0:00

Hi and welcome to the Midlife Feast

0:02

, the podcast for women who are hungry

0:04

for more in this season of life . I'm

0:06

your host, Dr . Jenn Salib Huber . I'm

0:09

an intuitive eating dietitian and naturopathic

0:11

doctor and I help women manage menopause

0:14

without dieting and food rules . Come

0:16

to my table , listen and learn from me

0:18

trusted guest experts in women's

0:20

health and interviews with women just like

0:23

you . Each episode brings to

0:25

the table juicy conversations designed

0:27

to help you feast on midlife . And

0:29

if you're looking for more information about menopause

0:31

, nutrition and intuitive eating , check

0:34

out the Midlife Feast community , my monthly membership

0:36

that combines my no-nonsense approach that

0:38

you all love to nutrition with

0:40

community , so that you can learn from me and

0:42

others who can relate to the cheers and

0:44

challenges of midlife . Hi

0:50

everyone , welcome to this week's episode of the

0:52

Midlife Feast . If you are

0:54

like most of the

0:56

people that I talk to , at some point you've

0:59

probably experienced that feeling

1:01

of ugh . My pants

1:03

are too tight . I feel really bloated . There's

1:05

something I'm eating that's not agreeing with me

1:07

. Maybe you have

1:10

irritable bowel syndrome . Maybe you've been told

1:12

that you have a food sensitivity . Maybe there are

1:14

foods that you're just afraid of eating because you have no idea

1:16

how they're going to react . If this

1:18

is you . You will definitely want

1:20

to tune into this episode with

1:22

Dr Kim Bretts . Kim is a naturopathic

1:25

doctor in Ontario and her whole

1:27

area of interest and expertise

1:29

is gut health , and what she shares

1:32

with us in this episode will

1:35

blow your mind . I'm making that

1:37

really bold statement because there were a couple

1:39

of things that I learned that I had never

1:41

heard about before . So give it a listen

1:43

and , as always , let me know what you think . Welcome

1:49

Kim to the Midlife Feast . Oh

1:51

, thanks so much .

1:52

I'm really excited .

1:53

I love talking about this area

1:55

of health and gut and women and

1:57

all things , so yeah , and

2:00

gut health , bloating all the things

2:02

we're going to talk about today has been a

2:04

frequently requested topic

2:06

, and I'm so glad

2:08

that you've agreed to come and talk to us today , because

2:11

I feel like you are going to be the perfect person

2:13

, so let's

2:15

dive into it . We're going to talk about some myths , but

2:18

I do want to just kind of talk a little bit

2:20

about what do we know about

2:22

what happens to gut

2:25

health that big umbrella term as

2:27

we work our way through the menopause

2:30

transition , so from perimenopause

2:33

and menopause to postmenopause , what

2:35

do we know ? What is actually happening ?

2:38

So unfortunately we don't know

2:40

a lot and I don't think that's terribly

2:42

surprising , because things are

2:44

pretty horrific in women's health

2:46

in general in the area of research

2:49

and , not

2:51

surprisingly , that link between hormones

2:53

and gut is even less with what

2:55

we understand . Now what we do

2:58

absolutely see is that women

3:01

, and especially in what we call disorders

3:03

of gut brain interaction or functional

3:05

GI disorders , like irritable

3:07

bowel syndrome or constipation or

3:10

dysptheca or things where we're experiencing

3:12

symptoms that are not Crohn's

3:14

or Colitis or Celiac or sort of the ones

3:16

that you get diagnosed on

3:18

a colonoscopy we see that these levels

3:20

are really high , to

3:22

the point and specifically I'm going to

3:25

use the numbers in Canada

3:27

. But we see , for women in

3:29

their especially in their reproductive years

3:31

and leading up and into menopause

3:34

, the rates of women

3:36

having at least one of these disorders

3:38

of gut brain interaction in Canada was

3:41

47.6% . So

3:43

basically one in two women

3:46

are going to be experiencing this and

3:48

that study was done across the world

3:50

and we saw in general same with

3:53

Canada . Rates in general for

3:55

the populations were over 40%

3:57

and then close to that one

3:59

in two for women . So it's very

4:02

, very prevalent

4:04

, even though we don't understand very

4:06

much and why it's more in women

4:09

.

4:09

Yeah , and I mean certainly

4:11

. I think that reflects anybody who works

4:13

with women . You know gut complaints

4:16

and you know whether that's constipation

4:18

, diarrhea , irritable bowel bloating

4:21

, which we'll talk about shortly . With that , like

4:23

you know , that discomfort has

4:26

always been top three

4:28

reasons why people come

4:30

into my office , virtually or otherwise

4:32

. So , yeah , so I think that that's

4:34

probably going to

4:36

be pretty relatable for people . Do we know

4:38

, and we don't know why , other than

4:41

just we don't know why .

4:43

Yeah , we know that we have things

4:45

. So we have our hormonal fluctuations

4:48

and that's happening for every woman

4:50

. I mean our estrogen , progesterone

4:52

go up and down within our

4:55

cycling , reproductive

4:57

years . That that's happening and

4:59

that's happening for everyone . So we

5:01

can see , in general

5:03

, a lot of women will have a slowdown

5:05

. That's happening a bit before your period starts

5:08

. We can get then water retention

5:10

and bloating . That's happening with that and

5:13

that happens for women who don't have

5:15

a lot of complaints and women who

5:17

do . And then we also see around

5:19

the time of the period when we have certain

5:22

other chemicals that are released . We

5:24

can often see that as our period

5:26

happens we're also getting loose

5:28

stool . That happens as I

5:30

don't know some sort of horrific design

5:32

flaw that came in but certainly

5:35

not enjoyable . But then we have the menopausal

5:37

transition and our hormones are now

5:39

being they're very , very

5:42

scattered in what's happening

5:44

. So this feels like it's happening

5:46

more often . We get more

5:48

sensations that

5:50

are happening around that time as well

5:52

. But we also see sleep

5:54

disturbances are happening and potentially

5:56

more abdominal or pelvic

5:59

surgeries have happened at this point

6:01

. So again , changes happening in

6:03

that area . Then we would necessarily see

6:05

in a 20 year old it's

6:07

often the numbers aren't as high Very

6:10

social stress , traumas . Certainly

6:13

I know being in this midlife

6:16

time . There's a lot of stresses

6:19

and pressures that are going on , food

6:21

changes that we've made , affecting

6:23

our microbiome , like it's just this whole

6:25

host of things that I think we want to say

6:28

hormones , but

6:30

it's so much more .

6:32

It is . I don't know who you had

6:34

for physiology . I think

6:36

we went to the same school in Toronto , but

6:39

if I have one take home from those

6:41

four years , this one physiology professor

6:43

described our digestive tract

6:46

as one big , long tube with two openings

6:48

, and

6:51

I've used that analogy . I'm sure lots of people

6:53

that I work with are nodding their heads . And

6:55

I say that for most of

6:57

our life , if things are working well , that

7:00

tube is kind of like a sausage factory and

7:02

you have different people at different

7:04

stops along the line and they know their job

7:06

and it happens like a well-oiled

7:09

machine with very little intervention . And

7:11

then all of a sudden we hit our

7:13

perimenopausal years and this

7:15

hormonal roller coaster , and all of a sudden

7:17

it's like everybody forgets where they're

7:19

supposed to go , and so this sausage

7:22

maker now is like a drunk sausage maker

7:24

and you're going to have a

7:26

series of time where you're having lots of

7:28

sausages coming out and periods of time

7:30

where you're having no sausages being made . And

7:33

it doesn't necessarily mean that it's

7:35

. I mean obviously it's uncomfortable

7:37

when you're experiencing that kind of digestive dysfunction

7:39

and it's being augmented in this time

7:41

of life , but it's hard

7:44

because we don't have a fix for it , right

7:46

, like I can't tell someone , this is how we fix

7:48

it , any more than we can fix any other

7:50

perimenopausal symptom .

7:52

Well , and I think that's one of the big messages

7:54

that we have is that , as our hormones

7:56

are fluctuating , that portion of things

7:58

that is simply the

8:00

transition that's happening . That's not

8:02

that we can't we can't fix the hormones

8:05

, so it's not really that portion

8:07

of it that we're thinking about very much and

8:09

the very few studies on hormones

8:11

. What we've seen , with a

8:14

couple very not

8:17

well designed studies , necessarily , but

8:19

looking at either birth control pill

8:21

, where we've seen often a

8:23

decrease in symptoms that are happening , and

8:25

then conflicting results

8:27

in menopausal hormone treatment studies

8:29

, there's no consistency in

8:32

what we're seeing and I think that's because it's probably

8:34

we don't understand this yet and we have

8:36

such a varied level of what's

8:38

happening when the hormones

8:40

are being given . It's

8:43

that part of it isn't the thing

8:45

that we're usually trying to fix

8:48

, because perimenopausal

8:50

menopause well , there can be symptoms that we

8:52

want to deal with is not a disease

8:55

and that process is something

8:57

that we need to have happen . We're

8:59

not going to keep menstruating

9:01

for the rest of our lives , so this is just a thing

9:04

that is occurring .

9:05

Yeah , Okay , totally agree with

9:07

all that . Let's dive into the myths . So

9:09

one of the most common

9:12

questions that I get anywhere

9:15

, whether it's in my practice , online

9:17

, anywhere , is why

9:20

am I so bloated ? So

9:23

let's just start with that . How

9:26

do you respond to that question ? Because I have to get

9:28

that a lot .

9:29

Absolutely , and bloating we actually

9:31

see , especially in these types of things

9:33

. Bloating there's such a quality

9:36

of life thing that happens . It

9:39

has such a huge impact on how

9:41

we mentally and physically feel . It is absolutely

9:43

one of the biggest questions that I get and

9:45

we know when we combine bloating and distension

9:47

along with our other conditions

9:50

like IBS or constipation or

9:52

dyspensia , that we have

9:54

worse outcomes and worse quality of life

9:56

. So it's really important , even

9:58

though it's not being talked about very often

10:01

.

10:01

So can I stop you there for one sec to

10:03

clarify Sure . Can we talk about

10:06

bloating versus distension , because I

10:08

think that that's an important one .

10:09

It is so

10:12

. Bloating is actually a sensation

10:14

. We feel that

10:17

pressure or gas or something

10:20

and that's the way that we're describing

10:22

it which is distension , which is

10:24

actually where we see our abdomen

10:26

press outwards

10:28

. So there's that physical often get

10:30

that comment of I look four months pregnant

10:32

.

10:32

I look six months pregnant .

10:34

I look eight months pregnant where

10:36

we see it happening . So

10:38

that's the big difference that we're talking about there

10:40

.

10:41

And I think that's so important because I think

10:43

a lot of people don't realize that there really is

10:45

a difference and maybe , as we'll

10:47

get into , there's a difference in what's happening

10:50

usually , like that you know distension

10:52

can have a lot of physical

10:55

causes that need

10:58

to be looked into , and things like that versus

11:00

bloating , which may have more , certainly

11:03

can have physical causes as well , but

11:05

sometimes not things that we can fix right .

11:08

Well , and it's kind of interesting because we're seeing different

11:10

things right now , which is really exciting . But

11:13

the way that hopefully

11:16

we're seeing people think about it right now

11:18

is that we're trying

11:20

to figure out where people are on

11:22

a sort of a continuum of is it

11:24

altered physiology and

11:27

again sort of a Crohn's or Colitis

11:29

? Those are sorts of physiology

11:32

, strictly physiology conditions , and then is

11:34

it an altered perception condition and

11:37

bloating is usually going to fall more on the perception

11:40

side of things . And we've seen that

11:42

recently with

11:44

some studies that came out I would probably say within

11:46

the last 10 years or so , that are looking

11:48

at individuals who have chronic

11:51

bloating and distension and comparing

11:53

them to individuals who don't , and they're doing

11:55

MRIs to look and see

11:57

how much gas are you producing

12:00

when you feel

12:02

the bloating or see the distension

12:04

or have a challenge meal of something that

12:06

would tend to make most of us feel pretty

12:08

gassy and see what is the

12:10

magnitude of gas that you're producing

12:12

. And in that study we

12:15

saw that 25%

12:17

of people who experience bloating and distension

12:19

are actually producing more gas

12:22

or have it in sort

12:24

of abnormal pockets that we were

12:26

seeing . That means that the other

12:28

75% are producing

12:30

normal amounts of gas . And

12:33

when we're thinking about this category

12:36

, this umbrella category of disorders of gut brain

12:38

interaction , we're seeing that there's a

12:40

miscommunication between the gut and the brain

12:42

and we start feeling our

12:44

digestive processes happening . So

12:47

for a lot of people , they're

12:49

feeling the gas that they're producing

12:52

in almost any level

12:54

, versus those

12:57

of us who don't experience bloating and

12:59

distension , who are then just

13:01

not feeling the experience . Kind of like

13:03

I wander around my day wearing

13:06

glasses but not noticing

13:08

them most of the time . That is what is supposed

13:10

to happen , but this heightened

13:12

sensation , we start to feel

13:14

things a lot more than we should

13:16

.

13:18

That is fascinating . It

13:20

is absolutely fascinating and

13:22

I'm going to say like 8,000 questions

13:25

and I'm going to try and like keep the lid on for a minute

13:27

. Yeah .

13:28

Can I just say one other thing with this , because

13:30

this is even more fascinating , because when I

13:32

talk about this , all the

13:34

time I see patients or if I'm

13:36

presenting at a conference practitioner , I see

13:39

their hands going up at this point because

13:41

it's like , but what about distension

13:43

? Because I can see the

13:46

extra gas and

13:48

that's where I think we take

13:50

the one step . That becomes even

13:52

more interesting on this , because

13:55

if I think about when I get stressed

13:57

, I get a lot of tension in my shoulders

13:59

and neck . When we have

14:01

a lot of GI stress that

14:03

goes on and we actually , for some people , will

14:05

have a specific diagnosis

14:08

around gastrointestinal symptoms , specific

14:10

anxiety , but we'll see in

14:12

a lot of individuals that there's a contraction

14:15

that will happen in the diaphragm . So

14:17

when we eat , this muscle

14:19

that sits kind of on top of our abdominal

14:21

organs it's supposed to relax and

14:24

it actually goes up and it makes more

14:26

space in our abdomen so that when we

14:28

bring in food and we bring in liquid and

14:30

our bacteria produce gases and do

14:32

the wild and wonderful things they do , we

14:35

have extra space for that . But

14:38

when we've had GI issues going on

14:40

for a long time , we start to contract

14:42

our diaphragm and it pushes down

14:45

onto our abdominal organs

14:47

and there's not a lot of space

14:49

there . And I would say , especially

14:52

for women , and also think

14:54

around this around the time of our menstrual

14:56

period , when we're also drawing in more

14:58

water , our endometrial

15:00

lining has thickened , like there's not

15:02

a lot of space in there and we're contracting

15:04

everything . Now we can

15:07

feel things more acutely in

15:09

that scenario , but we also push

15:11

out because there's nowhere else to

15:13

go , although flatulence can also

15:15

become part of this as well . But

15:18

this is part of . It is that sometimes

15:20

25% of people were

15:22

producing more gas . We can see it extend

15:25

, but 75%

15:27

are not . But we can have this

15:29

abdominofrenic dyssinergia

15:32

, which is the diaphragm not doing

15:34

what we want it to do , and we're

15:36

seeing distention and thinking that

15:38

must mean more gas and

15:41

it may not Okay

15:43

, that just blew my mind because

15:45

I have never heard that piece

15:48

of this before . It's so exciting

15:50

where we're changing and where we're

15:52

going and retraining and rewiring

15:55

this miscommunication piece , which

15:58

is , I think , the really exciting part around

16:00

. We used to say just get

16:03

less stressed and just don't eat

16:05

dairy and see what happens and good luck to

16:07

you . And then that became

16:10

let's kill off the bacteria

16:12

and let's take away all the food and

16:14

I'll meditate . And now we're actually

16:16

getting concrete strategies

16:18

around how to deal with this , pairing

16:21

together our understanding around

16:24

where we got it wrong

16:26

, along with having more options

16:28

available . I think this is a really exciting

16:31

time in this area

16:33

of health because we've let people suffer

16:35

and this is the thing when I talk about

16:37

this sometimes , again , there's this idea that

16:40

it's just stress . And it's

16:42

not just stress . It's legitimately

16:44

that there is this miscommunication

16:46

in the brain . We can see pain

16:48

centers lighting up , so , even

16:50

though there's not more gas being produced

16:53

, we are getting signals

16:55

that something is really really

16:57

wrong and of course we feel like

16:59

that is dangerous . Of

17:01

course you're not supposed to feel

17:03

your digestive process is happening . It

17:05

is weird and scary to have that happen

17:08

and then to be told that nothing's

17:10

wrong . It's hard , it's really

17:12

really difficult for people and we're moving

17:14

past that point in time

17:16

of there's nothing wrong , we

17:18

can't fix you , we don't have options , and

17:21

that's amazing .

17:22

It is amazing and I don't know if

17:24

you've seen any research about this , but I

17:27

certainly know what I'm doing

17:31

. When we hang up is so many

17:33

people who are experiencing body dissatisfaction

17:35

. It is centered

17:37

around their abdomen and

17:39

many of us

17:42

kind of trained ourselves

17:44

to suck it all in and

17:46

hold everything tight . I

17:49

can only imagine how

17:52

that is playing into all of this .

17:54

I think it is playing a part , even if we

17:56

may or may not have strong research

17:59

about that . But we are seeing things around

18:01

biofeedback and pelvic

18:03

physiotherapy and some of the physical things

18:06

to help us in this area . But

18:08

we still see a lot of times that people are

18:10

thinking the solution has to be

18:12

take food away . Because when we

18:14

take food away , two

18:17

things are happening . One is that

18:19

we're not producing

18:21

as much gas . Certain foods feed

18:23

our gut bacteria and they ferment

18:26

those or those carbohydrates

18:28

and they turn it into gases and chemicals

18:31

. And those gases , for people who are sensing

18:33

things a lot more , feel uncomfortable

18:36

so it can feel better to take them

18:38

away . Or when it goes further and

18:40

you'll hear this a lot of the time that first

18:42

it will be like I'm bloated at the

18:45

end of the day and then it can feel like

18:47

I'm bloated after any meal and

18:49

then it's just I'm bloated all the time

18:51

because now we're just responding

18:53

to any stretch receptor that's been

18:57

affected in the gut . So we start feeling

18:59

all the things all the time

19:02

and that starts to feel like things are

19:04

more and more dangerous and I must take away

19:06

more and more foods , even if it's not

19:08

consistent , or I

19:10

get bloated with drinking water . I feel

19:12

too full with water and

19:14

I often again sort of talk about this with practitioners

19:17

that what is the condition

19:19

where water makes

19:22

us feel bad . That

19:24

should actually be a warning sign that if there's

19:26

more and more things that make us feel full

19:28

or bloated or we have

19:30

to eat smaller meals and we can't find anything

19:33

on a test , we need to start

19:35

thinking about perception issues

19:37

versus continuing that micromanaging

19:40

around damage or around diet sorry

19:42

, and thinking that we're going to find the

19:44

one magic food versus

19:47

what we're starting to see now is

19:49

the more restriction that we have

19:51

, the more we're seeing this

19:53

sensitization and what we call visceral

19:56

hypersensitivity , where you start feeling

19:58

everything in a much more heightened

20:00

way around your organs . We see

20:03

motility changes , so

20:06

again a sensation can cause a physical

20:09

change . So we see a

20:11

lot of the time constipation , which is

20:13

going to increase that sensation

20:15

of bloating and gas happening , and distension

20:18

. But we can also see

20:20

gastric accommodation , so our stomach

20:22

doesn't expand properly . So

20:24

we're getting all of these physical changes

20:26

in response to the

20:28

more we restrict , even

20:30

things

20:33

like intermittent fasting . A lot of my patients

20:35

will intermittent fast , partly

20:38

because they've heard about it , because of weight loss

20:40

, but partly because they'll feel

20:42

better for the part of the day when they don't eat

20:44

food , but then they eat

20:46

a lot at the end of the day

20:48

and then all their symptoms are

20:50

ridiculous through the evening . But they're

20:53

like . I made it through work , I made it through my

20:55

kids coming home from school , but

20:58

it's not a solution . And so

21:00

when we try to have things again , if

21:02

we don't work on some of these other pieces

21:04

, we just feel bad

21:06

. Every time we bring something back and

21:08

we think again something's wrong

21:11

. Something's wrong , I need to try harder

21:13

. We become way more hyper , vigilant

21:15

. It's very difficult for people .

21:18

It is , it is and we're going to keep talking about

21:20

this , but what I want to do is to

21:22

just kind of sum up that bloating

21:24

it's not a myth . You are what

21:26

you are feeling is real , but

21:29

it may not be

21:31

the reason why

21:34

you have been

21:36

led to believe , or that there's more

21:38

to it and we're learning , and that there is

21:40

likely this complex interplay of

21:42

things , but it's not usually

21:45

always something that

21:47

needs to be fixed in the way that

21:49

many have been led to believe .

21:51

Right , and I think some of

21:53

the bigger things around that being fixed has been taking away

21:55

food and constantly doing things to

21:57

kill your microorganisms in the gut , which

22:00

changes your perception . But

22:02

you can't just keep killing bacteria

22:04

and not eating food . That's

22:07

not a good strategy in general

22:10

for health . It's a horrible strategy

22:12

for quality of life , and

22:14

one of the things that I'm really looking for

22:16

within GI Health is

22:18

that people can enjoy food

22:21

. Yeah , that is something

22:23

that we're looking for , because they don't think

22:25

health is not being able to eat with your

22:27

friends and family and being afraid to

22:29

travel and seeing that kind

22:31

of your world gets smaller

22:34

and smaller while you try to micromanage

22:36

and whack them all your symptoms within

22:39

your GI Health . That's not

22:41

getting us to where we

22:43

want to be . That's not health

22:45

.

22:46

It's not , and I mean anybody who listens to this podcast

22:49

probably , like 100% , agrees . And

22:53

I think that the

22:55

selling of solutions

22:57

to symptoms that

23:00

aren't problems

23:02

that need to be fixed in that way

23:04

is a big problem across

23:06

the entire spectrum of health . Being

23:09

a symptom , which can be a symptom of something

23:12

very real , sometimes something

23:14

very serious , but not in this case . Usually

23:16

, and then trying to prescribe

23:18

this like regimented do this

23:20

, do this , do this , do this and this is how

23:22

you cure it , has

23:25

led so many people down years

23:27

, if not decades , of disorder

23:30

eating , and I certainly see that

23:32

people will come to me and saying I

23:35

saw my first naturopath when I

23:37

was 16 and

23:39

when I was diagnosed with XYZ

23:42

and then my food sensitivities have

23:44

just gotten worse and now that I'm in perimenopause

23:46

I can't eat anything and

23:49

it's really hard sometimes

23:51

to say that . I

23:53

totally understand that what you're feeling is very

23:56

uncomfortable and I believe you that your

23:58

symptoms have gotten worse , but it's not because

24:00

you're more sensitive to foods

24:02

, it's not because there's more pathology

24:05

happening . You've

24:07

trained your gut in a way to

24:09

react this way by

24:11

putting less diversity in . Yes

24:14

, yeah .

24:15

It's that very inadvertent trying to do the right thing

24:18

, and one of the things that I've been talking about

24:20

with some of my colleagues is this

24:22

idea especially , I will say , in

24:24

natural medicine of being early

24:26

adopters . And it's something

24:29

that I think we identified that and

24:31

correctly that food can

24:33

aggravate symptoms for people in

24:35

GI sort of stuff . And it was only

24:37

in 2014 that

24:39

one of the American Gastroenterology

24:42

associations was like oh yeah , we're going to identify

24:44

it now , when people had been saying this

24:47

is a problem , this is a problem , this is a problem

24:49

. But I think one of the issues with being

24:51

early adopters is , if we don't keep up

24:53

with the research , we

24:56

keep kind of giving the wrong message . So

24:58

now , yes , food is

25:00

aggravating people in some cases

25:03

, but not because the food is bad

25:05

. In most cases there's things

25:07

like not allergies and celiac

25:09

disease , where sure , I'm not going to be

25:11

saying like here , eat this peanut , I'll hold your

25:13

EpiPen . That's

25:16

not what we're looking at . But in many of these

25:18

other types of conditions , we're

25:20

actually now seeing that some of the things that we thought

25:22

were intolerances or

25:24

things like that or

25:26

allergies and I'm using air

25:28

quotes right now because we

25:30

were using the word wrong and

25:33

thinking that people , the solution was just

25:35

to avoid those foods that

25:38

early adoption of that idea . We

25:42

could empathize with our patients

25:44

really well , because we did believe

25:46

that this was happening , but now

25:48

not being able to move away from it

25:50

and look at okay , there

25:52

may be other things that are part

25:54

of this condition , and actually

25:57

continuing to hammer down this pathway

25:59

of take away more and more foods

26:02

is actually spiraling

26:04

a lot of people , especially

26:06

in GI disorders and

26:09

especially with our female patients

26:11

in GI disorders , because

26:13

there seems to be more sensitization

26:16

that's happening in this population and

26:18

that's what I do , so I'm going to generalize to that

26:20

, but I think it's a problem in so

26:22

many areas .

26:23

Absolutely , and I just want to have one more

26:25

thing , and I feel like we have to move on because we have so

26:27

much talk about . You know

26:29

, one of the things that I used to do full disclosure

26:32

, because that's how I was taught is that if we put

26:34

someone on an elimination diet , that when we

26:36

reintroduce the foods , we would

26:38

do like three servings a day for three days

26:40

. Yes , that's

26:43

like the recipe for disaster

26:45

right , if you've got bacteria have

26:47

not had these foods and then all of a

26:49

sudden we literally throw large

26:51

quantities in . It's gonna

26:54

upset the apple cart any day

26:56

, any day of the week . And

26:58

so you know when I tell people

27:00

oh well , why don't we just try reintroducing

27:02

some of these things so that you can have more options and we

27:05

can have more diversity in what you're eating ? And

27:07

I say I want you to have a tablespoon of

27:09

hummus twice a week . Yes , and they're

27:11

like what I'm like . No

27:13

, no , If you have not had beans and legumes

27:16

for 20 years , you're

27:18

starting with a tablespoon twice a week . And

27:20

it's incredible how just

27:22

taking the slow , steady approach

27:25

of like giving you know your

27:27

gut bacteria a slow introduction

27:29

it's like knocking on the door instead of burging in the

27:31

house , yes Really makes all

27:34

the difference in the world .

27:35

I agree and we work especially with

27:37

our reintroduction programs on

27:40

when people have been kind of prescribed

27:42

diets and some of them they're appropriate

27:45

in the situation , like a low-fought

27:47

map diet in irritable bowel syndrome

27:49

, but there's no plan

27:51

to get people off of it or it's just like I hear

27:54

try foods and then it goes badly

27:56

for some of our

27:58

patients . And if we see not just

28:01

that we haven't been feeding the microbiota

28:03

, but we're seeing a lot of this sensitization

28:06

, hypervigilance , our selective attention on symptoms , we may

28:08

be going even lower and we're kind

28:10

of talking about what

28:12

is it like to sit with a symptom

28:14

if it's not dangerous ? This is a

28:16

really hard thing to go through

28:19

and that a lot of people are trying on their own

28:21

and then feeling

28:23

scared and like something is

28:25

really wrong and then we want more testing

28:28

and it kind of spirals in this

28:30

very , very

28:33

hard scenario that is

28:35

also often coinciding when

28:37

our hormones are making us not

28:40

sure what's happening as well and you're just like

28:42

I can't do this and

28:44

yeah , it's very challenging

28:46

.

28:47

Okay , so let's talk a little bit about

28:49

foods , and I know that the question , one of the questions

28:51

that I get all the time , is what foods

28:54

cause bloating ? Kim .

28:55

Yeah . So

28:58

when we're looking at that , there

29:00

are certain foods that contain components

29:02

that all of us as

29:04

humans cannot completely break

29:06

down , and they're often found in

29:09

our beans and legumes , our grains

29:11

, some of our nuts , a lot

29:13

of our fruits and vegetables . So plant-based

29:16

foods are generally the

29:18

ones . And it's actually interesting

29:20

because when I was a naturopathic student

29:22

and I learned the fact that 90

29:24

to 95% of our food is digested

29:27

and absorbed in our small intestine

29:29

, I was fascinated

29:32

with the small intestine and my care

29:34

about the large colon was almost nothing

29:36

because I was like it's just a repository for

29:38

waste , like water comes

29:40

back in the body . Congratulations , yay

29:42

, large colon , we're done . But

29:44

I also wanted to think about how

29:47

do I get that extra 5 to 10%

29:49

? Because shouldn't I want

29:51

all the nutrition for

29:53

my own human cells ? So

29:56

90 to 95% , we

29:59

vary deliberately

30:01

and I don't know how this was set up , but we don't

30:03

break down all of our food and especially

30:06

within our carbohydrate foods , we

30:08

don't have certain enzymes to break

30:10

it down . That 5 to 10%

30:12

ends up in our large colon and

30:14

it feeds our bacteria

30:16

. So they ferment it and they turn

30:18

it into gases and chemicals , and

30:21

that's a really good thing . We

30:23

need that to happen . I'm gonna say

30:25

germ-free mice where they don't have

30:27

any bacteria in them . They're

30:29

weird . They're just weird

30:32

. One of the

30:34

things about North America is we're losing our

30:36

diversity and richness in our microorganisms

30:38

and part of that is we don't feed them

30:41

. Some of that is a North

30:43

American diet , where it's highly processed

30:45

and we just lost those

30:47

things within our food system . But some

30:49

of it is where we're deliberately taking

30:52

them away because the gases make us feel

30:54

uncomfortable . But some of the bigger ones

30:56

I actually see people when

30:58

they decide to go keto , which

31:00

hurts my love

31:03

and heart are things like

31:07

cauliflower and onions

31:09

and garlic and stuff are really high , and

31:11

then people go on these diets which already

31:13

I have concern about . But if you

31:15

have a sensitization issue and you're like I'm

31:17

gonna eat all the cauliflower , rice and

31:19

all of the land , it's

31:22

going to make you feel horrific like

31:24

that . Apples are really high

31:27

, but these are all foods that we

31:29

want to be moving people towards

31:31

and for many people

31:33

they're perfectly fine and they don't notice

31:36

the gas production at all , like it's . It's producing

31:38

gas for all of us , yeah

31:41

, but for the people who it's affecting

31:43

, yeah . We

31:45

need to work on how to make you

31:47

not feel it , because you're not supposed to feel

31:49

it .

31:51

Yeah , so you touched a little bit on FODMAP and

31:53

I feel like that's a good one to kind of just circle

31:55

back to you for a second , because there

31:57

is and correct me if

31:59

I'm wrong , but there is a large

32:02

, good evidence base for using

32:04

this as a therapeutic intervention for people

32:06

who have IBS . Right , am

32:08

I wrong ? That is ?

32:10

correct and

32:12

it always has the caveat of

32:14

this is short term

32:16

, and I actually often use

32:18

it to help me understand . Are

32:21

we getting a lot of this sensation

32:23

issue that's going on and we

32:27

can help with people decreasing

32:29

their symptoms while we're working on some of

32:31

the other stuff , but for

32:33

me , our reintroduction starts within

32:35

four to six weeks of starting the program

32:37

and it's a very timed

32:40

what we're doing , which

32:42

we can slow down and speed up as we need

32:45

to . So , yes , the

32:47

guidelines are clear . It's a

32:50

reasonable option to use , with

32:52

the very big

32:54

caveat that we should be off

32:57

of it within a few months and

32:59

many people that I'm seeing are coming

33:02

in on it for years .

33:05

And that's a symptom of because I

33:07

see the same thing that's a symptom of DIY

33:09

culture , because you can

33:11

download guides and apps

33:13

and you can do this whole therapeutic

33:16

intervention without any

33:18

consultation with a professional , without

33:21

any discussion of pros , cons

33:23

, risks , benefits , how to start , how to stop

33:25

, how to modify it to fit your life . And

33:28

so people will hear , see

33:30

, be told that a FODMAP diet is good

33:32

for low , fodmap diets good for IBS , and then

33:34

they'll just be like , oh , there's an app for that .

33:38

But it's also challenging and I'm going to say , in a healthcare

33:40

system where it's hard to get into a gastroenterologist

33:43

, it's hard in primary

33:46

care to get someone who really

33:48

knows about this . They're often like , hey , go

33:50

on a low FODMAP diet and you're

33:52

not going to come back at the beginning because

33:55

your symptoms are lower . And

33:57

it's often funny because I think I can convince

33:59

people to try a lot of things because

34:01

I'm going to talk through the why we're doing it

34:04

and what is our roadmap and where we're going

34:06

. But in some cases it

34:08

is harder to convince someone

34:11

to come off of a low FODMAP diet

34:13

than it is to go on this

34:15

insane diet where we're saying you

34:17

can't eat onions and garlic and cauliflower

34:19

and apples and like , yeah

34:22

, absolutely , and all of these things

34:24

. Like I think sometimes people are happier

34:26

to do that , to avoid them until

34:29

it doesn't get better

34:31

anymore . And that's what we often see

34:34

is , not only is it not good

34:36

to stay on it and just beyond

34:40

the social context

34:42

of it , we're not feeding our gut bacteria

34:44

, but usually at a

34:46

certain point , because this isn't helping

34:49

the underlying miswiring

34:52

, like some of the bigger pieces that are going on

34:54

, then the symptoms start to come

34:56

back , even though you're doing this , and

34:59

that's where we see now people like should

35:01

I take out eggs ? Should I take out meat

35:03

? Should I try ? And

35:05

it becomes even worse in those

35:07

scenarios .

35:08

Oh , my goodness . Yes , I've seen that a

35:10

thousand times . I've seen that version

35:12

of right . So , if I'm understanding

35:16

and hearing you correctly , there are many

35:18

foods that produce

35:20

gas in our colon , which is ultimately

35:22

a good thing . But not everyone

35:24

experiences bloating

35:26

or discomfort or distention

35:28

, so that there isn't one food or

35:31

group of foods or foods that you

35:33

should always avoid if you experience bloating

35:35

or never avoid . There's

35:38

no list like that , right .

35:39

Absolutely . So yeah , I think

35:42

that we can use some food stuff

35:44

as a point in time to figure some things

35:46

out and to help people feel a

35:48

little bit better while we work on the other

35:50

stuff . And that's where , going

35:52

back to where we started on that figuring

35:54

out , is it altered perception , is it altered

35:57

physiology ? There may be

35:59

other things that we need to look at

36:01

to sort of figure out what's happening

36:04

, and usually it becomes multifactorial

36:07

because if we're not

36:09

eating as much like I saw this question

36:11

recently around I had a patient with

36:13

constipation and they wanted

36:15

to do a reset and they fasted

36:18

for three days and then their

36:20

symptoms got worse . I'm like , of course

36:22

it got worse because we

36:25

require food , like

36:27

it . Just sometimes the things that we're doing

36:29

are so not logical , but

36:31

the bloating may feel better during that time

36:33

period . But it's just this weird sort of

36:35

. There's so many pieces here that we need

36:37

to think about both from a physical

36:40

and a perception sensation . But

36:42

yes , there's not the , there's

36:46

not a food that I'd say . This

36:48

is causing bloating in

36:50

people versus

36:53

not happening in the vast majority of people

36:55

who don't experience bloating in gas like

36:57

legitimately in the studies , and they range , but

36:59

we are all supposed to produce , I

37:01

think , 1.5 to 3 or 4

37:03

liters of gas every day , and

37:06

many people don't feel

37:09

that at all . Yeah

37:11

, eating exactly the same foods .

37:13

So important , so important , and

37:15

I mean for any practitioners who might be

37:17

listening and even patients . I

37:20

think it is also really important that the

37:22

integrative health world

37:24

, while very well-meaning and that includes

37:26

our profession of naturopathic medicine often

37:30

creates a little bit of a haven

37:32

for people who might have some disordered

37:34

relationships with food and even eating disorders

37:37

, to have those food rules

37:39

validated . And I think

37:41

that it's so important for

37:43

practitioners listening and I do this a lot

37:45

in mentoring conversations with others that

37:48

you really have

37:50

to weigh the pros and cons

37:52

of telling someone that they

37:55

can't have something or

37:57

that they shouldn't , especially

38:00

if they already have a very

38:02

long list of foods that they don't

38:04

eat . That needs to be a red

38:06

flag and I think all

38:08

practitioners who work in this area

38:10

need to at least

38:12

be aware of how to screen or refer

38:15

for eating disorders because it is rampant

38:17

in English

38:19

and women in midlife .

38:21

Well , and I think with that as well

38:23

, there was a conversation that we had with some colleagues

38:25

around the idea that naturopathic medicine

38:27

is where eating disorders go to hide , and

38:31

it's made more challenging that for

38:33

a lot of people who go into healthcare

38:35

and we see studies around

38:37

dietitians and MDs and we don't have

38:40

them for MDs at this point , and

38:42

I don't know that we will , but the high number

38:44

of disordered eating or eating disorders

38:46

in healthcare providers and the fact that

38:48

we will often go into these types of

38:50

conditions because we saw a

38:52

benefit with it , but

38:54

with our healthcare practitioners and I think

38:56

about naturopaths in general we

38:59

live in a world where having

39:01

these restrictions has become normalized

39:04

and we

39:06

can find our way within this . Not that

39:08

I think that's good , necessarily , but we

39:10

can go to a conference where our salad

39:12

is broken down into everything

39:15

an individual ingredient and then

39:17

you just make your own thing and it's all inherently

39:19

wheat and dairy free and soy free and like

39:22

all of these things . But

39:24

most people don't live in that world and

39:26

so when we're asking people to do things

39:28

and have expectations around

39:30

what is happening in the world

39:33

, where you have to go to your in-laws house for

39:35

Thanksgiving and have this

39:37

list of things , or you can't

39:39

eat in an airport . It just we're

39:43

underestimating the impact

39:45

based on our own personal

39:47

lifestyles in some cases , and

39:49

I think , as patients , we

39:52

want to be really cautious about if

39:54

we're hearing some of these things that

39:56

, like , this is what I do

39:58

, and these things that that can be

40:00

a reverse red flag around

40:02

how do we think about our practitioners

40:05

and what are their goals for us ? And

40:08

it's just . It's a hard situation , but sometimes

40:11

as much for patients . We need

40:13

to be listening to what our practitioners are

40:15

saying , in the same way that I

40:17

need to hear some of the warning signs about

40:19

what my patients are saying

40:21

and what I think about restrictions

40:24

or how do we approach food and where

40:26

is it a complete contraindication

40:29

and where do we need a team

40:31

that's going to be working on this ?

40:33

Yeah , oh , my goodness , I feel like

40:35

we could talk for like eight days , but

40:38

in the interest of letting you get on with your

40:40

day , is there anything

40:42

else that you think you

40:45

, that you want to share , or that you think would be helpful

40:47

to anyone who's like oh , this is

40:49

me , this is me .

40:51

Yeah . So I think one of the things

40:53

that I love about this area is that it

40:56

is growing a body of literature

40:58

and people who are working in this area

41:00

so much more right now , and

41:03

so I feel like sometimes it can just

41:05

get into the . There's nothing

41:07

that can be done . This

41:09

is an area that I think we're going to see

41:11

quantum leaps and

41:13

with the change and how we're understanding it over

41:16

I would say , the last five to 10 years

41:18

, with having this different approach to things

41:20

, I am seeing so many

41:22

more people who are coming off of their

41:24

even holidays through

41:26

December saying you know what

41:29

I ate with my family or I didn't

41:31

think about my symptoms and

41:33

that's not a restriction thing anymore

41:35

I get . Changing the way that I practice

41:37

is changing the way that

41:39

patients are experiencing their relationship

41:42

with their health and food and their families

41:44

and community . I just think it's a really

41:47

exciting time right now to

41:49

be working in this area and

41:51

that patients , I think , can have a lot more hope

41:53

. That's amazing .

41:55

I love it . Food freedom definitely , yeah

41:58

, okay , so how can people

42:01

learn more about what you do and

42:03

where to work with you ?

42:04

Yeah , so we've got a website at drkimbratsndcom

42:08

, and Instagram is probably the

42:11

easiest place to for people to find

42:13

me . Those , yeah , those are the big

42:15

ones that we see .

42:17

And we'll have those in the show notes as well . Absolutely

42:19

so . What do you think is the missing

42:22

ingredient in midlife , Kim ?

42:25

So I've been thinking about this a lot , as

42:27

I've just come off a few years

42:29

of midlife just

42:32

chaos and

42:34

burnout and being in a place that

42:36

I didn't want to be anymore and

42:39

I think it really is that

42:42

community of people

42:44

that can support you . My

42:47

planning for what my second

42:49

half looks like is

42:51

not so much about places

42:54

and things . It is about who

42:56

is going to be with me along the ride . That

42:59

is my thing . I

43:01

love that .

43:02

I love that . That's amazing . Thank

43:04

you so much for sharing your time and expertise

43:06

today . This has been wonderful

43:08

.

43:09

Thank you , you're welcome Thanks

43:11

so much for having me .

43:13

Thanks for tuning in to this week's episode of the Midlife

43:15

Feast . For more non-diet

43:17

, health , hormone and general midlife support

43:19

, click the link in the show notes to learn

43:21

how you can work and learn from me . And

43:24

if you enjoyed this episode and found it helpful

43:26

, please consider leaving a review or

43:28

subscribing , because it helps other women just

43:31

like you find us and feel supported

43:33

in midlife .