Ep. 568 "It’s Not Just Stress!” – The Two 'Red Flag' Symptoms You Should Never Ignore with Dr. Izabella Wentz | Menopause, Perimenopause & Gut Health

Welcome to Everyday Wellness Podcast. I'm your host, Nurse Practitioner Cynthia Thurlow. This podcast is designed to educate, empower, and inspire you to achieve your health and wellness goals. My goal and intent is to provide you with the best content and conversations from leaders in the health and wellness industry each week and impact over a million lives. Today I have the honor of reconnecting with Dr. Isabella Wentz. She's a pioneering clinical pharmacist and bestselling author with a passion for getting to the root cause of complex health conditions. She's consulted on thousands of difficult cases and her most recent book, her upcoming book, is called IBS, Finding and Treating the Root Cause of Irritable Bowel Syndrome. Today we discussed relevant statistics, the impact of dietary triggers, specific labs that can be helpful navigating an IBS diagnosis, red flags, the impact of fiber, how short chain fatty acids and thyroid health can be intricately interwoven, how stress trauma and the nervous system impact gut health, as well as practical strategies and rapid fire questions. Dr. Wentz's new book is really a fascinating expose on IBS, how to find and treat it and be able to advocate for yourself. Isabella, so nice to have you back on the podcast. Welcome back to Everyday Wellness. Thank you so much for having me, Cynthia. It's always such a pleasure to be with you. Yeah. You know, we were talking in the pre-chat about current statistics on over-the-counter medications that I was completely surprised at how much money we as Americans spend on over-the-counter laxatives and diarrhea medications, which tells me that we normalize a lot of symptoms that patients experience. So just for listeners, 1.7 billion for over-the-counter laxatives and 350 million for over-the-counter diarrhea meds. Why do you think IBS doesn't get the attention it deserves? I think one of the reasons is because it's so common, right? So most of us can't really think of a time that we've broken our legs or had gone through a serious health challenge, but many of us have gone through constipation or diarrhea. That's just part of the human existence, right? When it becomes pathological is when this is an ongoing problem for people. And unfortunately, the conventional medical model treats IBS as sort of a label that just gets applied to you without really doing any kind of a workup. So you could be having irritable bowel syndrome because you have a severe infection, like a protozoal infection, or you might have celiac disease or inflammatory bowel disease, or something else is really happening in your body that needs to be addressed. But conventional medicine just says, okay, your bowels are just stressed. And so you're going to have these symptoms. Maybe you should be less anxious or maybe you get more rest. And there's really not an investigation that takes place to figure out what's driving it. Yeah, it's interesting. When I was in my senior year of college, I started to experience a lot of IBS symptoms. And I recall my mother marched me off to the gastroenterologist. They did a bunch of testing. And ultimately, they were like, there's nothing functionally wrong with you. We think you're just stressed. And literally, that's what I was told. And the irony is it took me another probably eight years before I started investigating elimination diets. And for me, a lot of what drove my symptoms was gluten. And I'm sure that's probably not surprising. In your research for the book, what are some of the common kind of dietary triggers that you found to be surprising, perhaps less common? Because I think the way that I was taught about IBS is, oh, it's all food sensitivity driven. But yet the way that you explain in the book, and it's so comprehensive, all of the reasons that can contribute to why people experience, you know, irritable bowel syndrome. But some people tend to be, some people can be constipated. Some people can have diarrhea. People can unfortunately have a combination of both. It is definitely not as uncommon as most healthcare professionals believe it to be. Absolutely. IBS is such a common condition. It actually accounts for 12% of primary care visits. And it's one of the most common functional digestive disorders affecting anywhere between 25 and 45 million people in the United States. And just like you, I was one of them during pharmacy school. I started to have, you know, explosive diarrhea. It was not a lot of fun. I went to my primary care doctor and he was like, well, you're in pharmacy school. Of course you're stressed. You're eating like, you know, crap and you're in grad school. This is just part of the territory. I'm not going to tell you to be less stressed. I know what it's like to be in grad school. And he prescribed some medications that, you know, gave me some blurry vision and there was really no talk about, well, you can adjust your diet. And the interesting thing is that diet can be so, so relevant to the IBS symptoms. In my case, it was soy that was producing the symptoms. And so once I cut soy out of my diet, I saw significant improvements. The other common reactive foods are going to be dairy for many, many people. Dairy is going to make them bloated, constipated. Sometimes it can cause diarrhea. And there's also some surprising foods. We typically think of lettuce, right? As a great healthy food. But for many people including a lot of my clients, it's like the raw veggies like lettuce and raw fruits, fibrous things can really produce digestive distress. And then another category of foods that I feel like doesn't get enough attention is actually food additives. So these artificial sweeteners, erythrials is my least favorite one, but they can actually produce a lot of issues for people's digestion. Yeah, it's so interesting that this is where I think for each person listening, you really have to be your own detective. You really do need to pay attention. And I think sometimes when I'm talking to patients, they're surprised that I'm encouraging them to keep a food diary. And I was like, not to feel like you're doing anything wrong, but it's like, can we make patterns? Can we make connections to patterns of foods that you're eating and symptoms you experience? And in the book, you talk a lot about how sometimes people that are labeled with IBS actually have treated treatable underlying issues like SIBO or opportunistic infections or even the food sensitivities that we touched on. And I think about how at the beginning of my book, I talk about a trip to Morocco and how I picked up a friend. And my friend was Giardia. And Giardia gave me horrific symptoms that I was convinced I had SIBO. I thought I had everything, but in fact, what I had was Giardia. Let's talk a little bit about how some of the symptoms that mimic IBS are actually more suggestive of other pathologies that may be contributing. And I think this really also speaks to the fact that if you are diagnosed with IBS, I do not believe that it necessarily is a lifelong diagnosis. I think for some people, it may be a situational diagnosis as opposed to a chronic health condition. Yeah, absolutely. And it can be quite tricky when you look at the diagnostics for diagnosing IBS, it's based on patient report and how many, you know, what does your digestive function look like? But there's not necessarily a thorough investigation into lab markers for most patients. Most patients don't get any labs done when they actually present with these symptoms. If we were to do labs, we can find other causes. For example, somebody might have lactose intolerance. They might have digestive enzyme deficiency, such as excreta and pancreatic insufficiency, they are going to have a hard time digesting a lot of their fats. They can actually have infections like your friend Giardia. Blastocystisumonous is another common infection that's been correlated with irritable bowel syndrome. And so it really can be quite tricky because I'm never like you just have straight up irritable bowel syndrome or you have this exact thing. I really want people to do a thorough investigation into figuring out what's driving their symptoms. And there's also red flag symptoms. So for many people, they might actually have blood in their stools. They think that's related to IBS or hemorrhoids, but this warrants a more serious investigation for something like inflammatory bowel disease or colorectal cancer. This is something that I feel like, you know, if people listening just to this one thing is if you've been dealing with digestive symptoms for a while, you do want to go to an gastroenterologist and get properly evaluated, especially if you're losing weight. If you have any kind of fever, if you have been diagnosed over the age of 40, if you're finding that, you know, any kind of blood in your stools, these are kind of going to be red flags that something is going on that can be potentially very serious. If you're in perimenopause or menopause and are feeling more fatigued, dizzy, lightheaded, struggling with headaches or noticing your workouts feel harder than they used to, electrolytes may be part of the missing piece. 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But most importantly, I give you practical, realistic strategies you can start using right away without extreme diets or complicated protocols. You'll learn why the same diet that worked in your 30s may not work now, how your gut influences hot flashes, mood, and weight, the truth about fiber, protein, and blood sugar in midlife, and the daily habits that help your body feel safe, stable, and resilient again. If you're tired of blaming yourself for changes that are actually biological, this book will help you understand what's really happening and what to do about it. You can pre-order The Menopause Gut wherever books are sold, and when you do, be sure to check out the special pre-order bonuses I've put together for you. Again, you can go to www.CynthiaTherlo.com. You'll click on the banner. It'll take you to multiple options for where you can order The Menopause Gut in pre-sale. I'm so glad that you brought that up, especially because they have been several people in the light press that were young being diagnosed in their 30s and 40s with colorectal cancer. In the case of James Vandenberg, and I hope I'm pronouncing his last name correctly, he was in his mid-40s when he passed away, but his only symptom was a change in bowel habits. I think for a lot of people, it's embarrassing or uncomfortable for them to discuss what's going on, but it's really information that can help your healthcare provider make better decisions about your plan of care. You mentioned in the book a couple lab tests that I was not familiar with, so I was like, I love to learn about new lab tests that can help with the diagnosis of IBS. One was anti-vencoolin, which is an autoimmune gut protein, and the other one was anti-CDTB. Which can be helpful when you're trying to look at the diarrhea aspects of IBS. Did you find in your research that these are becoming more commonly drawn or done for patients, or are these still more experimental? I would say that most patients that are going to see their primary care doctors are unfortunately not going to get those tests done. In my research, it was like the statistics of how many people get the tests done was like 0%. The tests are out there, but they're not necessarily, most people are not necessarily getting them. Yeah, I think you probably, when I say you as an listeners, probably have to be really attuned and attentive to advocating for yourself, or at least seeing a specialist because integrative gastroenterologists would probably be doing these types of tests as opposed to a traditional allopathic one. One of the things that I think is really important, and I talk a lot about this, is the concept of digestive fire. How many people that are listening, one of the reasons why they may experience alteration in bowel habits could very likely be less hydrochloric acid, not enough digestive enzymes, or even the need for having issues surrounding poor bile flow. Can we talk about digestion as a component of this IBS syndrome? Because I do think, and you do, and again, you talk about one of my favorite supplements, Tedca in here. But I think for a lot of people, understanding that at a very foundational level, if your body can't break down your food, that in and of itself can actually exacerbate these symptoms. Yeah, absolutely. And so you had mentioned the condition SIBO, small intestinal bacterial overgrowth. This is a condition that a lot of times has been correlated with irritable bowel syndrome. And I know when I first started working with clients, if I had somebody with irritable bowel syndrome, just having some functional medicine training, I thought they must have SIBO, right? And spoiler alert, not everybody with irritable bowel syndrome has SIBO. And a lot of times if they do have SIBO, SIBO doesn't just come out of nowhere. Many times people who have SIBO actually have it because they have a low level of hydrochloric acid, which is our protein digestive enzyme. And what essentially happens is they're eating food, but they're not digesting it properly. And so this food becomes fuel for bacteria that can overgrow in the small intestine. And then other digestive enzymes that can be deficient would be things like the pancreatic enzymes or bile deficiencies. And this can cause issues with digesting fats because we need those to digest our fats. And so you might find a person, they find that fatty meals really upset their stomach, right? And they're just not really able to tolerate them. And then of course, there's the, I call them the veggie digestive enzymes that can be helpful. A lot of times people don't realize that our microbiome does a lot of our digestion for us. And so some people might find that they have issues with fiber digestion that's found in raw vegetables. And a lot of times that stems from our microbiome actually acting as our internal digestive enzymes. Yeah, it's interesting how fiber has become so controversial. I jokingly refer to it as the new F word, because depending on which nutritional paradigm you believe in, you may or may not think that fiber is helpful or even beneficial. But I think so much of it is very much a bio individual conversation, meaning for everyone listening, there's probably, whether it's soluble, insoluble, fermentable fibers, there's probably a tolerance that's a little bit different for each person. For you personally, when you're working directly with clients, what is your prevailing thought about fiber? Is it really dependent on type, quantity, frequency? Because so many women hear us saying on podcasts, we should be consuming 25 to 30 grams of fiber every day. But we know the average person that's eating a standard American diet is probably consuming anywhere from 5 to 10 grams a day. So we can approximate that if someone tries to go from 10 to 30, they're probably going to have an intolerance issue as their microbiome is trying to assimilate to this rapid increase in fiber consumption. I definitely am a bit proponent in pharmacy school. I learned start low and go slow, right? So you might have a target of getting to that 30 grams of fiber per day, but you don't want to start there because you're going to see a lot of digestive distress or sinning of symptoms as your microbiome adjusts. And so you do want to start with, if you're not having any extra fiber in your diet, maybe you've been keto carnivore, standard American diet, you want to start increasing it gradually with time, letting your digestive system adjust. And now I will say the caveat is this is for the average healthy person, the really healthy people don't really reach out to me for my help. So a lot of times I'm working with whatever is going on with the individuals in my care. And a lot of times they have multiple gut infections, they might have different food intolerances. And so we tend to take things a little bit slower with them as well, where we might have them on a more of an elimination diet to begin with. And then as we start shifting the microbiome, then we'll add more fiber towards the end. So to kind of, I feel like in functional medicine, I'm sure you've heard this before is you want to pull out the weeds, then plant the garden before you feed the garden, because the fiber will feed whatever's there. So if you have a lot of pathogenic bacteria, you're going to be feeding the fiber to them instead of your good bacteria. Yeah, it's interesting to me, like the more patients that I talk to or women that I interact with on social media, I think there's a lot of well-meaning practitioners that to your point, they are pulling the weeds, but they're not repopulating the gut before they start reintroducing all these higher fiber foods. And it can explain why, I went through a period of time where I had so many SIBO patients in my practice, and it was because they very likely had great practitioners that were probably being a little overly aggressive with the fiber consumption, and then they would end up getting to the point where they couldn't tolerate anything, which kind of leads us into the importance of short chain fatty acids, which one thing that I can say with great confidence is that as we start seeing alterations in estrogen and progesterone, I think short chain fatty acids become really important because they start to decline with age. And so when we are not consuming any fiber, I think that can exacerbate the loss of these short chain fatty acids functions. Can you speak to why you feel like they're so important? I mean, obviously we talk about this a lot on the podcast, but it's really good to reinforce with listeners the value of short chain fatty acids and how fiber is so integral to them. So fiber is going to be the fuel for our short chain fatty acids, the probably most well known and most talked about short chain fatty acid is known as butyrate. And this is something that I have found a lot of times people with thyroid dysfunction, autoimmunity, and with irritable bowel syndrome, they tend to be low in that butyrate can help support our gut integrity, meaning that it keeps things where they're supposed to be. It feeds our beneficial bacteria, and it also can help us with food tolerance. Now in my line of work, what I really love to use butyrate for and resistance starch, which helps to grow the butyrate is getting people to minimize their reactions to foods. Absolutely. And I think for many people, they probably know your beginning of your work was really thyroid centric. So I really appreciate that discussion about that interrelationship of low thyroid function can sometimes go, can kind of coincide with less short chain fatty acid production, which makes sense kind of intrinsically. But I don't know if necessarily everyone is making that connection, but it's certainly a valuable one because so many middle-aged women are dealing with underactive thyroids. It's almost, you know, someone called it thyroid pause, and I was like, that makes a great deal of sense. Like much like a lot of other hormones are not at the optimal levels they once were. This can magnify things. And I think it kind of goes along with the impact of women and stress and caregiving and, you know, emotional suppression. So you have a new baby. I'm sure that you are pulled in 10 different directions with two young children and book promotion and everything else. Talk to us about how stress impacts our gut function and how that in and of itself can contribute to IBS symptoms. It's really fascinating. Many years I found some research suggesting that our opportunistic bacteria can become pathogenic when they are exposed to stress hormones. And it's just really fascinating because they could be playing nice, but once they start sensing some adrenaline or epinephrine in the body, they'll be like, it's time to attack, right? And a lot of times people will say that stress can be a trigger for their irritable bowel syndrome. I know when I was in college, I had an uncle that got into a car accident and I went to see him at the hospital and he was in a very poor state. He was in the ICU. And, you know, I saw him, I talked to the medical team and I ran out with like digestive issues, right? Because I was so upset by the sight of my poor uncle being and, you know, just in a really dire emergency situation. And there's this crazy feedback that goes between our brain and our gut and our body. And so, you know, I kind of get a little bit annoyed when people will say things like, IBS is all in your head. You just need to relax more. I don't think that is the full story or the full truth. But I do find that stress reduction and relaxation processes such as cognitive behavior therapy or yoga or Tai Chi meditation, all of these things can significantly help irritable bowel syndrome symptoms. I think many people think of IBS solely in the lens of diarrhea. And yet there are different types of IBS. And so, I would love for you to explain what is going on in the gut when we have more constipation type symptoms. Yeah, absolutely. A lot of times people do think that IBS is primarily diarrhea. And for some people it can be, but others can present with a mixed presentation. So they might have constipation and or diarrhea that's fluctuating. And they might just be predominantly constipated where their stools are harder to pass. They feel like they're not going as frequently. And this too is irritable bowel syndrome. It can have some of the same causes and it can also have some different causes. I know for some people just being dehydrated can lead to constipation, for example, or they're not getting enough fiber, they're not getting enough fat into their diets. And that can all be a reason for constipation. It could be things like having an underactive thyroid or SIBO. You know, really a person should be going to the bathroom on a daily basis and they should have stools that are brown, easy to pass, not too soft, not too hard. And it should, shouldn't hurt. And so if you're deviating anything from that on a regular basis, then you need to really investigate your gut health. One of the reasons I'm so passionate about gut health is because in my work with autoimmunity, I found that gut disturbances can occur 10 to 15 years before we start having autoimmune dysfunction. And we know that this is something that we can absolutely prevent when we do the right things. And a big part of that is addressing the gut health. Yeah, let's talk about leaky gut because that's usually what is tied along with this autoimmune condition. In your opinion, what are some of the most common reasons women in particular deal with leaky gut? One of the common reasons would be small intestinal bacterial overgrowth. As you had mentioned, when we grow bacteria in the small intestine, this is going to lead to the intestine to become more permeable. Another reason might be something like celiac disease. So whenever you're eating gluten, this can lead to that permeability of your intestines. And then the glamorous infections that we can pick up when we're on vacation such as giardia or blastocystis, these can also produce high degrees of intestinal permeability. And then, you know, a lot of times one of my pet peeves is in functional medicine. We focus on food a lot, and I think food is absolutely medicine. But I've had a lot of clients over the years that they've gone on these crazy elimination diets, and they're eating ice cubes and still having digestive symptoms and still having a lot of their health conditions and markers that are out of alignment. And in that case, a lot of times the infections are missed or the small intestinal bacterial overgrowth can be missed. Yeah, it's so interesting how sometimes these elimination diets, like I've been asked recently, multiple times, like if you were going to give someone an ideal diet, and I said, well, it's as individual as we are. So what might work for you may not work for me, may not work for someone else. And yet oftentimes we're giving patients these very restrictive elimination diets, which are not per se improving their symptoms and may in fact be exacerbating them. And it also goes along with having a degree of anxiety about if you perceive that a food is going to cause a problem, it is going to set in motion within your body just not feeling safe. So whether you deal with constipation or diarrhea or a combination of both that can all become problematic. If you're a woman in midlife or beyond, you'll probably notice those changes in energy, strength and recovery just don't feel like they used to. And what's frustrating is that for many women this happens even when you're eating well, lifting weights, prioritizing protein and doing all the right things. You're not lazy, you're not unmotivated, and you're not doing anything wrong. A big part of what's changing actually starts inside your cells. 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AX3 has also generously offered a 20% discount on your very first order AX3.life and use promo code SYNTHIA20 at checkout. Again, that's AX3.life and use code SYNTHIA20 at checkout. My family and I are actually taking Astra Zanthan to see if we can drop our LP little A. Stay tuned. So when someone is coming to you and has been struggling with IVS, this is perfectly timed. If someone's coming to you that's been struggling with symptoms and in particular IVS for years, what is the first step you recommend? Because so many people probably by the time they come to you are so desperate for help. They're willing to try and do anything. What's the first thing you would recommend to them? I would evaluate their diet as a first step. So I would look at whether they're eating a lot of processed foods and if they were eating a ton of processed foods, then I would recommend shifting that. Their research has shown we primarily we're going to do better on home cooked food without a lot of additives when we're dealing with things like digestive distress. So they don't necessarily need to be eating all organic or any kind of specific diet per se, but the first step would be getting rid of processed foods. And of course, some of my clients are on the opposite spectrum where they do eat a perfect diet and they eat better than I do and they're still having a lot of symptoms. So for them, I would have a different approach. So for them, I would say, okay, you've cleaned up your diet. Let's see what else is contributing to what's going on with your digestion. And that might involve exploring digestive enzymes. That might involve exploring some testing to figure out if they have various gut infections that could be driving their symptoms. Yeah, it makes so much sense. And in terms of simple, foundational changes that can make the biggest difference for gut health, what are some of your favorites that you like to use? These aren't the complicated things. It's just the low-lying fruit that in many instances make a big difference in how someone feels. I would find fermented foods can make a really big difference for many people. So getting some of that fermented sauerkraut, I would recommend getting it from the grocery section where it is in the fridge rather than out on the shelf because, you know, those bacteria are still active and they're going to be helpful for you. Eating a lot, a big variety of green foods, so high fiber vegetables for the average person, this is going to support their gut health, making sure that you're eating organic whenever possible and high quality foods. We do know that pesticides and foods can actually impact our gut bacteria and our gut microbiome. So this is something to be mindful of when you are trying to support your microbiome. And then I do love fermented yogurts. So because a lot of people do have dairy issues, I might suggest something like a coconut yogurt to start with to try to get that those rich bacteria into your system. I think that's really reasonable. I think in so many instances people are sometimes fearful of fermented foods thinking that, you know, they're going to taste weird or taste off. And I always say sometimes it's two tablespoons of sauerkraut or small portion of yogurt can be very, very helpful. And it's interesting, I finally found a dairy-free coconut milk yogurt that's plain. And so I just stick it into a smoothie. But I always say to my husband that, you know, it's just there's so many different ways that you can integrate these into your diet. We're not talking about plates full of fermented. It's just like adding like a condiment in many instances can be very helpful. Now, when someone comes to you and they've been struggling with IBS and, you know, they're asking for a realistic kind of healing timeline, what are some of the kind of common themes you're sharing with them? Because I think when people are feeling bad, they think of it as a race and it really is a marathon to get them back to a degree of healed health. What are some of the timelines that you will say to them? Again, this is kind of a general thing. We're not speaking about specifics, but I think for people who are maybe feeling like they're at the end of their rope or they're so tired of having digestive issues or so tired of you know, racing for a bathroom or not being able to poop for days on end, they're really looking for like a timeline. Like what's realistic? If they're doing an elimination diet and if food triggers are a part of what's going on with them, they can actually see improvement in as little as three to five days once they eliminate the offending foods. It's been quite remarkable to see where people will say, I had no idea that dairy was causing me constipation or you know, that all these raw foods were causing me to have so much diarrhea, but I've shifted that right. So this can be dependent again on the person if they have all kind of issues they have going on. If they have more of an extreme root cause like an infection, it might take a couple of months to try to get that infection out of their system with the right kind of treatment. But I generally love starting with a simple elimination diet for a lot of people just to see if the food triggers are relevant for them because a lot of times people can feel significantly better in just those three to five days. And then digestive enzymes again, these can work in three to five days as well. Yeah, I love digestive enzymes. I think that I've gotten to a point now that I take a bio-optimizer's mass enzymes. I only need one. It used to be that I needed two or three with my largest meal the day. Now it's just down to one and I'm like, it works so effectively. And I'm not plugging that as anything other than that's just the brand that I use. But I think for a lot of people, digestive enzymes are a missing link in terms of optimizing digestive health. And I think for a lot of women in their 40s and 50s, I see tons of complaints around bloating, constipation and weight gain. Do you think differently about middle-aged women versus younger women that come to see you? Does your philosophy change? You may have a variety of both, but I'm curious, do you approach middle-aged women or older women differently than younger women? I work with both younger women and with older women. A lot of my experience has been with older women. And whenever I am working with somebody who tends to have, let's say, their symptoms set on later in life, I do want to think about inflammatory bowel disease as a potential trigger or root cause. So I would say that would probably be the only big difference in my approach is when you're older, you're going to have many more risk factors. But other than that, we're going to be working through a lot of the same things. Yeah, it's interesting because I, it's amazing how now that I'm a middle-aged person, I think differently about bloating, constipation and digestive issues than I did when I was younger. And the reason why I asked that question was now that I understand so much about gut motility changes, just that alone, how inflammation goes up and how our immune system changes. As we're getting older, it explains a lot of these odd little symptoms that a lot of even my cardiology patients would complain of. And we're like, oh, you're just eating too quickly or you just have some reflux. We're going to give you a medication to treat that. And now I think very differently about it. For a lot of women, there's this emotional and quality of life impact to IBS. You mentioned how it was embarrassing if you had a stressful moment, you had to race for a bathroom when you were in school. How have you seen, as women are healing emotionally, that that shows up in their gut health? I think it could be quite cathartic as women are healing emotionally. They're, you know, I find a lot of women that I work with, they oftentimes have physical symptoms that are very obvious and measurable, but they also have underlying emotional symptoms that can be just as important, if not more important to their health and healing. And for some people, they start with their physical body, so they might actually start working on their digestion, and they start feeling better. And then they're, for whatever reason, more tapped into their intuition. And then they start taking up more space, and then they start advocating for themselves more. And then they really focus on that emotional healing. Now, this isn't the journey for everybody. And I'm not going to say that everybody that has digestive issues needs to do emotional work, but in my experience, I have seen that oftentimes does play out this way. Yeah, it's interesting. When I reflect on patients, especially those with a lot of constipation symptoms, more often than not, there's a feeling of safety. It could be that you don't feel, because you have kids banging on your doors, you're trying to go to the bathroom, but for a lot of women that, you know, can only have a bowel movement in their house, or they don't feel comfortable, when they travel, or it's that safety feeling. So things as simple as like taking a couple slow deep breaths or having a squatty potty can make a world of difference. These are kind of simple things. But I think because women feel embarrassed, they sometimes don't discuss these concerns with their providers. So I'm glad that you serve as a resource. One thing that I've been doing recently on the podcast are rapid fire questions. So they're just quick questions with like short little responses. Most overused IBS diet. The low FODMAP diet, I would say, and it's something that can really impact the microbiome long term. It doesn't actually heal IBS. It basically avoids the things that can kind of trigger it. But the underlying reason is usually those bacteria that are overgrown, but it doesn't like kill the bacteria or get them to stop to move to the right place or anything of that matter. It's just sort of like makes you more sensitive to foods in the long term. Yeah, I was glad that you said that. One supplement that's often helpful for IBS. Probiotics. One lifestyle change that makes a big difference. Any kind of stress reduction like yoga, cognitive behavioral therapy, or meditation, prayer, all of these can be very, very helpful. A sign your IBS may actually be something else. Blood in your stools or weight loss. This is a big risk. Two big red flags. Absolutely. One myth about IBS you'd love to dispel. That IBS is just in your head. It's not just in your head. It's in your body as well. And there's legitimate reasons for IBS. And last but not least, most common root cause of IBS you personally say. Most common root cause, I would say probably food reactions are very, very common. The more underappreciated ones these days are going to be those protozoal infections. And last but not least, if someone listening to the podcast has had digestive symptoms and has been told it's just IBS, what message would you most want them to hear from this conversation? Other than of course getting your book, which to me is like a masterclass in IBS treatment, management, and information. I would say that you deserve to thrive and to feel your best and don't let somebody else tell you that your symptoms don't matter. And do your own work, do your own investigation into what might be driving your symptoms. Again, getting rid of processed foods is a great place to start for a lot of people. Getting on some digestive enzymes and probiotics can be a really big game changer as well. Well, thank you so much for this conversation today Isabella. Please let listeners know how to connect with you outside of this podcast and make sure to let them know what date your publication is for your book. Of course, I can be found on Instagram, Isabella Wenz Farm D. My book is available on Amazon and wherever fine books are sold, and it's available for purchase on March 17th. Can't wait. Thank you so much for your time again today. Thank you so much. It's been a pleasure. If you love this podcast episode, please leave a rating and review, subscribe and tell a friend.