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IBS, FODMAPs, and Intuitive Eating, with Rachael Hartley

| Episode 005

Irritable bowel syndrome (IBS) is the bane of many people’s existence. Unfortunately, it is quite common and if you do not personally have the misfortune of experiencing this condition, there is a very high chance that someone you know and care about lives with it. Many suffer with the signs and symptoms without having a diagnosis. Whether formally diagnosed or not, a low FODMAP diet or other elimination diet might be something that has been tried to alleviate some of those familiar IBS symptoms: cramping discomfort, bloating, fluctuation between diarrhea and constipation, the list goes on. On the other hand, maybe you have never heard of the low FODMAP diet before and are interested in learning more.

Join me in discussion with Rachael Hartley, a revered expert in nutrition and registered dietitian. Together we explore ways in which people use the low FODMAPs diet and other elimination diets: how it can be done right – and how it can be done wrong. We also plunge into the concept of intuitive eating and what it means for you, colon health, and your overall well-being.

Click the play button above to listen to my conversation with Rachael.

Highlights from Today’s Episode

  • What is irritable bowel syndrome (IBS)?
  • How does diet and nutrition relate to IBS?
  • What is the low FODMAPs diet?
  • Is the low FODMAPs diet and other elimination diets right for everyone?
  • How elimination diets intimately impact your colon health and gut microbiome.
  • What are some of the risks to intermittent fasting?
  • What is intuitive eating and how might it benefit you?

Select Research Articles Discussed

  • Hadjivasilis A, et al. New insights into irritable bowel syndrome: From pathophysiology to treatment. Annals of Gastroenterology. 2019; doi:10.20524/aog.2019.0428.
  • McIntosh K, et al.. FODMAPs alter symptoms and the metabolome of patients with IBS: a randomised controlled trial. Gut. 2017 Jul;66(7):1241-1251.
  • Halmos EP, Power VA, Shepherd SJ, Gibson PR, Muir JG. A diet low in FODMAPs reduces symptoms of irritable bowel syndrome. Gastroenterology. 2014 Jan;146(1):67-75.e5.
  • De Giorgio R, Volta U, Gibson PR. Sensitivity to wheat, gluten and FODMAPs in IBS: facts or fiction? Gut. 2016 Jan;65(1):169-78.

Guest Spotlight: Rachael Hartley

Rachael Hartley, RD, LD, is a nutrition therapist, certified intuitive eating counselor and nationally-recognized food and nutrition expert. She holds a Bachelor of Science in human nutrition and a Bachelor of Art in psychology from Clemson University. After completing her dietetics internship at Emory University, she worked as a clinical dietitian and, later, as the outpatient dietitian for a large medical center where she provided individual nutrition counseling and led multidisciplinary disease management programs.

In 2014, Rachael opened her private practice, where she specializes in intuitive eating, disordered eating and eating disorders, women’s health, and digestive disorders. She also runs the popular food and wellness blog The Joy of Eating. As a trusted voice in the dietetics field, she collaborates with like-minded brands for recipe development and nutrition communications.

She is active in her field, currently serving as the public policy coordinator of her state dietetics association, and previously served as the president of her local dietetics association and newsletter editor for the Nutrition Entrepreneurs dietetic practice group. In 2018, she was named one of Self Magazine’s trustworthy dietitians for nutrition advice.

Rachael has trained under dietitians Evelyn Tribole (co-author of Intuitive Eating), Marci Evans and Anna Sweeney. She is the author of Gentle Nutrition: A Non-Diet Approach to Healthy Eating.

Colon Health Podcast with Dr. Dac and Ariel Bridges

About the Colon Health Podcast

Co-hosted by Dr. Dac Teoli and Ariel Bridges, the Colon Health Podcast features guest interviews with expert physicians, leading researchers, nutritional scientists, integrative health specialists, and other foremost experts in colon health.

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Episode Transcript

Dr. Dac: Hello, and welcome to another exciting episode of the ”Colon Health” podcast brought to you by colonoscopy.com. My name is Dr. Dac Teoli and it’s my true pleasure to share in this journey with you today. In fact, on this episode, we’ll be speaking with special guest Rachel Hartley. Many of you listening today might be familiar with her book already, such as the ”Gentle Nutrition” and ”Non-diet Approach to Healthy Eating” or her popular food and wellness blog, ”The Joy of Eating.”

I wanna share more about Rachael’s background in a moment, but first, let me ask you this. How familiar are you with IBS, the low FODMAP diet, or what about other elimination diets? What about intuitive eating? What’s that all about? Let me show my own hand here and say I’m not an expert in any of those topics, but I sure wish we had a nutrition therapist here today, or maybe someone certified as an intuitive eating counselor or, you know what let’s just shoot for the stars. Why not have one of “SELF Magazine’s” most trustworthy dieticians for nutrition advice join on the episode? Well, I’m in luck and you’re in luck because Rachael Hartley has achieved all that and much more. Thanks for being here today, Rachael.

Rachael: Absolutely. Thank you so much for having me.

Dr. Dac: The pleasure’s all ours. So I just wanted to start off a little bit for our audience at home or wherever they’re listening from today. Start off a little bit about just a quick review on IBS. So IBS also known as irritable bowel syndrome, and it can take a pretty heavy toll on a person’s quality of life. And I feel probably most of our audience either knows that whether they personally suffer from that condition or either a friend or family member that that’s taken a toll on before. So it’s a very real and serious condition in that sense.

In fact, there’s a condition that can be described as having the signs and symptoms, including abdominal pain or cramping, bleeding relating to bowel movements, or appearance of bowel movements, or just the lack of consistency for lack of better words. This also tends to be a long time occurrence of not something that just sticks around for a week, but the folks that experience in this condition, it tends to be, unfortunately, a long-time burden.

There are a number of treatments or approaches toward the condition that the healthcare team might recommend to patients or those listening at home, recommendations sometimes is something called a low FODMAP diet. And that’s where I’m gonna tag in my guest today. Rachael, can you tell us more about what this low FODMAP diet is?

Rachael: Absolutely. So a low FODMAP diet is probably one of the most common nutritional approaches to managing the symptoms of IBS. Now I know when you hear the term low FODMAPs, it’s this funny acronym, essentially, it’s a shorthand for specific types of fermentable carbohydrates. As I tell my clients, these are the types of carbohydrates that we find in food that the bacteria in your gut just like fast food for them. They really love it. Go to town, fermenting those types of carbohydrates. And as a byproduct of that fermentation release, it create gas.

Now for someone who has IBS, that gas can contribute to some pretty significant symptoms. It’s not necessarily that these types of carbohydrates are harmful for people or bad or that everyone should be avoiding them. It’s really that people with IBS whose gut is just more sensitive to that, sometimes they can benefit from doing a low carb, excuse me, not a low carbohydrate, a low FODMAP elimination diet, and re-introducing them to help see are these the foods that are contributing to my symptoms.

Dr. Dac: A couple questions there because you make a lot of very interesting points. One question that I have is, is the low FODMAP diet, then the right answer for everyone? For example, your blog, your book, you’ve reached tens, if not hundreds of thousands of people over your career already, I’m sure some of them are wondering at home, should I, even if I’m not having any symptoms right now, should I look into this low FODMAP diet and do it myself?

Rachael: Yeah, absolutely not the right answer for everybody. There is a lot of great research for IBS specifically. It’s not just a healthy way for anyone who doesn’t have IBS symptoms to try and eat, but for people with IBS, we know there’s some really nice research showing a reduction in symptoms, but of course, that’s not everybody. One thing I really warn people about and when I work with clients in my practice, you have IBS, the low FODMAPs elimination diet, and re-introduction. You’ll hear me keep saying “and re-introduction.” I think that’s a really important part that gets missed, but it can be one tool out of many nutritional tools to help manage those symptoms.

At the end of the day, though, it is a elimination diet and anytime we’re eliminating food, there are risks that come with it. So it can be harder to meet one’s just basic nutritional needs. It’s stressful to do an elimination diet. It takes time and money. And also the management of a dietician on board to help you with figuring out foods, figuring out how to feed yourself for people who have a history of disordered eating or are at risk for disordered eating, doing any type of elimination really can be quite dangerous. So again, I always stress to clients it’s one tool and we can sit down and look at any potential benefits, any potential risks and help them decide is this the path that I want to pursue.

Dr. Dac: And that’s interesting because I searched a little bit more and looked a little bit more into this low FODMAP diet and on, for example, the internet, once you put that in the search bar, you’ll get these automatic lists of dozens. It seems like dozens of foods. So to your point, I imagine that could be indeed a risk for those who are experiencing disordered eating because suddenly they see this list of just dozens of types of foods from types of breads or beans or vegetables, you name it. And maybe they think, well, I need to eliminate all of these forever, but then you made a very interesting point earlier, too, that kind of, that counterpoint, that re-introduction or bringing things back. Can you tell us a little bit more about that again?

Rachael: Yes, absolutely. Yes. For anyone at home who is Googling low FODMAPs and feeling like their brain is going to explode with the numbers of foods that are listed as being FODMAP containing foods, again, these are not bad foods. These are not harmful foods. They’re just foods that produce more gas in your gut. And one thing that’s really important if someone is doing a low FODMAPs elimination diet, we want to reintroduce those foods to see what are the specific foods out of this list, what are the ones that are aggravating you?

So for some people, they might be really sensitive to things like garlic and onion. Others, it might be lactose. So milk and cream might be more of a problematic food for them. For others, they might find certain types of fruit really contribute to their IBS symptoms. And of course, some people do a low FODMAPs diet may find out, well, this actually isn’t helping me manage my IBS symptoms at all. For some, if not, maybe a pupil, their symptoms might have less to do with the food and the way that they’re eating.

Dr. Dac: Can you tell us a little bit more about that when it comes to the way of eating? I read up a little bit on intuitive eating, but before the past couple of weeks, that’s not a term I’ve been very familiar with, but I’m wondering if you could help me understand it and our listeners to understand what is intuitive eating?

Rachael: Yes, so intuitive eating, it is a non-diet approach to helping people learn how to feed themselves in a health-promoting way. And when I say a health-promoting way, physically health-promoting, but really mentally health-promoting. It’s helping people have a healthy relationship with food. So they’re not engaging with eating behaviors in this restrict and then follow these specific diets and this very rigid and rigid and precise way and then swinging back in the other direction and being in this like binge or overeating mode. Intuitive eating, it’s really all about helping people better understand their body, get back in touch with their body’s cues, things like hunger, fullness, how food makes you feel, your taste preferences, and really using that to help guide eating choices above all the many diet rules that you find when you’re out there Googling about food and nutrition.

Dr. Dac: Right. Phenomenal points. I bet you made a lot of phenomenal points as well in your book. Again, for our listeners, that’s “Gentle Nutrition: A Non-diet Approach to Healthy Eating.” Now with what you’ve been saying so far is of a lot of interest to our listeners go into even more detail in your book. Or can you share a little bit about your book with us now?

Rachael: Absolutely. So yeah, my book is really aexploration of the role of nutrition within intuitive eating. So within this non-diet approach, I think sometimes because we live in this very diet-obsessed world where nutrition gets put up on a pedestal and the idea of fueling your body and not thinking about weight management or weight loss as being the goal, but just really focusing in on fueling your body adequately, it shouldn’t, but it can almost feel radical. And I think a lot of times people hear that and think intuitive eating a non-diet approach. Well that must be anti-nutrition and absolutely not the case.

So I really wanted to create a book that would not only serve as a primer on intuitive eating that would help introduce the practice and really easy-to-understand approachable by, but also get a little bit deeper into the role of nutrition. So often when we read about nutrition, it’s all about don’t eat this food is bad, this is harmful, avoid this. Even within the context of what we call medical nutrition therapy, like the low FODMAPs diet, there can be such a focus in on elimination and avoidance and that’s why I kept really stressing that re-introduction phase of it.

So yes, so within ”Gentle Nutrition” within my book, it’s really all of what does positive nutrition look like? What does it look like to feed your body well and focus on adding nutritious foods in when you focus in on engaging in healthy patterns of eating and yeah, and putting weight loss and weight control on the back burner and focusing in on behaviors that are actually under our control.

Dr. Dac: Awesome. Our listeners have a pretty broad range everywhere from dieticians and those in nutrition sciences positions, but all the way to the other end of the spectrum folks that maybe don’t have the full breadth of knowledge when it comes to nutrition and health and medical terminology. If someone was interested in purchasing a copy of your book, but they’re a little bit worried because in the past, maybe they picked up nutrition or books written by folks in the healthcare field, but it was maybe they felt over their head or just difficult to read, do you feel like your book’s kind of written by anyone, someone could just pick it up and start reading or do they need to do pre-reading before reading your book or…?

Rachael: No, I certainly hope it’s something that really anyone can pick up and learn from. It was really important for me to create something that even someone who is well-versed in intuitive eating would be able to gain something from, but also someone who just, you know, liked the cover and was interested in whatever what was behind it. So I really wanted to create a book that would speak to a wide range of knowledge base. And so that’s been some of my favorite feedback I’ve gotten is from people who are new to intuitive eating and had never heard of it before and just liked the learning that they’ve been able to do through it. So that’s been, yeah, some of my favorite kind words to hear.

Dr. Dac: That is phenomenal. No, thanks for putting that resource together and authoring this book because I think it’s gonna continue to help a lot of people into the future. In fact, for our listeners, I’m gonna recommend again, you can go to our website, colonoscopy.com, and the podcast section, and we’re gonna have a link straight to Rachael’s book. But I’m curious. Say someone makes that purchase today and they’re waiting for Amazon or wherever it is for the book to arrive, what other resources would you recommend that they could check out maybe immediately? I don’t know, maybe a popular food and wellness blog, any of those on the top of your mind?

Rachael: Yes. Yes. I have a blog that’s called ”The Joy of Eating.” So I really, you know, I’ve been working on this resource for years and years and have lots of recipes and articles and actually quite a few articles that discuss the role of intuitive eating in the treatment of IBS. So for anyone out there who has IBS and wants to dig in and get some really specific guidance so with food, I really get a lot of great feedback on that series of blog posts. And you can easily Google ”The Joy of Eating” or IBS and intuitive eating, and it pops up pretty much towards the top.

Dr. Dac: Awesome. What recommendations would you have for our listeners at home maybe whether they’ve been diagnosed with IBS or another colon-related ailment and when it comes to just diet in general. Do you have any, whether it’s maybe common mistakes that you see folks make? And this is putting the FODMAPs diet aside. Are there any kind of common flaws of thinking that you see folks time after time seeming to make?

Rachael: Yes. Yes. Yes. I think the first thing that people want to do is start eliminating foods. And sometimes eliminating foods can be helpful. We were just talking about low FODMAPs and how this can be a tool for helping people manage their IBS symptoms. But I don’t think that’s the first thing to go to. I always talk to clients about first and foremost, really making sure that you’re A, eating enough, and B, eating enough throughout the day.

So I find that just chaotic eating patterns where people are skipping meals or going too long without eating and then eating really fast and eating too much all at once that these really chaotic eating patterns are one of the biggest things that contributes to symptoms of IBS. Another biggie that I find is actually hunger. A lot of people, their symptoms get aggravated when they go these long stretches without eating. So I really encourage clients to first and foremost, focus on, am I getting enough throughout the day? Am I eating something about every three to fourish hours? Am I eating satisfying meals, satisfying snacks, like amounts of food that I might serve somebody else and not feel like I was skimping out on them?

That really is I think the first line of defense. And the cool thing about eating enough is not only just getting into that more consistent pattern of eating and feeling adequately help manage IBS symptoms, but just from a gut health perspective, our gut loves to get a wide variety of food. Our gut likes to get enough food. So it’s a really nice way to help actually, heal your gut and to help the microbiome and the bacteria that are in your gut thrive by giving them the foods that they love.

Dr. Dac: Right. Perfect. Perfect. So someone in-home might be thinking, well, broccoli is healthy, broccoli’s a vegetable, I think, or maybe I should just eat whole broccoli. That’s not gonna lead to a very healthy gut it sounds like.

Rachael: Absolutely. Yes. You will have a lot of, yes, that will cause some big changes to your gut microbiota that, and also a super sulfurous kind of gas-forming vegetable, like broccoli might not be your first choice too.

Dr. Dac: So stay away from the broccoli. You mentioned chaotic eating. And that’s an interesting reminded me of a recent conversation I had with a friend of mine. And we were sitting down at a meal when he was having quite a time. It seemed like a smorgasbord there dish after dish after dish and I asked him what was going on? And he said, ”Well, I’m doing intermittent fasting now.” So it seemed like his interpretation was that well, he eats for eight hours a day, so that means he can run wild during those eight hours and eat as much as he wants. But then he mentioned that he wasn’t losing weight and he was having some kind of abdominal pain and discomfort toward the latter half of that eight hours. I’m curious in your expertise, then it sounds like he was missing the mark there with eating maybe three meals soon as that eight-hour period started, and then he was eating other meals too. That’s doesn’t mean you’re gonna lose weight. Is that right?

Rachael: Oh gosh. Yeah. Intermittent fasting has become this really popular diet approach. And I’m sure there’s some people who just naturally they do well when they follow a certain intermittent fasting or protocol. And I don’t want to, if someone has found a pattern of eating that works for them great, but really, what I see more commonly is what your friend has experienced is that it just leads to these long stretches of time without getting food in. It makes them feel fatigued. It makes them feel moody. They have a difficult time concentrating. When they do eat, they’re hardly able to enjoy their food and it really puts you into more of this binge mode.

So it’s definitely popular I would say fad right now. I’m fairly certain in a few years that there will not be nearly the number of pupils who are doing intermittent fasting diets. But yeah, that doesn’t necessarily mean that it’s right for you, that it’s going to help you feel good and help you feel energized throughout the day.

Dr. Dac: And with you shining a little bit of light on that, and now that you pointed it out, he did mention that he was having a lot of more conflicts it seems like with his significant other maybe related to his fasting schedule, maybe a bit more moody who knows.

Rachael: Yeah. Hanger is a real thing. Absolutely.

Dr. Dac: Well, it sounds like the low FODMAP diet, not necessarily for everyone, elimination diets, not necessarily for everyone, intermittent fasting, not necessarily for everyone, but you know what is for everyone and again, that is your book, ”Gentle Nutrition: A Non-diet Approach to Healthy Eating” and your blog, ”The Joy of Eating.” What else do you want to share maybe with our listeners, because I know you’re busy and I appreciate every minute that you’ve spent with us so far, but any parting thoughts that you want to share with either me or our listeners before we sign off?

Rachael: Absolutely. If you’re someone out there who is struggling with GI symptoms, talk to a registered dietician if it’s accessible to you, if it’s covered by insurance, or if you’re able to find someone in your area that has experience working with gut health. A lot of times it’s just sitting down with someone else and getting some outside eyes on your pattern of eating and getting someone else there who can talk through the different tools that are available to you to help you figure out what might be some things that I want to try, what might be some approaches that might be helpful. So highly recommend seeking out specialized guidance.

Dr. Dac: Good advice. And for the folks that are driving right now, and maybe they can’t safely log on to the website and find the go-to domain to type into their browser to get to you over the internet. Are you able to share your website with us?

Rachael: Yes. It’s rachaelhartleynutrition.com. And it’s Rachael spelled R-A-C-H-A-E-L and Hartley, H-A-R-T-L-E-Y. And yeah, and on there, you’ll find a link to my blog and, and just some other resources actually have a free handout on IBS that’s on my blog as well.

Dr. Dac: Perfect. I wanna thank you for being here today, Rachael, and sharing your expertise with our listeners.

Rachael: You know, thank you so much for having me. I really enjoyed the conversation.

Dr. Dac: And just as much I wanna thank you the folks at home, listening and from work at home, or maybe at the gym or during your commute. As always, we’re gonna have a summary of today’s episode, including key points, more about our guest, as well as links to her book and her website, and a list of other resources available on the colonoscopy.com website. Please take care, good night and good health.

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