Season 4, Episode 12: Season Wrap
I cannot believe that we are at the end of season four of the Gut Show. I've loved recording this, and it has been a lot of fun researching topics and having new conversations. I hope that this has been helpful for you every step of the way. In this final episode, I actually wanted to end on one of the most controversial topics that has come across my (virtual) desk, and it's the way IBS is marketed by different influencers and health professionals on social media.
During this episode, I share my thoughts on what IBS is, the dangers around the narrative that IBS is BS, what drives IBS marketing and how you should deal with your IBS.
In this episode, we cover:
Is IBS really BS?
Why I don’t believe that IBS is BS
The root behind IBS marketing
Doing the proper research behind IBS
How to deal with this narrative and your IBS
Don’t forget to connect to others in The GUT Community, a Facebook group for those with IBS and digestive disorders to support one another and dive deeper into each episode together.
Today’s episode is sponsored by Sunfiber. Sunfiber is a prebiotic fiber supplement that is gut-friendly as a soluble, low FODMAP fiber. Sunfiber-containing products typically contain between 5-7 grams of fiber, and it mixes into water or food without adding color, texture, or flavor. That means you can easily add this to your routine to increase your intake and benefit the balance of your gut without the symptoms. Sunfiber can be found in hundreds of different products. Find your favorites at Sunfiber.com
I cannot believe that we are at the end of season four of The Gut Show! I've loved the season! Filming it has been a lot of fun, just researching things, trying to add to conversations that I've had in many different ways, and I hope that that has been helpful for you every step of the way.
Usually I end a season with a little bit of a kind of free flowing conversation from me, but this season, I actually wanted to end on one of the most controversial topics that I think comes across my virtual desk. It's the question or the statement of you know, is IBS just BS?
You may see this marketed often by different influencers, or even health professionals who say, you know, IBS is BS, and it's controversial, it's fun, it's sexy, but is it true?
The short answer is, IBS is not BS, but it's also not a dead end. It's not an end all true answer. So what I mean by that is that IBS may not be the full picture and IBS should not be where someone stops in care with you. So instead of us just saying it's BS, or no, it's not, I want to get into more of an explanation of what IBS is briefly, a little bit of a reflection into other episodes, talk a little bit about why people use this as a marketing tactic, and where I personally stand as a provider.
This does not mean that this episode is the 100% truth that you need to go by because that's just not true. With science, we do have a lot of truths. When it comes to IBS, there's a lot of unknowns and mysteries, and even in marketing, there's a lot of people saying things in a different way that may be actually saying the same thing. So I don't think it's something that we need to say that it's just black or white, you're either for it or you're against it. But it is something that is very nuanced that I think is good to have a conversation over. So I'll share what I think and as I'm talking, I want you to think about what you think about this. I would love to hear what you think and for you to share that with me as well!
So what is IBS to start?
IBS is a functional disorder of the brain interaction. And this likely fits into two kind of major camps, which is our diarrhea predominant camp and our constipation predominant, even mixed symptoms will typically actually fit within a camp. And what I mean by that is the different potential like causes and contributors within this camp. Now we know that typically the diarrhea camp is going to be more post infectious IBS and might overlap with more malabsorption issues like pancreatic insufficiency or bile acid diarrhea. That's pretty common in this camp, or even like post gallbladder removal, we might fit more into this diarrhea camp.
The constipation camp is typically going to be a motility problem first, which is likely going to be due to various causes, which could be hormonal issues, maybe pelvic floor dysfunction, we may see stress or poor nervous system regulation, we also might see varying diet and lifestyle behaviors that would contribute to this camp.
Now to meet the criteria for IBS, it's not just that you have these changes in motility and gut symptoms, that actually is not the true criteria of IBS. These symptoms do need to be present, changing motility is important, but we also need to see the presence of pain. And pain is a marker of what we call visceral hypersensitivity, which is unique to IBS, in which is where a lot of research around IBS is focused, because it makes it different from just chronic constipation, or even functional constipation or functional diarrhea, or even some of these different conditions that I mentioned.
A lot of times whenever IBS is diagnosed, if you're not actually meeting the criteria, that's gonna lead to some confusion. So something I like to ask a provider is does this person and you can ask for yourself, do I actually fit into the criteria for IBS? Or are you actually saying something else? Are you saying that you just don't really know what's causing this? Because they might be saying IBS when they're not actually saying and truly diagnosing IBS, which is on them, but helpful for you to clarify.
Now I did cover the different causes of IBS in earlier episodes, and those are titled Is My Body Broken? And Will IBS Go Away? And I talked a lot more about like, is IBS cured and kind of the different nuance of that piece, so I do recommend that you go catch up on those episodes. So you can pause this episode if you need to go listen to those and then come back!
Now that we are all caught up and on the same page, let's talk more about this IBS is BS, actual BS that goes around. So why do people say this? Because if it's not actually true, if IBS is an actual disorder with diagnostic criteria, it's very well researched and we understand pieces of these camps, some are still a mystery, but we do understand the camps pretty well. Why do people say this? And why is it typically, health professionals?
Well, it's a marketing term. And it's a marketing term that's used by well meaning providers, most of the time. What they're trying to communicate to you is that an IBS diagnosis is not a solution. And so an IBS diagnosis should not be where a provider ends. So if someone is telling you oh, I've done everything I can, it's just IBS, go on your way. That is not okay. And I agree with that, that is definitely not okay. So that is what providers are most often trying to say.
They're also trying to say that there is actually solutions available, and that there are things that you can be done for you to actually feel better and have control of your symptoms. So they're saying a lot of what I've said throughout this season, that there are solutions available, there are ways for you not to fit into that criteria anymore. There are ways for you to address some of these causes and contributors of your symptoms. It doesn't mean that there's nothing that can be done just because you get this diagnosis.
Now the reason why people love this phase and the reason why even me knowing what people mean by it, the reason why I personally, as a provider who markets on social media, I don’t say this, is because it is sexy and it holds a lot of emotion. It is made to make you feel something, where you are like YES, or maybe like what, oh no! It’s meant to kind of stop you in your scroll on social media and make you be kind of be taken aback because you are for it, or maybe you’re not. It’s sexy and it has a lot of emotion tied to it.
So there’s a lot of emotion tied to this phrase and because many with IBS haven’t gotten answers, many have felt dismissed and like they haven’t gotten answers, they felt dismissed by providers, and they felt like their IBS was kind of a closed door, then they're going to feel like this phrase is like, eye opening, right, they're gonna feel like this is a new way of thinking about it, and that there are answers that they always wanted, and it really works well for marketing because of that reason.
Now, the phrase itself is not wrong. Remember, I don't necessarily disagree with the phrase and the meaning behind the phrase, I get it. And I know that that hope that you may feel when you hear it can be a good thing. But one thing that I've seen go wrong is that many people who hear this phrase may not actually feel like there's hope, or they may feel that hope at first but it leads them to think that their diagnosis alone isn't real, which might then make them discount or disregard the research around IBS, around what they've learned so far about their bodies, maybe they'll disregard anything their provider says because their diagnosis doesn't now feel real or feel valid. And instead of seeking explanations and further understanding and clarification on their diagnosis, many times they feel like oh, well, this isn't real and that means that these people are wrong. And so it can lead them down this other path of distrust, which, you know, we have to have a healthy amount of distrust because people get things wrong, humans are humans, and I get that. But also, when we develop this idea that well, IBS, that means IBS isn't a real diagnosis, all of this evidence around IBS must not be real and then you're kind of at the mercy of a lot of marketing, which some of it might lead you to a good place, some of it might actually lead you to a really dangerous place. And unfortunately, you know, as a provider, myself, I have seen the negative sides of this type of marketing, as well as what typically follows a lot of this marketing, where people are then running down this rabbit hole of trying to figure out what's wrong and that kind of leads into this whole like root cause conversation, which I'm going to get into a little bit later.
So I personally, as I've mentioned, I don't feel comfortable with this marketing tactic. I know the research behind IBS. I know what has gone into developing the criteria for the diagnosis, I was diagnosed with it, I no longer meet the criteria, but I understand where the research is coming from and I understand how the camps work so I'm able to still think about IBS itself and the person in front of me holistically, while honoring, I guess, the diagnosis itself and what it truly does mean even if providers before had not really taken that kind of stance or have valued that as much, and I also know that as a provider, I want to be careful with any sexy, emotion filled terms that might actually lead to someone distrusting the healthcare system, I want to be careful with that because, you know, screening for colon cancer, things like that really do get missed and I've seen the negative sides of it. I also want to be careful not to make someone feel like that the things, the strategies that we might do and like the explanations that we may give, may not be valid for them anymore, because they might actually be, there are going to be situations where someone actually doesn't have IBS and it's something else and we may take a different approach and their body may not respond to the things that work for IBS, but there are going to be a lot of people who do respond to those things and so we have to be careful with our marketing for that reason.
And that's just where I personally stand, I want to be careful with anything that's too sexy and that I'm simply using as bait in marketing to get your emotions high, so that you will then work with me or purchase from me or say that like, oh, I'm thinking outside the box, because I also again, I've seen the research and I know the research, there's more research that needs to be done and I can't wait for that day that we better understand all of these different layers of what we know of now as IBS, but we have to be careful not to just say that the diagnosis itself is not a thing or non existent, especially with the research we have around strategies, and even like the microbiome makeup and how the gut brain connection works with people who meet these criteria, all these different things.
Now, I do though, believe that as providers, and especially in the conventional health care model, we need to provide better answers, we need to help patients feel more heard, we need to help patients feel more seen in the entire process, we need to listen, and we need to provide solutions. We can't stop with just a diagnosis, we need to either give solutions and ideas and strategies that they can do in our own scopes, or we need to refer to other providers and professionals that can work within their scope to maybe take a different approach to help. We should not give up just because things aren't working like we expect and we shouldn't just give up because we've ruled out more serious things.
If you've felt that and that has what leads you to feel like well, IBS is just BS, that I want to encourage you that that is it, you deserve more, right, you do deserve more than that, but that doesn't mean that IBS itself is completely out the window, right? There's a middle ground here and we do need to do better as professionals. If you're a professional listening, do better, do better, please, we need that.
Now, what about the next steps of this if this type of conversation and what I've seen people come to me with, and that's this idea of this root cause marketing. And I'm calling it marketing, because I think there is a good motive behind looking at roots and peeling back layers to understand what is actually causing the problem in any area of health. And with IBS that is so true. And I've tried covering that a little bit through the season, but we do see IBS like an onion of layers, right? Where the first layer might be the symptoms themselves and we might approach symptom management on that surface level one way, but then we peel back the layer to contributors of those symptoms and going a bit deeper into what's actually contributing. And then we will peel back the layers more of like what's actually causing IBS, those drivers of IBS that I talked about.
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And the better understand that then we peel back that layer. And then alongside that there's some of the other onions of health concerns and needs that need to be addressed. And so we do have to do this layered deep approach and like the root of the problem is something that needs to be seen. But when we're thinking about marketing, and we're saying IBS is BS, we need to get to the root cause of this. Typically, this is meant to hit that same emotional chord for people living with IBS, because there is such a strong desire to understand what's wrong and going on. And so this type of marketing is meant to make you feel like, okay, like you have the answer, you're going to tell me the one problem.
And the Pro to this, this marketing is that we do look beneath the surface, right, we find the answers we need to address and that is so good. And it needs to be done. And that's something you should ask providers as you're maybe interviewing them or kind of deciding who you want to work with. Ask, you know, how do you get to the root? How do you kind of figure out what's causing this? How do you go deeper beneath the surface of my symptoms? Like those are great questions.
The con to this idea of root cause marketing is that there isn't always just one single root or one single cause instead there are typical, instead, there are typically contributors, especially when symptoms have been present for a long period of time, there are going to be layers, and sometimes we can get all the way down to one thing where we know this is the main thing. Sometimes we can't get there. And we see that with even post infectious IBS or we might be able to pull back that oh maybe you know a foodborne illness was the start of this, even for my IBS, and I'm in the constipation camp. It started with giardia. It started with a foodborne illness, I can look back and see that from my history, but I can't fix that. Which can lead a lot of people to having almost a false hope that there's one thing that's wrong, this person says they can find it, they're going to fix it, and I'm going to be 100% better. And that's probably not what they're trying to say. Likely, it's not I don't know of any health care professional that would say that with that much confidence. But that is what people hear. And I work with a lot of people that have gone down that path. And then they're in worse shape, because they've done things that maybe weren't actually the right thing to do.
Maybe they've done things that weren't the right thing to do him. And that led to more issues. Or maybe they were just one thing, but not other things. Or there's it gets kind of messy and they feel distraught, they feel sad. They're they've lost hope. But I've also seen is when people have gotten this kind of marketing, they're almost obsessed with finding that route and become so focused on it, that they can't get out. And so they feel almost trapped. And there's more anxiety, there's more stress. And they feel like nothing that they do is enough. And it's really hard to work on foundational work, it's really hard to work on these contributors, because what's going on in their mind is okay, that's fine. Like, I kind of understand that. But like, I need to know, I need you to prove that this is the one problem. And even in the most complex cases, I rarely see one single problem, and rarely Can we do a single test and figure out what that is. Sometimes you can. And so I don't want to say that can never happen. And if that's happened for you, that's amazing. I've seen that happen. I've been able to do that with clients. But I want to be careful and mindful about how I mark it to not kind of say that even subconsciously, you know, let that sink in for somebody, because I've seen the harm and the damage that it's done to people. And it's very difficult to undo that. Because that can create more hopelessness and more frustration that they believed it and they were holding on to that. And then now to feel like, is that even true? Like that can be really difficult.
So like I mentioned, while I don't use this term, I don't work it this way. And I really try not to make these promises to my clients right out of the gate, because I want to really honor their emotions, their mental health as much as I possibly can. And I want to set them up with the best expectations of what we do. I also do commit to digging deep, peeling back layers, doing the research, not stopping, continuing to ask questions. I've worked with people for months, and even over a year, really just trying to figure out okay, what have we not looked at what else could be going on, and that is okay to keep looking for answers. But we have to be mindful again of how we are communicating it, especially how we are bringing people in. And I kind of I don't know, other health providers, you may see this differently. And that's okay. I think we all have to do what we are passionate about, like what we believe in, right? But that's just where I stand. And and if you are saying the same. And if you are feeling the same way, if you have felt confused, maybe you've struggled with some of these messages, you know, I hope that this conversation is helpful. Because, you know, I want you to just think about the nuance of it. And, again, if you've fit into the world where you love that type of marketing, you love that type of, you know, perspective, and that's where you want to be. That's fine. I'm not saying that you're wrong. I'm just saying that there might be more to it than that blanket statement.
And we have to be careful about what we say especially online, and in a marketing way if we're making money on it. I am held to a code of ethics as a dietitian, all dietitians are providers that aren't legal providers are, I guess, credentialed providers. If you will, like a dieticians kind of the credentialed nutrition expert in the US, we're held to a code of ethics others may not be but that code of ethics does kind of hold us to a standard where we have to be in line with research and I honestly just don't think that some of these statements are fully in line with research. So that's where I stand. I know it's controversial. I'm kind of sweating talking about it. But if you've ever wondered where I stand that is where I stand. Now following that, what do we do about this? Right? What is gun control? What does get healing even look like? Because, you know, I can say all day that like you need to peel back the layers and like I don't really think we should say this, but what can that look like for you and what's your take home kind of message or list of things that you can be thinking about. And I think that it kind of works in these ways. Not necessarily one step at a time. But at least, we need to cover these different pieces.
The first is in Nino throughout is really digging beneath the surface to find out what contributors are at play. And that's where testing can help. That's where even some of these kind of root cause tactics can be really helpful. Where we do assess, and we do ask questions, and we do some trial and error, we really pay attention to how the body's responding, they have to dig beneath the surface. Next, we really need to not stop asking questions until we do get answers. So if we are digging and digging, and we're getting stuck, like we have to ask more questions, and we should be doing that as a multidisciplinary team. Like ideally, if you are struggling with any health need, and you have any providers on your team, you want them connected in some way, you might be the liaison between the different people, but you want them to make sure that they are somehow talking to each other or working together in some way to share info from other providers so that they might know how to fill in the gaps. Or they may have information that would help that person like it's really helpful as a team to ask questions. We also want to make sure we're applying evidence based strategies and know what the body is communicating as we apply those before and after.
So that's really important because typically, for applying something that is shown to work in research, and like the low FODMAP diet is an example there's a lot of evidence based strategies we can use. There's some anecdotal strategies that we can also use. But typically, if I'm put, if I am recommending a strategy, I know what I should be expecting to happen. And if the body does respond in that way, that tells me a lot about what maybe was happening, because I know what the research says. I also know if the body doesn't respond how I thought that is telling me a lot about what's going on in the body where it's not necessarily lining up with that other cause I was looking at. So that's the trial and error that actually works is evidence based, while also monitoring how the body responds, not just saying like, Okay, that didn't work, let's move on to something else. But really thinking about why didn't that work, then we need to identify triggers and modify them to stabilize the gut, that is really important. And that is a more surface level of that layer peeling.
But we do need to make sure we're looking for triggers. And as we identify triggers, just like the evidence based strategies I mentioned, that kind of fits in with that a bit, we need to see what the trigger kind of reason is like, what is it about that thing, whether it's a type of activity or an emotion, or a type of food or drink, or whatever it may be? Why would that cause a symptom, and if it does cause symptoms for you, what is that telling us about your body, so not only is that a way to help, modify, triggers to feel better, but it's also a way to understand your body. And we also do need to stabilize the gut, it's very hard to figure out what's going on and really work on roots, especially when we're thinking about IBS, where like the roots are the brain communication, some of the immune activation, the motility overall, as well as dysbiosis. In the gut environment, it's really hard to work on those pieces if we have it, stabilize the gut and stabilize your symptoms.
So that's the approach I take where I do stabilize symptoms first, and then I dig deeper and figure out okay, now what can I do to address this, and then we do need to support a healthy gut environment and create sustainable habits. That is key. And that is something that you can do, sometimes the big benefits and the big results from the work that you do. It doesn't come right away. It typically comes later. And again, I think this like sexy marketing and the like, it's just BS, like, let's get to the root, let's find the answer. Let's heal your gut. Sometimes that can come across, especially in the social media world as Oh, this is gonna happen quickly. This doesn't happen quickly. This happens in time, it takes time and especially the more complex the case, the more roots that are actually involved. There's a lot of time that can go into that the body needs time to really build up to heal, to relearn to kind of navigate these new habits and behaviors. And so that does take a lot of time and that's a good expectation has coming in.
Thank you for being here for season four of The Gut Show. Again, I've loved it. I hope that you have to and I really want to hear from you. Come find me on Instagram @erinjudge.rd Find us at the get community on Facebook. leave a review. If you'd like something specific that you want to see us bring back Leave it there, email me whatever you need to do to share what you liked maybe what you want to be different in the next season. And then even your thoughts on this particular episode because this is a conversation and I want to hear what you think whether it's an agreement with me or not, are completely different in a different perspective. I always want to hear that so please share it. I welcome it. And I cannot wait to see you again in season five.