IBS mucus & gas – a case study

Welcome to another IBS case study episode.

These are always quite popular when I look at my analytics. I think you really enjoy seeing some of the things that I do with individual clients. And some of the ways that it hasn’t worked as well. Because I like to be really honest about what I’ve tried and what people have enjoyed. And what people are not prepared to do as well.

Priya – with coeliac disease and IBS

So let me tell you a bit about Priya. I worked with her over four months. When she first came to me, she had been diagnosed with coeliac disease for four years or so. She had had IBS for another two.

This is quite common in people who have another health condition, where they are treating and managing the symptoms, and yet they’ve still got ongoing problems, so they actually are diagnosed with IBS on top of another digestive condition.

IBS symptoms – mucus and explosive gas

The sorts of symptoms that she was getting was a lot of bloating, some explosive gas and a lot of mucus as well.

It came in flare ups over the course of those two years. But prior to working with me it was becoming more and more frequent. She was finding she was reacting to lots of different foods. There didn’t seem to be any clear triggers really there was nothing obvious.

Priya was very confused about what to eat

She was looking for somebody to give her some structure and help her find a way out of this very confusing food landscape. She was managing her coeliac disease very well, was super careful in terms of not having any gluten in the house.

Priya was very cautious around eating with other people or eating out and so there was no thought that she was being contaminated with gluten. It was really well managed condition and she was very educated about it.

Some people with unmanaged coeliac disease get symptoms

So that was great because it sort of ruled out that potential. Sometimes people who have been recently diagnosed with coeliac disease. And I’ve also worked with people who haven’t been taking it as seriously as they could be. Perhaps they’re sharing butter with their husband or whatever. There’s crumbs in the house. They’re just getting some level of gluten contamination and it can lead to digestive symptoms.

She could really easily reassure me that that was not the issue, and that was not her problem.

Personalised advice for IBS

Priya came to me really because she’d also worked with another nutritional therapist in the past, but they hadn’t been able to give her any personalized advice. They’d just literally given her a lot of handouts that seemed very generic. They weren’t helping her tailor it and helping her actually implement it, which was what she needed.

Weekly calls with a personalised nutrition plan

She was a busy person she just really needed some reassurance, some support really. And so she was very pleased about the weekly calls that we had. The space to chat, to ask questions. Just for really informal conversations about digestion and food. And she was really open to learning.

Clear tests back from doctors

Now, as I mentioned, her main problems was this explosive gas and mucus. And she had had all the kind of tests that you can run at the doctors. They all were clear.

She didn’t have any ongoing doctor’s appointments, she’d had a clear ultrasound, a stool test. She’d had a blood test to look at the faecal calprotectin levels and general blood levels of inflammation and all of them were low. Her gluten Antibodies were tested and again, they were low.

Where next?

So it was really great. We had a clear round of tests. The problem is, is that it doesn’t really lead you down a treatment route. So sometimes you get all the tests coming back saying, Yes, you’re fine. There’s nothing wrong with you. And actually, you’re not fine. You’re really not fine. And it can be extremely frustrating.

A long list of eliminated foods

When I started going a bit more into detail with Priya about what she ate, the list of foods that she couldn’t eat was very long.

This is one of the first things I noticed, that there was a lot of foods on the restriction list. The major problem with this was that she had a very small body size.

Underweight but not eating enough due to IBS

She was underweight if you look at the BMI testing. I know we all know that BMI is not a great measure of health. However, when I can also put this together with symptoms that the client is telling me. About their digestion, but also other symptoms. Like energy levels and headaches, for example.

And I can see their food diary, so I can see the kinds of foods they’re eating. How often they’re eating, etc. This does give me a picture of whether they’re eating enough. And they are underweight for their body size.

In this case, I really strongly felt that she was not eating enough. In situations like this, I have to be, as a nutrition professional, really certain about the way people feel about eating.

So whether it’s disordered eating, or an eating disorder. Or is it just restrictions that have been put in place around food in order to control symptoms. And it kind of got out of hand and escalated a little bit.

Boundaries around eating enough energy

So, I was very clear that I would only work with this person if she agreed to eat more food.

And she was very happy to do that. But she was wanting to manage the symptoms and wanted a lot of reassurances not to eat foods that are increasing her symptoms. So, we had, you know, a little bit of back and forth at the beginning.

Some of the things that were also making me think she wasn’t eating enough was really that she was getting frequent headaches, particularly in the morning. Her energy levels were quite low, but she also had a real tendency to push on through. Try not to take breaks, like just keep on working. Keep on going, despite feeling pretty ill with her stomach. And with her headaches and energy levels.

Nutrition plan for IBS mucus & gas

So let’s get into what we actually did. I started off by, as I said, making sure she was eating enough and trying to stick to low FODMAP foods to begin with.

She was already on a very restrictive diet and I didn’t want to cut anything out of her diet. I wanted to increase it and make sure that she was eating more food but also more variety. So we started off just increasing low FODMAP foods until she was eating more quantity.

Heavy digestion

Part of the reason for her many restrictions and eating, you know, little small meals and not wanting to get full was that she felt that food sits really heavy in her stomach. She just said, “I can’t eat big portions. It makes me feel awful.”

We had to think about foods that were going to be easy to digest. But I also spent quite a bit of time with her working on how to chew your food. Sitting upright, try to make a nice special meal of it rather than just eating small portions. Totally scared of what you’re eating and how it’s gonna be affecting you.

Increasing volume before variety

That was quite a big thing at the beginning. Just to make sure that she was eating more food and eating more often. We worked on a clear reintroduction plan. Picking some foods that she thought that she would want to eat and gradually bringing them back in. It was very, very simple, slow process.

Change your diet as slow as you need

Everyone I work with has a different pace and things that they can manage. But this was a pretty slow one, I have to say. But that’s fine, that’s, that’s what she could manage at that time. There’s no pressure, there’s no rush. You have to start from where you are. You can’t work on my deadlines. It has to be what fits with you.

Over thinking digestion and food

Another thing I want to just sort of draw to your attention though, is when you are in that state where you are afraid to eat anything, You feel like when you do eat, it sits really heavy in your stomach. You’re worried about digestive symptoms lower down, like gas and bloating and mucus and explosive poos.

Then, that was definitely changing her appetite. So when you don’t eat much, you tend to, over time, reduce your appetite. Actually it’s quite hard to eat a normal amount of food. Or what you should be eating for your body size. When you don’t have a desire to eat, you’re not ravenous.

Reducing your food intake can reduce appetite

If it was me and I suddenly went to eat the amount of food that she was eating I’d be really really hungry. But over time she’d kind of reduced it down and down and down. And so was really eating small amounts but not getting enough nutrition. That was what I was working on with her like hammering home.

This is why you need protein. This is why you need zinc. This is why you need iron. It’s like really trying to educate and trying to push in some reasons for eating.

Eating well for high performance

It’s not just about regulating your digestive system. It’s also about making sure that you’ve got enough energy to function. You’ve got enough energy to perform high pressured jobs. You need a certain amount of energy for your brain to be able to function well at work.

And particularly where you’re someone who has, a key role in your business, or maybe you’re a business owner and you’re the only person who’s running that business.

Business owners with IBS – treat yourself as an important business asset

You need to be looking after yourself and prioritizing yourself. As a business asset, because actually, if you don’t, who’s going to look after you. Who’s going to run the business if it’s not you. If you are someone who runs your own business, you need to prioritize some self care in order to keep your business on the road.

Low appetite and zinc

Just going back to the appetite as well. I want to mention sometimes. Where people have got very low appetite, something that might be worth checking is your zinc levels. There is some research showing that people who have got reduced appetite sometimes are low in zinc. It’s a fairly cheap nutrient that you can get and it’s quite easy to get hold of.

Sometimes it can help to make sure that your appetite is not being suppressed by low zinc. It might just be worth a blood test, taking some zinc to see how you feel, for a short amount of time. You shouldn’t take zinc long term unless you know that you are low in it. However, it’s worth trying. Or food sources of zinc include pumpkin seeds, meat and fish.

Start the day with breakfast

Priya also was not very good at eating in the morning and I felt that her headaches were a by product of not having enough glucose in your system. Her body was just alerting her to the fact that she needed to eat. So we had an agreement that she would eat within 30 minutes of waking up.

Food introduction was better than expected

There were a couple of foods we introduced that she just didn’t think she was going to be able to cope with like broccoli and pineapple and steak. But these went really well and she was happily eating them. And like really incorporating them into her diet.

So she was just starting to get some good sources of iron, some different sources of fibre and that was really helping actually.

Reduction in IBS mucus

After about two months of working together the gas and the mucus was very rare. She was having kind of loose-ish stools. A type 5 if you look at the Bristol stool chart, but it was not considered diarrhoea.

It was just on the looser side. But this was, so this was really encouraging. Her digestive symptoms basically went away over the course of those two months. She started to eat more food. So it was going well.

The impact of stress on digestion

Then she had a little setback in that she had a pet that died and she also had a very big work project that all coincided at the same time.

This really set her back a lot in terms of reverting to eating behaviours like not eating enough. Not really looking after herself enough and kind of Just dropping all of those self care practices that we’ve put into place.

Now when she did that it also kicked off her digestive symptoms. So it was a really clear indication that stress and emotions were also tied up with digestive function.

The gut-brain connection in IBS

So you know the gut brain connection is really strong and where people are nervous, stressed and not sleeping well, not eating well. This does play out in our digestive system. You definitely get an upset stomach when you feel nervous. When you haven’t eaten properly and then you eat a big meal or you’re just running around and not feeding and fuelling your body properly.

The main focus for the last few months of working with Priya was really about trying to set up some self care practices that would actually sustain her in busy times.

But also to get her out of this flare up. So I was working a lot on how to work out what your body actually needs, how to listen to your body so that you understand the signals that your body is giving you.

Noticing what hunger feels like

This is quite common, I find, with people I work with who have minimized their digestive symptoms by not eating, and it can happen over time. But basically, you ignore your hunger so much that you forget what hunger actually feels like.

Maybe you are feeling hunger but you’re not noticing it as that and registering it.

So for example getting headaches, feeling a bit dizzy, feeling a bit weak and tired.

These can be signs that you’re not eating enough and the rumbly tummy feeling is sometimes not the start of a flare up, it is the sign that you need to eat more.

So this is what we spent a bit of time working on is, what does hunger feel like for you?

Regaining your body sensations

Everybody has a slightly different sensation of hunger. But when you’ve ignored hunger for so long because you’re trying to not eat, because every time you eat, you’re getting these terrible symptoms, then you start to blank it out. And so when you do that, this person had a tendency to block out other sensations in her body as well. Just had really tried to ignore the terrible symptoms.

But had kind of lost that connection to her own body.

How to be kind to your body in IBS?

One of the questions that I really like to ask people in this kind of situation, and maybe it’s something you can think about if this resonates for you, is thinking, what is the most kind thing I could do for my body right now?

Maybe it’s go to eat, maybe it’s go and have a lie down, maybe you take a deep breath, maybe you need a drink of water, maybe you need a cuddle from somebody you love.

Sometimes, what your body actually needs and what you want to do are different things.

Listening to your body

But when we learn to listen properly to what the body is asking for, then we’re much more connected and we are better able to manage the symptoms because we are not overriding some of the early warning signs that are being sent from the body.

So for example, if you are constantly overriding hunger, then actually learning to tune into that and eat when you start to feel hunger. can stop an escalation of those symptoms which might be the headaches, it might be feeling completely drained, feeling anxiety increasing because your blood sugars have dipped. This is fairly common with people who I work with with IBS.

Re-engaging your senses

We worked on increasing her appreciation of her own senses. So for example, she would take one day and try to really smell five things. Really noticing the smell of, it could be a food, but it also could be a perfume, a flower, washing liquid. Anything really, just to really notice the smells.

Then the next day, really focusing in on touch, like what does, I don’t know, a piece of clothing, like a nice soft scarf, some grass outside. Really thinking about the sensation that your body is giving you, because tapping back in. It’s just like a practical way to tap back into some of the messages from your body to your brain.

Creating your self-care toolkit

The thing we worked on was really trying to create a list of self care activities that she could go back to. Sometimes when you get overwhelmed you just can’t think.

Making sure that she had it written down. ‘These are the things that I can do when I feel overwhelmed or when I feel like things aren’t going well for me digestively’.

Maybe I can buy myself some flowers, maybe I can have a little dance to some music if I feel like it. Maybe I can go and lie down for 10 minutes and have a mini nap. Or maybe I can take some deep breaths or like do some basic yoga.

Those kind of things are very helpful when you don’t practice self care. So when it’s not something that comes naturally, it’s having it written down. That says these are things that I can do that are helpful for my body.

Not related to food all the time

And it doesn’t have to be about food all the time. So yes, there were loads of things we talked about with her diet, like increasing her range, increasing her volume of food. And like I said, the digestive symptoms really did calm down. A lot of my gut reset program is actually focused on helping you feel better in other aspects of your life.

Not just focusing on what you eat. It’s also your relationship to your food, your relationship to your body.

My reflections on this client case

This was a little bit of a different case for me, in that the digestive symptoms calmed down pretty quickly. During the time together we were working on really her relationship with her body and her relationship with her food and her diet.

And it kind of went a bit broader than just the things I normally do. And I just thought that it might be useful for you to listen to that.

If any of it resonates, maybe you can take something from this episode and apply it to your own life. By the end of our time working together, Priya said,

Yes, I got what I wanted out of this. It was targeted advice, and I know how to carry on.

Like, she still had a long way to go in terms of her relationship with her body, her relationship with food, and, just general self care, like I was talking about those kind of practices, making it something natural and normal to do. But, she really knew what to do, what the steps were.

Finding clarity on IBS through the Gut Reset

I think that’s sometimes where you get a bit muddled. There’s so many things you could be doing. You can read all the blogs, listen to all the podcasts about IBS, and everybody is telling you to do different things. And that’s because they’re probably all good things, but they don’t all apply to you in your life right now.

And having someone to help you work it through can be very transformative. So that is where I’m going to leave it for this week. If you want to work with me, you can reach out, just get in touch in my email addresses in the show notes and also on my website. And I’d love to hear from you if you are interested in finding out a bit more.

You can also follow me on Instagram, where I post a lot of videos and other information about IBS, digestion and diet.

That’s it for this week, I will leave it there. Thanks for listening to The Inside Knowledge.

Better digestion for everyone.