Hi! Welcome back to the Pelvic Empowerment IBS Series!
My name is Tori and I am doctor of physical therapy who specializes in pelvic dysfunction,
which means I treat things that can go wrong around the pelvis including bowel dysfunction.
Earlier this month I decided to try my best to unpack what I have learned about IBS in
a video series, and today I want to add a second installment all about trigger foods.
If you haven’t, please check out my first video all about what causes IBS,
as I am going to build on some of the topics discussed in that video today!
Assuming you’ve seen that video, I still want to quickly refresh you! One thing
that we discussed is that IBS, whether constipation dominant, diarrhea dominant,
or mixed, is likely caused by varying degrees of brain gut axis dysfunction. We isolated the
gastrocolic reflex as one brain-gut connection that could be dysfunctional in humans with IBS.
And we proposed that, while there is no curative treatment currently available for IBS, we could
use the idea of a dysfunctional gastrocolic reflex for IBS symptom management in the form of diet.
Now, remind yourself of what the gastrocolic reflex is—in a healthy gut, when you eat
something, the act of eating stimulates the rhythmic contraction of your intestines,
which propels food and eventually waste along the intestinal tract—the body literally makes room for
digesting the new food that you are now eating—and eventually you end up having a bowel movement.
So, if we look at trigger foods through the broad, general lens of the gastrocolic reflex,
the question to answer is: what kind of food triggers this reflex the most? But, if we look
at trigger foods through the individualized, specific lens of food sensitivity, well then
the question to answer is: what foods are you as an individual human specifically sensitive to?
In this video, we are going to answer the more generalized question. What food group
most powerfully stimulates the gastrocolic reflex?
But! I will be creating a different video answering the more specific question
surrounding food sensitivities or intolerances within this series. So then, let’s dive in!
According to this 2000 study investigating fats and carbohydrates effects on the
gastrocolic reflex in healthy humans who do NOT have IBS, the answer is fats.
Check out this figure. This is looking at the same healthy person’s intestinal contractions
after he eats a fat dominant meal (which is figure A) and a carbohydrate dominant
meal (which is figure B). The different Ps you see on the left hand side of the images
are measuring pressure waves in different parts of the intestinal tract, or, said another way,
measuring the pressure created by intestinal contractions. Look at how much more pressure
is produced in the different parts of his intestine in figure A vs figure B.
Also, realize that figure A is looking at these different pressures over a period of 5 hours,
where figure B only looks at these pressures over a period of 2 hours because, after the
carbohydrate dominate meal, pressure activity decreased in essentially 2.5 hours. Whereas,
after the fat dominate meal, pressure activity continued for well over 3 hours.
Clearly, high fatty foods trigger the gastrocolic reflex, which triggers the
rhythmic contraction of your intestines, significantly more so than carbohydrates.
In fact, fat is the most powerful gastrocolic reflex stimulant of all the macronutrients.
What does that mean for someone with IBS? That could be why, if you’re someone who
suffers from IBS attacks, those attacks happen so quickly after eating even though you know
intuitively that there hasn’t been enough time for the food you just ate to actually get
into your intestines. Instead, that food powerfully triggered the gastrocolic reflex,
and the attack you’re feeling is the result of dysfunctional intestinal contractions.
If someone with a healthy gut eats a high fat food,
what happens? He or she just ends up having a bowel movement.
If someone with IBS, and an assumed dysfunctional gastrocolic reflex,
eats that same high fat food, what happens? if you have diarrhea dominant IBS, what is likely
happening is an overly sensitive gastrocolic reflex—your intestines are contracting much faster
and with more intensity, so food moves through the colon so quickly that water isn’t absorbed and you
end up with abdominal pain from the intensity of the contractions, and diarrhea because the food in
your intestines literally moved right through you. On the other side of the coin, if you have
constipation dominant IBS, what could be happening is one of two things:
one—you have that same overly sensitive gastrocolic reflex, and the intensity of those
intestinal contractions actually causes a spasm in the intestinal muscle, which means abdominal
pain both from the spasm and in the form of bloating, and constipation because the food isn’t
moving through the intestines at all. Or two—an underly sensitive gastrocolic reflex
that means dramatically slow intestinal contractions which again leads to painful
abdominal bloating and constipation because food isn’t moving well through the intestinal tract.
So, with this in mind, would a low-fat, or potentially zero-fat diet help manage
IBS symptoms? It sure seems so! But, we can’t dismiss how important fats are in our diets,
and we can’t paint all fats with the same brush.
Fat is an important macronutrient, and while I am not a registered dietician,
I would not recommend someone eat a zero-fat diet. As the Cleveland Clinic puts it, we need fat as:
A source of energy A source of essential fatty
acids that our bodies cannot make A component of cell walls
A way to absorb fat-soluble vitamins: A, D, E, and K
A way to insulate our bodies and protect organs
So, should you totally cut out fats? I don’t think so.
Does the gastrocolic reflex care what kind of fat you consume? No. You could eat a tub of
butter or an avocado, and the gastrocolic
reflex will still register it as the same powerful trigger.
But! The rest of your body—your heart, your liver,
your arteries, etc.—will certainly feel the difference between a tub of butter and an avocado.
According to the World Health Organization, less than 30% of your total energy intake
should come from fats. So then, a low-fat diet would fall somewhere in the realm
of 20-25% fat intake. But here is the thing—all fats are not created equal.
According the World Health Organization: Unsaturated fats are preferable to saturated
fats and trans-fats of all kinds, including both industrially-produced
trans-fats and ruminant trans-fats. The American Heart Association agrees,
and recommends that you replace saturated and trans fats with unsaturated fats.
So, if you’re aiming for a low-fat diet, you want to make your fats count. Unsaturated
fats that include essential fatty acids (like olive oil, avocados, nuts, fatty fish & flax
to name a few examples) should be either the main or the only source of your fat intake.
I will get more specific about fats and how to pair them with other foods to be
kinder to your gastrocolic reflex after I cover food sensitivities,
insoluble fiber, and soluble fiber within this video series. But it is my intention
to discuss each topic well, so that you fully understand where I’m getting my ideas,
before I can outline the specific dietary considerations for symptom management!
So then, let me pause here and ask, what do you do with this information?
My intention in making this video (and all of my videos) is to empower you with
knowledge. I will not sit here in my living room and tell you to eat
a low-fat diet where most if not all of your fat comes from unsaturated sources.
First of all, I am not a registered dietician. Second of all,
I recognize that not only is everyone’s relationship with food different,
but also everyone’s body is different, and at the end of the day what you choose
to do with this information is just that—your choice, and yours alone.
Know that there is good evidence to suggest that maintaining a low fat diet
that limits or completely avoids foods high in saturated and trans fat (think red meat,
dark chicken meat and chicken skin, dairy, and egg yolks) will help you ease IBS symptoms.
But if it were me—once this series is complete—I
would run my own tests and draw my own conclusions.
So then, up next in the series, we will cover the more specific topic
regarding trigger foods—individual food sensitivities or intolerances.
Alright, thank you SO much for watching. I am so excited and honored to be doing
request videos, and I am so grateful to be building a platform here on YouTube.
As I said, in this IBS video series I will next cover food sensitivities or intolerances,
soluble and insoluble fiber, specific dietary considerations for symptom management,
and I also plan to cover anxiety and its affect on IBS, Linzess and Trulance,
and potentially more holistic IBS treatments—but if you have
a different IBS topic you want me to add to series let me know in the comments below!
Please, if you found this video helpful, give it a thumbs up, share it, and feel
free to comment your experience, questions, or content suggestions. I try really hard
to read and respond to all of my comments and I am so open to any and all requests.
Subscribe to my channel for more content surrounding pelvic health,
check me out on instagram, and thank you so much again for watching. Have
a wonderful rest of your day, and I’ll see you in the next video, bye!