Episode 5: Why Your Gut Feels Off (Even When Tests Are “Normal”)
Team Gut Girls discuss chronic digestive symptoms that persist despite normal tests, focusing on disorders of gut-brain interaction (DGBIs), which affect over 40% of adults and children and include IBS, functional dyspepsia, functional constipation/diarrhea, bloating, reflux hypersensitivity, and more under Rome V criteria.
They explain a biopsychosocial model of causes and risk factors (trauma, infection, stress, genetics, early life events, anxiety/depression, sleep, smoking, obesity, surgeries) and myth-bust that bloating isn’t automatically IBS, symptoms aren’t “nothing,” you can have overlapping DGBIs, and the microbiome isn’t the whole answer.
Key mechanisms include motility disturbance, visceral hypersensitivity, altered mucosal/immune function, dysbiosis, and altered CNS processing. Practical options discussed include CBT, gut-directed hypnotherapy, diaphragmatic breathing, consistent movement, personalized food strategies, supplements (nervines, demulcents, motility agents), and medications including neuromodulators, plus advocating for collaborative care and referrals.
00:00 Welcome to Team Gut Girls
00:34 Podcast Disclaimer
01:01 Why Tests Look Normal
02:02 What Counts as DGBIs
02:59 Causes and Risk Factors
06:37 More DGBI Examples
09:36 Myth Busting DGBIs
14:40 Why Symptoms Persist
16:16 Mechanism One Motility
18:57 Mechanism Two Hypersensitivity
22:02 Immune and Leaky Gut
22:22 Leaky Gut Immune Loop
23:28 Dysbiosis Beyond Probiotics
25:53 Stress Gut Brain Wiring
28:03 Gut Brain Therapy Tools
29:57 Movement Balance Matters
32:27 Food Triggers Reintroduce
33:46 Supplements And Meds
37:10 Talking To Your Doctor
39:59 Final Recap And Next Steps
Resources
Disorders of Gut-Brain Interaction (DGBIs)
Rome Foundation (https://theromefoundation.org/)
Explains conditions like IBS, functional dyspepsia, functional constipation, and functional bloating.
Provides evidence-based information for patients and practitioners.
International Foundation for Gastrointestinal Disorders (IFFGD) (https://iffgd.org/)
Patient-friendly information on IBS, functional dyspepsia, bloating, gut-brain disorders, and digestive symptoms.
Excellent educational handouts and advocacy resources.
Cognitive Behavioural Therapy (CBT) for IBS and Gut Symptoms
Finding a CBT therapist familiar with health anxiety or chronic illness
Online CBT programs designed for IBS
Psychology Today Resource Link – https://www.psychologytoday.com/
Gut-Directed Hypnotherapy
Nerva – https://www.nervaibs.com
Diaphragmatic Breathing Resources
https://www.med.umich.edu/1libr/MBCP/DiaphragmaticBreathing.pdf
Team Gut Girls Episode 5 Transcript: Why Your Gut Feels Off ‘ Even When Your Tests Are Normal’
Dr. Dominique Vanier, ND: [00:00:00] Welcome to Team Gut Girls, the podcast for anyone who’s ever unbuttoned their jeans at 10:00 AM, mapped out every public washroom in a 10-kilometer radius, or wondered why one bite of food can ruin an entire day. We talk about bloating, constipation, diarrhea, reflux, nausea, abdominal pain, histamine chaos, and all the quiet gut symptoms you’re told to just live with.
Join naturopathic doctors Dr. Whitney Baxter, Dr. Christina Carew, and Dr. Dominique Vanier. Your gut is talking, and we’re here to help you translate. You’re with Team Gut Girls now. Let’s dig in.
Dr. Whitney Baxter, ND: And before we dive in, just a quick note. This podcast is for educational and informational purposes only. It’s not meant for medical advice and doesn’t replace working with your own healthcare provider.
We’re sharing general information, not diagnosing or treating anyone. Please always talk with your physician or licensed healthcare practitioner prior to making changes to your health, medications, or [00:01:00] supplements
Dr. Dominique Vanier, ND: Welcome back, listeners. I’m Dr. Dominique Vanier, a naturopathic doctor, and I’m joined with my co-hosts and naturopathic doctors, Dr. Whitney Baxter and Dr. Christina Carew. And today, we’re diving into something that affects way more people than most of us realize chronic digestive symptoms that don’t show up on tests.
So have you ever been told that your tests are normal, but you still feel bloated after every meal, nauseous, or like food just sits in your stomach for hours? You’re definitely not alone. This affects a lot of people. Research actually shows that over , 40% of adults and children experience what are called disorders of gut-brain interaction, or DGBIs.
So we’re gonna refer to this group of symptoms throughout this podcast mostly as DGBIs ’cause it’s kind of long. These are conditions where the gut and brain are not communicating properly, so structurally everything looks normal on scans and blood work, but the function, this is where it’s key, the function of the gut or the function of [00:02:00] digestion is disrupted.
Let’s first talk about what DGBIs include. They refer to over 30, we call them functional, digestive conditions. In fact, there are 33 adult and 20 pediatric conditions. And so our listeners will probably know the most recognized one which is IBS. Some people will have also heard of functional dyspepsia.
This also includes functional constipation, which is like IBS constipation type, but it’s constipation without the pain or discomfort. Similarly, functional diarrhea also falls under this category. Again it’s diarrhea without the pain or discomfort like we see with IBS, as well as functional abdominal bloating, and there’s many other conditions.
So today, we’re gonna talk about, one, what these disorders actually are, two, what symptoms can… why symptoms can be so real even when tests are normal, and what people can actually do about them. Okay, [00:03:00] I think this is a good starting point, uh, talking about what causes DGBIs. And as we know, and we’ve talked about before, there isn’t just one specific cause or mechanism, but rather there factors that can make these conditions more likely to occur as part of a larger biopsychosocial model.
So, um, of your experience in reading, what are some of, what are some of these kind of characteristics or mechanisms that that you guys know to be causative or involved with DGBIs?
Dr. Christina Carew, ND: I would say, trauma is definitely one. So people will have, a historical event that has happened. Could be something recent like a car accident or something that happened to them when they were really little. , But it certainly is that brain-gut connection that gets interrupted, and that can also include things like, you know, being hospitalized or, , having, like, a really regimented household or maybe , a mom that was, like, really strict because of dieting, things like that.
Like, all of that sort of embeds into our [00:04:00] being, into our pattern.
Dr. Dominique Vanier, ND: Definitely. Yeah. Well, physical and, and then also the emotional trauma side. Yeah. Yep.
Dr. Whitney Baxter, ND: Yeah. It just, like, re- it wires our nervous system in a certain way from childhood, and then they can just show up as pain later on or even as a kiddo.
Sometimes kids recognize, yeah, I did have a really anxious gut or a sensitive tummy growing up. Other things like our genetics, culture, depending on how we were raised again or where we were raised, that can play a role.
Dr. Dominique Vanier, ND: Yeah. Things like infection, right? So we’ve got a lot of environmental factors beyond trauma, infection.
There’s, interestingly, parental behaviors, and I looked into this for another presentation I did. So how we interact when our child is having, , a disorder of gut-brain interaction, whether we’re adding to that level of anxiety or taking away from it, will directly impact the outcomes of that condition for that child.
And what we mean by that is, referring to how many doctor’s appointments they have, utilization of healthcare resources, which is, I mean, a very [00:05:00] interesting part of what DGBIs are. , Things like life stress will also be, , an involved mechanism, personality traits. Like, all of this is… It has to do with, , that biopsychosocial model.
So it’s not just, it’s often not just one thing. There’s multiple factors. , And then, you know, there are also known risk factors. , So a few of them would be the female sex, , definitely a history of gastroenteritis. So if somebody has had some sort of GI infection at some point, that makes them at a higher risk of developing, DGBI.
What other risk factors, are you guys aware of? So
Dr. Whitney Baxter, ND: we talked about this early life stress events. So as naturopathic doctors, even medical doctors are asking, , your medical history, and kind of walking through childhood and what it was like for you, what that looked like. History of abuse too, , and then current perceived daily stress.
Psychological disorders like anxiety, depression, or mixes of [00:06:00] both, that can all play into our nervous system’s interpretation of these discomforts as well.
Dr. Christina Carew, ND: Thoughts, behaviors, and, and a sort of like somatic symptoms, so like revisiting thoughts or recycling thoughts like OCD or where those sort of compulsive-type behaviors.
Certainly anything that affects our physical wellbeing, so having poor sleep- Mm-hmm … , smoking, obesity. So abdominal surgeries, things where, you know, our body has changed or maybe isn’t operating the same way as someone else’s.
Dr. Dominique Vanier, ND: Mm-hmm. Mm-hmm. Yep, absolutely. I think maybe it would be helpful for listeners right now to know what are some, some other examples, ’cause there are really so many conditions, and I…
And every time I look through, , some of the research papers, I feel like there’s more and more being added to them. So beyond the most recognized DGBIs, , like IBS, the ones that I had mentioned a few mo- moments ago, we have a few more. So there’s something called reflux hypersensitivity and functional [00:07:00] heartburn.
So those can manifest as, , GERD symptoms, but they’re… it’s not actually true GERD. It has to do with the sensitivity, to acid, events and, and often to the volume of acid, where we can feel heartburn. Functional chest pain is one. There’s four different types of IBS. , What are some other ones, , other DGBI conditions that you guys are aware of?
Dr. Christina Carew, ND: Yeah. So functional dysphagia or opioid-induced constipation, so things just, , not feeling like they’re moving in any kind of way. Anything to do with, , any kind of rumination syndrome, so thinking about things or focusing on things so much that they don’t happen. It’s like you- you’re like all day you’re anticipating-
the thing, and then it doesn’t happen.
Dr. Whitney Baxter, ND: Hate that. If you look at the… So I’m sure , you’ll bring this up, but the Rome criteria and, like, how these DGBIs are categorized. It’s a really nice presentation because the gut’s a long tube with all these different functions. So really [00:08:00] everywhere along the tube there is a category of these DGBIs.
Dr. Dominique Vanier, ND: Good point.
Dr. Whitney Baxter, ND: So if you’re feeling pain somewhere, like whether it’s reflux or upper, middle, and lower, there’s a section of and a category of this. So- Biliary pain. If they can’t find anything, so your gallbladder’s been, you’ve had ultrasounds, you’ve been assessed, you’ve had blood work, nothing’s coming up, there is a DGBI called biliary pain.
Yes. Yes. So it’s always kind of nice to consider this and start to talk about this. , And then functional anorectal pain. There’s generalized abdominal pain as a category. , There’s so many more, and then there’s into the pediatric categories of infantile colic, which is a DGBI, and- Yes … Dominique and I have littles, so- Yes, we have littles.
Yes … we’ve probably just-
Dr. Dominique Vanier, ND: We have lots of experience with colic … lived
Dr. Whitney Baxter, ND: with colic. Yes. ‘Cause they’re feeling all these new sensations- Yeah … and gas and mo- motility and movement, which is… Yeah.
Dr. Dominique Vanier, ND: That’s a really interesting point, ’cause [00:09:00] the… So for our listeners, the something called the Rome V, five criteria came out about a month ago, and they only update this criteria every 10 years.
And so when we had started our podcast, , at the end of 2025, when we were talking about IBS, it was as it relates to only pain. But now they’ve actually changed the criteria in the last month, and it’s pain and discomfort. , So anyway, maybe we should just do a separate podcast on that. But- As it relates to DGBIs, there is a very set, , like a set kind of umbrella for criteria and how these things are diagnosed versus what other conditions possibly need to be ruled out.
Okay, so let’s jump into some myth-busting. , So let’s talk about what some myths, you know, we’ve heard about with DGBIs. I’ll go first, , and this is a big one. So myth number one, bloating automatically means IBS, and that’s certainly not true. There are so many other causes of bloating beyond IBS. , But IBS, you know, has kind of become somewhat of , a [00:10:00] catch-all diagnosis.
And what’s also interesting, again, like relating back to that, that updated criteria from a month ago, is, um, chronic abdominal bloating. And so in chronic abdominal bloating, so breathing pattern dysfunction is part of now the pathophysiology of chronic bloating. So what that means is it’s no longer a nice-to-have breathing when we have chronic abdominal bloating.
Like, we need to do it, because it also has to do with how the diaphragm is moving. Other myths that you guys have come across regarding DGBIs?
Dr. Whitney Baxter, ND: Well, a lot of these include, a sensation of pain or dysfunction, like you talked about. So a lot of people think or talk about a DGBI symptom means that there’s a structural issue, and often that’s what’s bringing you to your doctor anyways. Mm-hmm. ‘Cause , it’s fearsome to feel something or be worried that something’s not working properly.
Of course, if there’s pain or, like, new onset loose stools or you’re feeling a lot of acid come up, , that’s worrisome. And what we want [00:11:00] you to know is that there isn’t a structure, it’s a function. So it’s altered perception, not your physiology. Mm-hmm. So there’s a miscommunication between your gut and the brain for some reason that we want to determine.
So if you think of it like this, your gut is a highway. So imagine tests and blood work and checking if the roads exist, but they don’t tell us there’s traffic accidents or miscommunication between the signals. So just the tests, just because these tests are normal, it doesn’t mean that there’s nothing wrong.
Mm-hmm. So there is… We just can’t test for that.
Dr. Christina Carew, ND: Mm-hmm. Yeah. I’d say the big one around this is, people that say, “I’ve had an endoscopy. I’ve had a colonoscopy. I’ve had a gastric swallowing test.” , So they’ve had all these- Mm-hmm … really, um, you know, diagnostic tools, but they’re not… They, they’re tools that talk about the structure, not the function, and I think that people don’t realize that piece.
Dr. Dominique Vanier, ND: Yeah, which is a- certainly helpful to rule out what can be, like, more [00:12:00] serious-
Dr. Christina Carew, ND: Mm-hmm …
Dr. Dominique Vanier, ND: issues. But I think,, sometimes,\, people can go down this,, rabbit hole of, if all these tests are normal, it doesn’t mean… we have to find that one test that’s abnormal, and that’s actually not how we wanna think about it because, like we said, the tests can be all normal, but we still have a chronic digestive condition.
Mm-hmm. Yeah. Myth number three. So you can only have one DGBI, , and we know medicine doesn’t work this way. Interestingly, , about 30% of patients with DG- one DGBI will have a second, and what we commonly see is there’s a big overlap between irritable bowel syndrome and functional dyspepsia. , About 55% of IBS patients also meet the functional dyspepsia criteria.
Yeah, what that means kind of clinically or for our listeners is when we’re trying to, you know, make headway on one area, , we can’t ignore that there isn’t something else happening at the same time. We don’t just wanna, pigeonhole at one section of the gut, , because that may not get us to where we need to be.[00:13:00]
Dr. Christina Carew, ND: And I, I think that’s, , that with a lot of our patients is that they come in… The way the traditional medical system has taught us,, one illness, one appointment, one solution.
Dr. Dominique Vanier, ND: Yeah.
Dr. Christina Carew, ND: But the more, I think the more patients that we see, we realize that there are so many more clues in knowing more about the entire system and how it all intersects each other.
Dr. Dominique Vanier, ND: Mm-hmm. Mm-hmm. Yep.
Dr. Christina Carew, ND: Okay, so myth number four, , if I fix my microbiome, I’ll fix my symptoms, that the microbiome is the key of all the problems. And, well, it certainly is one of our mechanisms. I think that we certainly don’t know enough about the microbiome yet. We are, like, a slice of pie in a big, big space, , in terms of what we know.
Um, it’s part of the story, but there’s all the things that make the microbiome function and grow, and signals, and nervous system, and how our body is responding and reacting, which is some of the [00:14:00] mechanisms by which, DGBIs are actually,, seen, at least currently, through the system. So, you can have the best microbiome in the world and still have a function issue.
Dr. Dominique Vanier, ND: Yes. I know, it’s just so confusing.
Dr. Whitney Baxter, ND: It is confusing. And people want that test, right? The, “Let’s do a gut microbiome test. Like, that’s- … that’s what’s causing this. It has to be causing this. I’ve had everything ruled out.” So it’s, it can be tricky but kind of fun to educate people and-
Dr. Dominique Vanier, ND: Hmm …
Dr. Whitney Baxter, ND: kind of teach them the mechanisms at play here.
And yeah. Yeah.
Dr. Dominique Vanier, ND: It can
Dr. Whitney Baxter, ND: get kind of complex.
Dr. Dominique Vanier, ND: Absolutely. Yep. So a good transition into let’s talk about why symptoms can persist even after microbiome support, you know, even when tests are normal. We wanna talk about what these mechanisms are. And I actually educate patients often on this because, , you know, similarly, , if we wanna shift your microbiome, for example, we have to make sure we’re looking at all the other [00:15:00] mechanisms, right?
So it’s not just gonna be one, one thing. One probiotic, is not gonna do it. , So there are five key established mechanisms in DGBIs that tend to cross over all of them under this, under this umbrella. We have had a motility disturbance at some point that is ongoing. There is visceral hypersensitivity, which we have talked a lot about in other podcasts, but that is where the patient or the person is subjectively feeling their gut so much more acutely, where we can have, like, pain signals amplified compared to somebody else who just ate the same food, just drank a glass of water, and has no symptoms at all.
A third mechanism is altered mucosal and immune function. And so that refers to, things like, , an increase in pro-inflammatory cyto- cytokines, like mast cells. , We do talk a little bit more about that in some other podcasts as well. , We’ve had an altered gut microbiota at some point.
And again, we go back to what we just chatted about as it relates [00:16:00] to, , what kind of caused this is, we wanna think about when we had gastroenteritis. That may have been just the light switch that went off, and there was a shift , in the microbiome after that. , And the last mechanism is altered central nervous system processing.
So let’s dive into each of these. Maybe we’ll tackle motility disturbance first. , Yeah, Christina or Whitney, do you wanna chat a little bit more about that?
Dr. Christina Carew, ND: I feel like this is our every day. Yeah.
Dr. Whitney Baxter, ND: So as,
Dr. Christina Carew, ND: as Whitney alluded to, it’s like one pipe, and so the pipe is kind of like an inchworm. Yeah. So think of it that way is that, like, each,, muscle contraction moves things down the pipe, and so the timing of things , is really much affected somewhat by how our brain perceives it, how much time we wait to be able to eat, how fast we’re eating, which medications that we’re taking.
Certainly, , the GLPs also affect this. So we have lots of other pieces of the puzzle that are [00:17:00] affecting our motility and not just our brain, although that plays a big role of it. Mm-hmm. And so it’s like, how frequent are those contractions? How fast do things move through the system? Does the volume move from one space to another, so, , leaving one empty and making one full?
Or does everything kind of trickle through like a leaky, leaky faucet? And so those types of things can affect you, where someone’s getting, like, reflux or burping or, feels like things are sitting in their stomach or bloating or constipation, and they’re all still motility disturbances. They’re just in different parts of the body.
And some of the tools we have work in lots of parts of the body, so one thing can help many things.
Dr. Dominique Vanier, ND: Mm.
Dr. Christina Carew, ND: Um, but it’s not always that case. Sometimes it has to be more specific to the area that we’re trying to impact. And sometimes fixing one area means that the one below it sometimes then becomes a problem because , it’s still a pipe.
And so, you know, what do we see? We see bloating. We see vomiting. We [00:18:00] see diarrhea. We see discomfort. We see heaviness. We see people that aren’t under… don’t wanna eat ’cause eating doesn’t feel good.
Dr. Dominique Vanier, ND: Yeah, early satiety. Yep. ,
Dr. Christina Carew, ND: And then we have a… we definitely have a range of tools that vary from physical things, , to herbs and vitamins, to medications that work in here.
So if you are experiencing a motility disturbance, don’t give up if someone’s tried one thing, ’cause there are lots of things , that can help. Oh, yeah. It’s just about understanding: how is your body contracting? And we unfortunately don’t have a magic test to tell this one yet, not through mo- not through the whole tube.
There’s some areas of the tube that we can tell, , but not the whole tube.
Dr. Dominique Vanier, ND: Good points.
Dr. Christina Carew, ND: Yep.
Dr. Whitney Baxter, ND: If you’ve been listening to this podcast, you know that Christina has the best metaphors. I
Dr. Dominique Vanier, ND: have one coming up, so just wait for it. Okay. I don’t know if it’ll be
Dr. Whitney Baxter, ND: good, but Okay. Okay. You’ll get it. Yeah. Love it. – Do
Dr. Dominique Vanier, ND: you wanna chat about the visceral hypersensitivity?[00:19:00]
Dr. Whitney Baxter, ND: Visceral hypersensitivity I always like descri- describing to patients because they’re like, “Oh, that makes so much sense.” We talked about their early life factors and that biopsychosocial model of what went on in your early childhood, and pulling it all together. ‘Cause this one means that there’s an issue with pain sensitization, so your viscera, your gut, is just more sensitive to normal things that are going on.
So it’s if you feel bloated with water, or you just had a little snack and all of a sudden you’re bloated and uncomfortable. Um, so it’s this sensitization in the DGBIs that changes the central nervous system feedback loop, so the gut and the brain just aren’t communicating effectively. It becomes inappropriate or faulty, and that we see instead increased pain signals and then this pain disinhibition.
So it’s, the pain is being communicated and not being told, you know, you’re overreacting. It’s just, it’s- Mm-hmm … you feel the pain, you feel the bloating, you [00:20:00] feel uncomfortable. So it’s this concept that’s really central to all disorders of gut-brain interaction, and not all of them present as pain.
Sometimes it’s, like, inappropriate bloating or reflux or some kind of function. But, , it’s, it’s this result that causes the discomfort, that’s really distressing and can cause a lot of fear, and, as it should. And that’s what should prompt us to rule out all the other things that it could be, and recommend that you do get the colonoscopies if it’s indicated and all these other things, because we need to rule that out.
But- Yeah, this is a big one.
Dr. Dominique Vanier, ND: And it can be a vicious cycle too, like that fear, that anxiety behind, “Oh my gosh, I’m having pain all the time now,” can then actually worsen that feedback loop, um, which is really challenging I find. Um, because we want- Mm-hmm … we wanna just calm the system. And in, in doing that, yes, we have, a bunch of tools, but it’s also, we need to just calm how the brain is communicating to the gut at the same time.[00:21:00]
Dr. Christina Carew, ND: I would say a big piece I see in here is, nervous system dysregulation and mast cell activation, meaning that the body’s just way more sensitive, so-
Dr. Whitney Baxter, ND: Yeah …
Dr. Christina Carew, ND: and we can think about this like, I’ll give you another one. A con- like a concert. So you go to a concert, and the concert is insanely loud. And it’s fine ’cause over time you get adjusted to the concert, and you’re playing the radio in the car on the way back.
And you go in the house, and the next day you turn on your car, and you’re like, “Oh my gosh, that radio was- Yes … so crazy loud.” It’s because you became sensitized to the noise in the concert, and you didn’t even realize how loud your radio was on the way home. But then once everything kind of calms down again, you realize, like, how loud that was.
And so the same thing’s happening in the body, is that there are other things that are adding onto this, like pile or this fire. And so something can feel really real in, in pain, but sometimes that’s as a result of this fire that’s already sort of
Dr. Dominique Vanier, ND: burning. Mm-hmm. [00:22:00] Mm-hmm. That’s a good one. Yep. Yep. And that’s maybe a good segue into, like, the alt.
So we talked a little bit about that altered mucosal and immune function, which can refer to w- you know, what’s known online as leaky gut. But medically, that’s intestinal hyperpermeability. So you wanna think of it like we have, like, a cheesecloth. This is another metaphor. Another one after this. Or like a window screen that’s worn out, that has enlarged holes, so now we’re seeing, things come through that we don’t, and the immune system is just freaking out a little bit.
You know, things like proteins that maybe are larger than they should be coming through. Other chemicals or other molecules are coming through. I like to think of it, you know that game cornhole that you play in the summer that has holes, and you throw the beanbag in? There you go.
That’s, that’s your small intestine, and it’s not happy. , So here we see that immune activation. , There can be, like, low levels of inflammation. And we’re not talking about, like, inflammation where we run somebody’s C-reactive protein, and we see the number high. That’s not… This is not systemic inflammation.
Although to make things complicated, you can [00:23:00] have a DGBI and systemic inflammation at the same time. , But this process interestingly, , will further contribute to visceral, that visceral hypersensitivity because we’ve got now altered receptor sensitivity in the gut. So, you know, each mechanism can, like, kind of lead into, lead into the next here.
We don’t see them all in isolation.
Dr. Christina Carew, ND: And we have a whole podcast on leaky gut coming up, so.
Dr. Dominique Vanier, ND: We do. That’s right.
Dr. Christina Carew, ND: Stay tuned.
Dr. Dominique Vanier, ND: Dysbiosis. Let’s talk about that. So this is, , point number four of these mechanisms. Anybody wanna chat about that part?
Dr. Christina Carew, ND: Sure.
Dr. Whitney Baxter, ND: Yeah.
Dr. Christina Carew, ND: Yeah, we were, we were just talking about this- Yeah … actually before we started. We were talking about- Mm-hmm … how, you know, people with different diets and different screening tools will see different microbiota patterns, and certainly this has something to do with culture and, and diet as well.
It’s a huge component of it. , And, and when we think about altering our [00:24:00] microbiota, people often think about adding in more probiotics, and it’s often a recommendation that j- is generally kind of blanket given to people, but certainly probiotics are only two of our good bacteria categories, um, generally represented.
Then there’s… And there’s many, many, many. So if anyone, , listening has ever done a stool test or done a viome or a biome or any of those kind of tests, they realize there’s pages and pages and pages. And so certainly we only are just starting to know. , But when we have dysbiosis, we generally see it as, you know, less of the good bacteria and more of the bad bacteria.
, But in some cases, more of the good bacteria can also be a problem. So you can have too much of a good
Dr. Dominique Vanier, ND: thing. Mm-hmm. That’s a good point.
Dr. Christina Carew, ND: Yeah. And so can the bacteria be playing a role? For sure. That’s a potential possibility, but it’s not the only possibility. And so if you have done work where you’ve, increased or [00:25:00] updated or, you know, replenished your microbiome and you still don’t feel better, it’s not that that wasn’t the thing, it’s just maybe there was more than one thing.
Yeah.
Dr. Whitney Baxter, ND: Mm-hmm. Mm-hmm. And sometimes taking antibiotics, on the flip side, you feel way better because now all of a sudden you’re not getting the fermentation gas production, which is normal, and so that visceral hypersensitivity is happy- Yeah … ’cause you’re feeling less things. So it makes sense to draw the conclusion of, “Oh, I, it was my microbiome,” where, yeah, with these things, there’s more than one pathway that’s causing that discomfort.
Yeah.
Dr. Dominique Vanier, ND: Yeah. And then, to make it even more complicated, right, we know that, , a lot of patients, when they’re having a flare-up of their DGBI report, cognitive challenges of just I feel more tired, I got more brain fog. Yeah. And then we can see improvements, and when we take antibiotics, I’m like, “Oh, I feel like I have more energy.
That’s strange,” right? , These kind of like downstream effects.
Dr. Whitney Baxter, ND: Yeah.
Dr. Dominique Vanier, ND: , I’ll go over the last point. So altered central nervous system processing, we’ve talked already a lot about that. We know that the [00:26:00] psychological stress can disrupt , the gut, like our gut pain threshold, impermeable mucosal secretory and barrier functions.
Again, it’s all kind of related to the things we’ve just spoken about. , But what is interesting is we know from the research that strong emotions can also stimulate, this contractility and induce, defecation and diarrhea., When somebody has a DGBI and they’re having a really, , a highly emotionally charged day, let’s say work is really stressful, we may be more likely to see them having to run to the bathroom.
An example is, of this is, if somebody even has anxiety leaving the house for work or leaving the house for an appointment, that, that acute stress on its own sometimes is enough to cause them to have to use the bathroom urgently, and that all has to do with this altered central nervous system communication between the brain and the gut.
Dr. Christina Carew, ND: And some of that is normal. It’s normal to be nervous.
Dr. Dominique Vanier, ND: Yes.
Dr. Christina Carew, ND: It’s normal sometimes that nervousness triggers intestinal problems, but it’s also a bit different. I had a coup- a patient a couple weeks ago who,, just didn’t [00:27:00] eat for two days before coming in because they were so worried they had to travel into the office that there wouldn’t be a bathroom on the way, and so they just didn’t eat so they wouldn’t have to go to the bathroom.
And, that’s not a normal response. Most people are able to eat and still be able to attend appointments.
Dr. Dominique Vanier, ND: Yep.
Dr. Whitney Baxter, ND: Yeah.
Dr. Dominique Vanier, ND: And that’s something- Mm-hmm … you know, Whitney, you’ve spoken about a lot, right? Which is, the consequence of having a chronic digestive condition into, how we engage socially, whether it actually leads into ARFID or avoidant restrictive food intake disorder, and it doesn’t even need to be a gut condition.
I’ve seen this happen in patients who are really trying to manage their blood sugar because they’ve been diagnosed with diabetes, and they won’t take medication at this point. Where it’s- Yeah … oh my gosh, is this one bite going to be affecting my blood sugar? And there’s this fear response and this change i- in our relationship with food that can happen.
Dr. Whitney Baxter, ND: Yeah.
Dr. Christina Carew, ND: Weight loss. It’s another one.
Dr. Whitney Baxter, ND: Yeah.
Dr. Dominique Vanier, ND: Yep.
Dr. Whitney Baxter, ND: Yeah.
Dr. Christina Carew, ND: Or trying to do- Yeah, and- … fasting mimic, , or fasting or all the [00:28:00] whatever the rage is on some of these other podcasts.
Dr. Dominique Vanier, ND: So on the topic- Yeah … of gut-brain, , connection, let’s talk kind of more about, practical takeaways, where we can talk a little bit more broadly, knowing that this isn’t specific medical advice, but more broadly about what are some therapies that people can think about. Um, so Whitney, do you wanna maybe go over, what some of these gut-brain therapies are?
Dr. Whitney Baxter, ND: Yeah, and we’ve seen a lot of these in the research more. CBT is a big one, so cognitive behavioral therapy. It’s just really easy to study and set up groups and control groups, so it’s always in the research of a recommendation. But there’s a lot of groups that are in communities, and a lot of times they’re virtual now, which is really nice.
And for some, it’s focused on anxiety, but they’re seeing that this is really helping folks with DGBIs. Mm-hmm. . And the gut-directed hypnotherapy. So there’s more specific things to our gut now and just, like, deep belly breathing and,, guided, meditation is usually what it sounds like.
But it’s just-
Dr. Christina Carew, ND: Mm …
Dr. Whitney Baxter, ND: [00:29:00] rewiring your brain to let you know that your body is safe and that these are normal processes that are happening. You’re not in an alarm phase. You know, like leaving the house, you’re gonna be safe. Or if you map out the bathrooms on the way, like setting up tools to make your body feel safe so it’s not just this panic and flush of loose stools.
Mm-hmm. , So there’s a lot of tools. And anything that’s consistent is what’s been shown to be the most effective. So even if it’s just diaphragmatic breathing, deep belly breathing every single night when you get into bed, if that’s easy, perfect. Mm-hmm. It is really effective, and there’s good videos on YouTube and a lot of tools that I’ve sent to my patients to be like, “This is how easy it is.
Whatever you can do.” There’s apps, and just to make it consistent can be really effective.
Dr. Dominique Vanier, ND: Mm-hmm, mm-hmm. Yeah, it’s the regularity of the implementation that’s actually key there. Yeah. And then movement, we can talk about movement. [00:30:00] So we know, exercise definitely can target both sides of this equation, the gut and the brain.
, It can help with the natural contractions of the intestine, so it can definitely help with constipation by speeding things up. It can also move gas, so we can see sometimes, a reduction in abdominal distension and bloating and it does support more regular bowel movements.
‘Cause even for patients that have IBS-mix, so where they’re jumping from both constipation to diarrhea, is we need to keep things moving. So sometimes we can have… Actually, the issue can be the more constipation side, where then they’re, the body is trying to, move things on its own and we just jump back.
Movement on its own can really help in that area. , And then of course it addresses the gut-brain connection, so we can see, a lowered sympathetic fight or flight tone. It does enhance, the parasympathetic rest and digest activity over time. So some level, again, the consistency of exercise, really important for people who do have DGBIs.[00:31:00]
Dr. Christina Carew, ND: I would also say we have to think about n- not moving all the time. So- Mm-hmm … um, sometimes we also see that people are, like, kind of always racing and running around, and so they aren’t getting an opportunity for the rest and digest. So again, more isn’t always better. It’s like having a little bit of everything can be helpful.
I had a lady, who tried to, to do this, and she walked 20 kilometers a day. And so every day she walked 20 kilometers, which is amazing, except that she had to quit her job because she didn’t have enough time to walk 20 kilometers a day. She had a regularity in her stool, and part of that was from all the walking she actually had really hyper-contracted muscles, which also created- Wow
some constipation. So- Yeah … like, it’s back to that., Too much of a good thing is, can be too much. I don’t know about you guys, but people are always like, “Oh, I never eat like this.” Always say it in front of you because they think that you guys, like we have the ideal eating.
Yeah. And I was like, “We eat that stuff, too.” [00:32:00] Yeah. It’s like- No judgment here. No
Dr. Whitney Baxter, ND: judgment …
Dr. Dominique Vanier, ND: sort of
Dr. Christina Carew, ND: like everything has to come in moderation. Yes. And
Dr. Whitney Baxter, ND: like a shift in routine, too. I always ask, , with this flare, when this started happening, what changed in your life? Oh, I got more of a desk job. Yeah.
Or I started training for a marathon. Or sleep is off. , Change in movement or habits, which happens in life, but just being able to kind of connect the dots for your own body is really, it’s really helpful.
Dr. Christina Carew, ND: Mm-hmm, mm-hmm. I would say a third area can be food triggers. And even though we’ve had a podcast about, , not all triggers, food triggers are warranted, and we have ones about testing food triggers, there are things that might be causing more sensation, and reducing or removing those foods or can be helpful.
, Also adding foods in. So sometimes when, , people do try things like low FODMAPs for a long period of time, they are gonna get more runnier stool ’cause they don’t have any fiber in their diet, [00:33:00] or very limited- Right … fiber. And so it can also be the other way. Actually adding in some foods may also change your sensation and change the movement of things in the system, , because there should be a balance.
And so, having, you know, taking all the carbs out of your diet, which certainly has been a craze of late, or eating only meat, , can still make you feel more food triggers even though you’ve taken so many foods out, because your body is also still looking for all those other nutrients to help things move and contract and move along the way.
So always if you’re eliminating things, always have a reintroduction plan. Yeah. We don’t want everyone only eating four or five foods.
Dr. Dominique Vanier, ND: Yes.
Dr. Christina Carew, ND: It’s why the price of celery is so crazy, people.
Dr. Dominique Vanier, ND: Yeah. It’s, And it- yeah, it’s really about the personalization aspect, and that relates to supplements, too. And, , there are so many supplements, so we’re, you know, like, because we’re now talking about over 30 conditions in there. So there are definitely some very good [00:34:00] evidence-based supplements that can help.
They are not the only thing. And so choosing a supplement to address, you know, more the prominent mechanism could be, like, a good starting point. So for example, if somebody is having functional constipation or IBS constipation, we need to move the bowels a little bit better and support, or help with, that, that gastric emptying.
We wanna be looking more at, like, motility agents. But again, , there’s conversations around, you know, do we need to address more of the pain aspect? So things like peppermint oil. Definitely wanna look at what we can use or add in regarding the brain-gut connection and just calming the nervous system down.
That category of supplements is often referred to as nervines. And then,, for people that are having more of, , that reflux hypersensitivity or functional heartburn, we wanna look at that category of supplements called demulcents. So they, soothe the mucosal tissue. For example, slippery elm.
There’s so many of them. So it’s really about that, , personalization aspect where you work with your practitioner and also discussing, , what are the [00:35:00] most prominent or heightened symptoms that we’re experiencing. Then of course, the goal is not to be on supplements forever. They’re just a tool.
And they’re… And then eventually, just like diet, we wanna look at can we, have the lowest number in somebody’s supplement regimen.
Dr. Christina Carew, ND: I would say we should also add medications into this category. Yeah. So there are things in the medication world that might help someone get further along faster to just feel more normal and calm some of the, anxiousness around the pain and sensation that might be worth considering.
And so, it’s not that, that it’s only supplements that can help or only food or only diet restrictions, that there’s lots of tools, and some of those include, pharmaceutical medications, even for a short time.
Dr. Whitney Baxter, ND: And I’ll j- I’ll just say, too, if your doctor’s recommended something and you… Just ask more questions about it, ’cause now there’s a category called neuromodulators, and what they are are the anti-anxiety or antidepressant medication.
However, they’re a lower dose [00:36:00] for a specific mechanism which is working through, the pain and visceral hypersensitivity. So even though they’re the same medication, it’s just a different mechanism that can really help DGBIs. So if a doctor has recommended this to you but you’re like, “Oh, I don’t have anxiety,” or…
Just ask more questions around why they’re recommending them and the dose and the plan, because they can be really, really effective If that’s what’s best for your body.
Dr. Dominique Vanier, ND: Yeah. Yeah.
Dr. Christina Carew, ND: Yeah. Sometimes it’s just like getting a reset in, right? You need a reset- Yeah … to get out of this loop that your body learned to start over again.
It’s no different, than you put… I, I did this the other day. I put my charger in a different drawer ’cause I was like, “Oh, it makes more sense to be over here,” and I keep going back to the original drawer and I can’t find it. And then I’m like, “I moved it. Where did I move it to?” And so until my brain relearns that’s not where I’m keeping it anymore, it’s gonna keep going back to those i- old patterns, and that’s what some of these tools can do.
They can help you get out of [00:37:00] this pattern so that your body can operate in a, a less hypersensitive or hypervigilant way.
Dr. Dominique Vanier, ND: Mm-hmm. Mm-hmm. Yeah, those are really good points. So, okay, so to close, we wanna, , help people be able to talk to their practitioner, when they feel like they’re possibly experiencing a DGBI.
It is true that a lot of people will walk out of visits feeling like they maybe didn’t quite say what they needed to say, or maybe they feel dismissed because their tests have come back normal, and it’s , then what? , And you don’t necessarily need to have the right words when talking to your doctor.
You really just want a clear sense of what you’re experiencing, what you want help with. A good plan, regardless of who your practitioner is, naturopathic doctor, family doctor, often, co- co-managing somebody’s care. But a good plan should feel collaborative and not dismissive. , Based on your experience, what are some things that a person who thinks they’re having a DGBI could say to their practitioner?
Dr. Whitney Baxter, ND: ” I’ve been noticing a pattern with my symptoms, like [00:38:00] bloating after meals or loose stools if I’m nervous or if I have to go to work. Can we look at might be… what might be driving that, like digestion or gut motility or…” And just ask them really specific things that you’re experiencing. And I think the bottom line is, “My symptoms are really affecting me and concerning me.
What’s a good plan, or do you have any recommendations on a referral or a dietician or some- something, a tool?”
Dr. Christina Carew, ND: Yeah. Yeah. You can even say, ” Do you have any other patients that are like this, and what are things that they have used, or, or what are people that they have seen? Do you know of other people that might know more?
I understand that this might not be your area of expertise.” Giving them both an out, but then also asking them to actually think about it from a, , who else could you see, , can be really helpful. , And they may not know. They may say, ” I actually don’t know. I don’t have any idea of who else you could see.”
But- A- not just asking your [00:39:00] practitioner that, asking your friends, asking your colleagues. Certainly there’s a million Facebook groups that everyone who’s listening to this podcast is a part of. Ask those people. They’ve already screened through the good practitioners and can say, “These are the ones- Yeah
that have been able to help,” or, “This is what this person told me. Maybe, look down this area or travel.” Our healthcare is not linear. It’s always changing and moving, and the only way we can get better ideas is literally, crowdsource them. And we even do that. We do that with each other.
Yeah. Because we all see different- Mm-hmm … things on different days, and your brain is in a different spot. And someone’s like, “Hey, remember that thing we did in first year of naturopathic school? Maybe that actually would work now.” And those do they do happen.
Dr. Dominique Vanier, ND: Yeah, it’s interesting. Yeah, you get to a point in practice, and I think regardless of your profession, where it’s like there’s so many people you see that are not textbook.
There’s… It’s just so much more, it’s so much more complicated. And it’s really not, black and white, right? Mm-hmm. Um, o- okay. So, [00:40:00] in conclusion, let’s just do a quick recap. So for our listeners, it’s really important to know that normal tests do not mean that nothing is wrong. In disorders of gut-brain interaction, the issue is function.
It’s not structure. So, you know, your symptoms are real, even if they don’t show up on labs or imaging. , And that should feel hopefully validating because I think a lot of people under this category of conditions have historically felt invalidated because they have gone and seen their practitioners, and their doctors have maybe said, “Yeah, everything’s, everything’s okay.
You’re all good,” when they’re, they really, they feel like crap. What about, Let’s do just a few more recaps here. So let’s… Yeah, go ahead. Jump in.
Dr. Whitney Baxter, ND: So bloating isn’t just about food. Clearly, we have many podcast topics on causes of bloating or con- contributors. So bloating can be driven by moti- motility, that visceral hypersensitivity, breathing patterns, the gut-brain connection.
It’s [00:41:00] not always just what you ate, even though it makes sense to think that way. But hopefully we’ve kind of introduced you to some other ideas that could be causing it.
Dr. Christina Carew, ND: Yep, there’s rarely one single cause, and there’s rarely also one single fix. So one problem is not one solution, as much as we would like it to.
There’s no magic supplement that will make everything go away, but there might be a combination of things that make things a lot better.
Dr. Dominique Vanier, ND: Mm-hmm.
Dr. Christina Carew, ND: , And every treatment means, , layers that both you try and then later grow through or abandon in a- an effort ’cause you’ve moved on. So it’s not that you are forever going to do this one thing.
It’s that in this moment at that time you’re doing something that hopefully is helping.
Dr. Dominique Vanier, ND: Mm-hmm. Mm-hmm. Yep. , The microbiome is only part of the story, like we talked about, but it’s not, it’s not the whole story. So focusing really just on this area, like fixing your gut bacteria, can miss other key drivers, , of symptoms.
[00:42:00] So we wanna look at, take a step back and look at the whole picture.
Dr. Whitney Baxter, ND: Your gut and your brain are constantly talking, not necessarily in a language that we can understand. But remember that your stress, your emotions, , the day-to-day, that nervous system is directly impacting your digestion. So this isn’t just in your head.
It’s a true, it’s a true sensation. It’s a true response that you’re experiencing.
Dr. Christina Carew, ND: You have more treatment options than you think. So despite the fact you’ve heard from many people to have more fiber and, and take a probiotic, those are not the only gut-supportive practices. There’s lots of things, both physically, nutritionally, , movement, strategies with medications and supplements, and lots of evidence for all of these, depending on what you need to improve your symptoms.
Dr. Dominique Vanier, ND: Yep. And then lastly, you know, our listeners, if you’re experiencing any of this, you deserve a plan, so not just reassurance. And a- again, if you’ve been told everything is [00:43:00] normal but you still feel like crap- … , it’s really reasonable to ask for next steps. Ask for a second opinion. Ask for a referral to a GI specialist.
Ask for, ask for a referral to a different GI specialist. Work with your naturopathic doctor. Really, if there’s just, , one thing you take away from this episode, ’cause this is under the category , of our bloating, of our bloating series, but bloating is not random. Chronic bloating is definitely not random.
It is not something that you just have to live with either. You wanna think of it like a signal, and there are ways to work with your body to improve it. Okay. Thank you for joining us on this episode about bloating and disorders of gut-brain interaction. We hope you found it helpful because as you know, better gut health changes everything.
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