“Your symptoms are not all in your head, but what’s in your head still matters.” My lovely podcast co-host, Dr. Nikki DiNezza, mic dropped this truth bomb one day when we were recording. To this day, it is one of my favorite IBS quotes.

My patients have struggled for years with GI symptoms. They have tried many different diets, supplements, medications and other interventions without relief. By the time they find me, they are losing hope.

Am I ever going to get better? The doubts creep in swiftly as patients hop from practitioner to practitioner, protocol to protocol and restrictive diet to restrictive diet. If you are currently stuck in this doom spiral after years of trying to get better, you are not alone.

As disappointment grows, it is easy to fall into mindset patterns that will hold you back. How you respond to symptoms can make or break progress. The IBS cycle relies on you treating symptoms as a threat. IBS mindset strategies help you accept that symptoms will ebb and flow as you work on strengthening your gut brain connection.

These mindset changes are not easy. You have to steer your brain to the less traveled path, when it will be screaming at you to go down it’s usual route.

But, you can retrain your brain. First, you have to be aware of your mental barriers. Second, you have to incorporate strategies that help you shift your mental patterns. In this post, I want to provide 5 of my favorite IBS exercises that can help you respond differently to symptoms.

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FMT in the functional medicine and holistic world is viewed as the best way to rebalance your gut. FMT is often presented as the “golden ticket” out of the IBS hell hole patients may have been…

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I run extensive thyroid testing on many of my patient…

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But, there are times when I review a patients diet log and I see som…

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A month ago, my 4 year old daughter had her first ear infection. And it was a DOOOOZY! Weirdly, she didn’t complain of any ear pain, so I was shocked she had a really bad double ear infection when we got her checked out by the doctor.

This wasn’t just her first ear infection, but this was her first antibiotic ever. I knew this day would come, but it was hard pill to swallow as a microbiome lover. But, I am so happy that I have knowledge that could help reduce the negative side effects of the course for her.

I used these strategies when I had my first ear infection as an adult last year. YES, it was shocking to me too. I didn’t know adults got ear infections. Unfortunately, my ear infection wasn’t nearly as responsive to the antibiotics as Cece’s was, so I was in pain and discomfort for 2-3 weeks until it resolved on its own.

As someone with history of IBS, I am always leery to take antibiotics, but they are necessary in many situations. And I often remind myself, we should be happy that they exist because they save so many lives.

You still want to use antibiotics wisely. I believe that doctors have been a bit better with antibiotic prescriptions, but there are still some that overprescribe. Many mild-moderate ear infections are viral and will resolve on their own. Many physicians encourage waiting a few days in these cases to see if the infection resolves and antibiotics can be avoided.

First and foremost, discussing options with your physician may be helpful to avoid unnecessary use of antibiotics. Are the antibiotics necessary in your unique situation?

Sometimes the best option is antibiotics. I want to share in this post, how to navigate antibiotic use. Mainly, I want to highlight strategies that will help reduce symptoms and microbiome fallout from each course of antibiotics that you may have to take.

Questions I want to answer in this post:

• How to avoid unnecessary antibiotics?

• What happens in the gut when you take an antibiotic?

• Are probiotics helpful during and after antibiotics? If so, which strains?

• Antibiotics for SIBO? How to best recover after antimicrobials or Rifaximin?

• What dietary strategies are best while on an antibiotic?

• What supplements do I recommend my patients take while on antibiotics?

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I have worked with many IBS patients who skip meals to manage symptoms. I understand why they do it—eating causes painful bloat or diarrhea, so they strategically sk…

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I look back on myself with so much compassion—I was frustrated, scared and…

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Histamine has been a hot topic in the health space the last 5 or so years. I have worked clinically with patients that have struggled with histamine issues or MCAS. I see so many internet posts about histamine being a driver of many health conditions including IBS. Unfortunately, I have seen many patients who go deep into the histamine rabbit hole only to exit worse off than when they started.

I have see many taking low histamine diets to the EXTREME. Histamine is in virtually everything. Some of the low histamine diets make Low FODMAP look like a walk in the park.

In the gut health space, I see many patients blaming histamine intolerance on gut imbalances. While dysbiosis could lead to histamine issues, I rarely see this being the full story.

I’m hoping that in this article, we can discuss the research linking histamine issues and IBS. I also want to share clinical pearls I have seen working with patients who struggle with histamine intolerance. What seems to help these patients the most?

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The abundance of research leads many medical providers recommen…

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I have wanted to highlight this study for a long time because it is …

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Many of my patients look nine months pregnant, but they aren’t full of a growing baby. They are full of gas, which is definitely less cute than a sweet little bundle of joy. The gas creates so much distension and cramping. Trapped gas is a pain in the butt—literally!

My chronically bloated patients are fed up with the cramping, pain and distension. Many feel self-conscious about how their belly’s look in clothes. Some have even been asked “when are you due?”, which as you can imagine is mortifying for them.

My patients are desperate to ditch this bloating. They want to feel confident to eat their favorite foods and wear their favorite dress. But, many of my patients are not focusing on the right strategies for LONG TERM bloat relief.

My bloated patients are relying on the low FODMAP diet to reduce symptoms. They are happy when these diet changes help their bloating and discomfort. But, then when its time to reintroduce, they notice bloating returns so they just stay on it long term. For most of these patients, low FODMAP stops working at some point.

Some of my bloated patients find relief with some anti-microbials or antibiotics for SIBO or IMO. But, like low FODMAP, the relief from these strategies is usually short lived. Symptoms usually return shortly after finishing the course of Xifaxan.

And then there are many other patients that trial dietary restriction and/or antimicrobials with little or no bloat relief. Unfortunately, these patients start believe than they are “difficult cases”. But, they are not difficult cases, these strategies are the wrong fit for their bloating.

There are two big assumptions about bloating that my patients and many providers have that are misleading and can lead you astray. Here are ideas that often trip my patients up:

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There have been …

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Often, my patients have b…

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Your health goals also …

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One of the hallmark symptoms of IBS is gut pain. It is often the most distressing symptom for many of my patients.

In the scientific literature, this gut pain has a few different names. More commonly it is described as visceral hypersensitivity and other times you see terms like visceral hyperalgesia and visceral allodynia (these names don’t sound fun, because they are not fun).

Visceral hypersensitivity is a heightened pain response in your internal organs. Visceral hyperalgesia and allodynia are both different flavors of visceral hypersensitivity. Hyperalgesia is increased pain from something that is normally painful. Allodynia is pain from a stimulus that should normally not be painful.

Visceral hypersensitivity means your gut is more reactive to gas, distension after eating, movement of food and stool through the gut, fermentation and inflammation. For instance, someone without hypersensitivity could eat a half cup of beans and may feel some mild bloating, but no pain from the fermentation of the fibers in the beans. Someone with IBS eats the same amount of beans and may even have the same amount of bloating, but has painful cramping from it.

One of my favorite studies showed that IBS patients may not have more gas or distension from eating FODMAPs compared to healthy controls. When the IBS patients and healthy controls consumed inulin and fructose, they produced the same levels of gas. There were also no differences between colon volume, small intestinal fluid levels or breath hydrogen levels. So why do IBS suffers have pain and discomfort when they eat FODMAPs?

The only difference between the two groups was sensitivity to the the changes in the gut. IBS patients may not be more gassy, they may just be more reactive to the gas.

Because I am a mom of 2 toddlers, the IBS gut is similar to an unhinged toddler. If you give them a banana without letting them eat it like a monkey—they will be pissed off. If you force them to share their favorite doll, they will melt into the floor. If you do something for them that they wanted to do themselves, they may run up and slap you.

All bets are off for a pissed off toddler. Like these little unhinged maniacs, a hypersensitive gut just needs a slight shift of gas or pressure to set it off. At least with toddlers you can bet on tantrums being a phase—but IBS can stick around unfortunately.

How does hypersensitivity develop?

The short and simple answer is gut-brain connection confusion drives hypersensitivity. IBS is a disorder of the gut brain interaction.

The gut and brain are constantly relaying messages back and forth to each other. If the signals become crossed, you can start to see an uptick in many gut symptoms, hypersensitivity being one of them.

If we zoom in a bit closer, IBS patients appear to have mucosal immune activation. That sounds like a mouthful (because it is), but basically it means that the immune system is usually overactive in an IBS gut. Your gut becomes like an overprotective mom and starts trying to prevent any perceived bad influences from coming near it’s precious gut lining. If your gut starts labeling more stimuli as threats, your gut will increase attacks which in turn leads to more inflammation.

Higher amounts of immune system mediators like prostaglandins, proteases and histamine have been found in the mucosal layer of IBS patients. These are all important immune molecules meant to keep us safe, but an exaggerated immune response raises levels leading to chronic inflammation at the gut barrier.

Increased immune activation is linked to gut pain (hypersensitivity). Recalibrating the immune system is a key target in the work that I do with my clients.

What drives this immune activation at the gut lining? Nutrition deficiencies, microbial imbalance, psychological/emotional stress, lack of joy/fun, lack of movement, lack of sleep and gut infections are the biggest drivers. Again—the unsexy basics are going to be the key to fortifying your guts lining and keeping your immune system balanced.

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