Podcast Episode #83: All about Digestion: Bloating, Constipation, IBS & More

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EVENT UPDATE!
This weekend (Saturday, April 20), Diane will be signing books in Rochester, NY – for more information and to RSVP, please click here. There is a special Paleo dinner being hosted Saturday evening as well, April 20 – contact Pittsford Performance Care and ask for Kelly: 585-203-1050 for more information, to RSVP and pay for your seats! See you there!

Topics:

Check out this awesome Spring Bundle of 30 eBooks including Liz's Skintervention Guide (a $37 value alone!) and Sarah Pope's Get Your Fats Straight plus 22 others for just $39! 

Last week's episode post now has a written transcript available. We will be playing a lot of catch-up, but bear with us as they're on their way! We'll also be trying to get current episode transcripts up-to-date and loaded with each podcast but it'll take another couple of weeks before we catch up there as well. We hope you're enjoying them!

1. Multiple Digestive issues
2. Shy Bowel Syndrome
3. Bloated all the time
4. Child with too much stomach acid?
5. Chronic IBS

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Welcome to the Balanced Bites Podcast with Diane Sanfilippo and Liz Wolfe. Diane is a certified nutrition consultant and The New York Times bestselling author of Practical Paleo. Liz is a nutritional therapy practitioner and the author of Modern Cave Girl. Together, Diane and Liz answer your questions, interview leading health and wellness experts, and share their take on modern paleo living with their signature friendly and balanced approach. Remember our disclaimer: The materials and content within this podcast are intended as general information only and are not to be considered as a substitute for professional medical advice, diagnosis, or treatment.

Diane Sanfilippo: Umm. Where's the time thing?

Liz Wolfe: We're starting! [Laughs]

Diane Sanfilippo: Where's the timer thing?

Liz Wolfe: I don't know. Do you ever have a timer thing?

Diane Sanfilippo: You're mean.

Liz Wolfe: You're mean. Welcome everyone to Episode 83 of the Balanced Bites Podcast! We had some technical difficulties. Diane was doing dubstep inside my computer.

Diane Sanfilippo: [Laughs] Liz was abducted by aliens.

Liz Wolfe: That was just really, really weird. I hope everyone else out there is OK! [Laughs]

Diane Sanfilippo: I don't even know what dubstep is.

Liz Wolfe: I don't know, but there was, like, an earthquake in Oklahoma yesterday, and I'm just hearing this. I had no idea. There's just some crazy stuff happening.

Diane Sanfilippo: Yeah. Things have been crazy all week, it seems.

Liz Wolfe: A little bit. So, updates: I am now a worm farmer. If anybody has been to my blerg lately, my blog, CaveGirlEats.com, where I wax awesome and unprofessional about everything that's going on in my life, I adopted a bunch of worms via USPS. I ordered worms on the Internet, and they were shipped to me.

Diane Sanfilippo: That seems like something you should get for free just outside.

Liz Wolfe: You'd think so, right?

Diane Sanfilippo: Yeah.

Liz Wolfe:You'd like to think that, wouldn't you?!

Diane Sanfilippo: [Laughs]

Liz Wolfe: So here's what I've learned so far… It's funny because I'm, like, already failing so miserably at this, and people are… they like me more right now.

Diane Sanfilippo: I've started a pool. I'm taking bets for how long this lasts.

Liz Wolfe: [Laughs] You're like: I love how much you suck. Well, it's a little too late now because we are closing on our property, which we went and walked the other day, and we were like… So here's me. Here's my husband.

CaveGirl: Hey, babe?

CaveHusband: Yeah, babe?

CaveGirl: Fifteen acres is a lot.

CaveHusband: Yep.

So anyway, it's like the most perfect situation it could possibly be, but it's a lot, and it's going to be really fun. I had somebody leave a comment on the blog that was something that Joel Salatin said at some point. It was something like: If it's worth doing, it's worth doing poorly at first. And I can promise everyone that I'm going to do this extremely poorly.

Diane Sanfilippo: I was about to say, I feel like you're playing Polyface, like Liz plays Polyface.

Liz Wolfe: That's totally what it is! But anyway, with regards to worms, you need to make sure, everyone, that they have… So I bought this worm composter basically because I got all scared that my compost wouldn't be ready fast enough to use, so I bought this worm composter. It's supposed to be really cool, and it is really cool. I wrote all about it at my blog, so go read about it there, and there are some videos there, too, of me trying to corral this rouge worm, and for some reason…

Diane Sanfilippo: I watched this video.

Liz Wolfe: I was so skeeved out. That was the saddest video. I had to put it up. It was so sad. I mean, I couldn't do it.

Diane Sanfilippo: I watched it.

Liz Wolfe: Like, my hand recoiled itself. I couldn't handle it.

Diane Sanfilippo: I was embarrassed for you.

Liz Wolfe: Me too. It's just a freakin' worm! I'm telling you, I don't know what my problem was. I just think that I was all ready to be a homesteader on my schedule, and I thought maybe I had a few more days before I had to start picking up worms with my bare fingers. I don't know. Whatever. But here, this is the thing… This is the thing that I think, you know, I'm starting from fresh scratch, like absolute and total scratch, and it's funny because all these ‘chicken ownership for beginners' and ‘worm farms for beginners,' they all assume that I have this level of knowledge that I absolutely do not have at all. Like, step one would probably be just to follow directions, but that's, I mean…

Diane Sanfilippo: That would require reading directions…

Liz Wolfe: Exactly!

Diane Sanfilippo: Which, as we know, people don't do.

Liz Wolfe: It's just not how the world works.

Diane Sanfilippo: Yeah. Nobody does it.

Liz Wolfe: No. Nobody does that.

Diane Sanfilippo: Ourselves included.

Liz Wolfe: So, the worms arrived, and the worm farm arrived, and I opened up the worms, and we videoed the whole thing, and of course, that was too horrifying to… I just woke up. It was like: Ooo, Christmas morning, we're opening up the worm farm. And then all of a sudden, you know, we've been cooing and goo-goo-ga-ga with these worms and introducing them into our little family, and then we realize it's 11:30 and we have to go meet my family for brunch. So I just kind of put the worm bag back in the box without sealing it up because I'm thinking: These things aren't going anywhere. Why would they want to crawl out of their shipping medium? Why do they want to crawl out of their giant bag of dirt? You know, thinking they wouldn't. So we get back and there are worms just like… I mean, the whole house is just full of rogue worms! And my mom was like: Oops. And I was like: Ahhhh! And that was the story of the rogue worms.

Diane Sanfilippo: I'm glad we're not neighbors.

Liz Wolfe: Can you imagine? Can you imagine what my life is going to be like going forward?

Diane Sanfilippo: No, but it's going to make for excellent podcast fodder!

Liz Wolfe: Isn't it? I can't even believe it. And other than that, we also, my husband and I, I'm sure there are people, couples that sit there namely their unborn children at night, but my husband and I, what we do is we sit there and we name our unborn goats after characters in Arrested Development.

Diane Sanfilippo: [Laughs]

Liz Wolfe: So we already have the names picked out, and yeah, everybody's going have to wait for that because they are freaking awesome, and you're just going to have to wait and see what they are.

Diane Sanfilippo: I can hardly wait.

Liz Wolfe: Waiting with bated breath.

Diane Sanfilippo: Bated breath, exactly.

Liz Wolfe: Whatever. So a real item of news: My Skintervention Guide, I'm really, really excited. I didn't know that this was going to happen or not, but I found out a couple days ago that my Skintervention Guide got accepted into the Village Green Network's spring eBook bundle. It's an amazing bundle, and I know we've had a bunch of these bundles going around lately. They've all be really great, but this is the one I really felt like I wanted to try and be in. It's the only bundle I'm ever going to submit the Skintervention Guide to. It's just the right time for me. It's the right time for the guide to go out in a bundle, and I'm really excited about, but this is it. This is the only time it's going out. The Skintervention Guide is normally $37, well worth it, in my opinion, and the whole bundle is 30 eBooks for $39. So folks, if you're interested, if you've been thinking about getting the Skintervention Guide, check out that bundle. You can find a link to it at my website, CaveGirlEats.com. Diane, I think you'll have a link to it as well.

Diane Sanfilippo: Yep, we'll put a link in the show notes, and I posted about it on Facebook today. I saw there were a bunch of cool different eBooks and different stuff that people haven't gotten before. I think Sarah Pope has a cool guide in there, The Healthy Home Economist.

Liz Wolfe: Yep.

Diane Sanfilippo: It's called Get Your Fats Straight. I know Matt Stone, who's pretty controversial about things, he likes to kind of play devil's advocate or just kind of go against everything that everyone wants to say, but I think at the end of the day we're all kind of saying the same thing about eating real food. He has a book called Eat for Heat, and I think it's about mostly metabolism and thyroid health and all of that. What else? The Grain-Free Lunch Box. Kelly the Kitchen Kop has written one called Real Food Ingredient Guide, so just a bunch of really different guides that I think are pretty useful. And people are asking if they can get them on their Kindle, and there are ways to open them on different e-readers. So it's a cool way to just grab all these things that have been out there and you've probably seen and are interested, but you haven't plopped down a chunk of change yet. You just get a whole bunch all at once.

Liz Wolfe: Well, people are always like: Why can't all this stuff be in one place? And it is literally all in one place with this bundle.

Diane Sanfilippo: Yeah.

Liz Wolfe: So that's kind of why I'm really excited to be a part of it.

Diane Sanfilippo: I kind of wish there was a bundle like that for some of the stuff that I tend to buy. I bought an eBook a couple of months ago on food photography, which as anybody who is following my pages and what I've been working on lately knows, I've had to become a photographer!

Liz Wolfe: Yep.

Diane Sanfilippo: And you know, there's a certain amount that I think as kind of a creative person and an artist I'm able to just kind of put together in terms of plating and making sure things look cool, but when it comes to camera settings and lighting and all of that… I mean, literally the camera setting issue for me was like Greek. I mean, Bill Staley tried to explain it to me probably at least six different times, and it was in one ear and out the other. So I bought an eBook, and I probably spent close to 30 bucks on it because in that moment I was like: This is exactly what I need. This is going to help me. I can constantly refer to it. I can search it on my computer. As much as I love paper books and I always tell people to get Practical Paleo in paper because it's a totally different experience, if somebody has written an eBook, they've put together a whole bunch of information that's stuff that people ask them over and over again, like what makes me any different? And I'm not. So I just think it's cool because this is the easiest way for people to get their hands on a ton of information, and I actually really love that you can search it on your computer, like if you need to just search through the PDF that somebody's eBook is, you can just get to the information really quickly, which for me… I don't know. I like the digital media stuff for that purpose.

Liz Wolfe: I'm obsessed with eBooks. I love the instant gratification of the whole thing. Now having one out there, I kind of understand where you were coming from all those years. It's your baby, and there's no kind of layer of publisher between you and the people that you're trying to help, so it's like you have the Facebook page… You have the Facebook page for The 21-Day Sugar Detox. I have the Facebook page for the Skintervention Guide, and in a way, that's kind of extra stressful, but it's also a way to make sure people do OK.

Diane Sanfilippo: Yeah. I mean, it's also our way of, like I said, taking all of the best information, all of the sort of most frequently asked questions, our favorite chunks of information that people ask for over and over again, and put them in one place in a really organized way. I've been a big fan of that medium for a really long time, so I'm excited to promote it, so cool!

Liz Wolfe: Cool beans.

Diane Sanfilippo: So what else? Do you have more things to update people on? I'm reading notes here…

Liz Wolfe: Oh! I do. I got a nice leather NASCAR fanny pack, so that was my big news.

Diane Sanfilippo: [Laughs] You know, fanny packs have been big for quite some time at my gym, by the way.

Liz Wolfe: They never weren't big.

Diane Sanfilippo: I have one from American Apparel from a couple years ago, but I just wasn’t bold enough to get some kind of fluorescent or cool looking one, so it's this black, slim-lined, wear-it-out-clubbing-because-I-go-clubbing-all-the-time fanny pack!

Liz Wolfe: That's what you're doing right now, right? When that crazy dubstep music was on earlier.

Diane Sanfilippo: Yeah. Oontz oontz oontz. I wonder how that's going to get transcribed. [Laughs]

Liz Wolfe: We're trying to stump the transcriber, guys.

Diane Sanfilippo: It's pretty funny. She's pretty amazing. Yeah, so anyway, I did laugh because fanny packs at my gym… like, the owners of my gym stick out like sore thumbs no matter what wherever they go partially because Big J is 6'5″, and they don't wear normal clothes, so it's like you're 6'5″ and you're wearing purple shorts and striped knee socks and some kind of weird Croc-looking shoes and then a fanny pack that's bright orange as well. So anyway, fanny packs. I guess we'll get comments about people who are tired of hearing about fanny packs and also people who are excited, that fanny packs rule.

Liz Wolfe: Yep. It's a mixed bag of listeners.

Diane Sanfilippo: So just another couple of quick updates: Working on The 21-Day Sugar Detox book that will be printed and published. I know we were just talking about the eBook. There's a whole blog post on BalancedBites.com about what's different between the printed published book and the eBook. I put that up pretty much as soon as the book went up for sale on Amazon because I know tens of thousands of people will have questions. What else? Rochester this weekend, so it'll be Saturday, April 20, for folks in the Rochester, New York area, I'll be signing books at Wolf Brigade Fitness… something to that effect.

Liz Wolfe: Ooo, that's fun.

Diane Sanfilippo: Yeah, it's going to be cool. Let's see… I think we're doing a book signing at the gym for a couple of hours, and there will be snacks catered by Roam Café – not to be confused with Roam Artisan Burgers, which is my favorite burger place in San Francisco – but it's called Roam Café, and they have paleo items on their menu, but they're doing a paleo sort of snack spread for the book signing, which will just be for a couple hours at the gym. And then after the book signing, we're actually having two seatings of a dinner at the Roam Café, and there are very limited seats available. I think there is a 5:30 and a 7 p.m. seating for a four-course dinner. If you are in that area and you want to come to dinner, check out the Eventbrite link and RSVP for the book signing because I'm only going to be sending out information to people who are signed up for the book signing, and I'll be posting a little bit of information also on Facebook about it, but it's really limited. I think there are maybe, like, five seats per time slot there. So if you're in the area, definitely come out. We're going to be having this dinner, and I'll be there, and I'll be signing books and hanging out. And that's it. And tonight was snatch night at the gym, so my back is rocked and I’m tired, and let's answer questions about digestion!

1. Multiple Digestive Issues

Liz Wolfe:OK, so this first one is a beast, and I'm going to read the whole thing because I got S+'s in handwriting and I got S+'s in reading. All right, Jared says: “My name is Jared and I am 22 years old.” Hi, Jared! “‘Digestive discomfort,' I believe, is the best umbrella term for establishing context as to the range of my symptoms that have plagued me in both minor and major ways throughout a large percentage of my lifetime. I have always been one to have bowel movements quite regularly, maybe even on the ‘too regular' side – average five times per day. I have also always been one to have an ever greater number of bowel movements when in the presence of nervousness tied to a particular present event.”

“Digestive issues really plagued me about four years ago. I was beginning my freshman year at Whitman College in Washington, and I started experiencing symptoms of nausea and abdominal pains during, after, and before eating. The symptoms were both present when I was consciously in a stressful state and when I was far from one. I remember being in class after breakfast and feeling like my insides were tearing themselves apart. Now, keep in mind, this was two years prior to my introduction to CrossFit and paleo and all its magic; therefore, as I began to seek help, I was being prescribed heavy doses of antacids, and eventually upon seeing my first of three GI docs over the duration of the next year, a host of non-over-the-counter pharmaceuticals as well. I got an endoscopy, colonoscopy, barium test, gastric emptying test, celiac disease test, the list goes on. More drugs were prescribed with no mention of nutrition, nor any decrease in my symptoms. Spring of 2009, I was ‘treated' for H. pylori with antibiotics, which did nothing to improve my symptoms, and worse, I wonder if today I'm still paying the price of the attack that took out my potential good bacteria as well. September of 2009, I was back at Whitman for my sophomore year and ended up taking a leave of absence by October in order to try and get a handle on the chronic irritable symptoms as well as weight loss that had gotten too much to bear with school. When I returned home, I started seeing a psychiatrist who prescribed me with a couple of SSRIs and eventually lithium, which, for the first time, allowed for enough relief from the symptoms for me to start having an appetite again and enough of a buffer to begin rebuilding myself physically and emotionally.”

“Fast forward, I found CrossFit, and that was a huge catalyst in me productively taking a real preventive, educational, and empowering route to getting things even more on track both health and passion wise. Fall of 2010, I was back at school but now in California. I was still heavily medicated at this point, which had its own cascade of effects later into the year. By about the beginning of 2011, I was full-blown paleo, working to get off meds, and trying to get everything I could get my hands on educationally as far as strength and conditioning training as well as nutrition training, e.g., Wolf, Chris Kresser, Sean Croxton, yourself, etc.”

“Fast forward to now: I feel very confident in my extracurricular work that has taken place over the past two years and led me to being evermore informed and passionate as far as my own lifestyle practices and how I wish to help educate others both recreationally and as a CrossFit coach. However, my digestive issues still plague me in some roundabout way that keeps suggesting I have yet to really address the underlying cause. I have listened to your podcast on digestion with Chris Kresser multiple times as well as just recently purchased your book, and I am so overwhelmed tackling this without more individualized, personal direction. I am an auditory and personal relationship learner at best.”

“Most currently, my symptoms are indigestion with bloating, and the longest bout of loose stools that I have ever witnessed (three months), with intermittent abdominal pains, often when I wake up. I have been strict paleo for about a year, aside from the occasional ice cream, and I used to cook with grass-fed butter, but have since eliminated to see if that would affect my loose stools. Stools actually began to normalize with the removal of dairy (really just the butter) but didn't stay that way. I was trying the NOW Foods Super Enzymes tablets and went through the protocol but never experienced any heat near my sternum. I also recently went through a bottle of just betaine HCl. I experienced some changes in symptoms but nothing really substantial or lasting. I recently started using a bitter tincture before eating in the mornings for digestive enzymatic support.”

“I have Hashimoto’s and have been taking 60 mg of Armour for about half a year. Before that, I was on Synthroid.”

“Supplementing with high potency probiotics once a day, fermented cod liver oil/butter oil blend 2 capsules once a day, selenium once a day, and Carlson vitamin D drops once a day.”

“I have been working with a naturopath for about a year now. Most recent blood work (done in June) looks pretty good. Vitamin D is 69 ng/mL. Some not-so-good things being total testosterone is 174, and free testosterone is 2.65. White blood cell count is 3.7,” and some other stuff. “Put on some adrenal support,” but he feels like his adrenal state is no longer an issue.

“I'm very cognizant of not being overtrained.” See, these people, they know what we're going to say before we even say it. [Laughs] It's like: I'm not overtraining, I don't have adrenal fatigue.

Diane Sanfilippo: Um-hum.

Liz Wolfe: “I haven't taken protein powder in the last six months. Lately, I have been trying to incorporate more bone broth as well as raw sauerkraut. I also just did a comprehensive stool analysis/parasitology test conducted by Doctor’s Data, Inc. Results: Muscle fibers were found in the stool. Slightly elevated lysozyme levels. Secretory IgA…” Numbers, numbers, more numbers.

“I have been being mindful of FODMAPs as well as veggie consumption. Diet is consisting of lots of sardines, tuna, salmon, chicken, meat, starchy potatoes, both regular as well as yams and sweet potatoes, olive oil, some avocado, bananas, applesauce, some berries, very little nuts, coconut oil, and occasional dark chocolate.”

“I am 150 pounds, 5'8″, muscular build.”

“It's been particularly difficult trying to manage all of this, especially from a continual elimination approach when also trying to stay competitively conditioned and strong, most specifically from a caloric standpoint and I worry about from a nutritionally sufficient state as well with how my stools are looking.”

“My naturopath has been fine; however, he lacks a complete paleo ‘buy-in' as well as an understanding of the interplay between the fitness-heavy side of my life as well.”

“I feel like I'm biting off more than I can chew, especially when I'm the one recommending methods of treatment to my naturopath via Kresser and Wolf info, e.g., low-dose naltrexone? SIBO? Micronutrient deficient? Gut/brain axis?”

“Thanks for all you do. I understand completely if at this time you cannot be of service,” etc.

So I think this was probably a question that we kind of rerouted to the podcast because it kind of seems more appropriate. I have to say, though, part of the reason I wanted to read this whole question is because we get so buried in these details of what's wrong with us, when a lot of times we can't pick through this and say: Oh, bilirubin is this, and low-dose naltrexone that, because honestly when this type of stuff happens, we don't always know. We can throw stuff out there. For me, with some of the stuff that you said, I think it's really important to get a good amount of gelatinous type of content with our protein, not just muscle meat, but actually get some of that gelatin and the connective tissue in there as well. I think that's important, and I think that's helpful digestively. But I don't know. For me, it's kind of like I really don't know where to put this besides tackling, number one, what's right, what the mental state is and kind of the underpinnings of everything else that's going on. What do you think?

Diane Sanfilippo: I think first of all when we get questions like this and people feel like they've tried everything and they just haven't really gotten to the root of it, I think the best thing for somebody like this who said he does best with learning by auditory means, which I'm the same way, or a practitioner, I think that this type of problem requires sort of that witch hunt for a practitioner. It's not easy. Even people like Liz and me at this point have almost extracted ourselves from the pool of those who are helping people one-on-one because we really can't. We can't handle the amount of influx of clients who are approaching us as well as all of this other work we're doing to try and help as many people as possible with as broad sweeping strokes as we can. So anyway, that being said, I think getting a practitioner to work with whom you can go through all of these things one at a time and realize that the practitioner doesn't know what's wrong with you. All they know is what the possibilities are. And so what if you're the one who has to bring the ideas to them? It matters more that you find somebody who's willing to go through each of those tests, who's willing to maybe read the article that you read or listen to the podcast that you listened to, somebody who has an open mind and doesn't think they already know everything, because that's really where a practitioner won't be useful, if they just assume they know everything, yet you're still sort of struggling and suffering. They have to be willing to just work with you.

One of the things that I think could be at the root of this, just my hunch, I have a really, really good friend who probably has a similar set of circumstances, and she just has a lot of digestive issues, and there are other issues as well, and it's almost like she's been fighting this uphill battle trying to figure out what's wrong with her digestion when it's really not her digestion at the root of it at all. It's really this autoimmunity that's at the root of it. And you're saying you have Hashimoto's. I would really look at managing the autoimmunity as sort of the… If you're thinking what can I do right now, what's sort of the strongest plan of attack, I would put myself on an autoimmune protocol, and I would get rid of any of the vegetables that are irritating to your digestion as well as eggs, nightshades, nuts and seeds. And I know you've said you've already gone through so many different eliminations, but this is where I think that the focus shouldn't be digestion. The focus should be the autoimmunity because I think the autoimmunity could be what's at the root of what's upsetting your digestion, because if you have an autoimmune condition that's not calmed down, it's not managed… And you mentioned the low-dose naltrexone. I mean, I can't prescribe anything for you. I can't tell you what to do with any of that, but if you talk to your doctor or your naturopath about that, maybe? Maybe taking that, it's going to suppress your immune system in a very small way. You know, it's a very low dose as it's called, and it doesn't do what a lot of other immune suppressing drugs do in terms of just how potent they are and how sort of far-reaching they can be in terms of turning down your immune response to possible negative issues, not just the autoimmune response that's going on. So that could be helpful, but I would really just approach this as the autoimmunity is at the root of this.

When we teach about leaky gut and I kind of go through this, this is in my book and I don't get to really emphasize it the same way when I write as I do when I speak, but if you have a known autoimmune condition, you may always have leaky gut to some degree. This is according to Dr. Datis Kharrazian. This is stuff that he teaches when he teaches for… I think he teaches for Apex Energetics perhaps still, but when he teaches about leaky gut, and he explains that when you have autoimmunity, your gut may never heal completely, so you may be in a situation where you need to be on a gut-healing protocol in terms of supplementation, in terms of the types of foods you're eating, in terms of what type of exercise you're doing, possibly meditating, relaxing more, finding ways to work-in versus workout. This is stuff that Paul Chek talks about a lot. But managing the autoimmunity sounds like it's really going to be your first step here because digestion will settle down more when you get the autoimmunity under control better. And there's no way for us to know exactly what that's doing.

Maybe getting your thyroid levels and your antibodies tested more regularly would be helpful, but really your body is telling you more than just the blood work will tell you. You're more than what your blood work says, so I think just going with your symptoms now. I also think that sometimes we pay too much attention. I know that sounds crazy, but sometimes – and this is definitely something that those of us who have learned a lot, who can process a lot of what we're learning and understand it and especially those of us who teach others, we're so in tune with our bodies that I think it's almost to a fault at some point. Not that you should ignore what your body's telling you if it's not working perfectly, but I honestly think that sometimes just stressing more about the fact that your digestion isn't perfect and it's not working, it's just adding insult to injury. It's really just snowball-effecting this whole cascade of your stress that you perceive or don't perceive. If you're constantly looking in the toilet bowl and disappointed at the formation of what's come out of you and you're kind of getting that response, I just think that could be problematic as well, so that's sort of the emotional, hippie-dippie side of things. But I think at the end of the day, continuing to work through some possibilities of practitioners, and it may or may not be somebody local… You know, I don't know if Dr. Lauren Noel is taking patients, but she may be taking patients. She may be doing that via Skype. I don't know if she's already even too busy, but I know there are a lot of people who are out there. It's just going to mean maybe checking out Paleo Physicians Network or PrimalDocs.com and finding somebody who can kind of hold your hand and walk through all of this stuff.

Liz Wolfe: I don't think that's hippie-dippie at all. I think a lot of this emotional meditative stuff a lot of times precedes issues like this. That kind of dysregulation can actually precede any physiological dysregulation, and it just keeps spiraling from there, and I think there's definitely that point where you have to say: I'm doing the best that I can, just like you said to triage the physical. Now what am I doing to sweep up some of the mental/emotional stress, really that type of stuff.

Diane Sanfilippo: People discount life changes and life events that affect our physiology very, very powerfully.

Liz Wolfe: Most definitely. Good job. Good job, partner.

Diane Sanfilippo: [Laughs]

2. Shy Bowel Syndrome

Liz Wolfe:All right. This next one is… This is a fun one. Lydia says: “Hi Diane and Liz. Have you ever heard about a shy bowel syndrome? We hear about shy bladders, but in my Googling to learn about others with a shy bowel, I came up with not much of anything. I seem to have a shy bowel and have a difficult time eliminating when away from home for the weekend or longer. Now, I am able to poo outside my home, this isn’t a psychosis THAT bad, but when I go away for a weekend, I am unable to go #2. This summer I was away for two weeks, and didn’t have a bowel movement for the first 10 days. I was beside myself. I didn’t even have the urge to go! I know the desirable transit time is between 18 and 24 hours. And when I am home during the week, I have no problem eliminating one to two times per day, usually a little looser stool even. I am concerned, as traveling becomes uncomfortable. After several days I begin to feel full, yet have no physiological urge to poop. I have heard you mention low stomach acid as a possible cause, but what can I do to make this go away when I’m away for weekends or longer? Pop a handful of magnesium? (Is this even safe?) Take HCl? Any suggestions? Thanks!”

And her basic supplements are Primal Defense Probiotic in the morning, cod liver oil, Carlson vitamin D drops, glutamine for leaky gut, magnesium and calcium in the evenings, and occasional milk thistle. Four to five days a week or exercise. Love the fasted, low-intensity cardio. Mix of running 4 to 5 miles at an easy pace, etc. Grad school starts in one month. Stuff like that.

OK, so I wanted to talk about this because Lydia sounds a lot like me. This is Liz still talking. She eats stuff for breakfast like what I eat: eggs in coconut oil with sautéed greens and avocado, sometimes bacon or pork sausage. Lunch: veggies, salmon, sardines. Woohoo! Sardines or tuna, avocado, olives. Dinner: CSA lamb, veal, store-bought chicken thighs, CSA veggies, that type of thing. Now, Diane, you know this because both of us are very open about our digestive function, but when you and I first started traveling together, I'm not a travel pooper.

Diane Sanfilippo: [Laughs]

Liz Wolfe: I'm just not. I've never been, and it would get to, like… Oh, gosh, how long were we at… I think we were in California once for at least five days, something like that, I swear, and I didn't poop once. And I didn't feel like I needed to. And this type of gastric tourism is probably not what people want to hear from me right now, but this is… Now that we've said it out loud on the radio, pharmaceutical satellites are tuning in on us and they're inventing shy bowel syndrome, inventing medication for shy bowel syndrome. But really, as long as you can come home and you're regular again… I'll kind of double up on some probiotics when I travel and stuff like that and just try and make sure I'm doing the same things, bringing my sardines with me, bringing my cod liver oil with me and all that stuff, and I probably needed to be doing a little bit more meditation, a little bit more relaxing, conscious efforts toward relaxation and stuff like that when traveling, but this is something that has always happened to me. It got a little bit better as I got used to traveling more, but that said, if you're going to a new place or a new situation every time you're traveling and it's not this regular thing that you're getting into a rhythm of environments and sequences that you recognize, I don't know that a person is ever really going to necessarily just get regular. I don't know.

Diane Sanfilippo: Yeah. And you were sort of making fun of me for always picking the Double Tree Hotel, and I'm like: There's a reason!

Liz Wolfe: [Laughs]

Diane Sanfilippo: I know what to expect. I know the room's going to be clean. I need to create some semblance of routine for this whole I'm-on-the-road-way-too-much deal, which I've cut back on this year, which has been nice. But I think the only one thing I would point out from her specifics in terms of supplementation, when you travel I wouldn't take the glutamine because glutamine can have a binding effect. Usually that only happens if you take too much, so you'd have to take a lot of it, but if you're already a little bound up or stopped up, I wouldn't take the glutamine there. I think magnesium can be helpful, but otherwise I really do think it's just a change of environment. Usually there's a change in food, change in schedule. I think that's really what does it. The best thing you can do is to keep your food to be similar or the same. I think that'll help, but otherwise I really do think it's just a stress response. It's a whole change in environment, and I just don't think that we really, again, can understand how far-reaching some of that environmental impact can be on things like our digestion. So either travel more or travel less or deal with it.

Liz Wolfe: [Laughs]

Diane Sanfilippo: You know, traveling more really does help. I think air travel is definitely tough. The pressure change in the cabin can definitely affect you. I definitely feel kind of bloated when I get off of an airplane. I just think that there's weird stuff happening with cabin pressure. But when you get used to it, it's really not as bad.

Liz Wolfe: I tend to drink a lot less water when I travel, and part of that is because I hate public bathrooms and I hate airplane bathrooms and I just don't want to deal with that. I don't know. That sometimes can actually help me a little bit, when I actually suck it up and drink some extra water. Simple things. You're not alone, Lydia. I have shy bowel syndrome, too. SBS. SBS'ers unite!

Diane Sanfilippo: [Laughs]

Liz Wolfe: Shut up, Diane. You can poop anywhere.

Diane Sanfilippo: Just wait until you're 30. Everything will change.

Liz Wolfe: Shut up! Shut up. That's not a number that we say in my house.

Diane Sanfilippo: [Laughs]

Liz Wolfe: So close.

Diane Sanfilippo: You kids.

3. Bloated All the Time

Liz Wolfe: OK. Next one: Bloated all the time. Leah says: “It’s been about four months and I’ve been bloated. I eat gluten-, dairy-, egg-, soy-free and pretty strict sugar-free. I’m not sure what’s causing it. Doctor has ordered candida IgG, IgA, IgM blood test. I’ve done FODMAP, Specific Carbohydrate Diet as well. I have results for a Genova Diagnostics comprehensive stool analysis as well. Issues with stomach acid – I’ve been on Azeo-Pangen and betaine and pepsin as well as calcium d-glucarate. Thank you.”

What do you think are the most common causes of this type of bloating?

Diane Sanfilippo: I think that this sounds most like it could be a SIBO issue, small intestinal bacterial overgrowth. Is that the one test she hasn't had?

Liz Wolfe: Yeah, I don't see that in there.

Diane Sanfilippo: Yeah, bloating… Besides low stomach acid, I think those are the two things that we've probably pinned bloating on the most, Liz: stomach acid and small intestinal bacterial overgrowth. So that's probably, sorry, one more test that I would say to run, but also to just get in some supplemental digestive enzymes with HCl, hydrochloric acid. See how you do. This is one question that actually didn't have tons and tons of backstory, so it's actually pretty hard to dig a little deeper, but those are my thoughts.

Liz Wolfe: I was wondering whether she had been tested for SIBO just because she's taking the calcium d-glucarate. I'm wondering if that was something her practitioner had her on because of it.

Diane Sanfilippo: I think she would have said that, though.

Liz Wolfe: Yeah.

Diane Sanfilippo: But the FODMAPs… She says: “I've done FODMAP, SCD diets as well.” I know a lot of people who try a lot of different ways of eating, and sometimes they try it for a week or two, and sometimes they try it for a month, and the reality is you're dealing with something very chronic, it often takes more than two weeks or even a month of a dietary change to just find out. But I think after a month of doing something, you should know if you experience some kind of reduction in your symptoms at least how to target what's going on. But that's kind of what I'm thinking. I also think… This is kind of the crazier side of things, but hidden gluten could really be doing this, and there are a lot of people who all of a sudden they check out a spice blend that's been in their cabinet and they're like: Oh my goodness. I cannot believe I've been eating this, because we just haven't relooked at certain things. So I would really scour your pantry and your refrigerator and see what you're eating. Check out the Guide to Gluten that I have on my website. It's a free PDF under Resources & Freebies. It's one of the pages in there. Maybe there's some ingredient that you're eating that's really irritating, but that's kind of digging pretty deep.

Liz Wolfe: Yeah, that reminds me a little bit of some of the stuff that I wrote about in the guide, in the skincare guide, that folks that they've eliminated everything that could be causing them skin irritation, and then they find that one thing that they haven't gotten rid of. I was talking to Stacy from Paleo Parents about this. They're using Tom's Toothpaste, and they think that's a great choice, but in reality Tom's has SLS and a couple of other really irritating conventional chemicals in there that could really be causing a lot of irritation. You pull those out and boom, things improve. So that's a really, really good point. Check for hidden ingredients, hidden gluten.

4. Child and Too Much Acid?

All right, next up. Holly asks: “How can a paleo diet/lifestyle help with heartburn or gastritis? My daughter was diagnosed with gastritis when she was 5. The doctor told us that her stomach produces too much acid. Ulcers run in her father's family. She was on daily Prevacid for three years, and then her condition improved and she was able to stop the daily meds. We were hopeful that she had outgrown the condition. Recently her condition has gotten worse and she is back on the daily Prevacid. She is 11. I have been told about how some of the heartburn meds may be depleting people of magnesium. I worry about her being on a daily preventative medicine. I have recently discovered paleo and we are making the transition. I am considering doing something like The 21-Day Sugar Detox with her in hopes we can fix this naturally. Any advice will be greatly appreciated.”

So this one, Diane, obviously sometimes we get questions from folks who are kind of thinking about transitioning to a paleo diet, that type of thing, and obviously like we say in the beginning, we can't really give direct advice regarding medicine. We can't really tell a person what to do with her meds or her kid's meds, but just talking generalities, these heartburn meds were never developed and they were never intended originally for chronic use. They were intended for use in acute situations. And the dangers of chronically suppressed stomach acid are absolutely nutrient deficiencies. Without these really vital gastric juices… And I don't know who it was. Way back in the day when medicine was basically divided up into the humors, different fluids in our bodies, and one of those, I think, categories is digestive fluid. It's just so, so, so critical to health. When we're suppressing that chronically, we can see all manner of nutrient absorption issues, digestive issues. Some things will get worse. So I think it's really great that Holly's looking at a new type of lifestyle. Again, can't tell her what to do with the meds, but I absolutely think this could be helpful. But one thing to remember is that if the little one's stomach acid has been suppressed with any kind of drug, it may be that big hunks of protein and big hunks of veggies aren't going to be really easy to digest. So chewing extremely well and maybe focusing on some really well-cooked sauces and soups and stews just to kind of help nourish the digestive system and make that process a little bit easier is probably going to be really helpful. I just don't want anybody to get tripped up because they're feeling like they can't digest a hunk or protein or something like that, because a lot of how well you digest real food is contingent upon how naturally robust your digestive system is. Your thoughts?

Diane Sanfilippo: Only a couple of things I'm curious about. You know, when kids are getting diagnosed with conditions like this at such young ages, I think it's important to find a practitioner who will work with you on more natural remedies, finding a doctor or a naturopath who's not just out to pump meds into now an 11-year-old child. And I think that understanding why the body is not working properly is really the most important part here. We don't know if it's true that her stomach produces too much acid. The doctor said that. I don't know that I believe it, because we know that at least 90% of people out there who think they have too much stomach acid have too little, so we don't know if that's even true. We just know that it's what the doctor said. I'm not saying it's not true; we just don't know. It is possible that a very small child could have low stomach acid production. There are reasons for this that go so far beyond just what the kid's eating. Back again to stress. I think this should be called Digestion and Stress, this whole episode. But kids who are in utero and the mom is very stressed tend to be born and their cells have the signal of stress. And their body can just be more stressed. They may perceive and process stress differently. We don't think of kids as feeling this stuff, but they absolutely can. We don't know what's going on with what's happening in her life. We don't know if the family moved when she was 5 years old, if maybe something traumatic happened in the family at that time. It's really important to think about all of those things because if stress is one of the reasons for it, then finding out why the body is not working properly, what mechanisms are kind of breaking down, that's really the more important thing here than even just whether she's on meds or supplementation. It's trying to figure out why it's happening.

I know it's frustrating because we always say work with a practitioner, and people feel like there aren't great practitioners, but there ARE great practitioners out there. A lot of them are even chiropractors who have become sort of more along the lines of a naturopath or a functional medicine type of doctor because they're learning a lot more about the functional medicine stuff or clinical nutrition and they can help a lot more people. So just kind of keep your eyes and ears open for that. Ask your friends on Facebook. Ask on some of the nutrition pages if other people have found a practitioner to work with them on this issue either in your area or remotely, because I actually put out a call for one of my friends looking for somebody in the New Jersey area who could help with autoimmunity and thyroid conditions and got a whole bunch of recommendations. So use our pages for that purpose. There's no other reason to have tens of thousands of people together in one place with common interests and common goals than to really crowd source and get this information, so I would rally with some other moms who have dealt with this too, because I don't think this is the first time we've had a question like this. We've definitely had a lot of questions about very young children and stress and digestion issues, so I bet there's a ton of moms out there who have dealt with this, and I bet they'd have some really, really good advice.

5. Chronic IBS

Liz Wolfe: Agreed. All right, next up, Jennifer says: “First, let me say thank you, thank you, thank you from the bottom of my well-adjusted belly.” Awww. “I ADORE your book, and listening to your podcasts and following the blog has helped begin to heal so many of my digestive issues. I can’t begin to tell you how much better I feel since starting a paleo diet. You have been my hero (heroes – Liz, I love you too!)” [Laughs] “Anywho, my question is not about the chronic constipation or IBS symptoms that I have had for years, but about a 10-year battle with psoriasis. It’s on my elbow. It sometimes shows itself in other places. It isn’t very big (about the size of a quarter), but I can’t seem to get rid of it! I realized in the past few years the connection to whole foods and autoimmune conditions, which I believe this is one, right? And have been trying to figure out the cause.”

“I have eaten gluten-free for the past several years, with occasional cheats, but have been 100% paleo for a few months now. My typical breakfast is eggs, avocado, bacon or sausage, a non-starchy vegetable. Lunch is a protein, veg and salad, usually with lots of butter and/or olive oil. Dinner is a repeat of lunch with the (not-so-occasional) glass of wine (or two if the mood strikes). Some daily good quality dark chocolate. I find fruit generally upsets my tummy. I occasionally throw some berries on my breakfast plate but pretty much stay away from fruit. I sleep as much as I can with a 15-month-old at home, generally 6 to 8 hours, depending. I know I have a gluten intolerance, so I stay away from that and have been super conscientious of sugar since discovering you and The 21-Day Sugar Detox. My exercise is sporadic, sometimes CrossFit, sometimes just stroller walks and yoga, sometimes nothing. I stay at home with my daughter and work evenings teaching Pilates, and between the two I have very little energy to ‘workout.’”

All right, so I feel like this one is kind of for me. I talk pretty extensively about different types of skin conditions that are related to autoimmunity, digestion, stress, the gut, things like that in the Skintervention Guide. If Jennifer has that, there's a ton in there going through the digestive system, just to kind of check herself on what she is doing, what she's not doing, and what maybe hasn't occurred to her yet. But the most important thing, I think, here to consider is that psoriasis absolutely can flare up – just like eczema, just like acne – as a result of stress. And it sounds like she has a ton going on. Anybody with a 15-month-old… I don't know. My freakin' dog stresses me out, and I can't even imagine having a child, so that level of stress, I think, a lot of times women glaze over and think that it may not be affecting them in the way that it is. And coupled with some potentially irritating foods… Dark chocolate is usually OK for most people, but for other people there is some potential food intolerance there. Chris Kresser actually talks a lot about a high-arginine diet. Chocolate is high arginine. There could be a little bit of a problem there. So I guess my question for Jennifer is, how much do some of these things add to your quality of life – the chocolate, the wine that type of stuff – coupled with stress? And how much do you want to kind of experiment and see what pulling those things out is going to do for you? For me, depending on where I was in my life and what my stress load was, I might be bothered by a small quarter-size patch of funky skin, I might not. So it's just one of those things. You could pull out the wine. You could pull out the chocolate. You could look at some real digestive healing like I talk about in the Skintervention Guide and like we talk about here. It's kind of up to Jennifer. What do you think, Diane?

Diane Sanfilippo: Just a couple of things. I mean, I'm wondering if she's ever had a time when she wasn't drinking wine regularly. I know for as many people out there who want to say that having wine every day is OK or healthy, or coffee every day is OK or healthy, I think that when people are dealing with some things that are obviously gut-irritation symptoms, it's good to take that stuff out for at least a month. So I would ask her if she's ever done it for a month, and if not, to go ahead and do that for at least a month and see if it helps at all, because the alcohol can definitely promote leaky gut, and I think that's really what we're looking at with the root cause of the psoriasis. Again, hidden gluten or some irritants that are just sneaking in, even dairy if she's doing butter. The dairy could be exacerbating that, and then again, stress. So a lot of the same possibilities, but try something. Try eliminating something that you haven't before, that you haven't done strictly, and see. And I'm one of those people where I'm like I don't want to tell you not to eat butter, but if you want to get rid of the psoriasis and you want to see if it's really going to work, do it strictly for at least a month. Give yourself a chance to heal, give your gut a chance to heal, and see what happens. And then you may find that you can still enjoy those things every so often, or you may find that you don't want to eat them anymore because when the psoriasis goes away you're feeling like that's the right approach for you. So I don't know. Those are my ideas.

Liz Wolfe: If you wanted to try something topically – I talked about this on Dr. Lo's radio show; I was a guest last week – try some neem oil. It's not a miracle cure if you don't have the other stuff in line, like Diane was talking about, but if you do want to give that a try. I have a hunch that this person is maybe not in the States. Whenever people say “veg,” I always think they're maybe not in the old US of A. Anyway, you can get some neem oil. Mountain Rose Herbs has some neem oil cut with a little bit of olive oil, which is really great, so just not to leave you hanging too much there if you want to do something topically. But yeah, good call on all that, Diane.

All right, that's it. So we'll be back next week as usual with more questions. Until then, you can find Diane at BalancedBites.com, and you can find me, Liz, at CaveGirlEats.com. Thanks for listening. We'll be back next week. Bye, everybody!

Cheers!
Diane & Liz