Gut Health: Practical Solutions for Common GI Issues
Episode SummaryIn this episode, Dr. Lucy McBride addresses the most common gastrointestinal complaints she encounters in her primary care practice. She emphasizes that most GI issues aren't mysterious and often have simple solutions when approached systematically. The conversation covers five main digestive problems—IBS, GERD, bloating and gas, constipation, and colon cancer prevention—while highlighting the important connection between emotional health and digestive symptoms. Dr. McBride advocates for a holistic approach that considers everything patients consume, their stress levels, and lifestyle factors, rather than relying solely on lab tests for common complaints.Key ConceptsIRRITABLE BOWEL SYNDROME (IBS): IT'S REAL AND IT'S MANAGEABLE* IBS is a functional disorder where the colon becomes spastic and irritable, causing alternating diarrhea and constipation, bloating, gas, and abdominal discomfort - it's not dangerous but can be very distressing* Common trigger foods include alcohol, caffeine, sugar, dairy, and gluten, plus FODMAP foods (short-chain fermentable carbohydrates like beans and certain fruits and vegetables)* The gut is literally the "home of many of our emotions" - stress, anxiety, and emotional distress often show up as digestive symptoms, which is why travel causes constipation and anxiety can trigger diarrhea* Treatment involves systematically identifying your personal trigger foods, managing stress through exercise or therapy, and addressing underlying emotional health rather than just taking testsGERD: WAY MORE THAN JUST HEARTBURN* GERD happens when stomach acid travels upward into the esophagus instead of downward - it can cause chronic cough, sore throat, sinus symptoms, and morning nausea, not just chest burning* Common culprits include NSAIDs (Advil, ibuprofen), acidic foods and drinks (wine, coffee, vinegar, tomatoes, citrus), certain medications, and emotional stress that increases acid production* Simple fixes include reducing acidic foods, elevating the head of your bed with wedge pillows, eating earlier in the evening, and reviewing your medication list with your doctor* Dr. McBride recommends the book "Dropping Acid" as a practical guide to reducing dietary triggersBloating and Gas: The Usual Suspects* Primary triggers include sugar-free gum and sweeteners, NSAIDs, too much fiber (yes, you can have too much of a good thing), eating too quickly, and not moving your body enough* Many gas-producing foods are FODMAPs, but don't eliminate everything on the list at once - pin it to your refrigerator and notice correlations between what you eat and your symptoms* Your gut needs movement to function properly - if your body isn't moving, your gut sits there "too quiet" and needs motion to get things going* Focus on gradual identification of your personal triggers rather than wholesale dietary restrictions that leave you feeling restrictedCONSTIPATION: FIBER IS YOUR FRIEND (PLUS A FEW OTHER HELPERS)* The most common cause is simply not getting enough dietary fiber from fruits, vegetables, leafy greens, and whole grains - "fiber, fiber, fiber, fiber, fiber"* GLP-1 medications like Ozempic, Mounjaro, and Wegovy commonly cause constipation as a known side effect* Dr. McBride's go-to recommendations include Colace (docusate) as a safe stool softener, magnesium supplements (400-500mg) for muscle relaxation, and Swiss Kriss - however hers is not a substitute for advice from your personal physician * Don't forget the basics: regular exercise, adequate hydration, and stress management all support healthy bowel motilityCOLON CANCER SCREENING: THE GOALPOST HAS MOVED* Screening colonoscopy is now recommended starting at age 45 (down from 50), or earlier if you have a family history of colon cancer, especially in first-degree relatives* Colonoscopy is both diagnostic and therapeutic - it can detect cancers and polyps while removing polyps during the procedure to prevent future cancer* Cologuard stool tests are "pretty amazing" technology but aren't as sensitive as colonoscopy and can't remove polyps if found* Red flags requiring immediate medical attention include rectal bleeding, persistent changes in bowel habits lasting weeks or months, unintentional weight loss, and severe abdominal painTHE GUT-MIND CONNECTION: YOUR EMOTIONS LIVE IN YOUR STOMACH* Stress, anxiety, and emotional distress commonly express themselves through digestive symptoms - some patients use their gut as a "check engine light" for when they need better self-care* Address mental health through therapy, exercise, journaling, and stress management alongside dietary changes for the most effective treatmentUpshotCommon digestive complaints often have straightforward solutions that don't require extensive testing or complex interventions. The key lies in taking a systematic inventory of everything consumed, recognizing the profound connection between emotional health and gut function, and addressing lifestyle factors like movement and hydration and behaviors around eating. She advocates for patients to become detective-like in tracking their symptoms and triggers, while also ensuring appropriate medical evaluation to rule out serious conditions. Get full access to Are You Okay? at lucymcbride.substack.com/subscribe
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