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Unravelling Complicated Cases of IBS with Maria Allerton (née Shaflender)

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Unravelling Complicated Cases of IBS with Maria Allerton (née Shaflender)

Irritable bowel syndrome (IBS) is a diagnosis of exclusion, meaning all other digestive tract conditions must be ruled out first. But what happens when patients receive a diagnosis yet still get little relief of symptoms?

That’s where Nutritionist Maria Allerton’s (née Shaflender) expertise and passion lies, in treating complicated cases of IBS. In this episode she discusses a variety of contributing factors and treatment options for this syndrome, including the challenges of getting an IBS diagnosis, how antibiotics can contribute, the importance of testing during treatment, and how things like hypnotherapy and nutrition together can reduce symptoms and improve a patient’s quality of life.

Covered in this episode

[00:58] Welcoming Maria Allerton (née Shaflender)
[01:42] Maria’s struggles with IBS
[04:38] How antibiotics may contribute
[08:48] Challenges with IBS diagnosis and treatment
[10:59] Medications
[13:16] Trivialisation of IBS
[16:37] Testing for food sensitivities
[18:57] Issues with FODMAP diets
[21:47] Serotonin, acetylcholine and mood disorders
[26:20] Vagal nerve stimulation
[28:03] Mindful eating
[29:04] Discussing digestive stimulants
[31:40] SIBO
[33:58] Issues with stool testing
[36:56] Treating IBS-D
[38:32] Zinc
[39:38] Hypnotherapy and IBS
[43:41] Additional resources
[46:26] Thanking Maria and closing remarks


Andrew: This is FX Medicine, I'm Andrew Whitfield-Cook. Joining us on the line today is Maria Allerton (née Shaflender) from True Foods Nutrition. She's a fully qualified nutritionist who's trained in all modes of functional medicine testing, including gastrointestinal testing and analysis and microbiome management plus thyroid, hormonal, and toxicity testing and treatment. 

Maria has extensive clinical experience addressing complicated cases of IBS and other gut-related disorders, especially because of a passion which began with her own journey with irritable bowel syndrome. And I warmly welcome you, Maria, to FX Medicine. How are you?

Maria: I'm great, thank you. Thanks, Andrew, for having me.

Andrew: Now, amongst your other passions, thyroid, and hormone analysis and treatment, today we'll be discussing IBS. Because you do have a personal passion for this condition, don’t you?

Maria: Absolutely. Yeah, yeah. I've had gut problems for most of my life, pretty much since birth. And it's been a bit of a journey finding out what works and what doesn't and how to treat it. And that's actually what led me to study nutrition.

Andrew: Now, you say that you were diagnosed in your early teens. Is that correct?

Maria: Correct. Yeah, high school. During the high-school exam period.

Andrew: Okay. So, is one of the problems with, especially irritable bowel syndrome, because that we see this sort of perfect storm of the high-stress, hormones are raging, there's high school, there's all of these issues, and then bang, you get a gut issue? So, the diagnosis is made there. But, as you said, you've had issues all your life, yeah?

Maria: Yeah, yeah. I think there's definitely a genetic predisposition. And we know from research that the microbiome that we inherit from the mother during the birth is predisposing to how our gut is going to function. So, I think it started from not inheriting a fantastic microbiome, it had a lot to be desired from my mum's health at the time. And also things that happen, which we see in clinic all the time, respiratory infections that kids get because of nutrient deficiencies and low vitamin D, things like that. All sorts of infections that require antibiotic treatments, ear infections, otitis media is another common one, which is…

Andrew: Ah, yes.

Maria: Yeah. Usually food intolerances trigger that, and then they end up on rounds and rounds of antibiotics. So, I think, when I was trying to work it out, I had about 40 rounds of antibiotics by the time I was 10-years-old. 

Andrew: Wow.

Maria: Conservatively speaking. Yeah, so, that definitely was not a great predisposing factor for gut health. And then I actually moved to Australia from Russia when I was 13 and the foods that were available here were really different and very exciting, all these boxed cereals and all these exciting packaged cardboard foods. Which I embraced very excitedly. 
So, I was pretty much eating, you know, soy milk and light skimmed milk and cereal in boxes and lots of pasta and very processed carbohydrate foods and sugars that were completely the wrong thing to be doing for one's gut health.

Andrew: Can I just take a step back a bit? Do you know if there's any research looking at multiples of courses of antibiotics? So, not just 3 and 4 but 10 or whatever with worsening risk of irritable bowel syndrome?

Maria: I haven't seen any specific papers on that but the research that I've looked at to do with antibiotics is telling us that, from one round, it usually takes 12 to 24 months of recovery for the gut to come back to its original condition. So, I think if someone is exposed to multiple courses over a period of time, especially without taking anything or doing anything to actively repair and replenish, I think that creates a really negative environment that predisposes them.

Andrew: There's a lot of variance in that recovery period. I've read papers saying as short as like 3 months and as long as 24 months. But I guess one of the issues there is, well, you get the answer to what you've measured.

Maria: Yeah, yeah. And, look, I think a lot of the time people don't actually do anything to actively recover, that's the other issue. 

Andrew: Right.

Maria: You know, they might get a random probiotic from their health food store and take it for a couple of months, and that's it. If that. So, it's the lack of active recovery and then just a perpetuating diet of highly-processed foods which is then feeding the negative bugs that have taken residence. So, yeah, it becomes a really perpetuating cycle.

Andrew: Sure. But, you say that...I'm imagining your symptoms would've worsened and culminated in the diagnosis during your early teens. But you can remember episodes of pain and gut problems in your childhood?

Maria: Yeah, absolutely. Probably not pain, I don't remember ever being in pain, but definitely just not digesting things and having like weird toileting habits that, you know, children don't really normally pay attention to. But just having trouble digesting things and also having different reactions from one day to the next to the same meals. Which is really characteristic of IBS, where people can be eating the similar sort of stuff from day to day but getting different reactions. So, it's that, yeah, really dysregulated system. And I think there’s a lot of evidence from studies that shows us that higher cortisol levels in childhood can really predispose to disrupted gut-brain communications. 

Andrew: Right.

Maria: So things like moving countries or any sort of traumatic events, emotional events that happened to us in childhood, would really put someone in a state of predisposition to IBS.

Andrew: And do you think it's one of those conditions that you have a perfect storm happening? Like it’s the food, then the changes in the food, the packaged food you were talking about. And then you add on a stressor, so, the move from country. And then you add on the change in stress that you feel from changing body image, say for instance, entering your teenage years and the pressures of school. And then bang, it sort of...

Maria: Absolutely. Yeah, yeah, absolutely. I think the amount of pressure that kids even these days, a lot more than when I was at school, have in terms of performance and getting academic results and getting this one mark at the end of high school, which is supposed to determine your entire destiny. There's so much pressure. 

And I can see that with my own kids who, one of them has just started high school, that it's really a lot to cope with. And these days there's also social media and all sorts of body-image pressures as well. So looking after our stress management becomes really critical at a very early age.

Andrew: So, let's talk about irritable bowel syndrome as a diagnosis. What's the pathology, what's the current thoughts on the pathology of IBS?

Maria: Well, the IBS seems to just fall into this sort of catch-all bucket of when everything else has been excluded. So, it seems to be through the medical system people go through and get their colonoscopy done, and sometimes endoscopy as well. They get their basic stool tests and, essentially, unless you have something wrong on your colonoscopy or they identify parasites, which they prescribe antibiotics for, if there's nothing of this found during that time and things like Crohn's disease or ulcerative colitis have been ruled out, it becomes, "You have irritable bowel syndrome." So, a syndrome, as we know, not a disease but a collection of symptoms.

So, then that puts the person into the sort of no man's land of trying different things. Often they get prescribed the FODMAP diet where they cut out a lot of different foods that some of them are triggering of the symptoms. And essentially, they just get told to watch their stress levels. So, that's the most common story that I see.

Andrew: I love that one, "Watch your stress levels." Don't do anything about it, just watch them.

Maria: Yeah, there's a lot of sort of, "Let's wait and see and monitor," those seem to be the words that are used a lot. Yeah. So, it kind of takes any sort of proactive action away from the person. Yeah.

Andrew: It seems to be rather placating, doesn't it, rather than an active treatment?

Maria: Absolutely. Yeah, it's very rare that I've had someone come in clinic where they've actually been recommended to see a psychologist or do any sort of mindfulness work or even start yoga, breath work. Like any of those really simple things that people can do often is not on the list of recommended things. And, a lot of the time, it’s "Download your FODMAP app and off you go." Yeah.

Andrew: Okay, so, what about the use of even medications here? Like, you know, maybe Loperamide to help with the diarrhoea or Mebeverine, Colofac. Why isn't there even offering of these medications?

Maria: Yeah. I think the constipation type of IBS, they usually will get prescribed laxatives which from long-term use of laxatives, we get a whole bunch of different bowel issues as well. So, it's not really a long-term solution. It might help someone in the short term but it doesn't address the root cause. 
And I think with diarrhoea, just from my experience, there's always some sort of underlying pathogen that is missed, that keeps triggering the diarrhoea. Or some really major food intolerances, usually to dairy, which sends people straight to the toilet a lot of the time. 

Andrew: Got you.

Maria: So, yeah, there seems to be some really obvious causes and triggers that are often masked by the medications.
Andrew: Okay. And, do you find these people are diagnosed using just rough symptomatology or do you find that healthcare professionals are getting on board with things like the Rome criteria and they're really delving into functional GI disorders?
Maria: Yeah, absolutely. So if they end up going through to a gastroenterologist, there's a lot more of the work that’s done. Usually celiac disease will be ruled out. They might be taking samples from the colon or the small intestine to look at something else. And, yeah, there's definitely...people do get that work up. 

But I find, a lot of the time, they're not really progressed through to the gastroenterologist unless there's some really, really serious symptoms. So unless they're having explosive diarrhoea or something that the medical professional might get really concerned about. But most people I find fall into that sort of group of mild annoying symptoms that disrupt their day-to-day life and create a lot of anxiety, and often depression, that are not really taken that seriously.

Andrew: Do you think there's a real risk of IBS being trivialised in that, people...and this is all people, including health professionals, seem to sort of treat it as, "It's a little bit of an upset tummy," and it's an embarrassing condition. Whereas I've known people who have been hospitalised with IBS.

Maria: Yeah, absolutely, yeah. So, I guess that's why it's such a frustrating diagnosis where the severity can be really varied. And people do end up with bouts of, especially if they've had a major stress or something go on in their life, they will end up with a really severe flare up and end up in hospital. And a lot of them are really frustrated by the lack of a proper diagnosis, they’re just being told that, "Oh, yeah, IBS. There's no cure." A lot of the Facebook forums that I follow that are public Facebook forums on IBS, just to understand what people are saying about their condition. It's very much about, "This is a lifetime thing that you need to manage." So, no one even talks about resolving it at all, as far as I can see. Yeah.

Andrew: Right. Okay. So, the appropriate sort of stepping stone is A, how do you get to the GP, get them to understand there's a real issue? And B, how do you then get specialist involvement for a diagnosis?
Maria: Right, exactly. And I think, unfortunately, you have to have something wrong on one of your tests to be able to progress through all those steps. So…

Andrew: Really?

Maria: Yeah, I find that often that's the case. So unless you have polyps in your colon from your colonoscopy, or ulceration in your small intestine or something that's found to be a pathology, it's really tricky to actually get proper attention. And that's where nutritionists and naturopaths I think can really shine in terms of our more holistic understanding of gut conditions.

Andrew: Yeah. I can see also there's a risk of being treated for that abnormality rather than the IBS. Like if you've got a solitary rectal ulcer, if you've got haemorrhoids, if you've got...oh, forgive me, I can't remember the condition where you basically got to push-me/pull-you with the rectal muscles. Incomplete evacuation is what it leads to, that sort of issue. I can see that it really does require some expertise to go, "Hmm, what's going on here?"

Maria: Yeah. And I think also people end up being selectively treated for certain pathogens usually with more antibiotics, which then perpetuates their gut problems and perpetuates their IBS. So, a lot of the time with parasites, if a parasite is found on a stool test, usually someone will be prescribed antibiotics. And then it doesn't resolve the problem. 
So, even if the retest comes back with no parasite, the person is then often still experiencing the symptoms and just wondering, "Well, what happened? Parasite's dead and I'm still having all these problems." So, as we know, it's a lot more about the terrain of the gut and the overall condition of the gut rather than a presence of a specific organism.

Andrew: Right, and also perhaps failure of treatment. You mentioned…I know I'm sort of dancing around a bit here, I will sort of get back onto a train of thought, but you mentioned food sensitivities before. I'm thinking about testing here, how useful is testing for food sensitivities?

Maria: So, I find, it's a tricky one. Lots of clients come in with having had food  intolerance testing done, either ordered it themselves online or with a previous practitioner. And they come with a list of 40 things that they are "intolerant to." And they then exclude all those foods from their diet, and usually that doesn't really resolve their symptoms either. 

So, I think we have to make a really obvious distinction between food-intolerance testing, looking at the immune activation, so for example, testing your IgG antibodies or food allergies, testing your IgE antibodies. So, that's really looking at the immune system and what's happened with those foods triggering a reaction.

But, as we know, a lot of the time it's the condition of the gut which is allowing that to happen. So with leaky gut or intestinal permeability, if the gut doesn't have a really well-integrated protective layer and all those cells tightly standing together in their little tight junctions, those proteins from food are going to be coming in and out, triggering all sorts of immune activations. So, yeah, it's a lot more about the gut condition.

And then I think people also get confused with sensitivities. So foods that are high in FODMAP with fermentable carbohydrates, they might trigger bloating and gas and discomfort. That's not because someone is intolerant to the food, that's because it's triggering a gut response from a bacteria in the intestine. So, that's going to create symptoms but that doesn't mean the person is intolerant to the food, it's just not getting digested properly.

Andrew: Yes. I'll give you a big hear-hear. And I don't have issues with reasonable use of FODMAPs of the FODMAP diet, my problem is that the FODMAP is called "The low FODMAP diet," not the "no FODMAP diet." And I have real issues when people exclude important food groups.

Maria: Yeah. And I find also, frustratingly, it doesn't exclude the ones that really need to be excluded. For example, with dairy, I find the frustrating part is, "Yeah, let's take the lactose out." But… 

Andrew: What about the proteins?

Maria: ...it's not just the lactose that's the problem. Right? Yeah, it's usually the protein which is the casein, which is really inflammatory for a lot of people with gut issues. So just taking out the lactose is not going to resolve the issue. 

Or, you know, gluten, for example, just taking out the fructans from the wheat doesn't take away the inflammation and the toxicity that comes with gluten. So, that's the frustrating part is, the foods that really should go are not taken out. And then the foods that can still be eaten in moderation and are really important, prebiotic fibre foods like fruits and vegetables, with a humble apple, for example... the poor apple that's just been completely demonised, that's taken out and the person is not getting the fibres and the prebiotics and the vitamins and the minerals from those foods. So, that creates a whole bunch of other issues.

Andrew: Yes, you remind me saliently of Mike Ash's stewed apple ramekins. The recipe which is up on the FX Medicine website, if anybody wants to go and look there for it. But I'll always remember his sentence, he said, "Low FODMAP anyone?"

Maria: Yeah. Yeah, absolutely. And I actually, since that time that I heard Michael Ash talking at the symposium, just a few months ago, I did a phone interview with him for a program that I've been working on, an online program for IBS. And we talked at length about the cooked apples and all the amazing constituents. And there's more than one and it's not just pectin, there's a whole bunch of different constituents.

Andrew: Raffinose, yeah.

Maria: Yeah, yeah. And all those fibres and prebiotics and gut-healing substances. And I found it so amazing because cooked apples is something that my grandfather used to make for me when I was a kid, it's a very traditional Russian dessert, stewed apples with cinnamon. And it's just...those amazing foods.

Andrew: Okay, so, just going back to pharmaceutical medications again. There's a lot of options there. They do one job very well, sometimes two well, sometimes with ensuing side effects. I remember one of the setron groups of drugs, the 5-HT...I think it's 3...antagonists. It was taken off the market, in Australia at least, because of side effects. But what about the use of, you mentioned, depression? So, antidepressants, SSRIs?

Maria: Yeah. Well, as we know, a lot of our serotonin is produced in the gut. And I think experts sort of have a debate about "Is it 60%? Is it 80%?" A large percentage of serotonin is produced in the gut. So, if someone is lacking abundant microbiota to be able to produce those neurotransmitters, sometimes, putting the serotonin back in can help us regulate that bi-directional flow between the gut and the brain. So, yes, it can help definitely if the person is actually deficient in serotonin.

So, a lot of the time when I do some biochemical profiling with mood disorders, I find that, just based on people's symptoms, when you really look into it, it's not only serotonin that's a problem. A lot of the time with gut stuff it's acetylcholine, which is so important for the motility of the gut. So, yeah, look, just prescribing a drug to boost one particular neurotransmitter...sometimes it works, you know, there will be a certain group of people that it will help, but I find the majority it really doesn't.

Andrew: Yeah. You've got various receptors in the gut. Like is it 1, 3, 4, 7? And they have varying functions with propulsion. So, if you just add a serotonin reuptake inhibitor, there you go. It's not really controlling how those receptors do their work, so, I totally get your point about acetylcholine. So, what, therefore, do you use then to support acetylcholine?

Maria: Well, look, with acetylcholine the main issue is that the person will be put into sympathetic dominance. So, it goes back to that whole stress connection because acetylcholine is there to really power the parasympathetic nervous system. 

Andrew: Right.

Maria: And what it also does is helps us release our hydrochloric acid and enzymes and help with the whole peristaltic action of the gut, the movement. So, if we're deficient in acetylcholine, we're going to have problems right at the top of the digestive system with breaking down the proteins in the stomach. 

So, I guess, one of the nutrients that really feeds into acetylcholine is acetylcarnitine, as well as our B vitamins and choline. And most people do not get enough choline in their diet. You know, maybe from eggs a little bit but most people's diet is really deficient in choline. And most people's mitochondria don't work too well to produce acetyl-L-carnitine. So, it becomes a bit of a tricky thing. But I think that it's bi-directional again. 

So, if someone's spending a lot of time in sympathetic dominance if they're stressed, then they're going to be using up their B vitamins and magnesium and all the other things that require us to produce those neurotransmitters.

Andrew: You know, there's so many issues I see in the research, and one of the issues is “the messenger is shot” basically. There's an issue with TMAO from choline metabolism but it's metabolism. Metabolism, it's the bacteria that's the issue. And yet it's choline that's blamed.

Maria: Yeah. And, yeah, look, I also think that it's a catch-22 because, when someone is stressed, it's going to put their stomach acid down. So they're going to have a lower level of hydrochloric acid. Then absorbing all those nutrients from the food is going to become a problem. And then when they don't have the nutrients, they can't power up those neurotransmitters. So, it becomes a bit of a vicious cycle.

Andrew: Right. I wanted to get to this a little bit later but I have to bring it in now. And that, do you favour the use of things like vagal nerve stimulation to help with the sympathetic nervous stimulation, to settle it down?

Maria: Well, I haven't had any experience with devices. I know a lot of practitioners use devices, particularly in chiropractic and osteo fields, that actually will stimulate the vagus nerve. In our clinic, we use more breathing exercises and hypnotherapy. Yeah, hypnotherapy, mindfulness, stress reduction, breathing, all of those exercises to give someone the tools that they can just use at home to start reprogramming their vagal tone.

Andrew: Now, hypnotherapy was very interesting because it had a very high success rate.

Maria: Yeah. Yes, all the studies with hypnotherapy and irritable bowel have been really successful. So, I know there's a study that showed hypnotherapy was on par with FODMAPs in terms of resolving symptoms. My approach is, and that's what I've been working on with the program, to put both together. So, I don't think it's either nutrition and diet or mind work, I think you have to really do both. And that's where people have the most success. 

So, I don't think you can say, "Well, I'll just keep eating gluten and dairy and all these problem foods and I'll just do hypnotherapy and I'll be fine.” I don't think it would work like that. So, I think the combination of both is the most powerful tool.

Andrew: And when you're dealing with the gut, I mean there's a whole world opening up to you. Like we've spoken about this before in podcasts, do you really start with simple things like, "How do you chew your food?" "Do you try and relax before a meal?" "Do you eat in a stressful environment?" those sort of basic simple things that grandma told us about and we never did?

Maria: Absolutely, yeah. And it's really about slowing down and being mindful. So, that's where a lot of the mindfulness stuff comes in to really draw people's attention, not only on what they're eating, but how they're eating. So, exactly what you said, chewing properly, not having your mouth open when you're eating, you know, chewing for many many times, being in a calm environment. So people are eating when they drive and people are eating in front of their computer, and they're not going to be digesting their food when they're doing that, really. So, yeah, a lot of that stuff is really really simple things that we've forgotten how to do.

Andrew: Yeah. And what about things like starting high up with things like aperitifs? Good old gentian, maybe, as a herb? Is there any particular things that you use that might help even stimulate stomach-acid secretion?

Maria: Yeah, absolutely. So, even apple cider vinegar and lemon juice and water. 

Andrew: Brilliant.

Maria: Yeah, really really simple stuff that's available cheaply to anyone. You just have to be careful. I find some people can't really tolerate apple cider because they've got so much gastric inflammation, it's literally just burning their insides. But unless it's really serious like that, most people can handle it. It's a really nice, yeah, digestive stimulant. 

I find even the apples do that as well, the cooked apples can be a really nice digestive stimulant. And the other one is ginger, which is really I think underused and undervalued, where you can do grated ginger or just boil some ginger pieces in hot water, drink it as a tea. But it's one of those warming digestive tonics. Yeah.

Andrew: Nice. Now we're on to the stomach. And, you know, like the gut superhighway begins basically, so, with...what about digestive enzymes? Do you ever employ those? And, you know, what sort of facility do they have, what sort of promise do they hold?

Maria: Yeah, absolutely. I'm a massive fan of Betaine and digestive enzymes. Yeah, and usually a combination of both of those things. Because with the stomach, and this is something that I've struggled with in my life as well, it all starts with the stomach. 

So if we're looking at the causes of IBS, which we haven't really touched yet on SIBO, anything which is the causal driver will usually originate in the stomach where people are not digesting their food properly, and particularly not breaking down the proteins. So, instead of getting individual amino acids going nicely through our intestine and getting absorbed, they're ending up with peptides, with multiple bits of protein that's not properly broken down. 

So, I find that enzymes, hydrochloric-acid boosting supplements, all those things, anything that helps the stomach, zinc and B6 is another really really important one, everything that we can do to make the stomach work better is going to really help with IBS.

Andrew: So, SIBO, we're on to that. I remember Steven Sandberg-Lewis opened my eyes, and Nirala Jacobi, but I still have questions with regards to SIBO. I note that it doesn't appear at all on Rome criteria. So, where does it sit?

Maria: Yeah, sure. Yeah, look, it's a tricky one. So I think, amongst the complementary health practitioners, there's probably a bit of a division, I would say, with the SIBO believers and the SIBO non-believers and someone in between, in the grey area in between. 

So, look, I see SIBO as a symptom. It's a bit of a symptom and a cause. So when the stomach is not working properly, you're going to end up with a bacterial overgrowth in the small intestine. So, when the gallbladder is not working properly and you're not getting the bile to be the antimicrobial substance, you're going to end up with an overgrowth in the small intestines. Right. So is that the cause or is the low hydrochloric acid actually the cause that originates everything?

And then you've got the movement issue, so, the peristalsis that goes off in SIBO. So, yeah, look, it's an interesting one, definitely I don't think yet recognised by the medical mainstream. But what I find is, if people are having responses to carbohydrates, so if someone is getting gassy and bloated any time they eat one of those FODMAP foods, pretty high chance they have some sort of bacterial overgrowth in there. 
And a lot of the time I find that just doing a bit of a trial with an antimicrobial substance, something simple like a bit of oregano oil, is really effective to see how they will respond and what's going on in there.

Andrew: Okay.

Maria: So if you trial that for a month with a practitioner and your symptoms significantly reduce, well, there's a pretty high chance there's a bacterial overgrowth in there that needs to be addressed.

Andrew: We know that we can't get into the middle portions of the small intestine, we can only get into the upper portions of the small and the highest reaches, if you like, of the colon. So, there's a whole area of the digestive tract that is really out of the realms of assessment. I'm also very cautious about if we're doing poo testing. You're looking at what's coming out, not what's in there or what's staying in there.

Maria: Yes, absolutely. And, look, this comes down to the clinician sort of using the tool that they use and getting really good at it. So my belief is choose a tool that is consistent for the client and is consistent between the first test and your treatment and then the second test. 

So, I actually do utilise stool testing in clinic and I do find it really useful. And a lot of the time, if there's an overgrowth of bacteria in the bowel, it's pretty common that it's going to go up into the small intestine as well. And I've had many many, a huge number of clients come through with having done a SIBO test and being negative for SIBO. And then we do the bowel test, they've got all this bacterial overgrowth in there. We treat that and then their symptoms resolve. 

Andrew: Right.

Maria: So I find that, from my clinic experience, looking at the bowel is far more interesting than doing a breath test for SIBO. But that's just been my personal clinic experience.

Andrew: Got you, okay. I was also reminded by a gastroenterologist about the concept of dysbiosis is, as he said, a concept. How do you treat a concept? But I guess the proof in the pudding for your patients is, A, their symptom resolution that is maintained, but B, if you can show a difference in tests over time. So a baseline and a test level. So, is this what you find, you can show this?

Maria: Absolutely. Yeah, yeah. So, using your DNA PCR stool testing, looking at starting with your baseline and addressing whatever microbial imbalances are there, focusing on rebuilding the gut environment, so, lots of pro and prebiotics as appropriate for the person. And then changing their lifestyle, changing their diet, doing all that work I find usually for about 6 months, and then doing a retest. And 95% of the time there's a huge improvement, both in the diversity and the count of the positive bacteria, as well as elimination of things like parasites or helicobacter pylori or anything else that comes in there.

Andrew: You said "prebiotics." Now, prebiotics can sometimes cause excessive wind indeed. One of the prebiotics, lactulose, is used to help the gut, but it's also used as a laxative. So, when you've got an IBS-D dominant patient, how does that work? Do you just decrease the dose? Do you use it at all?

Maria: Yeah, I definitely do. I find with IBS-D, 95% of the time there's going to be some sort of organism that's triggering the diarrhoea. So usually it will be a parasite or some sort of bacteria that's become extremely dysbiotic, as well as food issues. So, it's incredible how many people with IBS-D are regularly having cow's milk and not putting the two and two together. 

So, that's a really simple starting point where we go through the diet with a very fine look and get rid of anything that can be driving the diarrhoea. So, a lot of the time, just the dietary change is pretty significant. Then looking at any dysbiotic or pathogenic organism and targeting that first. And then I would be looking at adding a prebiotic and probably using the single ones. So guar gum, partially hydrolyzed guar gum, seems to be a really nice non-reactive one that's become quite popular. So, starting really really low with like a pinch, and just building it up slowly. Yeah. Yes.

Andrew: Oh right, okay. And you were talking about terrain earlier, so, Betaine, and what about other just micronutrients, for instance zinc?

Maria: Yeah. Look, zinc is one of the things that I absolutely love in life. And I think, if I had to be put on an island with a choice of one supplement to take with me, it would be zinc.

Andrew: Oysters!

Maria: Yes, it would be oysters and zinc in a bottle. I absolutely love zinc. Pretty much every one of my clients walks out with a bottle of zinc, in some form or another. So, yes, it's amazing at, well, first of all, helping with our hydrochloric-acid production. It's completely fundamental for that. It's fundamental to hold the tight junctions and the gut together. It's fundamental for our mood and serotonin production and probably 100 other things that I can't think of right now. Immune system, right? Yeah.

Andrew: What enzyme system isn't affected by zinc?

Maria: Exactly.

Andrew: So, hypnotherapy. Take us through a little bit of how hypnotherapy is approached with IBS.

Maria: Yeah. So, in our clinic, my partner, Scott Allerton, who's a clinical hypnotherapist, looks at a lot of my gut cases. And usually, when someone comes in with IBS and gut issues, 99% of the time they'll also be experiencing either anxiety, or depression, or PTSD, or some other mood-related issue. 

Usually those things perpetuate, what we call a “sympathetic state." So, a fight-or-flight state where the person is stuck in that stress state where everything triggers them and their entire nervous system becomes hypersensitive. So a lot of the time, people will come in with they're sensitive to noise, they're sensitive to light, they're sensitive to music. They become hypersensitive. So, just like their gut is hypersensitive to food, so, visceral organ hypersensitivity, their nervous system becomes really really sensitive. So, of course, they're going to be reactive to things.

So, what hypnotherapy does is it basically takes the logical-thinking brain out of the equation for the duration of the treatment. So, putting someone into a state of focused trance, so, a very calm and relaxed state. The person's still totally awake but they're calm and relaxed and their brain's not thinking. So, there's all that critical thinking and evaluation goes out and they tap into their subconscious. And that's really where things come up. So their stressors, their past trauma, whatever is driving their stress usually comes up to the surface. And then it's the therapist's skill to talk them through it in a way that's very safe and emotionally cleansing, I guess.

Andrew: Wow.

Maria: It’s a really powerful tool. And, you know, what most people will say is like, "Oh, you know, I'm too awake. I can't be hypnotised. I always have to be in control," and all that sort of stuff, they're usually the people with the gut problems.

Andrew: Yes.

Maria: So, yeah. Yeah, everyone can be hypnotised and it's up to the skill of the professional and also just allowing oneself to relax enough to be able to stop thinking for a little while.

Andrew: Which is a challenge unto itself.

Maria: Yes, yes.

Andrew: So, what about ongoing therapy? Does the hypnotherapist teach the IBS patient to take home some skills so that when they're encountering a stressful situation, they can sort of...regress is not the right word, but retreat into themselves?

Maria: Absolutely, yeah. So, usually after a few sessions, the person is calmed down enough and is parasympathetic enough, relaxed enough to be able to handle things better anyway. So, their entire stress baseline is taken right down. And then there's lots of techniques with breathing, visualisations, specific tools that can be used day-to-day to be able to manage our stress much better. There's always usually recordings that can be listened to as well. 

So Scott does a lot of recordings and we put that into the program. So, something that they can then just listen to before they go to sleep to really bring their day stress level down. So, it's usually something that requires some input and ongoing management from the person, to be in control of their own stress response.

Andrew: What about any other resources that we can learn from? What are some of the best that you've come across?

Maria: In terms of stress reduction specifically?

Andrew: Stress reduction, IBS, whatever you feel is great.

Maria: Yeah. Look, there's lots and lots of literature out there in terms of the stress and IBS connection. So, there's been really good studies that I've come across that talk about how the gut-brain axis operates, how we deal with stress, how all those things impact. So, there's lots of research out there. 

In terms of resources, I would say, seeing a practitioner is probably really important. Because it's important to personalise your treatment. Right. So, testing I think is a really really important part of that where you can really look into the gut and understand what's happened in your own unique microbiome.

In terms of online easy-to-use resources, I'm about to launch the IBS Healing Program. So, yeah, that's an online program that Scott and I have put together that covers a nutritional component with everything to do with how to get rid of the wrong foods, how to find out what the right foods are for you, how to use food as medicine and healing, as well as all those stress-reduction techniques. So, that will be available online very shortly.

Andrew: Okay. So, that's more of a patient resource, right?

Maria: Yes, absolutely. Yes.

Andrew: All right. And for practitioners?

Maria: For practitioners, there's quite a number of books on hypnosis and stress reduction. There's lots and lots of research into everything ranging from Hans Selye who’s one of the pioneers looking at the stress response. There's also a lot of books on...I'm just trying to think of the author. But everything that looks at how our emotions affect the gut and how the stress response becomes dominant in the body and how difficult it is to turn it off. 

One book I can think of that's fantastic is Gabor Maté and it's called When the Body Says Nothe Cost of Hidden Stress. So, he's someone who's identified lots and lots of health conditions where stress has been a major driver, including gut-related conditions.

Andrew: Brilliant. Well, I'll definitely put these up on the FX Medicine website for everybody to learn from. This is fantastic information, Maria. Thank you so much for taking us through this.

Maria: You're very welcome.

Andrew: And your personal journey today. Because like, I realise that, when somebody suffers from something, it can be, A, quite confronting when you admit that, if you like, to the world, but B, can it also empower you. Because it's really sent you on a true journey of expertise to help other people. So, I really thank you for discussing your story but also where it's led you in helping others today.

Maria: Brilliant. Thanks so much, Andrew. It was great talking about this topic.

Andrew: This is FX Medicine. I'm Andrew Whitfield-Cook.



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FX Medicine is at the forefront of ensuring functional and integrative medicine gains the recognition it deserves and ultimately establishes itself as an integral part of standard medical practice. Hosted by Andrew Whitfield-Cook, our podcasts are designed to promote research and evidence-based therapeutic practises, acting as a progressive force for change and improvement in patient health and wellbeing.