Anxiety and Irritable Bowel Syndrome/GI Issues w/Dr. Sula Windgassen (Ep 034)

SPEAKER_02 0:02

Acid reflux, bloating. Uh, my digestive cycle was completely off. Some days I wouldn't couldn't go to the toilet.

SPEAKER_00 0:10

I mean, it's hardwired in our body for our gut to be impacted by feeling stressed or feeling anxious.

SPEAKER_02 0:18

Some days I was frequently urinating.

SPEAKER_00 0:21

Billions of neurotransmitters from the lower third of our esophagus all the way down to um our anus, essentially.

SPEAKER_02 0:28

I'd be constipated for like up to a week sometimes and freak out over that.

SPEAKER_00 0:33

We often feel our feelings, first of all, in our gut.

SPEAKER_02 0:37

Other days that I've have to run to the toilet.

SPEAKER_00 0:40

You know, the cognitive brain, the thinking brain, then interprets this as what's happening here, which then adds to this. And so it ends up being quite a vicious cycle quite quickly.

SPEAKER_02 0:52

Welcome to Disordered. This episode is on the topic of anxiety and IBS. My name is Joshua Fletcher, also known as Anxiety Josh. Now I'm a psychotherapist based in Manchester in the UK, and a previous sufferer.

SPEAKER_03 1:07

I am Drew Linsolata, the other co-host of Disordered. I'm a grad student in clinical mental health counseling, a therapist and training, author, podcaster on the topic, former sufferer of anxiety and depression for many years. And I am in New York in the US of A. And today we have a special guest to help us talk about anxiety and IBS. Take it away, special guest.

SPEAKER_00 1:27

Hi, I'm Sula. I'm a health psychologist, CBT therapist, and EMGR therapist. And I work clinically with people with long-term health conditions and um specialize in working with gut disorders and pelvic pain.

SPEAKER_02 1:42

Very good. Welcome. Welcome. Um anyone who's listened to uh my old podcast, The Panic Pod, uh, one of my favorite episodes was having Dr. Seuler on to talk um about IBS, and it was fascinating. And I learned a lot in the podcast uh and asked some questions um from about me personally. Um, that I'll re-ask again because they were so good and I think people will relate to them. Um I'm yeah, I'm really looking forward to this. So thank you for joining us. Uh we're really looking forward to talking shit with you.

SPEAKER_03 2:20

Uh we gotta leave that in. Because you never hear that joke, I'm sure.

SPEAKER_02 2:23

Yeah, you never, never ever hear that joke.

SPEAKER_03 2:25

Yeah, nope. Should we start with the did it anyway to celebrate the community before we get into it with Dr. Sewler?

SPEAKER_02 2:30

Yeah, we always like to celebrate the wins from our community. What we got today?

SPEAKER_03 2:34

Well, let's play it. How's that? Here we go.

SPEAKER_01 2:38

Um, my name is Francis. I'm from Manchester in England. Uh, feel free to use my name. And my Did It Anyway involves revising. I took a couple of exams recently to get my construction and labour licenses, which would open up my career in a massive way. And I'm dyslexic with ADHD, and reading has always been really difficult for me. Like the words jump out on the page and they get jumbled up, and it causes me such anxiety because it makes me feel really low and useless because I'm 34 and I feel like I should be able to read. Um, but I face I wanted to face my fear this time, and I decided to read the revision books. And despite Craig the Critic being in full swing telling me that um this was a bad idea and I was gonna fail and this was useless. Not only did I pass both exams, but I got 100% on both, which inspired me to get a library card. So if you guys have got any book recommendations, that would be fantastic. Uh thank you for doing the podcast, by the way. Every Friday morning when a new episode comes out, I start my day off by playing and listening to you guys whilst I'm in my workshop, working on some commissions. So thank you for keeping me company. Love you both.

SPEAKER_03 3:53

Oh, that was really great. Awesome book. I totally feel like Francis was also setting us up to plug books, which I so appreciate.

SPEAKER_02 4:03

There's only one book you need, Francis, and it's called And How's That Make You Feel. You can pre-order it now through the schoolofanxiety.com, and it comes out in March. You don't need any other book.

SPEAKER_03 4:13

That was great. That was an awesome did it anyway. Thank you, Francis. We appreciate you sharing that. And like, yeah, enjoy the library card, dude. Look, you can do it. Yeah, that's good.

SPEAKER_02 4:22

That's good, that's great. Uh, there's a the there's a book under filthy erotic novels called The Anxious Truth Homework.

SPEAKER_03 4:29

You do not know what you stumbled into today, so that's good.

SPEAKER_04 4:33

I I know, yeah.

SPEAKER_02 4:35

Um Drew, did you ever have problems with digestion, IBS related symptoms when you were going through your anxious struggle?

SPEAKER_03 4:45

This is one of those that I have to chime in and say, I hate to say this because you know I feel like I'm rubbing it in. I didn't. I don't have the anxious tummy stuff, which I know I'm a total odd duck in that situation because it feels almost universal. Like everybody goes to gut things right away and and stomach upset and GI issues. I never really had that connection. When I was when I was telling paper off of the antidepressants, yes, then I did have that problem. But I'm not, I don't have an anxious stomach.

SPEAKER_00 5:14

Did you have any other kind of physical symptoms of anxiety?

SPEAKER_03 5:17

Oh, I had all the other ones. So I made up for not having that one with all in rapid succession, but I did not have stomach issues. So I can't share my personal experience with that. I can only tell you what the community has told me over many years.

SPEAKER_02 5:30

Oh, I I uh I used to get um acid reflux, bloating, uh, my digestive cycle was completely off. Some days I wouldn't couldn't go to the toilet, some days I was frequently urinating. Uh sometimes I'd be constipated for like up to a week sometimes and freak out over that. And then I, you know, I other days I'd have to run to the toilet because my I my butt my body wanted to expel things. Um sorry for the imagery at home. Uh but but uh and and I just I I came I came at it all wrong. I think I was a bit like maybe there's something wrong with my gut, and if I fix that, then I can fix my feelings. Um I think first of all, why why do we why does that happen? What what's going on?

SPEAKER_00 6:17

Why why do the gut symptoms happen, or why do we go to I need to fix my gut?

SPEAKER_02 6:23

Uh the the first one, the gut symptoms. So what anxious people.

SPEAKER_03 6:26

Yeah, why is it such a common thing for like we even have phrases in the language? You know, my stomach was in a knot, I thought I was gonna hurl. We we we universally acknowledge it.

SPEAKER_00 6:35

Yeah, absolutely. Yeah, I mean it's hardwired in our body for our gut to be impacted by feeling stressed or feeling anxious. Um, in in recent years, we've got so much more understanding about the super highway, right, between our brain and our gut. The fact that we've got what's called the enteric nervous system, which is known as our second brain in our gut, which is billions of neurotransmitters from the lower third of our esophagus all the way down to um our anus, essentially, our rectum. And um these neurotransmitters, neurons are dedicated to sending messages to the brain as well as receiving them from the brain. So um we often feel our feelings, first of all, in our gut. They're just independently responsive to how we're feeling. And we um have this superhighway, which means that these messages from the gut go straight back up to the brain, and we've got this intercommunication that's happening, you know, at lightning speed before our you know ability to even verbalize what's going on. And you know, the cognitive brain, the thinking brain then interprets this as what's what's happening here, something doesn't feel right, which then adds to this anxiety, stress, which then manifests more in the gut because of how these neurons communicate, and so it ends up being quite a vicious cycle quite quickly, and um yeah, I mean, as you were saying, Drew, some people have a much more responsive and sensitive gut. There's like an upregulation in uh sensory experiences in those neurons in the intro nervous system, and some people might feel it elsewhere, but there is a large proportion of the population that will feel quite a lot in their gut.

SPEAKER_03 8:31

Yeah, incredibly common. That by the way, I I'm I'm here for the rest of this episode because that was the best second brain explanation ever in the history of anxiety. I guess thank you, thank you, Silva. Because it makes the signaling part of that the most important part. As we'll get into it maybe later if we want to get super controversial, but I appreciate you explaining it that way.

SPEAKER_02 8:53

Yeah, we obviously a lot of people listen to this podcast uh struggle with anxiety disorder. So a lot of the time they have a fear and misinterpretation of the threat response. Um, maybe they're struggling with OCD or agrophobia or panic disorder. And a lot of what we hear is a worry about the symptoms themselves. And this is something I used to do. Or not only am I gonna go somewhere and challenge my anxiety or challenge my agrophobia um or challenge my intrusive thoughts, on top of that, I'm worrying about is there something wrong with my gut? Is what's happening to me here? Um I think what I would ask is when we're in that fight or flight response, why does the body want to just start getting rid of things and and messing up things? Or why does it want to do that?

SPEAKER_00 9:50

It goes back to our you know, evolutionary basis of our nervous system, which has evolved in lots of ways, but in the basic survival hasn't really evolved so much. So our threats and stresses are different these days to what they were. But if we understand what they used to be, we can understand why the the hardwareing of these processes exist and that they were protective, right? So I think a big part of the work that I do with people is trying to move from that threat appraisal through to an appreciation of what our body's trying to do with us, and maybe just needs a bit of helping out to recalibrate there. But evolutionarily, it made sense that if we saw a predator or somebody that was going to you know threaten our safety in some way, we would need to act really, really quickly. And so all of our resources would need to be sent to, let's say, the leg muscles so that we could run away and our heart rate would increase to allow blood flow to go there, um, and we'd be able and we'd have all of that adrenaline response to enable us to fight. And so, in that process, our sympathetic nervous system's activated, and our parasympathetic nervous system, which is our rest and digest branch of the nervous system, isn't really online. And that's the part that helps us uh process food and is responsible for peristalsis, which is the contractions in our colon, which move through food through. So in that scenario, it means that our gut just stops and uh our resources are spent elsewhere. What that means in the present day, if our gut stopped for a period of time, when it comes back online, it can be quite erratic. I always use the imagery of like an old car with an old motor, an old engine starting up and it's kind of chugging. It's a similar thing for our gut, right, when it comes back online, particularly if there's been repeated bouts of having to be paralyzed and then having to start and reprocess and all of that kind of stuff. But the other evolutionary benefit, because we know you know our stress response isn't always the same. It's not like it always paralyzes, and it's not like we always get the sweaty palms and the dry mouth, which sometimes our stress response is different. And it's the same for the effect on the gut. Sometimes what happens instead is that the gut speeds up incredibly quickly with this um increase in adrenaline. And the benefit of that is for us to excrete waste. And there's two thinking, two lines of thinking around this. One is we can be lighter on our feet, we're carrying less of a load, but the other is also that we're less of a tasty snack if we're soiled. So we're, you know, predators are less likely to want to eat us.

SPEAKER_03 12:32

You know, I I kind of dig that because yes, a lot of times people in our community, when it comes to this sort of stuff, they will interpret it as something wrong, physically wrong. But there's also the embarrassment of when I'm anxious, I can't go far from the bathroom. I feel like I'm this could be embarrassing. If what if I don't make it, I feel like I have to go all the time. Evolution doesn't really give a crap, pardon the social norms. So that mechanism evolved without any care for the fact that it's embarrassing to evacuate your bowels. The evolution didn't care about that at all, did it?

SPEAKER_00 13:05

Absolutely not. No.

SPEAKER_03 13:06

Yeah.

SPEAKER_00 13:07

Those social concerns come much later than that.

SPEAKER_03 13:09

Yeah, much only in the last even a thousand years is a small amount of time for that mechanism to adapt. So this is good.

SPEAKER_02 13:17

There might be like a a percentage of of people who who do worry about their IBS and stuff, thinking now, like, oh my god, does that mean like I'm gonna explode on myself and you're like like no, uh no, it's okay. I mean, it you might feel uncomfortable, but you have control unless you have a chronic condition, right?

SPEAKER_00 13:35

Right, exactly. I mean, a big part of my work in working with people with IBS is to help the interpretation of what's going on to go from less threatening to completely natural and not something that we need to micromanage as it's happening or even after it's happening. You know, there's just some basic things we can do to help gut regulation more broadly. But then the other thing is uh building the confidence and the knowledge that actually your likelihood of soiling yourself is so minute and minuscule. For all of the hundreds of people that I've worked with with IBS, uh there's just been such a slim minority of people that have soiled themselves. And those who have, when we actually unpack what's gone on, either it's just a little skid mark, which I think, you know, in the the scheme of soiling oneself, I I wouldn't really class it as soiling oneself. Um, or they've also had some kind of bout of gastroenteritis or something else that has made their stomach super dodgy, you know, whether it's to do with um big evasive medications uh beyond you know your standard ones. So usually it's more to do with that kind of stuff than the natural response to anxiety. And so we can build more control over our rectum to reduce that likelihood. But generally the work is about helping people realize that the likelihood is much, much smaller than you might imagine it would be when you get in those overwhelming symptoms.

SPEAKER_02 15:18

Yeah, I remember I I always felt like I was gonna lose control, but never did, you know. Um, and the only times I have is when I've when I've like been ill or something, or or like had food poisoning or norovirus or something like that. And but in general, no, and I think for a lot of people with anxiety that there's Drew's notifications.

SPEAKER_03 15:38

Oh yeah, I thought I turned them all off.

SPEAKER_02 15:42

World of Warhammer buddies are like coming come and join us. Um, but I remember going, um, yeah, I mean my brain trying to get use IPS, use these symptoms to get me to avoid um whether it was losing control one way or whether it was throwing up, you know. Um, do you hear that a lot about um people who get bad acid reflux and they're they're they're afraid it might you know come all the way up and they might be sick and things like that. What's the likelihood of that happening?

SPEAKER_00 16:13

Yeah, I mean, it's really, really slim again that you're gonna be sick because you're feeling anxious. It does happen, but usually that's in you know, extreme, extreme overwhelm and distress. And again, what what's happening is our brain is conflating the strong symptoms of feeling something going on in our digestive system, whether it's upper uh gastro tract like reflux or lower like IBS, and and that being equated with the worst case scenario, um, so throwing up or gonna uh soil oneself, but the the likelihood is always much less than the sensation, and also if we understand what's happening in the brain, the brain is up amplifying those sensations and sensory signals. Um, and one of the areas of the brain that process those sensory signals is overlaps with the area of the brain that processes threat and stress and um fear. So the more that's going on, feeling stressed and fearful, the more we're gonna get those sensory experiences. So if we can calm down the stress response, we can calm down those sensory experiences too.

SPEAKER_03 17:28

Yeah, makes sense. Yeah. So did you find Josh, you live that experience when you get in that situation, and like Sula was saying, you the brain is gonna amplify that, it makes it seem urgent, it sounds so scary. Did you get caught in the cycle of like I have to super micromanage my diet, my gut, my this? I have to manage my gut health, my biome. Oh, yeah. Try to counteract that.

SPEAKER_02 17:49

Uh, for example, when I had bloating and then a so like and then a social event coming up, I I would try to micromanage, I'd have all the uh senacots and all these things to try and get and get because I don't want to feel bloated when I'm there, and that might lead to um you know an event or serious discomfort. I used to sit there and eat uh thrice fermented kimchi that we uh talking about, you know, having all these things or the actamels or the bio yoghurts to try and fix, but what for me what was going on was actually I had the fear of fear, I had an anxiety, this it was the stress that was the problem. It I was trying to dampen down the stress, and I was kind of looking in all the wrong places for it. Once I found that I when I became less anxious and feared anxiety less, the symptoms kind of naturally dissipated. Um and I was spending actually quite a lot of money like throwing stuff trying to tape tape over the cracks. Um, do you hear that um quite a lot?

SPEAKER_00 18:53

Yeah, it's a it's a big part of the work in in CBT for IBS is is working with those you know, gut-specific behaviors that people fall into, which I think has gotten worse over the years because of paradoxically or ironically, the increase in awareness of gut health. So, you know, you've got so many people talking about the benefits of prebiotics, probiotics, kimchi, you know, use this formula for your gut. And actually, what it ends up doing is making people think that they have to micromanage their gut health much more than they actually do. That there are some very simple basics, which is you know, have a nice variety of different plants and what have you in your in your diet, eat regularly, um, do exercise and um yeah, look after your sleep. And and those really will stand you in good fare for for good gut health. But what happens is those messages feed into the thick, the fear and the sense of I'm not doing enough, or this could get worse. And so then you feel like, well, which avenue do I have to go down? And there's so many, like hundreds potentially, that you could go down. And so you've got that decision paralysis as well, and you might try one thing, but you can't try everything 100%. So then it just kind of perpetuates this whole thing of I'm not doing what I should do, and then you know, what it has on the gut.

SPEAKER_02 20:18

I relate to every single word of that.

SPEAKER_03 20:21

I can see Josh like nodding his head furiously as Sula's talking. I've been podcasting on anxiety disorders for many years. You are now officially, all due respect to everyone who's ever been on a mic with me. You're my favorite guest ever now. That that that gut health thing, again, please rewind it and listen to Sula say that as many times as you need to, please.

SPEAKER_02 20:41

Do you know what it's interesting? It reminds me. Um I I was obsessing as because anxious people, people with anxiety disorders are fixators, they will obsess. I remember many years ago I was obsessing about my gut health because it was it was worrying. I was monitoring, I was monitoring like bowel movement times and all these things, and and I became super obsessed with it. I mean, it it's not a fun hobby either. Um, really not. I'd rather not do that. And do you know what one day? I just got so annoyed with it. I think a friend came and said, Do you want to just come for some beers? Screw it, you know, and we went out and I had a laugh with my friend, and we just drank beers, and I just and for one evening, I was like, I just can't be bothered. I'm not saying beer is good for you, but what I did do was let go of the whole compulsive inwards monitoring and fixating. And I was like, you know, for an evening, I'm not gonna do this, I'm gonna do the opposite of what I've been doing. And and then we I think we had like pizza and chips, and and and I and because I had a really nice time because actually I'd engaged the parasympathetic nervous system out of stress. And what I noticed is that I was less bloated. And I was like, hold on, the wellness fear tells me that I shouldn't be putting this deep fried stuff in my stomach and all that. But actually what helped and what I realized is that when I stopped trying to obsessively micromanage and fix it and allow my body to just uh go into that parasympathetic state by having fun, do it socializing, doing these things. Uh don't get wrong, the day after felt a bit rough, but that's why I was making poor choices. But I noticed in the moment I had just I let it I left it alone and con and and actually dealt with my stress, my stress level. And I and then that for me, the penny clicked. It was like, yeah, I eat well, I eat plants, I I I make sure my sleep's okay and do these things as a general rule. But the fixating and the micromanaging and trying to, you know, you know, I had this book about the FODMAP diet, which which could, you know, you could throw it at a building and the building would fall down. It's that big. Uh, and and I was like, you know what, I'm just not gonna bother. I'm just gonna do what non-anxious me would do and see how that happens. And that actually helped my digestion. Don't get me wrong, I know when I've eaten rubbish for a while, that is evident, yeah, you know, and I've not been eating properly. But I just thought I'd bring that up because actually it highlights that the role of stress and hyperfixation that has on your IBS symptoms.

SPEAKER_03 23:16

And an anxious person that wants to dig and dig and dig, like I need to find, I need to fix, I need to know, I'm gonna research, will find no shortage of, you know, there's 72,000 pages on you know Mercola.com about gut health and this, and you should buy this. And when if Paltro is weighing in and it's everywhere, your work your job must be incredibly frustrating, Zula. Yeah, you're waiting in it.

SPEAKER_00 23:38

Yeah, it is really hard because um there's so much profiteering of off gut health and and and people uh selling particular products and and some of the products will be helpful, uh you know, but the the issue is that gut health IBS is best understood from a biopsychosocial framework. So, yes, there's going to be physiological things that have an impact, of course, but there's also the psychological experience that has an impact and the social context. If your social context is do this and that and the other for gut health, otherwise, you know, you're you're failing or you're risking this, or you know, check your poos, otherwise you could have cancer or IBD. That has a big impact on how you feel and how you're interpreting what's going on physiologically. So it's kind of like a backwards thing, um, as opposed to you know coming from the gut necessarily sometimes. We're we're having all of these social and psychological influences on what's going on in our gut. So we're re-interpreting what's happening. And actually, just to explore that, you know, I've never really been bothered about what's happening in my gut. I've never really noticed whether I do one poo a day or two or every other day or whatever. I I don't, I've never noticed. Um, and even all of this time doing gut health research and working with people with IBS, I've never thought about it. I just go when I go, and that's fine. Um I was leading a uh IBS group for people with IBS earlier this year, and we were all talking about how that awareness of when you're going to the toilet, whether you'll be caught short, um, and whether you can hold it has a real big impact on how you feel when you get that urge. And so, you know, sent them off with behavioral experiments and what have you. And then I had a meeting the following later that week, and the meeting meant that I had to leave much earlier than I usually would leave my house. And I realized, oh, I actually haven't gone to the toilet this morning yet, which was the first time I've ever really thought about that. But obviously it was hot off the back of this group. And then I made my way to Paddington, which is about an hour from my house. And when I got to Paddington, I got a coffee and um some food for the train, and it was going to be another little while on the train. And then as I was waiting in the queue, thinking about, you know, the stimulatory effect that coffee has on your bowels, and I've still not been, and you know, I didn't need the toilet at that point, but I was like, there are toilets here, I could go. I got on the train and then I suddenly got this overwhelming kind of hot visceral sense of, oh gosh, something's happening in your body and feeling it in my stomach. And then I was like, Do I, should I, should I go to the toilet right now? You know, it just all started feeding in. And that's me working in this area with this knowledge of like, you know, you can hold it till you've had a whole, you know, um, lifetime of of holding it and not having an accident, and you teach these principles. And so I I, you know, in solidarity with my group, I was like, no, I'm not going to go to the toilet preemptively. I mean, at that stage, to be honest, I probably could have gotten, but I was just like, no, I'll sit, I'll sit there. Um, and it, you know, I enjoyed my coffee and I still ate. I didn't avoid eating, and then you know, the urge went and I, you know, I didn't then go till later on. But I was just like, it's really interesting how that shine in a microscope to specific elements. I usually go at this time, and I haven't had that chance. So, what does that mean, you know, for later? Actually, we've got such a great ability to defer going to the toilet, but if we've not been flexing that muscle, you know, it feels like we're much more vulnerable than we are, and then that's gonna increase that that hyperfocus.

SPEAKER_02 27:26

Yeah, that's so interesting. I can relate to that so much as well. Like the immediacy, like the urgency, like everything, the priority suddenly is my digestion. When actually I can kind of trust my body to do this itself. Obviously, this applies for people who who can do that, you know, that we don't forget people with chronic conditions and things where where where that doesn't apply and they do need to have that extra attention. But in general, yeah, I just find that, yeah, so I I remember having that myself, like oh, this is the time where I need to do it. This is so important. Actually, no, it's all right. You you know, your body can leave it alone. That you're just adding stress, yeah. And I was anyway, for talking about me, but you're just adding stress by fixating on this, and also, you know, we've got a lot of people with obsessive compulsive disorder who listen to this podcast, and I've had clients like this. The digestion can become a theme of obsessive compulsions as well, whether it's checking stools and checking color of urine and and obsessed with hydration and things like that, which uh I don't want to forget about.

SPEAKER_03 28:28

There's a the uh uh I have found people who get into incredibly rigid uh schedules where they must, if I know I must leave the house at 10, then if I do not uh visit the the toilet uh at nine, I I'm gonna maybe cancel my meeting and not leave the house. Yeah. Yeah. And they get so rigid, and then if that is disrupted or that schedule is threatened in some way because it's not practical or life is can't won't allow it. There's such a sense of distress over that. So I know that's interesting. Josh Josh always is careful to point out, like if you do have a chronic health condition, of course. One of the things I find is that people that suffer from IBS, which is clearly a real thing, but they will often, and there's that anxious component to it, will uh but yeah, I do, I do suffer from a I have IBS. So you you they will sometimes hear what Josh said as, yeah, he's talking about me.

SPEAKER_04 29:18

Yeah.

SPEAKER_03 29:18

And it sounds like part of your work is no, no, no, you got to reframe what this means, right? It's different.

SPEAKER_00 29:24

Yeah. I mean, because we can take a comparison condition like inflammatory bowel disease, siceliacs and Crohn's, where there is, you know, organic tissue damage, which is changing uh, you know, how the bowel's functioning and what's happening in the bowel. And there'll be people with different experiences of IBD, you know, um whether they've had to have a stoma or not. So of course that's going to change how how all of this works. But people with um well-managed IBD that's in remission, some of these principles still apply. You know, you can still have that degree of bowel control. It might be diff more difficult for some people with IBD. I'm not saying for for everybody, um, it's definitely different. But it also, you know, I work with a lot of people with IBD, and we can use the same principles and they'll they'll have the same experience that actually I was much more in control than I thought I was. So where I was talking before about the percentage of people who've had an accident with IB IBS, that might be increased for those with IBD, but it's still smaller than it feels like. And and I I completely understand why it's hard to trust that you can hold it when you're getting that full visceral experience.

SPEAKER_02 30:36

I mean, I really felt it on the train, but um, finding ways to realize that that actually doesn't equate to I've got no control is really, really important for being able to cultivate that sense of trust in your body and your ability to work with those urges challenging the belief system um very CBT uh approach, which uh I I personally found very helpful as well. Uh I could think about how many what are the reasons for why we get bloating with IPS? Because that was something I struggle with.

SPEAKER_03 31:18

That I had that I did have. So Josh and I had commonality there if I get anxious. So, like, why do I look like I just gained 60 pounds in five minutes? What happened here?

SPEAKER_00 31:28

Yeah, yeah. So to understand this, we we need to be aware of what's generally happening in our gut, right? So that would involve the area of the gut, which is the colon or the large intestine, which is you know wraps itself around um in our abdominal region, and it's 1.5 meters, so it's a fairly lengthy uh bit of organ, and um, it's all creased up and and bundled together. And in order for us to pass a stool and to digest things, our food would have moved through our stomach where it's broken down, our small intestine where the nutrients are absorbed, and then it will have gone into the colon. And when that's all functioning nice and regularly, we'll have these peristaltic contractions which are coordinated. So one bit contracts, the other bit releases, that releases, the next bit can um contracts and then releases. And so we've got this nice kind of wavy motion going on. When we have a dysregulated gut, or when our gut is responding to the activation of our sympathetic nervous system, so our fight or flight response, that changes how that peristalsis is working. So we might get a complete kind of clamp down of some areas of the gut, and that might mean that there's then pockets of air that build up. Um, so we've got multiple pockets of air that are building up, and because of how it's kind of crowded together, the only space is for it to kind of move outwards. Um, and and there we get the bloating. So it can happen quite instantaneously for that reason, and also our diaphragm's kind of moving up and down, which kind of pushes it out even more.

SPEAKER_02 33:10

Yeah, that was the one for me. Honestly, I remember when we did the original panic pod uh some years ago, uh, that was the symptom that no one could ever explain to me. Where I could have a completely flat, relaxed stomach, and then I'd feel anxious and stressed, and it would be bloating. And for many years I thought, well, maybe there's some dodgy lettuce leaf that's hit a certain part of my colon and it's made everything go mad. No, it wasn't, it was it was that explanation. So if you get this, do you know what's weird as well? I got this. Every time I get this bloating, I feel a bit dissociated as well, do you realize like my everything, and that was never ever explained to me. I asked some of the world's experts on anxiety disorders, literally the world experts, like, why do I get bloating and DPDR at the same time? They are intrinsically linked most of the time for me, what's going on, and they were like, Oh, um, you know, it's just part of your flight response. But I I'm a kind of person who needs to know why. Yeah, and when you explained, actually, no, yeah, there's pockets of air going through this track, and they go, it goes outwards. That would explain. That would explain why I had constant bloating and I had pressure under my ribs, rib pain, chest pain, it even linked to my heart palpitation sometimes. My heart would skip a beat because of the pressure and the comp and the and the and the pressure in my sternum. And I was like, this is making sense now, and I wish someone would have told me this, you know, because I went to the doctors and I had heart tests and ECGs, and then they would pick up on the ectopic beat from the from that, and they're like, Oh, yeah, we did notice one or two. That's creating more anxiety. That anxiety is then creating more stress, which is then making my intestine squeeze, cause more bloating, and then I'm obsessing and I'm smashing the the senicots, I'm smashing the the fermented foods, and I'm going around and around in this horrible circle because the psychoeducation was not there.

SPEAKER_00 35:09

Yeah, yeah. The power of psychoeducation, I think it's one of the biggest you know elements of the CBT protocol for IBS is is that people understanding actually what's going on.

SPEAKER_03 35:20

Yeah, what is that? That was so exciting that I remember when you had Tula on the panic pod, Josh, like, I'm gonna ask her the question. We like knew it as a question. I'm gonna ask her now. And I'm getting curious what that message is. She knows, she had the answer. I'm so excited to hear about the colon.

SPEAKER_02 35:40

I'm like, this is honestly, it was so so good to know. It was the only explanation that made sense, uh, you know, other than oh, maybe you have a lentil intolerance. You know, no, no, it wasn't a lentil intolerance, you know, it was nothing, it was I was in the cycle, and IBS can often be a cycle, yeah. Uh, where our intervention makes it worse. Yeah.

SPEAKER_00 36:01

The thing that adds to that as well, because if if we understand that's like the instantaneous thing that can happen in our gut, and then we have our response to it of like exactly like you're saying, Josh, it can be, oh, well, maybe that stray lettuce leaf is bad. So then I have to restrict that. And that mechanism then means that we our our food uh choices become more restricted, which also means we're probably more likely to skip meals, or even if it's not to do with food choices, we might just think, oh, I shouldn't eat because I'm bloated. And if we understand again what contributes to peristalsis, nice regular rhythm, is our gut knowing when we're going to get fed. And if we're deferring that and deferring that, it's like, what the hell's going on? And it can't get back to its usual rhythm and routine. So it's it's more likely to maintain bloating. So a lot of the stuff in this uh CBT for IBS protocol is about helping people understand a the physiology that just causes the symptoms to begin with and the different factors that feed into that physiology, and then how our responses to that physiology then maintain it. So, you know, there's two levels, and and often the things that we're doing intuitively in response to these things actually contribute to that ongoing dysregulation, and it's just a few tweaks, really, to change it, but it can be hard.

SPEAKER_02 37:15

So tweaks, but powerful tweaks. Um, uh I've got a question that Drew is too shy to ask. Uh, every time Drew goes to the toilet, uh he hears every time Drew goes to the toilet, he hears this noise.

SPEAKER_03 37:27

Oh no.

SPEAKER_02 37:29

What's that mean? What's going on?

SPEAKER_03 37:32

Eagle in it's gotta, it's gotta be in every episode.

SPEAKER_02 37:35

It's actually does he need to go to the doctor?

SPEAKER_00 37:39

I think your foo's just happy to be released. It's like woo!

SPEAKER_02 37:46

On a motorbike with a flag and a gun.

SPEAKER_04 37:52

So uh very good.

SPEAKER_02 37:54

Uh yeah, we've got a couple of quick fire. I I put on my Instagram stories before. Uh, if you don't follow me on Instagram, it's anxietyjosh and the anxious truth. I'm gonna have a look now. Let's have a look. Um, some quick fire questions for for Dr. Sula. So uh here we go. We've got uh some of these questions have nothing to do with the IBS. Um is is IBS really a diagnosis, or is it just the body's response to stress and anxiety?

unknown 38:26

That's a good question.

SPEAKER_00 38:27

Yeah, it's a really good question. Yeah. I mean, the the difficult thing for people with IBS is that it's a diagnosis by exclusion, right? So you get these bowel symptoms, and generally the way that you should be diagnosed is doctors will check out is it to do with anything else? You know, could it be inflammatory bowel disease, could it be, you know, other things? And that might involve not always, but it might involve blood tests, it might involve like a hydrogen breath test, it might involve um, you know, trying to exclude certain things by the time, or it might be colonoscopies and all that kind of stuff, by the time you know these things have been ticked off, then doctors are like, yeah, there's there's no structural reason for it. So it's a functional gut disorder, so it's IBS, and then they get it. Sometimes doctors are quicker to get there because you know they've seen it a lot, um, and there's no red flag symptoms to say it'll be anything else. So they might give that diagnosis before the process of exclusion, which can be hard, particularly for people with anxiety disorders, because it feels like, well, this was just too easy for the doctor to diagnose without doing any tests, which I completely understand. Um, and it's well within your rights to you know check out other avenues. But generally speaking, there you know, there is good uh basis for that. Um, but specifically, is it just you know, how did they phrase it?

SPEAKER_02 39:53

Is it a diagnosis or is it yeah, is is it real like a is it a diagnosis or is it um you know a word to describe just like kind of the body's response to to anxiety? Because I know some people refer to it as oh my IBS is playing up, but they've not actually had a diagnosis. So I think I think what the question was is you know, is is it like a a legitimate diagnosis or is it okay for people to refer to their constantly playing up digestion as IBS? Because um I I mean I get it. If your digestion's been playing up for years and years alongside anxiety, I conceive the the appeal to you know to call it um IBS, you know, the self-diagnosing, but at the same time, you know, it it it depends really, doesn't it?

SPEAKER_00 40:40

Like there's a diagnostic criteria for IBS, which is uh developed by a working group of gastro gastroentrologists, psychogastroentrologists, and yeah, a whole lot of experts in the area, and they review all of the evidence and you know, um epidemiological studies to look at how symptoms show up for people with IBS. And their most recent guidelines is that in order to have IBS, so this is this is helpful when you're thinking of having a diagnosis by exclusion and you want to see does this fit in to you know the criteria for IBS, it's the presence of some kind of abdominal discomfort or pain. They actually changed discomfort or pain to just pain, which I've got some issues with because I think for some people it is more discomfort, you know, that sense of distension as opposed to pain. But yeah, some kind of abdominal discomfort or pain was the previous iteration, now just pain. And that has to be related to your change in um bowel motions, so either increased or decreased frequency, or you know, the stool consistency. So is it looser, is it harder? And if you fit those crit, and you've been having those, I think it has to be for at least six months. If you've been having that, then you have, you know, those are the criteria for IBS. So um there is like kind of a diagnostic criteria, and you can fit into that, and it's likely that you have IBS. In terms of like, is it just you know the manifestations of anxiety? We understand IBS as a functional um gastrointestinal disorder, so an FGID, and that's on a whole spectrum of different functional gastrointestinal disorders from like acid reflux, functional um reflux through to like constipation and diarrhea, which isn't quite IBS because it's just you know one of those dimensions, and there's all sorts of other things, functional dyspepsia. And IBS is just one of those functional gastro disorders. Um, but we understand all of them from a biopsychosocial perspective. So it is important that there has been some kind of physiological gut disruption that changes how the gut is functioning, and yes, it gets exacerbated and massively impacted by anxiety and stress. And for some people, that will be really present anxiety and stress, which will be relevant for your audience. But for some people, they'll be like, I don't feel particularly stressed, but I do have IBS. But they will be stressed, they just don't, you know, psychologically experience it as that, you know, their body's running on adrenaline and having to do loads of things, and that's having an impact on their gut. So, in short, the answer is yes, but for some people with anxiety disorders, it it feels harder to delineate the difference.

SPEAKER_02 43:28

And as a therapist as well, um I often see that when people come in and a bit like me, when when their anxiety comes down, their symptoms come down. Whereas I imagine there's some people who come in and have anxiety, their anxiety comes way down, but they may still have other symptoms. I think that would be a a good way um to kind of distinguish there. Uh another one, uh three people have asked this similar one. I'm just gonna put it into one question. I kind of mentioned it before. But yeah, it's can indigestion. Gas, acid reflux, uh cause PVCs, heart palpitations. Well, loads of you have asked the same question, and I said that, so I'm gonna presume that's a quite a short yes.

SPEAKER_00 44:11

Yes. Yeah, absolutely. And again, if we just think about the interconnected nature of our body, right? What I think we're socialized to believe that other, you know, areas of the body have nothing to do with each other. Because you know, you go to gastroenterology for your gut, you go to gynecology for anything reproductive organs, you go to neurology for your brain, but of course our whole body is interconnected. And um, you know, just understanding a bit about our nervous system and how different areas are communicating with each other, if our gut's picking up on something or is dysregulated for whatever number of reasons, that also feeds back into you know how our nervous system is interpreting that, even on a, you know, again, a pre-conscious level of feeling under threat and stress, and then that's gonna um exacerbate that sympathetic nervous system activity, but also just how proximate things are, like you were saying, Josh, if your diaphragm's acting differently or if you're bloating, that's gonna you know change um yeah, how you feel in your chest and all of that kind of stuff too.

SPEAKER_02 45:14

Makes sense. Thank you. Where can people find you, Dr. Silver?

SPEAKER_00 45:19

Um I am on Instagram, so it's the health psychologist, but underscore in between everything and after psychologists.

SPEAKER_02 45:28

Fantastic page, and I follow it, it's brilliant.

SPEAKER_00 45:31

Thank you. And then I've got a website which has got lots and lots of free resources, um, booklets and things to download. Um, and I've just recently actually launched um a membership which is called Body Mind Connect, and it's divided up into three, I call them modules. Um, one is the body, so it's just understanding some of this mind-body physiology, you know, how your brain's working, how that has an impact on other aspects of your nervous system, what's happening in your gut, and then mind, which is you know the role of our psychological experiences and working with some of those things, and then connect is I because I don't think we really emphasize enough just how much like our social environment has an impact on all of those things, and often by osmosis, so it's clarifying some of those things, but it's also because it's a membership, so we we meet we meet weekly and um do some deep dive practices together.

SPEAKER_03 46:21

I will put all Dr. Silva's links in the show notes for this. So if you go to disorder.fm and find this episode, which is number 34, I'll put all your links there.

SPEAKER_04 46:29

Thank you.

SPEAKER_03 46:30

Thank you for coming on. It's been a pleasure. Really, really great.

SPEAKER_00 46:33

Answered some great things up.

SPEAKER_03 46:35

I appreciate it. You're welcome here anytime.

SPEAKER_00 46:38

Yeah, thanks so much. It's lovely chatting.

SPEAKER_03 46:40

All right, guys. Are we done? I guess we'll see you next week. Thanks for joining us for this episode of Disordered. Josh and I both hope that you're finding it helpful in some way. For more information about Josh or me or the Disordered Podcast, find us on the web at disordered.fm. That's disordered.fm. Hop on over and find links to our social media platforms, join our mailing list so we can let you know when new podcast episodes are available, and we'll send you easy ways to ask us questions and share your wins so we can answer questions on the air and share your successes with the community. And if you're listening to the podcast on Apple Podcasts or Spotify or any platform that lets you rate a review, do us a favor and leave us a five-star rating and maybe write a review if you're digging disordered. It really helps us out and we appreciate that. Thanks again for coming by, and we'll see you in the next episode.