The Uneducated PT Podcast - #27 Kirsten Jackson - Do you have IBS

Episode Date: April 22, 2024

In this episode of the Uneducated PT Podcast we speak to IBS SIBO and Gut health dietitian Kirsten Jackson about all things Gut Health. Kirsten has been 12 years helping people with IBS and has a wealth of knowledge and experience as a dietitian. You can follow Kirsten on instagram at the.ibsdietitian and go check out her book 'Take Control of your IBS' 

Carson, welcome to the podcast. Thank you so much for having me. I'm really excited to be here. First question, what inspired you to pursue a career in GoHealth and helping people with things like IBS? Yeah, good question because a lot of people want me, they know that I'm a dietitian, so they want this really nice story about how I had gut problems, so became a dietitian because of that. But embarrassingly, I was already a dietitian. Then I got gut problems, and then I was thinking, well, if I can't resolve this,

how is the general public supposed to? Because I was supposed to already have that knowledge. I think it's then when I learned how to apply the science, I realise that actually so many people out there are actually able to read bits of science and things like that, but they can't put it together. And that's what made me very passionate about the area because really it's like it ruins your life

and it's considered this not very serious issue but actually impacts everything. How long of a gap period or a timeframe are we talking about between obviously you being a dietitian figuring out that you have this and kind of actually wrapping your your head around how to to solve this issue? I would say two answers to that question probably. So first of all, I was like first diagnosed with IBS when I was like just qualified. So this is 12 years ago. So very early on. So I've done the four year degree to be a dietitian. I was registered qualified, etc. But probably a good, I'd say two

years but then my other answer would probably be that even 12 years later now I'm still not like I get really good control I know the science of course but at the end of day we're all human so we make slip up so you find out new research or new supplement so I'm always learning I guess as well and what did what in obviously we're going to speak about obviously you've after writing a book about this is there anything that has come up for you in terms of the last two years of writing this book that surprised you in terms of I don't know, hot processes you had about this subject that has changed throughout the work that you did over the last two years of writing it. Yeah, absolutely. So I think, I guess it's the same idea that has developed over probably 12 years, not just two years. But I guess when we think about

IBS and how to control it, everybody, including me as a dietitian, privacy, was very much concentrated on what food causes it, what triggers it, what can we take out, what diet, what restrictive diet can we put somebody on? When actually IBS, when you look at the science, which backs this up, is very much multifactorial. So actually, IBS, your gut's not working properly because of your mental health and your sleep and your movement and probably genetics and other elements. So really the core of this book and everything that I've done with my clients has come from this multifactorial approach where we look at different areas, not just what part of the diet can we take out? What crazy restriction can we add on to somebody? Because that's not really going to get them the results that they need.

So let's say someone's listening to this and they've never even heard of IBS before. Like can you explain essentially what it is and how it impacts people's lives? Yes, so IBS is, it stands for irritable bowel syndrome and it's actually considered a disorder of the gut brain access, which means that the gut and the brain, they actually talk to each other. And so we think people have IBS that this connection is not working. It's malfunctioning essentially. So we don't know exactly what causes it, but we know that there's certain things that are linked to the onset, So things like stress, depression, antibiotics, having an infection in your gut,

always seem to be linked to people starting to have this condition. And the symptoms range from constipation to diarrhea, bloating, abdominal pain, flatulants, which of course all those symptoms people can have from time to time anyway, but these are symptoms that are occurring quite frequently. And it's a chronic condition. So to get diagnosed, you have to have had these symptoms for at least an onset of six months ago, with symptoms being quite frequent within the last three months. So it's not just a, oh, I've been out, you know, on a heavy night out last night

and they wake up and you've got some loose stools. It's a chronic issue that's ongoing as such. Yeah, so it's, it's of what I gather then. So it's difficult to get diagnosed with it. It's not just like people at Google and, oh, I have these symptoms. I have IBS. Yeah, exactly. Because when you actually look at the symptoms, if you look at abdominal pain,

please don't do this because I don't know if you're like me. I do not follow my advice. I was going to Google and just Google what it is. The first thing comes up is like the worst case scenario. And it's the same with digestive problems because actually things like bloating, abdominal pain, constipation, it could be celiac disease or inflammatory bowel disease or even cancer, Crohn's disease.

There's so many things. So of course we need to, when you have those symptoms, let's not guess about it or do a Google, go to the doctor, have those things ruled out. And at that point, if you fit the criteria, then you'll get your IBS diagnosis. but don't do not self-diagnosis because you just never know yeah yeah and here's a question for you is there any cure for ibs no so i say no and yes so no is the official line in that there's no proven scientific cure out there

um as of yet maybe there will be in the future um however we can 100% use things that are based on science to improve someone's symptoms to the point where they can eat whatever they want depending on the person, but that means that we do need to look at their mental health, the sleep, which I'm sure we'll go into in a minute, but other, lots of areas of IBS. And then they are 100% able to manage those symptoms. So that's still necessarily a cure, I guess, but it's also giving people, you know, there is light at the end of the tunnel. It's not, you just now have to come to terms of these symptoms you're going to have forever. Well, I presume that there are people out there who feel like, oh, I'm just always going to feel like this. This is always going to be, and they have

this almost helplessness about what's going on. yeah absolutely and i think it's partly the way it's diagnosed you know you go into your doctors and the way we think about medicine is that we're going to have a test it's like going to be positive or negative we'll get a diagnosis and here's your medicine and that's it it's resolved but with ibs it's quite long drawn out and it's almost like a pat on the back when you've got ibs because it's like oh don't worry it's just ibs you know well done it's not cancer and you kind of come out of that doctor's office thinking feeling grateful because of course you would rather have ibs and something nastier but there's no next step given to us. So often those people are then just left to their own devices,

unfortunately. I know you touched on lifestyle and mental health and them sort of things as well, but in terms of actual diet and specific foods, is there specific foods that trigger IBS? Yes, absolutely. And definitely everybody's different. So don't, with anyone listening to it, don't go and write down notes, but I'll never eat those foods again because these foods are ironically quite good for the gut. So I'll explain it. There's something called Fodmaps, which stands for, and anyone listening to this, you do not actually need to remember this to do the diet if you want to go down that process. But Fodmaps stands for fermentable oligararized, disaccharides, monosaccharides and polyols, which is a huge mouthful.

They're not going to remember that, I don't think. Yeah, I mean, even as a dietitian, I'm struggling to get the big words out here. But long and so short, there are different types of carbohydrates that we find in different foods. And we know that people in IBS, they end up in your large bowel and undigested, which is a bit right at the end of your gut. At this point, you've got your gut bacteria, which is eating it, giving off gas, and also they can draw in a lot of water. So you can get gas, pain, bloating symptoms. So carbohydrates, to answer your question in the first place, are things like lactose, which we found in some dairy products, fruitions, which we find in some products which contain wheat. So gluten, ironically, is not an issue, but it can be the

fructants that's in these foods. Things like fructose, which is in things like honey, mango. So sometimes people will go and have like a big fruit bowl or a smoothie thinking it's good for their gut. And actually it's very difficult to digest. So those are some examples. Sometimes people can be quite sensitive to just fat. So something like fish and chips could actually really set them off because it triggers

their gut to move. But because their guts not working properly, it triggers their gut a lot more than maybe somebody else would. So they then get symptoms. Or it can just be portion size as well. And that's why we're very keen never to put anyone on a very restricted diet. Because if you look at wheat, some people have issues with wheat. But actually it's not an allergy.

It's not a celiac disease in this case. It just could be a portion size. So it could well be they can have a smaller portion. It's fine. But actually the gut just can't cope with a larger portion. So there's a lot to consider that with, I guess, potential intolerances. So it becomes very difficult to just point to figure out, don't eat this, don't eat this,

because it's going to be individual to each person. So I presume like some sort of an elimination diet and then adding things back in slowly is going to be a way in which you'll treat patients. Exactly, which is very tedious and very boring for everybody. But it's the most accurate. So what we do is avoid these carbohydrates for around four weeks. Weight dis symptoms are resolved.

Typically do other things alongside that to improve gut function and then systematically bring each FODMAP back in to find out one is it actually causing an issue. and number two, how much of that food you can have before it becomes an issue. So you get very specific results. I'd say that could be difficult because people find the hard just tracking their food in general, but then tracking their food to then understanding whether they get a reaction or not to it is another layer on top of that.

Yeah, I mean, I say yes or no. So the clients I work with are very motivated. Yeah. So because they've got, it's not just something that they can do later on. They suffer typically with this for years. and also they are spending money with me. So they don't want to waste that, which is like one of the things,

I guess, any coach in lots of different industries of things we bring is that accountability. You've got someone at the end of the week saying to you, show me your diary, what's going on? We've only got 12 weeks together. And that's one of the huge benefits actually of going through.

But it is really tedious doing it. But there is no, unfortunately, shortcut at the minute. Well, I guess it's kind of thing like, well, it's either do the tedious thing or live with these symptoms where it's probably got to a stage where it's like, that's not an option for you anymore. Absolutely. And to be fair, I have talked to people maybe on inquiry calls before,

whether symptoms are sort of milder. And then I've explained that this, what we need to do, potentially, and they're not really interesting. And that's fair enough. You know, they would write, at the end of this is not going to kill you this condition. But people with maybe more moderate or severe symptoms, they're definitely going to want to do this.

Sometimes, like, the pain of change isn't as bad as the pain of, staying the same and until it gets to that stage people won't kind of act on that. What about what about yourself when you were going through to symptoms? Was it a case where it's like, okay, I need to solve this problem right now? Yeah, absolutely. I would say I got to a point. So I didn't obviously just have symptoms one day and be like, right, I'm going to go into this altogether. I think for me it was something that crept up over a period of time and speaking to other people, it's the same. You almost don't realize how bad it's got until it's gone because you start off with kind of mild symptoms and then it gets worse.

And then you start doing things like avoiding social events. And that might just happen maybe one or two times. And then your mental health starts getting affected. And but at first you just think I'm just tired or I'm just. And then you start feeling quite icky about how your body looks and being bloated. So it's a kind of a slow burner. And then typically something happens, whether that's a loved one saying, look, this is ridiculous.

You can't continue like this. Or, you know, something happens in your life. And that's the point where you realize actually I need help with this. and I've gone as far as I can do on my own or you reach out or you have a big overhaul. It's the analogy of the frog and the boiling pot. It's like until it starts the boil and then you're at a stage. It's like, how did I, how did I end up here? Yeah, absolutely.

You touched on lifestyle in terms of impact on IBS. Can you go a little bit into that? What you mean by that? Yeah, so lifestyle can typically be in three kind of categories, I guess. And obviously these overlap. And I'm sure you talk about this all the time. and so one of them is sleep which is hugely underrated and I would say it's actually the one even now mental health used to be more of a taboo and it's coming to more popular we're talking

about it but actually if most of my clients would just go away and have good sleep this is to be hugely impactful for them because if you have not enough sleep that's going to impact how you deal with your mental health and also how bad your symptoms are it's going to change your microbiota for your gut function it could cause inflammation etc etc so that's sleep the other one is your mental health. Of course, because the gut and the brain, they like to talk to each other. So if anyone's ever had butterflies in the tummy

when they get anxious or excited, that is your brain speaking to your gut. So that's that symptom there. But of course, it can manifest into, we are going to cause pain for you or we're going to cause bloating or diarrhea or even constipation because your gut isn't functioning properly. So when you have that argument with your partner,

which everybody does, that's actually going to trigger off symptoms for you or financial issues or, you know, day-to-day things that we have to deal with. So that's another thing. And they're looking at different forms of movement. So I'm not sure if you find this of your clients, but I know sometimes some of my clients,

I don't realize how much they're not moving. And it's not, no one's fault, really. It's this day and age we're sat behind computers. And even I've got clients who are maybe cross-fitters who are hardcore three, four days a week, and the rest of the time, they literally don't move. So it's not necessarily that we need to be in the gym doing hardcore things every day of the week,

but we do need to be moving our body on a regular basis and start to maybe think more about movement rather than just exercise. So really looking at someone overall to get their gut functioning really, really well. You touched on even, you touched on mental health there. Would you say that's like something that would benefit a client of yours who might be really struggling with their mental health for whatever reason, circumstances or otherwise like having a therapist or working side by side with a therapist or a psychologist,

is that something that you recommend? Yeah, so this is something we cover in a lot of depth in the book because obviously it's a huge factor in gut function. And I'd say it really depends on the person because there is no, okay, your mental health is now five out of ten. You should go and see a therapist, unfortunately, it's not that black and white. So really the way I probably talk to my clients, because typically when they see me, they're not seeing anyone else. They're only seeing me to start with. If their mental health is really poor or they've maybe tried other elements, then that's the time to invest in seeing a therapist. However, if someone has got, you know, lots of money is no issue and they have access to therapy, etc,

then even anyone I think would benefit from it. There's no, you know, at that stage. But then as kind of a lower end of the scale, you can actually see a lot of benefit. And this is backed by research, by just doing things like meditation for 10 minutes a day, which you can get from a free app on your phone. If you dedicate yourself to that 10 minutes a day, we can start to see what we call neuroplasticity, which has changes in the brain and how we deal with day-to-day stress, which means your fight or flight response in your body,

your stress response is not going to be as triggered. And then even things that your movement and sleep will then change how much stress impacts you. So there's some interesting research looking actually, and I'm sure everyone can relate to their sleep. If you've had a poor night's sleep, you can find yourself in that stress pathway a lot easier. So that means, say, for example, you're sat in a traffic queue and you set really well last night,

you're more likely to be like, okay, it's fine, I'll get to work when I can, it's fine, it's what it is. But say last night, actually, you step really poorly, you'll find that you're actually starting to get more stressed, and that's going to impact your gut. So it really depends.

Again, I don't know, this is where gut health is a little different, difficult, in that there's no black and white, one size fits all. And sometimes even medications can help with mental health. So things like amytriptylene, which is actually an antidepressant, is routinely prescribed for,

irritable bowel syndrome at a really low dose because we know that it targets the gut brain access. And that surprises people because they go to their doctor with what they see is a very much physical issue having irritable bowel syndrome. The doctor starts talking about what they see is mental health medication and then they shut down. But actually, so there is no one size fits all approach. It really depends on you. And you might if want to try a couple of these things together, try something maybe for a short period of time and then if it's not working, try something else.

whatever you feel is is best for you. So would you say that you could essentially have a client who comes to you with IBS and you change nothing about their diet but you help them to improve their sleep quality, reduce their stress, increase their movement and that could essentially cure their symptoms or reduce their symptoms to have a good quality of life? Yeah, absolutely. So I actually, I might always tell the story. I had a client complaint last year because when they got to the end of it,

they didn't find their dietary intolerance because they're seeing a dietitian, right? So they're expecting me to go, we found it. This is the issue for everything. Now you can just go on with life. And basically when they first started working with me, their lifestyle was all over the place. It was really, really, I'm not going to go into details. Of course, I can't go into someone's personal. But it was really disruptive.

And over three months, we did a few different things with their movement, their sleep over time. It's not an overnight change. And what they found is actually, when they were sleeping really well, most of the time, the mental health was controlled and they were moving every day. Guess what? The gut started functioning so much better. So then they could actually eat a really normal diet. Because there could be so many different factors or to figure out what it is that's really impacting this, does that mean that you have to probably settle out of realistic expectations with clients coming in in terms of when this is going to be

solved? Yeah, absolutely. And, you know, part of it as well is when you've had that first assessment, you're almost starting off with the best case scenario. And sometimes that doesn't even work. And I have to say in a positive way, if something doesn't work, but you're looking at it in a systematic way with someone like a dietitian, then that's actually useful for going ahead

because you can almost cross it off. Oh, that didn't work. Now let's go. Does that, I hope that makes sense. Yeah, that makes sense. Yeah, so it isn't going to happen overnight. But that really helps for people because even little things, for example,

some of my clients with all the messages, we see online they're physically not eating enough calories. So when I ask that person, right, we now need to increase your calorie and take by 500 calories a day, which is quite a lot for that person. We know that eventually they'll feel good. First week, they're going to feel really full, really awful, etc. And so telling them that, really, they're fine with it.

But if you don't tell them that, then it's not going to work out well. Communication with them is going to be key for something like that. Is there anything between weight gain or weight loss and IBS? So there's nothing directly. So IBS shouldn't cause weight loss. And it's one of the things I always ask in my clients because there are some things that mimic as IBS. So there's certain types of cancer. So I do always say, have you had any unexplained weight laws?

However, some people will lose a lot of weight simply because they're not eating because they're so scared to eat different types of food. Or equally, someone might be actually overweight and they struggle to lose weight because they have no energy because of their IBS. They can't exercise. They feel actually quite bad about their body. You know, they don't want to be in a gym. They don't want to be in tight clothes. and then also this is really not fair for them, but all the healthier foods, lower calorie options,

are really high in fibre, bodmaps. So actually what they can eat is really limited. So in those scenarios, you really want to stop any weight loss because that's not good for people if they're having this uncontrolled weight loss, but stabilise that and then really focus on the IBS because as soon as that's controlled,

guess what? If you want to lose weight and suddenly you've got loads of energy and you're able to eat what you want again, it's 10 times easier. You, we were speaking about elimination diets there and taking things out to put them back in. Is there a concern that people will take so many things out of their diets that could have beneficial health outcomes, but because they feel better now after like 90% of their diet out that they don't put these things back in? Yes, absolutely.

And if you look at actually gut function in general, so take away IBS for a minute, all good gut health comes from having variety because your microbiota, which is all your living things and your gut like your bacteria that people are probably heard of by now, that needs to be fed. So if we have a really restrictive diet, especially if we're avoiding Fodmaps, which are actually prebiotics, ironically, then you might feel good to start with because somewhere in that long list of foods that you're avoiding probably is an intolerance or something that's a bit difficult for you to digest. But after maybe six months or even less time than that, people then start to get more symptoms or the gut gets more sensitive because we're not feeding it.

And also, of course, the psychology element of that, the relationship with food is really quite poor. So even when I'm working with someone, they think it says a dietitian, you're going to say, okay, you just have to now eat everything. Off you go. And actually, that's not very realistic. Because even if I sit the other side of that consultation saying, oh, you're fine with that, that, we're fine. That's okay for me to say, but we've got to understand that that person's actually really scared of that. So it's about getting back to a wider variety, but again, in a systematic way, step by step slowly, so that you're as least restrictive as possible. Because I presume that even then that could turn into some sort of disorderly eating. Yep. There's a huge, huge crossover

between disordered eating and IBS and digestive problems in general, but also actually eating disorders. So many clients would previously have anorexia, bulimia, and then suddenly they're having to keep a food diary again. They're having to potentially even weigh out foods. And so lots of things that they're being told not to do because it can be triggering. And that's where really, if anyone's in that, I wouldn't even let them in my group program. That's something they would need to do one to one. So you can really step by step, hold their hand to just make sure you're not causing more problems to get out of that situation. That makes sense. You spoke a lot about even the goat and the brain. Is there any link between good health and depression and anxiety?

Yeah, massively with that. So there's actually some very small amount of research showing that probiotic potentially can help, not enough to yet recommend them. So we're hoping that will help in the future. So probiotics are live bacteria that you can take as a supplement. Then the other element is the Mediterranean diet. So I'm sure people are familiar with this, but something that is based on Mediterranean, so oily fish,

having whole grains, having a variety, we know that that has been shown to really improve people's mental health. So again, that's something we'd always recommend, not just for gut function, but also mental health as well. And then looking at the other connections that can happen. So if someone's experience, for example, pain or symptoms digestively, that will impact their mental health. So there's connections kind of either way. I think I've heard a couple of dietitians speak about how the research on good health is is quite minimal compared to other areas of a diet. Is there any reason for that?

Yeah, so it's quite difficult to actually research gut health. Because say, for example, if you look at a probiotic or let's just call it a supplement, so if I give somebody that supplement in a research study and it shows it improves their gut health, well, you've got so many other factors of that. Unless you're going to keep them in a lab for six months with like a controlled diet and a controlled mental health and a control is very, very difficult. So you have to have really large-scale population studies or you have to have at least, you know, quite a lot of people

in a controlled trial. And you can only control for so many factors. So you might see quite a lot of wild statements online, which are really confusing. And people are basically looked at bacteria that's already been studied in a different research. And they've tried to use that then and their new product, but they've actually not used it in quite the right way,

which to the public, they're going to go, oh, but it is the same. you're like it's not the same amount or it's not the same type or the same format so it's not going to work so and so I think also researching gut health is very expensive and so there's lots of issues there so that's probably why you see dietitians always come up quite general claims rather than saying real specifics because it's rare that we can get such specific information when it gets to comes to gut health so if you see any kind of good health specialists online given absolutely it that's a bit of a red flag yep absolutely especially if it's an expensive supplement they're trying to flag or even like health claims that we're not even

allowed to talk about a health claim to say you've got a probiotic which is literally being scientifically proven to help ibs i can't take money from that brand and go online and say that which is frustrating as a dietitian because you need to end living and if it's been proven by science why not but that just shows you the level of regulation where there's so many people now talking about being a gut health expert it's really confusing damn ethics yeah I heard you speak about wanting to change the name from a low Fod map to low FodMap process. Yes. Explain that for me.

So a low Fod Map diet, which I talked about already, like everyone talks about a low Fod Map diet. And doctors will literally, when you go and get that diagnosis, go, here's a diet to follow and you get a printout and A4 sheet of all the foods to avoid. And actually, it's only part of a process. So it's only supposed to be done for four weeks. then you go through a very systematic reintroduction and then you end up on what we call modified Fodmap which means that you're only avoiding those one or two foods that you know cause an issue.

There's actually research to show that even in those four weeks that we're on the restriction that actually your levels of good gut bacteria actually drop down and also levels of things that calcium drop down. So you can imagine someone doing that for long term the detrimental effect on them, bearing one of these people already don't have a great gut health. Yeah.

Also speaking of, on red flags or things to watch out for online. I also heard you speak about there not being any accurate field intolerance tests. Is that true? Correct. Yes, there's not a single one out there. Maybe I'll be a millionaire by now.

Yeah, unfortunately, there just isn't. And there's so many wild claims. There's like bioresonance. So where we're like holding things on our hands. There's hair testing. But probably the most popular one at the minute because it looks sciencey is what we call IGD testing because it's a test.

And some of them are actually. 600 pounds as well which is crazy especially you know people are desperate to get help so i find it really unethical um so you have this blood test you send it away and then you get this really fancy report with all the foods and it's always random things that banana um and like odd weird things in there about what you can and can't have but there's no follow up with that there's no support or there might have to be someone who's not actually regulated to give you support on this new crazy diet but the issue is it's food intolerances don't actually involve the immune system. And IGD is part of the immune system.

So it doesn't even, it makes no sense. It sounds sciencey and you're sending your blood away. But you could do that test a hundred times and you would have 100 different results. Wow. See, that's the thing. Isn't online, like it's the people who are most desperate are the ones that are going to end up falling for that, which is quite sad. Yeah, absolutely. And we, anyone listens to us, do not feel, you know, ashamed of that's you because we've all been that.

Like, you know, when you, you just want to like get something. Like, and you think, well, why not? And you start seeing the reviews as well. And they will have some positive reviews on there. And that's simply because actually in IBS, because it's such a psychological condition. It's not a psychological condition, but it's a psychological connection. There's actually up to a 50% placebo impact. So if you're paying this really like high amount of money, you're getting this fancy test.

And also you've gone and taken everything out of your diet, chances are you might, might feel better. but actually long term it's going to do you some real quite harm. That's that's the difficulty is where people feel better. It's like, well, it's worth for me because I feel better, whereas obviously the things. I put up a question box on social media for a couple of people to ask you some questions. So I'm going to shout a few of them out. So first question that got asked was, why does artificial sweeteners instantly ruin my body's ability to take a shit? So making you constipated, I have no idea.

because actually artificial sweetness, they're either okay or some of them, which is like what we call sugar alcohols. You always can tell like something that sorbitol. If you look, it's got O-L on the end or Manatol. So things that chewing gum have got them in. So if you use too gum all day and you get digestive problems, that's an easy win just to cut it out. But they shouldn't cause constipation.

So what I would say to you is if you are having artificial sweetness that day or more than you would do normally, look at what else is changing your diet. So it might actually well be that your fibre intake is dropped. and that's actually the thing that's causing the issue rather than, because I get asked this about meat. People say, does meat cause constipation? There's nothing in meat that causes a constipation. But typically when people have a really high meat diet, they're not eating as much plants and fibre.

So that's the issue there. That makes sense. Second question was, what's the best way to support clients with IBS from a personal trainer? Personal trainer. So I think it's just being aware of a couple of things. So don't try to give any dietary advice to start with because it might seem really. simple but even like I help doctors and dietitians who are trained in this but they don't have it is really complicated area. First thing is I'd really urge them to go to their doctors because the

symptoms might not have been diagnosed properly and their symptoms can be anything. So please to say go to the doctors even say this could even be things like cancer and I know we don't like to use that word but it might well be just because we're younger or older it is still a risk. So get them to go to the doctors and then ask them just how they're feeling because I know this sounds like quite a personal question, but as personal trainers, you have to be getting their personal. But if they feel comfortable to open up with you, it could well be that they don't want to do to certain types of exercise because they think it's going to trigger their gut. Or it could well be that actually they're feeling really drained that day or really bloated and they don't want to do certain things

that they have lower energy. So you can work for them just to tailor that plan. And then also it's good to connect with a registered dietitian who's got gut health experience because it's nice to be, I think it gives them a lot of confidence in you to say, okay, so I'm, I know, I know, I know, about nutrition for general wellness or health, whatever you're doing with that. But actually, I think it would be good. I've got a friend who's qualified in this. They can help you, just give you a few tips on this.

So refer out is what I would say. But probably the best one is being like, not a friend, because I know you're their PT, but just actually just having that conversation, just being aware that sometimes they might turn up 150% and sometimes it might be 10%. Yeah, it makes sense. I think that's the biggest thing about personal training

is that when you feel confident to be able to say that I don't have the answers here you and I'm going to refer you of someone who does have the answers. Absolutely. And we do it as well. And to be honest, I've got more confident with that as time goes on, which doesn't make sense because you think I'd get to know more things. But I guess when you're qualified and people are coming to you, they don't understand. They think you should know everything. And I always joke. If someone came to him with diabetes, like I know what diabetes is, but that's it. Like, I'm not to date with the medications or how, you know, because

that's not my field of expertise. Yeah, I would say a similar thing is when I was starting out, I felt like I had to know the answer to everything, even though I knew nothing. And now I'm happy to say that I know nothing, even though I know a little bit more than when I start. Another question was probiotics and prebiotics. Can you explain the difference between the two and what is your opinion on them as supplements? Yeah, so very different, but very confusing. So probiotics are live microorganism. So that means it can be used, fungi, typically it's bacteria.

but actually that's what we think about them as, but there's a real definition. So that live microorganism thing that you're taking, it needs to actually reach what we call the target site in enough of quantity to then be shown to have a benefit. So if you look at IBS, it needs to reach the large bowel, which means it needs to go through your esophagus,

into your stomach, which is a pit of acid designed to kill bacteria, through your small bowel, which is really, really long, again, designed to kill things. And then right to the end of your gut. to actually have an impact. And that's why a lot of the probiotics you see will have like a, some sort of coating on them to keep them actually alive in there.

They might need to go in the fridge to keep them alive, etc. And prebiotics, very different. So prebiotics are actually food for the bacterial live microorganisms in your gut. So that can be, you can get supplements, but it can also be in food. So things are onions, garlic, wheat, beet root, mostly vegetables, part-based foods. They are all prebiotics. So it's very important to have a good range.

And we know that around 30 different types of plants in the diet per week is kind of considered the optimal. So in terms of supplements, and whether they're worth it, I would probably say no, sadly not. So in prebiotics, I haven't seen any good information to show that a prebiotic supplement is needed. Because really, it's the diet that we need. You know, when you look at an apple, it's not just a prebiotic you're getting in that. You're getting the fibre, you're getting the vitamins, and you can't just supplement your way out of this. So it's really about looking your diet for prebiotics. Don't start getting pedantic about this.

Just have a good range. You know, maybe keep a diary for a week and see, am I having 30 different sources of plants and things that we count towards it? So bread would be a tick box for that, which people don't think about. Onions, garlic, anything, fruits, nuts, seeds, spices, tea, etc. And then probiotics is the one that's probably got more research around about actually helping. But it's definitely not needed for anyone in general. There's no benefit to taking a probiotic, despite the marketing,

names, but there are some small benefits for people who have specific health conditions. So IBS, if that exact probiotic has been tested and shown to help IBS, then it will help them for IBS. But it has to be that specific. So you can't just have a probiotic and say, I'll help with everything. Or I'll just take any probiotic in Holland and Barrett. It will help. It won't. They all of us look at it as like an insurance policy, don't they? Yeah, exactly. Whenever I go in there, they're always trying to tell me, like, and they are, they call themselves. I can't remember the name of it, but some like science advisor or something weird like this. And they're basically sales advisors trained by Holland and Barrett. So they're not the only

ones. Any health food shop will be like that. But they're not qualified. Save your money. But to be honest, even in IBS, I rarely use a probiotic. Sometimes I use one, but it's going to give you maybe a slight edge. It's not going to be groundbreaking from my experience. And like you even said at the very start of this, you said that like, you know, your gut needs a wide variety of food. Exactly. So always venture out, especially if you're someone who just has that lettuce, tomato and cucumber on the side, which looks a bit sad, get a bit more exciting with things. Okay, I have two more questions for you. I call this Kirsten's wisdom. So what is one piece of misinformation around your work that you would love to just disappear?

Blutin. I am sick and tired of hearing people go over but gluten for. that, especially as a celiac, I actually have to eat this crap. You guys don't, you know, you guys can have all the different foods that you want. So gluten is a protein we find a wheat, barley and rye. But there's lots of claims online, everywhere, all the time, that gluten is bad for our gut, it causes inflammation. And there's definitely the case if you've got celiac disease, where your body starts an immune reaction to gluten.

The rates are actually really high in Ireland, so do get yourself tested if you've got symptoms. But outside of that, gluten is not an issue. where people get confused in IBS is actually a lot of products that contain gluten, the protein, also contain the FODMAP. So they might go, oh, actually I felt better from having that low, that gluten-free, I don't know, sandwich rather than having regular bread. But they're not, they haven't got an issue of gluten. It's just the FODMaps.

But that doesn't necessarily need to avoid wheat. It just means that maybe you need to reduce it down or swap over to something like sourdough bread, which is full of gluten, but not got the FodMaps. And your diet will be a lot happier. What do you think the reason is that it's so high in Ireland? I don't know. It's a weird one, isn't it? Because I'm half Irish.

I blame the Irish genes for that. But never go to Ireland, you would expect, because islands like, it's remote, you'd expect to get gluten-free is really difficult. Every restaurant, even in the north, you go to like a little cafe, and they've got gluten-free biscuits. They're kept separately.

They know about it. Whereas I go to some place, like even in like a Manchester or London, and they've not got an ocean. It's weird. Yeah, yeah. We're ahead on something at least. There you.

And then the second one that I wanted to ask you, so what's one thing about this topic that you would love the whole world to know? They really need to take more focus on sleep. So I don't know why. And we're currently writing the British Dietetic Association guidelines again because they need updating. But in all the guidelines on IBS, which are really bad as it is, there's not much in them to go on. there's no mention of sleep despite there actually being researched like lots of research around

the impact the quality the quantity of sleep on symptoms on the microbiome on the gut brain access it's all there in black and white and it's quite an easy win for a lot of people when you think about all the things we just talked about diet and actually if someone can get at consistently early night that's a much easier win than maybe going full than I just do not understand what well we might as well touch on that then as well so what do you think are some like big levers people can pull to improve their sleep. So you need to think about a routine. So getting up and going to bed and waking up at the same time

because internally you have something called your circadian rhythm, which is like your internal body clock. So if you're going to bed at 10, then 11, then midnight, then 9, your body has no idea like it's like going to different countries every day. And there's actually something called the social jet lag. So basically people are going to bed at maybe 10 being good boys and girls during the week. And then at the weekend, they're like rocking up to 1am because they're

watching Netflix, not even out socialising, you know. So it's this jet lag. So going to bed at the same time, waking up at the same time is easy. And you might hate me for that when you're getting up at 6 a.m. on a Saturday. But a week into it, you're going to be jumping out of the bed and feeling so much better. The other thing is light. So we're kind of coming in UK now. We're coming in sort of more summer, springtime. But just getting blackout blinds. Like I went to, I would say my dad's house every summer because I actually live in Dubai. I rock up and he's got rid of all the blackout blinds. I thought, how do you live like this? because all of the light is giving your body external cues, it's daytime.

So you might get to sleep because you're so bloody tired, but the quality of that sleep is actually not very good at all. Then looking at what you're doing in the hour before bed, so try to have an hour period before you go to bed. Say you want to go to sleep at 10 from 9pm, no phones, no screens, no bright light. You do not need it. No one is calling you up to be on like some sort of, you know, reality, it's not happening. So from that time and then try to be in bed half an hour early reading.

a book because your brain cannot go from zero from 100 to zero and small little things like that just do it for a week and if it doesn't work after that you can tell me that you know full of rubbish but honestly it could be a real thing but we know it will so it's it's just getting people to do it as well i i always say to my clients now it's like like you you all set an alarm to to get up in the morning start setting alarm to to wind down to go to sleep like to get in that little because you i think people just come home after a long disdain. day long day work and they just want to kind of de-stress or whatever it is so they end up being like, oh, I've had no time for myself, I'm just going to sit down on the sofa and they end up watching

tell you for two hours and then it's like 11 o'clock before they're even getting up into the bed. Exactly, but actually the irony there is if you actually step back, you probably wouldn't feel like you need to de-stress, you'd probably have tons of energy, you'd be hitting the gym, going out for over like phoning a friend, getting men to bed, happy, sleeping really well. You feel so much, it's like the caffeine. People take caffeine because they're so tired. but it's an agenda scene blogger. So it's going to stop your sleeping properly.

It's the circle. Yeah, it's either a circle down or a circle up in terms of momentum. Lastly, can you just tell us a little bit about the program that you run and also where people could find your book? Sure, yeah. So I ran a program called Take Control. And in a minute I'll talk to you about my book. It's called The Scene.

But Take Control as a program is over three months, although people get lifetime access to when they sign up. and it takes them through step by step how to control their IBS. And it goes through those four factors we talked about movement, sleep, mental health and nutrition in a very systematic way, step by step. And it's designed to show you a bit about the science. And then it teaches you how to tailor that science to what you need and your routine needs. Because of course, as I've mentioned, it's not one-size-fits-all approach.

Then they also get a weekly call where they can drop into and speak with myself, ask any questions, and there's a Facebook group. are really well supportive throughout. And what about the book? The book is also called Take Control. I'm not very inventive with this. So it's called Take Control of your IBS, a step-by-step guide that works,

and basically it's the Bible for IBS. So it's got everything the course has got in it, but more. So it's got things you'd expect, like it's got the mental health in there. It's got things like the sleep and the movement we talked about, but it's also got things that you probably don't expect that people actually need. So it's actually got things like dating advice in there,

talking to psychologists, speaking to your family and loved ones about these situations, how to go on holiday without getting seriously constipated for the first few days, looking at other elements as well, like histamine intolerance and CBO. So regardless of where you are in your IBS journey, whether you have got good control, not,

it's like the Bible, like the reference book to go to. I think that's a really good thing whereas people can go and read the book and have that information. But then also, like a lot of the times, it's like people can even know the information. but to be kind of around the community of other people who understand your problems is also really valuable as well. Exactly. And as I said, some of this is a bit tedious. So it's nice to have people

on those calls going. I've been there, give it a couple of weeks. It's so good. And if anyone wants to just reach out and ask you any questions about the program or any questions in general, where could they find you? So at my Instagram is probably the easiest. So it's at the dot iBS dietitian. Unreal. Okay. Carson, this has been unbelievably insightful. Thank you very much for today. And we'll have all the information in the show notes. Thank you so much for having me on. No problem with all.