#004 Dr. Barbara Bolen recommendations for IBS sufferers

Dr. Barbara Bolen recommendations for IBS sufferers looking at both physical and mental health

Why does 15% of the population suffer from IBS and what role does stress play? Dr. Barbara Bolen, a psychologist and health coach offers some sound advice on how to ease IBS symptoms through behavioural changes. She explains the role of food in the healing process of IBS sufferers and why the low FODMAP diet is a great way to start eating healthier foods without triggering IBS symptoms.

In this episode, you’ll learn:

  • How Dr. Barbara Bolen became interested in IBS and the low FODMAP diet.
  • Role of foods in causing and healing illness.
  • What Barbara recommends to IBS sufferers.
  • How food intolerance contribute to IBS symptoms.
  • Best ways to successfully follow the low FODMAP diet.
  • Can stress and antibiotics cause IBS?
  • Why 15% of the population suffers from IBS.
  • What disorder should be ruled out first?
  • Tips for celiac disease testing.
  • Tips to manage IBS symptoms.
  • Helpful IBS books of Dr. Barbara Bolen.

Can’t listen to this episode right now? Read the transcript below!

 

Larah: Hello and welcome to another episode of the low FODMAP diet and IBS podcast. I am a big fan of today’s guest. This amazing lady is a licensed clinical psychologist, an integrative nutrition health coach, a health writer, an IBS and low FODMAP diet expert and author of several very successful books on IBS.  She has also been the IBS expert for the website about.com since 2007, and also on About’s new site, verywell.com. She has even contributed to the screenplay for the documentary Microwarriors. I have the pleasure now to introduce you to Dr. Barbara Bolen.

Larah: Hi Barbara.

Barbara: Hi Larah. Thank you for having me.

Larah: Thank you so much for being on the podcast. First of all, would you be able to tell the listeners a bit more about yourself and how you got interested in IBS and the low FODMAP diet?  Also, considering that you studied to become a clinical psychologist?

Barbara: Yes. My journey in terms of supporting people who have IBS started in my work as a small town psychologist. I just kept having these patients come in to see me and they were telling me about this digestive problem called IBS. I had never heard of it before and had never heard of it mentioned in graduate school.  And the way they described it, it sounded terrible and they were so looking for help. Their doctor said it was psychological.  They had seen other psychologists who said you know it’s all medical, we can’t help you, so I really wanted to help them and started looking into trying to get some resources.  I was so thrilled to find out the kind of therapy I did, cognitive behavioural therapy, CBT, is actually helpful for IBS, but there was no self-help book written and so I sat down and wrote it, and that’s really what started me on the journey.

How I got involved in the low FODMAP diet, It’s more related to when I got nutrition training and I really learned about the role of food in not only causing illness, but also the role of food in the ability to help heal illness. I thought the low FODMAP diet was wonderful because it gave people who had IBS a way to start to eat healthier foods but in a way that they felt really safe and didn’t trigger their symptoms.

Larah:  That is so great, Barbara, that you are able to understand your patient’s physical health as well as their mental health. Fantastic.  And now I would like to ask you, how do you combine all your qualification and skills to help IBS sufferers manage their symptoms?

Barbara: So right now, I work predominantly as a health coach. and as a health coach, I really focus on working with my clients to figure out which foods are right for their unique body. So we kind of start with the nutrition, but then we also definitely get into coaching and I work with them on mindset changes and habit changes, most often in terms of prioritising self-care.  And then, of course, my background as a psychologist comes in very handy in terms of helping people to deal with their stress. Often people with IBS also often have depression and anxiety alongside of it, so that is where my background as a psychologist really does come into play in terms of really helping people to understand what that is about and what they can do about it.

Larah: That’s fantastic that your patients are able to see someone like you who has got so much knowledge in various aspects of health.  So what are some of the changes that people who have been diagnosed with IBS can adopt to improve their IBS symptoms?

Barbara:  Well, one of the first things I always recommend is that people start to eat clean. This means to cut out the junk food and stay away from foods that are filled with chemicals and preservatives, and also, then, to really work to find what specific food triggers are contributing to their symptoms. But it’s also not just about taking away food. When I work with clients. it’s also very much about adding in food because I believe that in order to help to heal the gut and make it healthier, people need to be eating more produce than they’re eating. And again, this is where the low FODMAP diet comes in so handy because it helps people to eat more produce, but again, eating it with confidence instead of fear, which is awesome.  And then, I also do recommend some sort of a mind/body technique — whatever works for that particular client whether that is meditation or yoga, physical exercise of any kind or spiritual practice because IBS is stressful. Life is stressful and stress sets off the digestive system. Helping people to learn ways to calm their body physically, we can go a long way towards helping them feel better.

Larah: Yes, absolutely. I agree with you. So would you be able to talk a little bit about the differences between food intolerance and food allergies, and is there any connection to IBS with any of those or both of those?

Barbara: So food allergies actually are pretty rare — more likely to show up in children and less likely to show up in adults. Food allergies actually involve an immune system response, and so that’s sort of a classic. If someone is allergic to shellfish and then they eat some shellfish and the throat starts to close up.  So that’s not necessarily related to IBS. I mean, a person could have food allergies, but that’s not necessarily related. It’s really more of the food intolerance, and what that is, is it’s a digestive system reactivity. Now there’s no way to test for that kind of reactivity; there’s no like medical tests. Really, the only way to test is the use of an elimination diet, where you eliminate the food for some period of time. You assess to see whether nothing helps your symptoms and then, at some point you challenge it and you eat that food again to see what happens. The challenging part is always hard for people because, “I’m feeling better. Why would I want to try it?” But the point is, you want to really be careful about what food intolerance you are identifying, because you always run the risk of really restricting too many foods from your diet.

Larah: Yes, very true. So that was very clear for me to understand, the differences about allergies and intolerance, and hopefully has been the same for the listeners. If someone suffers from IBS symptoms and has been told to follow the low FODMAP diet, what are, in your opinion, some of the best ways and resources that can help this person to successfully follow the diet?

Barbara:  Well, number one, I do strongly recommend, as does the Monash University, the developer of the diet, that somebody work with a trained dietitian or a health coach. Again, to really help navigate the diet, it’s not easy. It helps if you’re working with someone and it helps with motivation to keep on track, but it also helps you, again, to not fall into the trap of restricting too many foods.  I also absolutely recommend that Monash University app and there’s other apps springing up, but that one is the best. It’s so user friendly. Within a second you can see if it’s a red light food or a green light food, and even for myself, I’ve written a book on a low FODMAP diet, but I still can’t remember some of the ingredients. That app is so simple. What I love about the app is that every time a new food is tested, they’re updating it so you’re really getting the most cutting edge information on that Monash University app.

And then last, I always recommended that people really start to find some other favorite low FODMAP bloggers such as yourself, Larah, for recipes because it’s challenging to cook low FODMAP, but it doesn’t mean you have to be eating a very restricted bland diet. There are some amazing recipes out there and there are so many bloggers, who are on the diet and who are using  great low FODMAP ingredients. That can be a great resource and support for somebody who’s trying to follow the diet.

Larah: Yes, that’s very true. I remember at the beginning when seeing the list that the dietician gave me, I thought I was going to faint. It had everything I was eating. You know, being an Italian, I ate lots of pasta and garlic and onions were in large quantities in every food I ate, but now, I have been able to replace everything. There is not that much that I miss.  And also, some of the things I was not allowed during the elimination phase, I can now have in small quantities, so I’ve adapted perfectly to that.  It was a bit daunting at the beginning, but I would say, “Don’t worry too much. Get through the first few weeks of elimination phase and you’ll feel so much better. Then, when you can reintroduce some of the other food back, you can just carry on with that.

Barbara: That’s great.

Larah: It is also so true about the Monash University low FODMAP app. So that was with me every second. I used to go in the supermarket, open it up and say, “Okay, can I have this? Can I not have it? How much can I have of it?” It’s such a good companion and only $12. I would pay $50 for it, really.

Barbara: Right.

Larah: Personally, I always thought that my IBS was caused by a combination of stress and the fact that, a few years ago, I had three attacks of bronchitis in the short time of six months and I had to take antibiotics. I thought that maybe that interfered with my gut bacteria. Do you have any opinion on that? Can stress possibly cause IBS, or can antibiotics cause IBS? And if not, is there any explanation at all why 15% of the population suffers from it?

Barbara: I think, Larah, that you absolutely identified two key factors in the development of IBS.  Stress can leave the gut vulnerable to the gut bacteria getting out of balance, and certainly, antibiotic use can really take its toll on gut bacteria. So often, I hear kind of similar stories from other people that those were sort of the series of events that led to the development of the IBS.

Why 15% of the population? I think that we do live a more stressful life than ever before. Antibiotics are prescribed too much, and again, that affects gut bacteria. Little kids don’t get dirty. We don’t get dirty as much and there’s all those good bacteria in the soil that’s good for our gut. And people kind of stopped eating traditional foods, fermented foods, you know, a lot of fake foods now, and all of that really sort of adds up for guts that are more vulnerable for the developments of IBS.

Larah: Yeah, that makes total sense. Yeah, that’s great. So now, I just wanted to talk about something I found quite intriguing. It’s that you used to suffer from chronic migraine headaches — so that’s not intriguing; that’s not really good — but after watching one of my favourite documentaries, “Fat Sick and Nearly Dead” by the Australian entrepreneur and film maker, Joe Cross, you started to drink green juices and your chronic headaches disappeared. I’m also a very big fan of the documentary and Joe Cross, and I love green smoothies. Instead of just extracting the juice from the vegetable and the fruit, I tend to blend them, which also gets the fibre. But would you think that green juices and smoothies can be good for IBS sufferers considering that a lot of vegetables and fruit that you’re going to consume in quite a concentrated form, even if you are using vegetable and fruits that are low in FODMAP? And also, considering that when those fruits and vegetables that are low FODMAP, you can only have in very small quantities most of the time. If we consider people’s safe threshold and the accumulation of many low FODMAP digesting fruits, will that then make the juice high FODMAP?

Barbara: This is such a great question, Larah, and I am waiting for the day for somebody to do some research on this.  So I’ve heard of so many people who have started to juice regularly and their IBS has gotten so much better, probably because they’re nourishing the gut bacteria, but it’s such a good question in terms of what happened with FODMAPs? So the one thing I kind of know about juicing is that it kind of takes out the insoluble fibre, so what makes its way down to the gut is soluble fibre which, in general, is better tolerated for the person who has IBS. What I don’t know, is where those FODMAPs are going. Are they staying behind as insoluble fibre or are making their way down with the soluble fibre.  So I don’t know the answer to that question. I’m hoping that someday somebody will give a great scientific answer to that. So in the meantime, what I tell people is, “I think you should try juicing, but I think you should start with the low FODMAP vegetables and a little bit of low FODMAP fruit, and then trial and error. Just see how your gut, how your belly reacts to that. In theory, it should be really great for IBS. But everybody is different and that question as to which FODMAPs are still making their way down into the gut is unanswered, but I think the first people should just give it a try and see what happens.

Larah: Yes, I agree. Maybe just try the smallest quantities to just see how you react to that and then slowly increase to a larger quantity until you find your happy medium.

Barbara: Exactly, exactly.

Larah: So we know that IBS symptoms can be also very similar to other medical problems or other digestive disorders. Could you briefly explain which disorder should be ruled out first?

Barbara: The very first thing that should be ruled out is celiac disease. It is under diagnosed in general, and people who have IBS are at a higher risk for an undiagnosed case of celiac.  It still surprises me how few doctors are testing their patients for celiac considering that it’s out there, that it’s undiagnosed, but here’s the really important thing to know about celiac disease.  You have to be eating gluten at the time of testing in order for the testing to be accurate.  So, while I think that no one with IBS should ever be eating gluten, FODMAP fructan or gluten protein, whichever, you can’t go gluten-free until you’ve already been tested for celiac. And it’s really important to know if you have celiac disease because if you have celiac disease, you can’t ever cheat and just have a little bit, whereas if you just have trouble tolerating gluten or tolerating the fructans in the wheat, you can cheat. You might pay for it, but at least you’re not doing much to your body.  So, definitely, people should be screened for celiac disease.

The other things that you rule out through doctors is IBD, the Inflammatory Bowel Diseases, and all sorts of colitis and Crohn’s disease. Doctors pretty much do that. The other thing is that many people really get frightened when they have IBS that it’s a colon cancer because how could it be that you were in this much pain?  You know, there must be something really terribly wrong. So doctors, again, look for signs of colon cancer, where typically there’s signs of bleeding from the rectum, unexplained fevers, significant unexplained weight loss and really persistent fatigue. So again, colon cancer usually sort of makes itself known, and that is something that doctors will look for.  So if somebody has a new onset case of IBS, they should absolutely go to their doctor because, again, these are the things that need to be ruled out. Once they’re ruled out, the statistics show that doctors have been much more accurate in coming up with a diagnosis of IBD.

Larah: Yeah. Thank you so much, Barbara. I consider myself very lucky because in 2013, I changed doctors and by then I had been suffering from IBS symptoms for probably a couple of years, without knowing that it was IBS at all. And all other doctors just gave me tablets and things to reduce my symptoms, but never went to the bottom of it. When I found this doctor, he didn’t say straight away, “You could have IBS.” He said, “Okay, let’s do some tests”. So again, the celiac test, and then he got me to do some checks of my internal organs and even my heart because my acid reflux sounded like unstable angina symptoms. So after ruling out everything and doing a lactose breath test and fructose breath test, he then came to the conclusion that, “Yes, you have IBS. You need to see a dietitian,” and my life changed and I never looked back. So I’m very thankful for my doctor for really wanting to look at the cause.

Barbara: That’s great. That’s really great.

Larah: Would there be any final tips you could give to IBS sufferers to help them be able to manage their symptoms at all?

Barbara: Well, you know, again, the bigger picture is identifying which foods are right for the body and reducing stress, but for more immediate symptoms like when you’re really in a lot of distress, I’m a big fan of soothing teas. You just have to be careful which teas are low FODMAP and which are not, but teas can be very soothing. I’m also a big fan of the use of heat, so either a hot water bottle or a heating pad when spasms and cramps are really at their worst.

Larah:  So excuse me, where would you put those heating pads. Like on the tummy?

Barbara: Exactly, yeah. Where it hurts.

Larah: Yeah. Where it hurts.

Barbara: I think heat is good. It relaxes the muscles and also relaxes the central nervous system, and when you relax the central nervous system, you’re going to help to quiet down the pain.

What else do I recommend? Guided imagery for pain. It’s not morphine, but anything you can do to sort of reduce the experience of pain can be really helpful. Using some imagery in the brain can help to quiet things.

I think one of your questions was about gas relief? So some simple yoga poses and sometimes, twists can be very nice and soothing and it helps kind of move through any trapped gas, and that can help relieve that kind of pain.

Larah: Thank you so much I really appreciate these tips and hopefully they’ll be useful for the listeners as well.  So now, let’s go to the books that you’ve been writing on IBS and the low FODMAP diet. Can you tell us a bit more about them and where they can be purchased from?

Barbara: My books can all be found on either Amazon.com or Barnesandnoble.com. My first book was “Breaking the Bonds of Irritable Bowel Syndrome”. That is a self-help CBT approach for managing IBS symptoms. That’s a really good book for people who find that anxiety very much contributes to their symptoms, that there’s a lot of worrying about how they’re going to feel, how they’re going to handle the situation, how they’re going to be. That book is excellent for that.

The Everything Guide To The Low FODMAP DietMy next book is “The Everything Guide to the Low FODMAP Diet”, is a combination book. It’s half science and half cookbook. So the science makes the diet really understandable and helps a person to feel like the diet is doable, as you have learned. And then the second half is filled with lots of delicious, nutritious recipes and again, all based on whole foods, clean eating. So really, they’re good for the overall health, as well as helping a person to get through that tough elimination phase.

And then my most recent book is “IBS: 365 Tips for Living Well”, and this book shows you everything you would ever want to know about IBS — causes, treatment and how to live with it — and all that information is given in this very easy, small little chunk-at-time format. So those are the books.

Larah: Thank you, Barbara, and I do have one of your books, “The Everything Guide to the Low FODMAP Diet” and the recipes are just amazing.  So I will suggest to anyone that doesn’t have it to go and get it. It’s a very, very useful book.

Barbara: Great. Thank you, thank you.

Larah: So if anyone wants to keep in touch with you, where can they find you?  What is the easiest place they can reach you?

Barbara:  The very easiest way to reach me is that I have a free Facebook group. It’s called Freedom from IBS and anyone is welcome to join, and you really can kind of contact me in real time because you just post your question and I’ll get back to you as soon as possible. The group is also filled with really supportive people who give lots of love and lots of wonderful advice, you know. They’re in it. They know exactly what it’s like to be doubled up in pain in the middle of the night and they have great suggestions for getting through that. It’s a place for people who can speak openly about their symptoms because IBS doesn’t really lend itself to that kind of talk. So, it’s Freedom from IBS Facebook page. Anybody is welcome to join, and that really is the best place to contact me directly, but I also do have my website, drbarbarabolen.com, and there are lots of resources there on this site as well.

Larah: Thank you so much, Barbara. Yes, I agree. Some people may find it daunting to talk to their family or friends about their IBS or IBS symptoms. I personally don’t have a problem. I tell straight up, “I can’t have that. I have IBS,” and most people look at me kind of puzzled and say, “What is IBS?” So I explain it to them, you know. It doesn’t worry me. I don’t think I should be ashamed. It’s not something I want to have, but it’s something I have, and I think talking about it openly could even help family and friends. They might recognize or have the same symptoms, but not have an idea. And maybe, that could be the question they can ask their doctor — if they can go through the steps to have a diagnosis. But yeah, having a place like a Facebook group where people can anonymously go and find useful information and find other people who have this type of issue is, I found, very, very helpful.

Barbara: Good for you for being so open about it. It’s like my mission in life to get everybody with IBS to be open about it because why shouldn’t you, right? Like why is the fact that you’re running to the bathroom with diarrhoea urgency any different than, you know, having an asthma attack? It’s just a different body part. And you’re right, when you talk about it openly, or when anybody talks about it openly, it’s then freeing up that openness for other people to absolutely figure out what’s wrong with them and get the help that they need instead of just sort of dealing with it all by themselves.

Larah: Yes. That’s so very true. I’m so grateful that you were able to answer all these good questions. For everyone listening, Barbara this has been so, so useful. I can’t thank you enough for taking the time to be here today and it was a pleasure to get to finally meet you in person, even if it’s on Skype. For a couple of years, we’ve been kind of following each other, emailing each other, so it’s good to finally see you.

Barbara: Absolutely, absolutely.  What a pleasure, what a pleasure. Thank you for having me.

Larah: Thank you, Barbara.

I really hope you have enjoyed this new episode with Dr. Barbara Bolen. If you would like to access all the links and the resources we’ve been talking about during this episode, please visit my website at www.lowfodmapdiets.com/4 . I hope you will join us again next time, and until then take good care.  Goodbye.

Links and resources mentioned in this episode:

Barbara’s Website

Barbara’s Books:

Links to Dr. Barbara’s social media:

Other links and resources mentioned in this episode:

Disclaimer:

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About Larah Brook

I have been suffering from Irritable Bowel Syndrome for many years, but it took a longtime to get a diagnosis, since then I have been following a low FODMAP diet, which has changed my life for the better. This is my story and experience with IBS and the low FODMAP diet.