May 2021 Diet & Digestive Health (DDHChat) Twitter Chat with IFFGD, and Lauren Cornell, MS, RD

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2021 May DDHChat: GI Health Management Tips

IFFGD – introductory tweets and remarks: 

The views and experiences shared by our participant are their own and do not reflect the official positions of IFFGD. Each patient is different. Always consult with your healthcare provider or a registered dietitian (RD) on a diet treatment plan that is right for you. Information and resources shared during today’s chat should not replace the medical care that you are receiving. And as a reminder, be sure to include #DDHChat in each of your tweets.

IFFGD – welcomes everyone to the chat and introduces co-host Lauren Cornell, MS, RD:

Welcome to our May #DDHChat on GI Health Management Tips with lead host Lauren Cornell, MS, RD. The digestive system, also known as the gastrointestinal (GI) tract, plays a significant role in our overall health. Its job is to receive food and break it down into essential elements, making them available to the body so that it can exist and develop. Often, this function can be disrupted by many factors. For those living with chronic GI conditions many may experience a host of uncomfortable symptoms. For example, some of these symptoms might be abdominal pain, bloating, indigestion, and more due to factors that we will discuss during today’s chat. When you notice changes in your symptoms, it is important to communicate these changes with your healthcare provider. It is natural to have some concerns about finding the right treatment plan for you. For some, seeking support from a registered dietitian and developing a team with healthcare providers could help. During the next hour, we’ll discuss GI Health Management Tips and how to overcome challenges.

Today we’re joined by registered dietitian (#RD) Lauren Cornell, MS, RD to share her unique insights on GI Health.

IFFGD and Lauren Cornell, MS, RD Q&A:

Q1: What is “GI Health,” and how is it important to our overall wellbeing #DDHChat

Lauren Cornell, MS, RD: I would briefly define “GI health” as having a functioning GI tract that can digest and absorb nutrients and eliminate waste with regular bowel movements and without chronic symptoms that disrupt one’s quality of life. And I firmly believe one can achieve and maintain GI health regardless of having a GI condition or compromised digestive tract. That’s my favorite part about my job! The importance of gut health to our overall wellbeing is the reason I specialize in GI. For starters, ~70-80% of our immune system lives in our GI tract, so if your gut is not healthy, you’re not entirely healthy. It’s also really important to maintain health in the system responsible for absorbing our nutrients since nutrients are essential to life and sometimes even a mild deficiency can have large effects. If nutrient absorption is compromised, there’s bound to be issues. But also, GI health is important for mental health (we’ll talk about the gut-brain interaction), psychosocial health, bone, and skin health, etc. The GI tract is really at the core of holistic health and must be considered in treating most health concerns. #DDHChat

Q2: How does hydration play a role in our GI health, especially for those living with chronic GI disorders, and can you provide tips to help patients increase their hydration? #DDHChat

Lauren Cornell, MS, RD: I can’t say enough about the importance of hydration. Every function in the body happens in an aqueous solution (happens in water), so if you’re not sufficiently hydrated, simply put, your body doesn’t have what it needs to function optimally. And for GI health specifically, fluid + fiber help regulate bowel movements (BMs). You certainly want to work with a dietitian to ensure you’re approaching fiber in a way that works best for your individual needs but drinking more water is an easy action with tons of health benefits! Easy tips for increasing your hydration: get a water bottle you’re excited about (it really works!), associate daily time milestones with a certain amount of water consumption (e.g., finish 1 liter before lunchtime), and flavor your water with fruit slices. #DDHChat

Q3: Finding the motivation to exercise during a symptom flare can be challenging. What are some challenges that your patients often face, why is exercise important for Gut Health, and what tips do you have for our followers today?#DDHChat

Lauren Cornell, MS, RD: Exercise is important for GI health because it helps manage GI symptoms and mental health by way of releasing endorphins and acting as a stress release (think: gut-brain axis), but it also may encourage synergistic GI motility. Exercise also helps maintain GI health by providing us time to get out of our heads and into our bodies, which helps to reduce stress and anxiety. I find exercise to be almost meditative in that way. Some challenges my patients with GI issues face with exercising is fear of having an accident during exercise or increasing their pain/symptoms by overexerting themselves. Or the challenge of knowing when and what to eat before workouts to avoid symptoms. Motivating to exercise when experiencing a symptom flare can be tricky, especially when you’ve recently experienced abdominal pain or a bout of runner’s diarrhea. My first tip to getting back to exercise is to start slow and mild and stay close to home if running. Maybe you just set out to walk for 20-30 minutes/day in your neighborhood or do some gentle yoga at home that gets your body moving. It’s probably not best to plan to do a distance run or a HIIT workout when you’ve been symptomatic. Also, when in a flare, avoid twisty movements or exercises where you’ll be in a crouched or compromised position for longer periods of time (like spin or twisting yoga poses/ab exercises). Reducing or omitting high FODMAP foods or GI-stimulating foods before an exercise event can also help reduce symptoms during exercise. In general, I wouldn’t recommend consuming foods high in fiber, fat, or protein just before exercise, as you’ll be digesting those during your workout. Instead, go for easily digested carbs and give yourself 30-60 minutes to digest before starting exercise if possible. In general, don’t push exercise if you’re not feeling up to it. It’s ultimately most important to listen to your body and practice self-compassion. #DDHChat

Q4: Lauren Cornell MS, RD, what are the first steps for someone interested in adding dietary approaches to their treatment plan? #DDHChat

Lauren Cornell, MS, RD: Make an appointment with a dietitian! I can’t emphasize the importance of this enough. It will save you time, money, angst, and treatment fatigue and will preserve your nutritional status to consult with an expert on your individual needs. If you don’t have access to a dietitian, look for the RDN or RD credentialing after the author’s name of anything you’re reading, listening to, following on social media, or watching for nutrition tips. You could also start keeping a general log of your ins and outs: what you eat and drink, what your BMs are like (and when they happen), how much water you’re drinking daily, and what GI symptoms you’re having (and when). While there are known dietary changes that may help with GI conditions, nutrition is highly individualized, and there really is no blanket approach that works for one symptom or condition. #DDHChat

Q5: Abdominal pain, bloating, and indigestion are just a few symptoms that may develop due to disruptions in the digestive tract; how might dietary modifications alleviate these issues?
#DDHChat

Lauren Cornell, MS, RD: Dietary modifications can certainly help manage GI symptoms, though I think it’s also important to note that food isn’t the only treatment modality to consider. When evaluating someone’s diet, I look at intake of fluid and fiber, GI-stimulating foods, FODMAPs, and/or signs of an imbalanced diet, under eating (malnourishment), or consuming large quantities in one sitting, which can tax the GI tract to name a few things. #DDHChat

Q6: Inflammation can dramatically impact our overall health. What are some GI disorders associated with inflammation, what types of foods can aid in decreasing inflammation? #DDHChat

Lauren Cornell, MS, RD: First, it’s important to delineate between inflammatory and non-inflammatory situations. Pain and discomfort and/or the physical appearance of “swelling” that’s actually abdominal distension/bloating do not necessarily = inflammation. That is a common misconception. Inflammation must be confirmed. The presence of GI inflammation can be confirmed by elevated C-reactive protein levels (not GI-specific), fecal calprotectin (a stool (fecal) test that is used to detect inflammation in the intestines), visible inflammation during a scope, confirmed through biopsy, etc. The confirmed presence of inflammation may lead to a GI disorder diagnosis  associated with inflammation, such as inflammatory bowel disease (Crohns disease or colitis), gastritis, or esophagitis, to name a few inflammatory GI conditions… Inflammation may not be present or the cause for symptoms in functional GI disorders. If you do have an inflammatory GI disorder, curcumin (turmeric) at pharmaceutic has been shown to have antioxidant and anti-inflammatory effects as well as foods high in omega-3 fatty acids (salmon, arctic char, flaxseed, walnuts…). And I’d strongly recommend working with a dietitian to determine whether there are foods that might be triggering your inflammation (such as in EoE) before just eliminating foods from your diet without good reason. Unnecessary dietary restriction is common among people with GI disorders, and it can create another host of health issues (malnutrition, disordered eating, psychological issues). Remember, those foods carry vital nutrients that get eliminated as well!
 #DDHChat

Q7: May is Mental Health Awareness Month. Depression and anxiety are just two aspects of mental health. What role do these factors play in overall GI health, what symptoms develop, and can you provide tips to help patients manage these aspects of mental health? #DDHChat

Lauren Cornell, MS, RD: The gut-brain axis, thought to be at the core of functional GI disorders, is a bi-directional communication pathway between the brain and the gut meaning the two may cause (or alleviate) symptoms in one another. If you’re  anxious, you may feel GI symptoms and vice versa. And GI symptoms associated w/ depression and anxiety might be bowel irregularities (e.g., sense of urgency & diarrhea OR constipation when you’re anxious), abdominal pain or cramping, nausea, acid reflux, etc. Symptoms manifest differently for everyone. That said, managing your mental health is just as important as managing your GI health. One cannot be managed and healthy without the other. Establishing daily habits that tackle both is the easiest way to manage and prevent flares. Maybe you meditate every morning, which helps reduce your overall anxiety and also your GI symptoms. Or from a food perspective, perhaps reducing GI-stimulating foods like caffeine or high-sodium foods help to reduce sense of urgency that then reduces your anxiety. Neuromodulators are also a treatment option for IBS due to the effects of the gut-brain interaction, which may be something to discuss with your doctors if you notice that your mental and GI health are closely correlated. #DDHChat

Q8: Inadequate sleep and stress can alter the function of our digestive system. Why does this happen, and what are your tips to help patients improve sleep quality and decrease stress? #DDHChat

Lauren Cornell, MS, RD: Circadian rhythm (is a natural process that regulates the sleep-wake cycle and repeats roughly every 24 hours) plays a major role in hormone regulation, and hormones play a major role in regulating the functions of the GI tract, hunger/satiety cues, etc. So, if our sleep and circadian rhythm are disrupted, potentially our GI function is as well. But also, a great deal of tissue and cell repair and regeneration occurs while we sleep, so if we miss out on this vital time of rest, our intestinal lining, enzyme production, etc., may suffer as a result. I often have my patients check out sleepfoundation.org to learn more about what happens when we sleep because it creates an a-ha moment for how important it is for our  health that we prioritize sleep. (Social media: @sleepfoundation)

Tips I use to improve sleep: limit bedtime media, keep consistent bedtimes and wake times, have a bedtime routine that soothes all senses (lavender spray, white noise, comfy sheets, etc), and have compassion for yourself if you can’t sleep. It happens.  #DDHChat

Q9: Medical follow-up and health screenings are very important for those living with chronic illnesses like GI disorders. What types of medical follow-up and screenings are critical for patients with GI, and why are follow-ups important? #DDHChat

Lauren Cornell, MS, RD: Annual wellness exams and complete blood work/urinalysis (and regular women’s health exams, ladies) are always recommended. It just provides us with information and helps us to understand our body trends at the very least. For chronic GI conditions, I punt to the individual’s gastroenterologist to determine which screenings are necessary, though I always recommend that my patients familiarize themselves with the standard and recommended routine screening/follow-ups for their condition. For example, if you have celiac, have your celiac serology (anti-DGP IgA & anti-tTg IgA) and bone density checked at least annually, and small intestinal biopsy at least every few years to rule out refractory Celiac and ensure no gluten is sneaking into the diet. I’d also say in general and for any GI condition – functional or not – it’s a good idea to schedule a follow-up anytime symptoms or the body’s functions change from your normal trends without explanation or significantly. Listen to your body and don’t wait. Get checked out. #DDHChat

Q10: What other modalities might patients benefit from that help improve their GI health? #DDHChat

Lauren Cornell, MS, RD: For functional GI disorders, a few of my favorite alternative modalities include diaphragmatic breathing, biofeedback therapy, abdominal massage, hypnotherapy, meditation, and physical therapy with a pelvic floor specialist (for pelvic floor dysfunction) to name a few. My patients also find ginger chews helpful for upper GI symptoms (acid reflux, nausea) and entercoated peppermint oil for lower GI symptoms (bloating, gas, and pain associated with bloating). #DDHChat

IFFGD – final tweets and remarks:

There are many approaches to improve your GI Health and working with your healthcare team to find the best treatment plan for you is the first step to help you manage your GI symptoms. It is important to understand the role that food, stress, hydration and much more plays in our GI Health, but with help and support for your healthcare team you can begin to enjoy life again. To learn more about this topic and more from Lauren Cornell, MS, RD, visit https://www.laurencornellnutrition.com 

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