomach acid output, and you're just not putting out very much, you want it to be as max potency as it can be as acidic as possible. So don't dilute it with water. So that's gonna help you, especially with protein breakdown to have max potency of your stomach acid. So maybe limiting to three to four ounces with a meal. I think it's easiest when you actually serve yourself that much, don't serve yourself a big glass and expect yourself to not drink at all, serve yourself in a three or four ounce glass with your meal.

Dena: (22:06)
And you know, that's what you're gonna use. So it's basically like wetting the mouth between bites when you need to versus like getting your hydration done with your meal. So limiting fluids with meals, I think would be number four, that could be helpful. Number five would be trying out a digestive tea after dinner. These would be like along the lines of taking bitters. Some people take bitters in the form of supplements. Some people eat bitter herbs and bitter greens with their foods and these things, the bitter flavors of them on the tongue actually sends signals down to our gut to improve release of digestive juices. So they really are signaling mechanisms. Some of them increase motility to some degree. So we're really trying to, again, communicate to the body what we need from it to help it do its job a little better. So there's one that PKA makes pu K K a has an organic after dinner tea.

Dena: (22:54)
I just like the blend there. And I think it tastes pretty good too. So it's got like, you know, F and licorice and a niece. Some of those that are pretty common digestive aids. So I think on top of the fact that the components themselves are digestive aids, just the relaxation of like having a cup of tea after dinner, you know, something about sitting with a warm beverage is just relaxing too, which a lot of us need to take a moment and not like jump right up from whatever we're eating and run off to life. Again, we need to take a moment and let our body process what we just gave it and think through, you know what, we've just done. Let things sit a bit before we jump right back into life. So I think after dinner tea can be nice after one or more of your meals during the day.

Dena: (23:34)
And then especially if you're someone who deals with slower motility, I mean just a hot beverage is a bowel stimulant. I mean, when that heat hits the body, it does send a nerve signal down to the lower bowel to kind of encourage it to release, to make room. So warm things on top of the fact that it has those digestive aids can be really helpful in a digestive tea. So those would be a handful of things about like the moment of eating. How can you approach that and do that better to help your body out? I think some other things that are less focused on that would be like considering giving your gut some rest every now and then, especially if you're someone who feels like the digestive burden is high, your gut's just not processing things. It's backed up. It's bloated, it's gassy. Maybe it's constipated.

Dena: (24:18)
It's like up to its neck and stuff. It needs to process. It's like at work when the papers are piling up and you still only have a certain number of hours in the day, there's just no way. At some point you're gonna finish it, right. There's always a breaking point where too much is too much. And the body's really the same, especially if it's really burdened by digestion. So I think considering maybe weekly, maybe even monthly, you know, it doesn't have to be every other day or something, but taking a break from the burden of putting more and more and more food down and maybe doing like a liquid day where you do bone Bross and electrolyte drinks and clear liquids. It just, just things that are a little gentler, a little easier on the body and see, you know, if that helps you, if that does feel like it gives your body a breather and your symptoms kind of wane a little bit, and then you kind of go back to your norm the next day and it gives you a little bit of relief.

Dena: (25:04)
Maybe that's something you could rotate in. I think, you know, fasting, quote unquote, you can get definitely where you're doing too much of that and skewing things further. And we don't wanna get the body, the gut specifically, but other areas of food, relationship and metabolism and other things on a swinging pendulum, you know, we wanna be careful with how often, and in what way we introduce something like a fasting type of thing. But I think, you know, one day here and there of doing liquids, doing, you know, caloric liquids even can be really helpful to give some people a break. So that's an idea. I think number seven would be, you know, send like specifics of this to clients a lot of times, but breathing exercises that go beyond, like I'm still sitting at my desk or I'm still sitting at the table trying to do some breathing in the right way, but taking a moment to get down on the floor, lie on your back, spread your body out, unbuckle your pants.

Dena: (25:53)
We're really trying to like give the musculature, give the gut itself like room to expand space to do so to kind of flop and fall open. I mean, if you will, that's basically what we're doing. We're trying to like give it some space. We all spend so much time crouched over hunch over physically tense, sitting up in chairs where our physical body is compressed. Our gut is compressed. And so we're just trying to like spread that out, give it some room and then do some of the steep belly breathing again, focused on long exhale. So methods like 4, 7, 8, or similar things like that, where you're really, really focusing on a long, slow exhale. So we're helping the physical digestive tract spread out and expand, but we're also, again, circling back to that nervous system and ushering it out of fight or flight and into rest and digest.

Dena: (26:40)
Interestingly, when I was dealing with IBS years ago as like a young, you know, high achieving dietician, working too hard, giving too much myself, super overstressed, I would have these like, you know, seemingly random, you know, gut cramps. And it would just build and build and build through the Workday, you know, where it was like, oh, I just need to sit down. But I couldn't. And the only thing I knew to relieve it was to like, just get home at the end of the day. And I would lay down on the floor in the living room and I would just do a bunch of breathing. And I didn't even understand the physiology of that at this point. I didn't know anything I know today about the nervous system and the innovation with the gut and all of that, but I just knew that's what made me feel better.

Dena: (27:13)
Finally, at the end of the day, it just didn't even take it all away, but it at least took me down several notches and I could like, huh, regroup. And by the next morning, I was fine after a good sleep, but this sort of laying down, letting the gut expand and doing this sort of deep breathing is really, really a powerful tool in your pocket to help your body kind of unwind and relax. So I think that can be really helpful. You could even layer onto that something like a heating pad or something warm over the abdomen, you know, to kind of just push even more relaxation. So I think those sorts of advanced lie down on your back and breathe deeply approaches can be really helpful. And along similar lines, number eight would be like positions like a lot of yoga positions actually.

Dena: (27:53)
But you know, you could do this. Anytime doesn't have to be in a formal like yoga class or video, but a lot of the yoga positions, like there's one even called wind relieving pose, maybe you've done, you know, but these are great ways to like put the body in a position where it can expel, um, trapped gas, where it can encourage freedom of movement inside the abdomen. So wind relieving pose is one of them tabletop or cat cow would be another, there's a fetal position pose that can work quite well. The Masana squat, which is like a super, super deep squat where your butt's like almost on the ground, but your knees are hiked up when you're standing on your feet, but you're like squatting down deep. That one can be really good for relieving trapped gas and then happy baby is another one. So there are several yoga poses that you can just do these for a few minutes even, and see if they help you.

Dena: (28:39)
But certainly if you're dealing with these things regularly, I would try to be doing these things daily, you know, have some time for some good abdominal relaxation, deep breathing, maybe some yoga positions and see if it helps you, you know, do it for a week or two and see if it helps. I think number nine would be abdominal massage actually massaging. And some people who are tender in that area are like, Ugh, I don't know if that feels, that sounds like it would feel very good, but it can really help to, again, just assist the body because you're gonna use pressure to move gas and to move stool that's trapped. And so you would lie down on your back, ideally for this as well. And you're basically, you can Google this on YouTube. I mean, abdominal massage for trapped gas or IBS, but you're basically gonna take your fist or the Palm of your hand and apply kind of like medium pressure at your right hip bone, that front hip bone, right.

Dena: (29:27)
So bottom right of your abdomen lower. Right. And you're just gonna like push up and then across the abdomen, under the ribcage and then down the left side and then toward the middle, like toward the middle of the pelvis and out. So you're basically just tracing, we're tracing your large intestine. You could use light pressure. And that would actually be more for like simulating lymphatic flow, which also is sort of ging up behind like moving, moving the gut, but medium to deep pressure would be more like actually engaging that colon and nudging what's in there along. And we're, we're kind of simulating honestly what normal motility would be. There are multiple kind of layers of musculature in the GI tract that are always squishing and squeezing and throbbing to move things through. And so we're kind of just like doing that from the outside by doing these, you know, abdominal massages.

Dena: (30:15)
So that can be helpful. You could layer these together, right? You could do the lay down, the deep breathing, the warm heating pad, and then you could do some massage and just see, you know, what it feels like if it helps you. And I think finally number 10 would be like using a stool, using a potty stool. These have become more popular in recent years. You know, it used to be just for our toddlers to get on the toilet. But now, you know, a lot of people are really trying this, um, this is the way like traditional peoples would've gone to the bathroom normally. Right. And so we're kind of just hiking up the knees and putting some pressure in the abdomen to help it to move things along. So you can get a little stool for cheap on Amazon, or you may even have something like that that would serve you at home. I mean, that could help to like position your body where it's easy or to move things out. So there's not so much straining and pressure when you're having a bowel movement, if that's difficult for you. So those 10 things that I think are super simple, people can try

Christa: (31:03)
Today. Yeah. And I wrote, you know, very clearly at the top of my, I always, this is my like brain. I just have to like write while you're talking and am I already have half of this written down? I wrote down how you eat, not what you eat. This is how you, you eat strategies. And so we're having a little bit of a context shift in our brain that how you eat. And because we always think about like, oh, stress, lifestyle, et cetera. Like these are the stressors from how we eat eating fast, trying to eat in fight or flight versus rest and digest, et cetera. Mm-hmm, mechanical digestion. Oh, there's a lot of mechanics here. Right. So I know what you're talking about with the quote unquote Squatty potty discussion or ancestral version of sitting like that. But can you describe that a little bit more if this is the first time someone's heard about

Dena: (31:45)
This? Yep. So these are little stools. Usually they like fit around the base of your toilet. So they might be elevated by six inches or nine inches. And it's just a platform for your feet to rest on. So your feet are not now on the floor when you're seated on the toilet, they're resting on the stool six or nine inches above the floor. And what that does is it, you know, your knees are gonna pop up a little higher in the air, but we're basically just kind of providing a little bit of compression to the abdomen. And so it naturally has a little more force on it to expel things. So the pressure isn't on you to like urge and squeeze and push because that, you know, too much of that can cause some problems. So this is just positioning your body where there's natural pressure and gravity working for it.

Dena: (32:23)
When you move bowel movement. I mean the quick and easy thing to do without buying a stool would be to, you know, you can even experiment with raising like one of your knees and hug it with your left arm, pull your knee up to your left, you know, breast or chest area and kind of pull back on it with your arm to create that pressure on the left side of your gut. Even just pulling that one knee up while you're seated on the toilet to see if that helps put a little pressure on that descending colon, where stool is packed up there and trying to wait to get out. I mean, that'd be a super simple thing you could do yourself, but buying the stool would be just a good like practice, I think, to get in for people who have to push and work to expel bowel movements.

Christa: (33:00)
Perfect. All right. So you just shared 10, essentially mechanical or how you eat for the most part tools that everyone can use for improving gut health. So now let's just give a little bit of lip service to this is a step toward trying all the things, right? Because one thing people may have done is adding things, adding something like MiraLax, adding fiber, which by the way, if we add fiber too fast, we can get impacted and constipated as well. Actually sad reality is like, we tend to go all in on something, but you can actually make it worse in the short term. So just throwing that in there really quick hydration, some of those things can be looked at. And then the next thing people will look at is, is there something in my diet that is creating this sometimes mm-hmm , these are mechanical.

Christa: (33:42)
I mean, again, backing up that digestion is the most important tool. So if we can do anything to help support and improve digestion, it's going to create less immune system dysfunction downstream and create less immune system chaos downstream. So we've talked now about these mechanical, how you eat easy to do things. What kind of problems in the gut would these 10 things? Now, these could be supportive for everything, but what comes after that? Like in our holistic practices that maybe an advanced strategy beyond this, that someone may need. I think we just wanna like spell out that by the way, there are other things that can be going on for sure. Mm-hmm these are the DIY options that you should use, but what comes next after this, for us as clinicians to help someone fix this from a root cost perspective, longer term.

Dena: (34:30)
Yeah. Well, I think what you build on top of this stuff is, especially if you've had symptoms for longer or they're pretty severe, you wanna be trying to get to what caused them in the first place. And so our investigation would usually be like, are you really making enough stomach acid? It might go beyond, you know, the strategies that we've talked about, there may be a reason for that. Maybe you have pylori may be, you have nutritional deficiencies that don't allow you to make stomach acid. We need to figure that out. We need to test for those things we need to bring in, you know, supplemental help or, you know, killing agents or whatever to fix that. That would be one example. I mean, another example would be like, if you're suffering from these symptoms and you have a really entrenched microbial imbalance lower in the gut, in the small intestine or in the large intestine, like a bacterial overgrowth, like a yeast overgrowth, like undergrowth, a good bacteria, highly under recognized cause for IBS symptoms in my experience.

Dena: (35:23)
But if you have these imbalances, the strategies we're talking about today are not enough, very likely. And so we need to test for, and sort of understand what specific imbalance you have so that we can then layer on top of these things, a more targeted approach, whether it's supplements, medications, food changes, all of that. to effectively head on, tackle the imbalance and write that ship. So that would be examples. Or, you know, if you have a leaky gut that's really driving part of your IBS, part of your food sensitivities, we need to shore that up. We need to lower chronic stress. We need to lower things that we know disrupt the gut lining. We need to bring in supplements that actively rebuild it. We need to do any and all of that to, you know, address that directly. And so usually we're adding on something like testing, like, you know, I do comprehensive stool testing for so many people and it's really helpful.

Dena: (36:11)
And that can be kind of your next level of naming the specific imbalances that are going on so that you can add a more targeted approach to address those while you're also tending to these foundations. But I, I don't know if you've seen this Chris, but like the longer and longer, the deeper and deeper I go into gut work, you know, and then usually the more and more people you help, the more and more complex people come to you. And so, you know, I mostly see at this point, like really complex long term gut cases. So they're way beyond, Hey, buy a potty stool and you know, everything will be fixed for you. But the more of that work I do, the more I actually appreciate how important these foundations are because so many people are desperate and in pain and they want relief from something big.

Dena: (36:55)
And it's important to go there and have someone who can guide you through those more advanced tests and protocols and all of that. That's really critical. But if you're skip jumping over this stuff, cuz it does not seem that important or cuz it takes, you know, a few extra minutes of your time throughout the day, you are not gonna get as much out of those other things because the things we've talked about today are the long term strategy to help your body do what it was designed to do well. And if you're just ignoring that and looking to some medication or supplement protocol to get you out of the ditch, you know, you're calling in the toe, but then, you know, you're trying to run on four flat tires and you're just not gonna get very far basically.

Christa: (37:32)
Yeah. I want to mention something that I'm seeing that kind of piggybacks on you saying I'm seeing more complex issues. So, and I appreciate that. You didn't mention you didn't name comprehensive stool testing. One thing I'm kind of hesitant to do at this point, because this is what I'm seeing in practice is name. I'm happy to tell people what I use in practice. I have no problem with that. What I think is the issue is that people go and pursue these tests or maybe get different tests. And some of them are not very good. Sometimes they get a good test, but the interpretation and intervention is poor. And so I get on my doorstep is like I've done. They truly have done the right things. Totally kind of the right things. Right. They were definitely on the right track, but did not get results. And my conversation that I'd like to bring to this is that that is an unfortunate problem.

Christa: (38:22)
And I have a lot of empathy for it. And I think all failures are lessons. And so we can only take why that didn't work, unravel it and like go through it. So usually in that case, I'm like, please send me those results before we talk about this, then tell me what you did. And then hopefully I can see the holes in what you did very quickly. Right? That's what I want to do for someone like, oh, you had an ineffective protocol. That's a really common situation. Or someone is just treated by the test. That's so inappropriate. Right. And that's what happens conventionally all the time. Not that we're, I'm not, I'm not trying to pick on anyone, but that's what it's, you know, that's reason that people have normal test results and don't feel good, right. Is because the test says it's fine, but the symptoms clearly do not display that things are fine.

Christa: (39:02)
And so that's kind of the epidemic. , that's the gray area epidemic that we have now. So I just wanna mention that people could be doing holistic type strategies. They can be taking the right tests if they're not being successful and it's not okay, I'm sorry that it hasn't been successful, but unfortunately as more and more people adopt these things in practice, um, you know, there's gonna be a gap in how everyone practices and experience matters. And so you wanna just make sure that you're being treated by your symptoms and not just your test and you wanna make sure you have effective protocols. And so alls we can take from every experience is that if something doesn't work, let's make sure we do something different next time and do a better job next time to get results. And so I just wanna mention that because I'm sure that it applies to some people listening to this and I've it's, I mean, we did some marketing recently for our food sensitivity program and I just could not believe the number of people that had this exact experience that kind of landed on my doorstep. And so just wanted to mention

Dena: (39:58)
It 1000% agree. And you know, I think years ago, like when I started this kind of work, it was sort of like I was getting people on my doorstep, as you say, from conventional medicine who had kind of been burned that way and the longer and longer I go on and the more complexity I see now I'm getting them, like you're saying from more like a functional medicine or holistic approach, they're falling on my doorstep too. And I think it's just like you're saying, I, I think the downside of the availability and the number of practitioners who are doing this kind of advanced work is that they're not looking at it from an experienced view of understanding the whole picture and gluing it back into the puzzle of the whole person and their symptom picture. They're just looking at the, the values on the readouts and you know, I call it big box functional medicine, but I, I think it's starting to fail more and more people where they're like, oh, it's H Lorre, this is our protocol for that.

Dena: (40:50)
Take these things. Good luck, you know, oh, you also have this, then we'll add on these four supplements that should totally do it. You know, hope that works for you. And like, that's, you don't heal that way. You kill things that way. And that that's a piece of it. mm-hmm but it cannot be about just that. Or you're gonna end up in this spot again. You just don't know how long it's gonna take you to end up there. And I think that kind of approach is why like SIBO treatment and, and other things are, you know, totally have such a terrible recurrence rate. I don't think it's because they're necessarily using all the wrong agents. I think it's, cuz they're looking at the whole thing wrong. They're like zooming in and finding a problem, naming it, one thing and doing a certain thing just for that problem, forgetting that problem developed in the context of the entire gut and not only that the entire person and their life and everything that was going on.

Dena: (41:34)
And if you don't roll it back and look at all of those inputs from a 360 view, you're only gonna get, 'em a few steps down the road, you know, and that's where you get the cyclical recurrence. And I won't say like I bet a thousand and everybody who comes to me in that situation, I know exactly how to fix them, but I do my very best if I know you do to like really time out, zoom out and look at the whole picture. And that's kind of the emphasis of what we talked about today. These things that seem simple and seem small. They're really, really not. I know they're not sexy, but they are critical to how you approach eating and your interactions with your gut and with your whole health. And if you don't really work on that thoughtful, mindful approach, you're not gonna get past this stuff if you don't retrain some of these behaviors. So yeah, yeah, totally. That was my little soapbox that yeah, totally with you.

Christa: (42:23)
Well, and I, you know, as we back up and move on and practice, I'm, I'm aware that maybe there's opportunities to provide mentorship, you know, to try to do what we can in the world to support people because the more longer I've been doing this the longer, I think everyone needs help and support and a holistic STR. Sometimes you have to have some failures to be ready to be all in on all the things. Unfortunately it's kind of human behavior. Mm-hmm yeah. Um, inspiration versus desperation. We're usually desperate before we change. So well, it was so good to talk through all of this with you. So just to recap, because some notes from before and so recapping, we have these basic cheap and easy practical strategies that are going to basically be those what you do every day matters more than what you do every once in a while type approach things, you know, that will compound over time.

Christa: (43:11)
And these are all wonderful things and it would be good to have a list and to dedicate some time on assessing these in our own personal lives. And then some of the things beyond this, that this episode does not cover is those significant bug problems like imbalance of the bacteria, use parasites, et cetera, which we've talked about already, those like longer term gut dysfunction stuff where there's enzymes efficiencies or gut permeability and all of those things and what needs to be done to support and heal that. And then the mechanical issues that you listed, which were hernia, et cetera, or like, you know, essentially resectioned colon and all types of different things. So I mean there's a lot to gut health, right? That's all,

Dena: (43:47)
That's all we

Christa: (43:48)
Have to say. There's a lot to, there's a lot to gut health. So I think it's exciting. There's so much opportunity when we think about it that way, it's not like, oh my gosh, there's so much to do. It's like, there's a lot of opportunity to improve. If you feel like you've addressed one area or a couple facets, there's still a lot of opportunity for things to do and the right combination of things. Um,

Dena: (44:09)
So

Christa: (44:09)
True can help you. So Dina, if you could leave people with one statement today or like partying thoughts, what would you want to tell them? And then where can people find you online?

Dena: (44:19)
Yeah, I think it's just what you said, Christo, which is like, there is so much opportunity here. And so many people are suffering from IBS and really in pain and do feel desperate, but there are a lot of tools in your hand that don't cost much and that you can do if you'll take the time to do them and kind of commit to the discipline of rethinking your approach to your gut health. Um, so there's a lot of hope here I think. And I'll also share with you in case you wanna include it in the show notes. I have a couple of articles about these things. So one is about root causes of IBS. I think it's more than 15 on our list of like, you know, helping people think through what could be the real cause of some of my symptoms and then an IBS tips article with a lot of these and more and a free download called the mealtime checklist that I share with clients sometimes too, just things you wanna check through and think about as you're approaching food, some of which we talked about and a few others.

Dena: (45:10)
So I'll include those links for you in case you wanna share those with people, just more free resources, where to find me online. I'm at back to the book, nutrition on Instagram and Facebook. And then my website is back to the book, nutrition.com. And if people are interested in one-on-one work, I offer a free 10 minute discovery call. You can sign up for that in my social profiles or from any page on my website. And that just lets me kind of hear a little more of your story and give you a really good, honest read on whether I think I can help.

Christa: (45:36)
Perfect. Thanks so much for coming on today.

Dena: (45:38)
Yeah. Thanks for having me

Christa: (45:40)
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