Exam Room Nutrition: Where Busy Clinicians Learn About Nutrition

24 | Happy Gut, Happy Life: Boost Gut Health with Nutrition

December 12, 2023 Colleen Sloan, PA-C, RDN Episode 23
Exam Room Nutrition: Where Busy Clinicians Learn About Nutrition
24 | Happy Gut, Happy Life: Boost Gut Health with Nutrition
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If your patient were to ask you, “what can I do to improve my gut health?” What would you say?  Do you know how to improve their gut health naturally through nutrition? I am joined by Christa Smith, a Registered Dietitian, to unpack the strategies that are foundational to optimal gut health.

What you'll learn:

  • How to be aware of factors such as stress, diet, lifestyle, and sleep that can significantly impact a patient's gastrointestinal well-being
  • Learn to address the root causes of digestive discomfort
  • Why not everyone needs to follow certain restrictive diets
  • Why "cleanses" are not helpful
  • Understand the difference between IBS and IBD and known trigger foods to avoid
  • The importance of dietary fiber and excellent food sources to recommend
  • How much caffeine is too much 

Stay to the end for Colleen's Nutrition Notes segment for an encouraging quote, you need to hear today!

Connect with Christa: @christasmithnutrition

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Disclaimer: This podcast is a collection of ideas, strategies, and opinions of the author(s). Its goal is to provide useful information on each of the topics shared within. It is not intended to provide medical, health, or professional consultation or to diagnosis-specific weight or feeding challenges. The author(s) advises the reader to always consult with appropriate health, medical, and professional consultants for support for individual children and family situations. The author(s) do not take responsibility for the personal or other risks, loss, or liability incurred as a direct or indirect consequence of the application or use of information provided. All opinions stated in this podcast are my own and do not reflect the opinions of my employer.

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Colleen:

nausea, heartburn, indigestion, upset stomach, diarrhea Sounds like the Pepto-Bismol commercial. Right, I'm not here to talk about medication, but today we're unpacking ways you can help your patients improve their uncomfortable GI symptoms, naturally with nutrition. If your patient were to ask you what can I do to improve my gut health, what would you say? My name is Colleen, I'm a pediatric PA and registered dietician, and this is the Exam Room Nutrition Podcast where each week, I'm giving you answers to common nutrition questions to help you be a more confident, compassionate clinician. On today's episode, we're unpacking a hot topic right now the world of gut health. You'll learn some foundational strategies patients can do to alleviate their symptoms, like the importance of eating enough calories, chewing thoroughly and getting in their fiber. You'll learn why not everyone needs to be on a gluten-free diet and whether my guest dietician supports going on a cleanse or not. You'll learn the difference between IBS and IBD and which foods could be potential triggers. So get settled and join me in welcoming Krista Smith to the show. Krista is a registered dietician who specializes in GI and human performance. She is an ulcerative colitis patient and athlete herself, so she is no stranger to the GI and sport world. She earned her postgraduate diploma in sports nutrition from the International Olympic Committee and holds a master of clinical nutrition from UT Southwestern Medical Center.

Colleen:

Krista, thank you so much for the gift of your time. I'm super excited to have this conversation. Welcome to the show. Thank you so much for having me, Colleen. I'm really excited to be here. Obviously, I always have registered dieticians on the show, but I love when my registered dietician, who has expertise in a field, also has that personal expertise too. So I think it's really unique, the blending of your career and your personal health. So thank you so much for just giving us your wisdom and your practical insights and tips, and I love that you bring the science with it too. So we're gonna just open the floor. I really want you to just give us an overall nutrition education on general gut health.

Christa:

Yeah, absolutely, and I love this topic. I think it's such a fun and it seems to be booming right now. Right Like everybody's kind of talking about gut health so kind of foundationally, what I always like to remind people is that we kind of forget that eating enough is really foundational to our gut health. We have to have enough energy coming into the system to be able to process food and be able to have energy for life and activity, and I think a lot of like my active clients forget that, but it really is foundational to the health of your GI system and so if we don't have enough energy coming in, then the gut's gonna be on the back burner and you're gonna start seeing symptoms Like it's gonna slow down so motility and that's when we see like lots of constipation and bloating and gas and sometimes just eating enough gets the system going again. And so don't forget that Like that is foundational to just general gut health. And then also just some other points and things to consider with gut health just like thinking foundationally it's an offshoot of eating enough, but really like lots of consistency and intake, so eating every three to four hours, you know, ultimately balancing blood sugar, which I know. You just had a guest talking about this and I loved it. But really doing so, eating every three, four hours and also having plates that are really balanced Ideally all food groups are represented a good mix of carbohydrates, protein and fat and fiber. Our bodies really love consistency and so when we do that and we have all those things represented, then that helps the system move things along appropriately. We want lots of variety and then also so chewing really well is so foundational to our gut health. So when we think about the cephalic phase of digestion that starts in the mouth and that's whenever we have all of these different amylases and enzymes and things that are starting the process of digestion along with the chewing, and so when we chew to like applesauce consistency, then we're going to produce more enzymes, and the more enzymes and the more broken down, the more surface area that those enzymes are exposed to, then the easier it is on our system.

Christa:

And when we do some of these foundational things, I often see this as like a first line defense and also like if there are some other GI symptoms going on, like bloating gas or just discomfort, then doing some of this foundational work helps and we start to see some improvement. Because if we have more enzymes hitting the food, then it's more broken down. When it's lower in the GI system, then that creates less of a burden, less taxing on the system and then we see less bloating, gas and pain. So those are just a few things. And then also, whenever we think about foundational gut health, I always like to stress lowering stress and sleeping well and moving your body, you know, in adequate amounts is also super foundational and helpful.

Christa:

And then also, like assessing bowel movements can be really helpful too, especially like when we think you know other practitioners, like PAs or other people that are going to be kind of first, you know, first line of people that are going to see patients, just kind of assessing, like how often are we going? Are we? Are we actually having a full bowel movement every day? Are we seeing too much stool coming out? Is there lots of diarrhea or are we alternating constipation and diarrhea? Oftentimes that's going to be really severe constipation, especially if we see, like you know, three, four days of constipation and then like an overflow diarrhea type picture and then we go back to constipation. So there are definitely things that we can encourage, obviously all of the things that I just mentioned, but also things like drinking enough water, maybe bringing in some electrolytes, just some basic electrolytes, eating enough fiber, reducing alcohol, you know, addressing the pelvic floor, things like that.

Christa:

And then if there's more of like a diarrhea type picture, then maybe we can bring in some foods that would help bind some of that extra moisture, so things like bananas or beans or oat bran or sweet potatoes or even psyllium husk, and then also addressing that hydration.

Colleen:

Hey, we'll get back to the episode in just a moment, but I wanted to give you a gift for hanging out with me today. I want to give you access to a free guide that gives you a step by step strategy to navigate a talkative patient. You know the one who always rattles off 10 different concerns the minute you say so how can I help you today? I've been there, trust me. So I created a simple framework called steer that will allow the patient to feel heard but also keep you on time. The patient will feel respected and their concerns will be addressed, and you won't be constantly running late. In this free PDF, you'll learn this simple acronym to guide your conversations, and I've included useful phrases you can use that will completely transform the way you talk to your patients. And it's all free and it's my way of saying thank you. So check it out in the show notes below. Now let's get back to the episode.

Christa:

Hopefully that is helpful in just kind of thinking foundationally about gut health. And then just addressing diet is always important and so just thinking through, you know, less processed foods, if we can, more whole foods, whole grains, nuts, seeds, fruits and veggies, healthy fats and omega-3s, and just being, you know, mindful of some of the jargon that we see out there. A lot of the things that are touted for gut health are often not as helpful. And so just kind of being mindful of product wording and, you know, reaching out to a provider that can help if there's confusion there.

Colleen:

That was such an excellent foundational overview. Thank you so much, and I really love that you mentioned chewing your foods thoroughly, because you know adults, we kind of forget the basics. So I love that you explained that chewing foods the applesauce consistency spreads out the surface area, because now you can really understand what the science is actually doing within your body. So that's a great thing that we can explain to our patients and that they can easily understand how that simple task will improve maybe their bloating or maybe their diary or constipation. So those were fantastic foundational principles that we can all be recommending. I want to linger here a little bit and I want to backstep to where you had just said to watch out for some of those things that are claimed to be for gut health and that they're really not. Can you maybe address what some of those might be so that the clinicians could be aware of it and properly guide their patients to maybe something else that would be truly beneficial instead of that claim? That's on social media?

Christa:

Sure, oh gosh, and there's plenty. I'm probably going to miss a few, but I think as a provider it can be really helpful to just listen for some of the buzzwords that patients are talking about and you can often hear even some fear in some of what they're saying, and so that can be really helpful and to kind of an insight into how they're processing day to day. But oftentimes I hear this all the time when we have really really significant or just not helpful gut symptoms and our patients are trying to figure them out on their own. They're looking to social media or they're looking online and often I'll hear okay, I'll take out gluten, I'll take out dairy, I might definitely the processed sugar and processed foods and added sugars and things like that, which, yes, they're innocent. Some of that can be helpful to reduce.

Christa:

But it's so helpful to do that with a dietitian or with a practitioner that understands, because we think, like gluten-free or dairy-free, they're going to have some sort of extra added filler, something in there to make it taste like the actual product that it's trying to mimic.

Christa:

So if it's an Oreo or whatever, then it's going to have extra stuff in there to make it taste good, so there may be more added sugars, or there may be sugar, alcohols or there may be tons of other ingredients that can be just as irritating to the gut, and so it's good to be mindful of that. Those products that are gluten-free, dairy-free, plant-based, whatever they're not always inherently better, and just generally, and then also not always inherently better for gut health. So, yes, we do want to encourage less processed foods and encourage more whole food options, but that doesn't mean that we have to take out full food groups and things like that. It often takes so much more digging than a practitioner is going to have in 15, 20 minutes with a client or with a patient, but that can be a really good point of interaction where you can say you know what? I think a referral to a dietician or seeing someone would be really helpful, because then you guys can kind of work some of this out and find better options.

Colleen:

Super helpful. Now, what are your thoughts on any of these cleanses juice cleanse, lemon cleanse, cabbage cleanse there's a cleanse with every food out there, so what are your thoughts on that? If our patients are telling us, hey, I'm going to do a juice cleanse, I'm going to do this cleanse, is that appropriate or should we be suggesting something else?

Christa:

Such a good question. I think this comes up with everything because they're like well, I need to, you know, just get rid of everything, get rid of all of it and just kind of start over blank slate. But does that really address the root of the issue? No, it never does, and so I always steer my clients clear of that, because we have to remember foundationally, like that's going to significantly reduce calories, which that doesn't help the overall picture, that doesn't help blood sugar balance. Right, like you know, you're not having any sort of balance. Really.

Christa:

You typically, whenever you see a cleanse, and then also we have less control over what those products are, especially if they're relying on, like, some sort of supplement version of this or they're purchasing a product, like we don't have much control over what's in that product.

Christa:

And then, even if you think about like, just for an example, let's say that you know the root of the issue is this person is just not creating a lot of stomach acid. Maybe they've been on a PPI for a really long time and you know you don't have all of the history, but we have a picture of low stomach acid and that's kind of causing a lot of the downstream effects. And then you put on like a cleanse or you know something with lots of like, lots of other herbs and things that might irritate things. Or you know what, if it's high stomach acid and we're adding lots of like lemon juice and things like that, I mean it's going to be extra irritating and so oftentimes it's just not helpful. They might feel a little bit better for a couple of days, but it's all going to come back.

Colleen:

I couldn't agree with you more. So we've got a great picture of some overall general gut health recommendations and foods and things that our patients should be trying to consume more of. Now I'd love to do just a little rapid fire segment on some quick tips for IBS and even IBD, since you yourself are a patient of ulcerative colitis. So I'd be super interested to hear some of those quick tips that we can provide to our patients.

Christa:

Yeah, okay, so just kind of differentiating the two IBS irritable bowel syndrome so irritable, not inflammatory. Yes, there are symptoms, but there's not actual inflammation. Ibd inflammatory bowel disease we're actually seeing inflammation and so there's actually a disease process in IBD and where you know, the gut lining is actually damaged. With IBS, yes, we're seeing symptoms. Like this is frustrating for patients and we know that there's some sort of dysregulation with, like, the gut and the brain access as well, and so they may be experiencing like a very normal amount of gas production or things are very normal anatomically speaking, but they're perceiving it as pain or whatever, and then it is causing diarrhea or constipation of abdominal pain and I often find that I mean, I just feel so bad for our IBS patients. It's just like they get slapped with that diagnosis and they're like what do I do with that? But I think we have to do some digging.

Christa:

I think it's always best to work with a dietician who knows what they're doing, because there's so many things that could be triggering it and there's so many tools that we have in our toolbox that can help. Ibs is typically very influenced by our environment so stress, diet, lifestyle, sleep and I know that our patients experience that, because when things go crazy there's usually some sort of root in the stress, a stressful situation or lack of sleep or something like that. But obviously we always want to rule out those bigger red flags like IBD or Celiac or whatever, those inflammatory processes. But if those are not present, then we want to hone in on what the triggers might be. So it might be a FODMAP issue, it might be more related to lifestyle, more related to stress than anything else, but we want to know what those are.

Christa:

So I always encourage patients to journal it out, take three or five days and long everything. And this is something that practitioners could totally do, because then a patient could take that to a specialized dietitian and be like OK, here's my last week, I don't know what's going on, but based on what I've written down, it kind of seems like these two things are related. And then the dietitian can help sift through a lot of that, so logging all your food, your movement, your bowel movements, all your symptoms and the timing of those symptoms to kind of create those connections. And then also thinking through OK, we kind of have some foundational things with IBS that can be really helpful, like creating that meal consistency, those three meals a day, even spacing, balancing those carbohydrates per teeter fat, just kind of working through those basics staying hydrated, working towards stress management, improving bowel movements, things like that can be really, really foundational for IBS.

Colleen:

I think that's super important that you said that those triggers are what we need to know, because one food might not bother one patient, versus that same food can really be upsetting another patient. So it's not where we can just blanket say, oh yeah, everybody needs to be on a gluten-free diet or everybody needs to be dairy-free and I love that you mentioned that, because it's just not the case and I would hate to eliminate a great nutritious food group for somebody if they don't really need to eliminate it. So I cannot agree with you more that keeping a food log prior to sending them off to a dietitian is so important. Now, with that said, I know everything is so nuanced, but are there any certain foods that are Oxygen, pretty often known to be triggering or bothersome foods for the majority of people, that maybe we can try to tell our patients to avoid? So we're giving them something to leave the clinic with.

Christa:

Yeah, that's a really good question and you're right, so nuanced, everyone is so different. If it truly is like a FODMAP issue, then typically what I'll see anyway is like garlic onions, really even apples, like that kind of thing usually is a struggle. If you're finding that, like the patient, just they can't even figure out, they're like I don't know, one day I'm fine, the next day I'm not, and it just kind of seems to flip flop and I can't really figure things out, then typically that kind of like tips me off to this is probably not a food related issue, this is probably like a microbiome issue. And then you might could dig into like have you been on lots of antibiotics? Have you been sick a lot? Do you notice bloating all the time, like it, can you not really get rid of it? That will kind of tip you off to okay, this is probably a microbiome issue and something where there's just there's probably some sort of dysbiosis going on. And even if they say, yeah, I've even tried probiotics and probiotics seem to worsen things, that always tells me okay, like there's definitely dysbiosis going on and we probably need to do lots more digging to figure that out, because it's not going to matter what they put into the system.

Christa:

I always, always am like okay, how much alcohol, how much caffeine are we doing? Because those are always triggers like they just they always are particularly like beers, because that's very fermented and that's going to cause a lot of gas just suggesting reducing some of that, especially if they have kind of a like a sporadic colon, you know they're having lots of cramping and then they'll have lots of diarrhea. We don't want that to worsen and obviously caffeine and things like that are going to do that. But you can always, always with like lots of confidence, suggest a fiber like so if they're having lots of diarrhea, okay, then suggest soluble fibers. And you can just say that and then they can Google soluble fibers, you know, and like things that are going to suck up moisture and then on the other side, with more of a constipation type picture, we really want to encourage consistent bowel movements. Both insoluble and soluble fibers can be really, really helpful.

Christa:

I love recommending no matter what. If it's diarrhea constipation, I love recommending PhGG. So that is, that's a partially hydrolyzed guar gum and you find it in sun fiber. There's tons of evidence for it. It's very neutral. It's not like an aggressive gas producer. It will create some gas production, but it's not super uncomfortable for people and it integrates into any liquid. Hot cold doesn't matter. You can't taste it. It's very. It's like an entry level fiber and it helps with both constipation and diarrhea.

Colleen:

So, krista, you mentioned so many golden nuggets in that last little spiel you did on those tips for IBS, but I wanted to back it up to two specific things that I think my listeners will want more info on. The first one is soluble fiber. So if my friend is driving in the car and they're going to the clinic and they're like, dang, I can't look up what soluble fiber is, but I really want to recommend it to this patient. Can you give us three things that we could say hey, this will really help. This is soluble fiber that you should start eating.

Christa:

Sure. So bananas, particularly like green bananas, and the beans, oats, oat bran, sweet potato, those types of things would be really helpful, even chia seeds, because that, you know, sucks up moisture too.

Colleen:

Beautiful. And then coffee you mentioned. If they're drinking an excessive amount of coffee, right, we all kind of know what an excessive amount of alcohol would be, because that is kind of everywhere on general guidelines. Coffee is a little bit different and sometimes hard to find and we don't always talk about it that much. So if a patient is telling us I drink this much coffee in a day, where would our standard be for? Okay, that's too much, that's excessive. How many cups do you think?

Christa:

Yeah, and I think pairing it even with symptoms is really helpful too, because everyone's going to react to caffeine differently. Some people won't even feel it after five, six cups, you know. But my ears kind of start perking up after three, four different instances of coffee or if they're relying on, you know, caffeine midday, that type of thing. So 400 milligrams is what like four cups of coffee. So you know, that's kind of where my ears start perking up. Or if we've got coffee in the morning and in the afternoon and we have an energy drink. Or you know, we've got other sources of caffeine coming in and even with like active clients, sometimes they may not realize that like there are caffeine in like sports products, you know, like gels and things which can definitely start to induce symptoms, just kind of unknowingly. So yeah, that's where my ears would kind of be like hmm.

Colleen:

And, yeah, I think it's important to remember symptoms and their amount, because everybody's tolerance is different, so you don't need to go around just telling everybody hey, you can only have two cups of coffee every day because not everybody you know needs to cut back. So thank you so much for clarifying all these things. This was so enlightening and helpful and I know that my listeners, who have anybody whether you're in family practice, gi, even pediatrics a lot of people struggle with bowel symptoms and they might not have the inflammatory bowel disease, but it could just be a disturbance and an annoyance and uncomfortable. So definitely, thank you so much for all these practical tips. I'm so grateful that you spend this time with me. If you would like to follow her, like I said, she's a genius and her content is brilliant, brilliant Please find her on Instagram at christa smith nutrition. You can connect with her or ask her any questions and, as always, you can find me on Instagram at exam room nutrition. Krista, thank you so much for your time. We'd love to have you back on again. Thank you, colleen. I love that. All right, guys, now it's time for my nutrition notes.

Colleen:

In this section, I will leave you with a nutrition tip and encouraging quote or an interesting case that I think might add value to your day. I'm going to leave you with an encouraging quote that you can share with your patients, or it might be an encouragement to you as well. It comes from Bear Grills, who, as you might know, he's a British adventurer well known for his TV series man vs Wild, and he says being brave isn't the absence of fear. Being brave is having that fear but finding a way through it. And that is such an encouraging quote for all of us that we all have fear in our lives, and it doesn't mean that it goes away, but that you can get through it and work through those fears.

Colleen:

Well, I hope you guys found value in today's content. If you haven't already, please subscribe to my YouTube channel or like the video, and if you're listening on a podcast app, I would love if you could just leave me a quick five star rating or even write a review. This just helps others find my podcast. If you have any questions that you would like me to feature, you can send me a message on Instagram at exam room nutrition. And that's all for today, guys. So, as always, let's continue to make our patients healthier, one exam room at a time. I'll see you next time.

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