How to Improve Gut Symptoms: When a Dietitian Can Help
Bloating. Diarrhoea. Constipation. Abdominal pain. Reflux. Flatulence.
If looking at these words hits a little too close to home, believe me, I understand. I spent the better part of 5 years struggling with ongoing gut symptoms and I know how frustrating it can be living with symptoms daily.
What might have started out as some changes in stool consistency or noticing a little bit more bloating than usual can eventually become the norm. For me, it happened so slowly that I didn’t realise how significant my symptoms had become until I was in constant discomfort. But experiencing symptoms shouldn’t be the norm. It is possible for symptoms to improve and even resolve and I’m going to give you a few steps to help you begin your pathway to symptom resolution.
1. See your GP about ongoing symptoms
If you notice ongoing changes in your bowel movements or are experiencing persistent gut symptoms, one of the first things to do is flag this with your GP. Your GP is the one who oversees your medical care, so it is vital they are aware of everything that is going on. Your GP is also the one who can refer you for different blood tests and investigations to figure out what might be causing your symptoms.
You may also be eligible for a GP Chronic Condition Care Plan to access up to five Medicare-rebated allied health sessions if you need further support to resolve symptoms. Speak to your GP to see if you meet criteria.
Note: If you experience any of the following symptoms, flag these with your GP as soon as possible:
Rectal bleeding or blood in stool
Unexplained weight loss
Iron deficiency anaemia or unexplained fatigue
Change in bowel habits that persists beyond a few weeks, particularly if you have a family history of bowel cancer.
2. Pause before commencing a low FODMAP diet or cutting out gluten, dairy or any other foods
If you have undergone different investigations and nothing has been found, or you’ve been diagnosed with irritable bowel syndrome (IBS), you might be told to trial a low FODMAP diet or cut out certain food groups (specifically gluten or dairy). Before you do, it’s important to take a moment to decide if this is needed just yet. Now, I mean no judgement to anyone who has done this already, or to those who have told others to do this. Usually, the reason people are told to do this is because it helps improve symptoms. However, the low FODMAP diet is considered a second-line dietary strategy. This means, we want to investigate if there are less restrictive ways to improve symptoms first. Restricting what we eat can increase the risk of nutritional deficiencies, cause increased stress from confusion or overwhelm, reduce gut microbiome diversity and affect social occasions. There are so many reasons why someone can be experiencing gut symptoms that could be explored first. A few of those include:
Underlying medical conditions: This is why I recommend seeing a GP as some medical conditions can cause symptoms, including, but not limited to, coeliac disease, inflammatory bowel disease (such as Crohn’s Disease and Ulcerative Colitis), endometriosis, Ehlers Danlos Syndrome, Mast Cell Activation Syndrome (MCAS), H. Pylori, Small Intestinal Bacterial Overgrowth (SIBO) and many others.
Supplements: Some supplements can contribute to symptoms. For example, iron may cause constipation in some people or high amounts of magnesium can cause diarrhoea.
Irregular eating: If we have large gaps between food (5 hours +), then our gut motility (how fast food moves through the gut) can slow down, causing symptoms of constipation, bloating and more.
Undereating: Not eating enough for our body’s needs can cause symptoms. This can occur as the body must prioritise where energy goes. Unfortunately, the digestive system is not a high priority compared to the heart, lungs, brain, etc. So, less energy is directed towards the gut, which slows things down, causing symptoms of bloating, discomfort, early satiety, constipation and/or diarrhoea.
Not enough fibre: Fibre is a type of indigestible carbohydrate found in plant foods. Think of it as a broom that sweeps through your gut, cleans it out and helps you poo. If we aren’t eating enough fibre (usually from not eating enough wholegrains, fruits, vegetables, nuts and seeds and legumes and beans), then we are more prone to symptoms.
Too much fibre: On the other hand, if we are having high amounts of fibre, or have increased fibre too quickly, or aren’t drinking enough water for the amount of fibre we are eating, we can experience gut symptoms.
Not enough fluids: As I alluded to above, not drinking enough water or fluids in general can contribute to symptoms.
Stress: Stress has been shown to increase gut symptoms, usually due to a miscommunication between the brain and the gut. This can be caused by visceral hypersensitivity (when your gut becomes over sensitive that normal digestion feels uncomfortable) and/or altered gut motility. A positive feedback loop can then occur that we feel stressed, we experience symptoms, which causes stress of experiencing symptoms, which increases stress and so on.
Physical inactivity: Not getting enough joyful movement can contribute to symptoms. Regular physical activity supports gut motility and gut-brain axis function (gut-brain communication) and can improve bloating and bowel regularity.
Common IBS food triggers: Alcohol, caffeine, spicy foods and/or fatty foods may trigger symptoms in some individuals.
FODMAPs: FODMAPs are a group of short-chain carbohydrates that are poorly absorbed in the small intestine and can trigger gut symptoms in some people with IBS. Certain foods are high in these FODMAPs, which is where the low FODMAP diet comes in to try and remove these triggers. The aim is to then reintroduce them one by one to figure out which ones are likely causing your symptoms. This whole process can take up to 12-16 weeks!
As you can see, there are many factors that can contribute to symptoms. Trying to figure out what might be causing your symptoms, cutting out food groups or going on restrictive diets can feel extremely overwhelming. The good news is you don’t have to do it alone.
3. Find a dietitian experienced in gut health
This is when it may be a good time to engage with a gut health dietitian. Dietitians are trained in medical nutrition therapy and can help explore what might be contributing to your symptoms, problem-solve with you and tailor advice to your individual situation. Think of it as an exploration process where we start with the least restrictive approach first. Your dietitian may also suggest other evidence-based options, depending on your situation, including strain-specific probiotics or gut-directed hypnotherapy. You may still need to eventually go on a low FODMAP diet (or even a modified one to make it less overwhelming), however a dietitian can support you with every step and ensure you are still meeting your energy and nutrient needs.
From working with clients in this area, what I tend to see is that there is not one thing that resolves symptoms, but many small changes that come together to not only help with symptoms, but improve energy levels, concentration, reduce stress and help you feel better overall.
If you’re struggling with ongoing gut symptoms, know that this doesn’t have to be your new normal. Reach out to PR Nutrition to learn how a dietitian can support you to understand your symptoms, improve your gut health and find an eating pattern that works for you.
