Mind Your Gut | Dr. Megan Riehl

June 10, 2024

The conversation revolved around the intricate relationship between the brain and gut, exploring how psychological factors can impact gastrointestinal health and how gut health can influence mental well-being. Dr. Riehl emphasized the importance of cognitive behavioral therapy and other psychological interventions in managing gastrointestinal issues, while Dr. Riehl highlighted the need for a holistic approach to address the interconnectedness of gut health and mental health. Additionally, they debunked common misconceptions about gut health, such as the notion that burping or farting a lot is a sign of GI problems, and the belief that probiotics must be taken when taking antibiotics. The conversation also touched on the potential of psychology and cognitive behavioral therapy in managing irritable bowel syndrome, with Dr. Riehl sharing experiences with diaphragmatic breathing and relaxation techniques to reduce symptoms such as cramping and urgency.

Natalie 0:00
Hi, and welcome to the Invigor medical podcast, where we’re going to walk with you on your journey toward optimal health, performance and well being. My name is Natalie.

Derek 0:09
And I’m Derek.

Natalie 0:09
And we’re going to be your hosts on this journey. In each episode we share insights from top professionals on physical, mental and emotional health. With that said, let’s dive into today’s podcast.

All right, today, we are so excited to have with us. Dr. Megan Riehl. Megan is a expert health psychologist specializing in gastrointestinal and chronic health conditions. Dr. Riehl is an associate professor of medicine at the University of Michigan, fellow Hoosier and co author of Mind Your Gut, the science based whole body guide to living well with IBS. Welcome to our show. Dr. Riehl.

Megan Riehl 0:44
Thank you for having me.

Natalie 0:46
Oh, we’re so excited to have you.

Derek 0:47
So excited. Yeah.

Natalie 0:48
Yeah, we have a lot of conversation surrounding gut health. I feel like more and more it keeps coming up…

Derek 0:52
Yeah.

Natalie 0:52
…with a lot of the guests that we have on and I think the last guest that we had on I mentioned that it really excites me because I think that there’s not been enough conversations around gut health for such a long time. And the more science and research that comes out, the more we’re learning how pivotally important gut health is to literally everything that it’s you know, the second brain of the body. And so I’m very excited to hear from you knowing that you’re coming from the leaning of psychology as it relates to gut health. That’s a super cool, I don’t know, I’ve really considered it in that manner before. Before we really dive in, and geek out like we love to do. I’d love to hear a little bit from you on your history and your background and and how you got here to what a field that I didn’t even know was a thing, honestly.

Megan Riehl 1:40
Yeah, yeah. So psycho gastroenterology. Say that five times fast. And if you would have told me that I would be you know, an expert in this area. When I was in graduate school studying to be a clinical psychologist, I probably wouldn’t have believed you. So you know, who would think that treating IBS everyday as a clinical psychologist would be the path but but here I am. Here it is. And, and the path really is that I studied to be a clinical psychologist, I have a doctorate in a master’s degree in counseling, and then clinical psychology. And then I did a fellowship, which as a psychologist, you have to do at least one year of I did two because that’s when I really started to dive into the field of gastroenterology. And, and really where we are is that we use psychological interventions that have been tailored to address the way the brain and the gut communicate to help patients manage their gastrointestinal issue.

Natalie 1:40
Wow.

Megan Riehl 2:42
So we we utilize, you know, things that I studied early on, like cognitive behavioral therapy, to treat patients with depression or anxiety or other mood symptoms.

Natalie 2:52
Sure, sure. What you would expect,

Megan Riehl 2:53
But, what you would expect, yes. But the science has really found that we can tailor those types of psychological interventions to hone in on specific health issues. And my area being Gastroenterology and people really respond to this multidisciplinary care approach. So that’s kind of what led me to then the University of Michigan where we have a fully integrated behavioral health program in our gastroenterology division. So even in this respect, there are three gi psychologists in our division. We are faculty members of gastroenterology, we aren’t faculty members of psychiatry or psychology.

Natalie 3:37
That’s crazy and cool.

Derek 3:39
Very cool.

Natalie 3:40
Yeah.

Megan Riehl 3:40
So it really helps our patients to not feel like you know, their diagnosis is in their head. A lot of patients that have a diagnosis and I’m sure we’ll dive into this in a little bit, but a diagnosis specifically IBS have been made to feel like you know, there’s nothing organically wrong with you, you did a colonoscopy, there’s no cancer, there’s no you know, organic disease, it’s IBS, good luck. You know, watch what you eat. Don’t get stressed and hope when you eat, you know, you can stay out of the bathroom. But you know, that’s not enough for people living with this diagnosis and many other GI diagnoses. And we find that a combination of our behavioral therapies, nutrition therapy, a good gastroenterologist to provide medical care, that’s what really helps patients to feel a lot better.

Natalie 4:32
Wow, I’m like it’s so it’s kind of really so far to the realm of anything I’ve ever heard or thought about that. I’m almost like struggling to collect my thoughts and like get into question mode. But the first thing I thought about when you mentioned IBS, but you said other gastroenterologist, gastric pathology gi do that. Let’s just say myself that I’ve been struggling with words this week. You know, it’s been a great week and a lot of ways, but also my brain is a little stretched from this week. It’s been been Ciao Anjan really, really great ways. But I was reading to my kids last night, it was a stroke hole I kept, I was going. And I never do that. So anyway, we’re gonna go back to Gi. That’s what we’re trying to talk about. And you mentioned IBS. So I’m wondering if you could list some other things that might be included, like I immediately thought of like maybe like Crohn’s with celiac, come up, come into play with that, like,

Megan Riehl 5:19
Yes. So there are different pathways, right. So Crohn’s disease falls under a diagnoses of inflammatory bowel disease, there’s also ulcerative colitis and proctitis. And so with that type of a diagnosis, the way somebody like myself, a GI psychologist would fit in, is helping people manage the long term aspects of of that disease. So this is different from irritable bowel syndrome, which is- uh, falls under the category of disorders of gut brain interaction. So it might be helpful.

Natalie 5:51
I didn’t even know that.

Megan Riehl 5:52
Yeah, so these diagnose- IBS used to be, you know, falls under the category of what we would use to call functional bowel disorders. And, and again, the difference between a functional bowel and then something like inflammatory bowel disease is that with IBD, inflammatory bowel disease, there’s actual organic disease that’s happening, and it can happen easily from mouth to anus.

Natalie 6:16
Okay.

Megan Riehl 6:17
And a lot of times patients with IBD require medical management, they need a medication to get the disease under control to prevent longer term effects. And so the pathway to that diagnosis can sometimes be long, and sometimes a patient has gotten a diagnosis of IBS first. And then you know, through later workups, they identify that it actually is inflammatory bowel disease. So there’s lots of different ways that we address psychosocial care in patients that have an IBD. You mentioned celiac disease, that’s another diagnosis where the medical treatment for that diagnosis is a gluten free diet.

Natalie 6:59
Sure.

Megan Riehl 6:59
For Celiac disease. And depending on when you get that diagnosis, it can have profound effects on your psychosocial functioning.

Natalie 7:07
Sure.

Megan Riehl 7:07
And you know, kind of, how do I live life following such a restrictive diet, which you can, you can definitely do it. But, but we can help, you know, connect people with support resources and expert registered dietitians that can help from a nutrition therapy perspective. But all of these diagnoses really benefit from a team approach. And, and that team oftentimes does include, you know, a gastroenterologist, primary care doctor, and then a dietician, a psychologist, the team can really kind of grow from there.

Derek 7:45
That’s great.

Natalie 7:46
Okay, sorry, I just want to say so I mean, you can go because it’s probably a bigger question. But like, I just had no idea I guess, to me, IBD, and IBS were the same thing, like I don’t know that I ever separated them, in my mind. So to hear you say that IBS, is a disorder between the brain and the gut and how they’re communicating.

Megan Riehl 8:06
Correct. And we call those disorders of gut brain interaction now.

Natalie 8:09
Disorders of gut brain interaction.

Megan Riehl 8:10
I kind of skipped over that before, but it used to be functional bowel. And in recent years, they’ve kind of changed that terminology, because functional makes us think what like, we’ll just function with it.

Natalie 8:22
You’re dysfunctional if it’s not working, right.

Megan Riehl 8:24
You know? Deal with it. But the reality of something like IBS is that the communication pathway between your brain and your gut is dysregulated. And there’s really kind of profound ways in which that dysregulation happens. So your motility, how fast or how slow things move through your system can be altered by a variety of things, whether it be stress, nerve sensitivity, nutrition, there’s a variety of ways that you’re motility can be altered and impacted. And then we also have the, you know, bi directional communication pathway between the brain gut known as the brain gut connection. And in people that have disorders of gut brain interaction like IBS, we know that the gut sends signals up to the brain, and there’s kind of dysregulation there, and then the brain’s interpretation of those signals down to the gut is also a bit dysregulated. And so that can lead to increased pain sensitivity. And again, those you know, trademark symptoms of diarrhea and constipation. So their symptoms are very, very real. It’s just a matter of the way in which we treat something like IBS, oftentimes includes a lot of different factors that like you, you wouldn’t necessarily think of. You wouldn’t think, Oh, I have IBS. I should go see a psychologist. And, and the reality is you can’t just see any psychologist or mental health provider. You really need somebody that understands and uses our, what we call brain gut behavioral therapies, which are evidence based therapies for the management of IBS as a part of a treatment plan that might include nutrition, pelvic floor, physical therapy, and a gastroenterologist, medical management.

Derek 10:18
That’s awesome. So just to summarize some of this, and maybe just to get some clarification up to this point, you’re essentially saying that there’s a variety of gastric pathologies that can happen. Some of them come from just the actual structure or the actual organ malfunctioning in itself, and that those need to be treated. And that kind of falls under the functional category. Is that correct?

Megan Riehl 10:41
When there’s disease, so actual disease, then that would fall under more of the, like inflammatory bowel disease or celiac disease.

Derek 10:52
Yeah. And so then the other option is essentially something that has more of a neurological base that then is affected potentially, by stress levels, or the the parasympathetic or sympathetic nervous system kind of firing up in different ways. Is, is that kind of, is that correct?

Megan Riehl 11:08
In a way? Yes. So we can come into an IBS diagnosis, you know, even from a post infectious perspective. So somebody that goes to vacation, they come back a week later, either on vacation, they’re in the bathroom nonstop, they’re like, oh, like I just, you know, my gut is terrible. And then they come home and it doesn’t get better. They may be something where either it was something they ate- a parasite, you know, some kind of an infection got into their gut microbiome and altered things. And then they can have what’s called post infectious IBS.

Derek 11:48
Interesting.

Megan Riehl 11:48
And so other other times we can be diagnosed with IBS at childhood, you know, the kids that have the constant tummy aches and and ultimately then end up with a diagnosis of IBS. And then we can, you know, be adults and and have that diagnosis kind of come up. So the pathway to IBS is different for everybody. But the same is really true for other GI diagnoses as well. So inflammatory bowel disease can be diagnosed along the lifespan. And same with you know, other well known diagnoses such as celiac disease, or GERD.

Derek 12:28
Great, so it sounds like essentially people that have these issues. You’re- you specialize in this so that you can come in and you have a very unique set of tools that you can help them with like a very holistic kind of treatment care approach, where they’re working with the dietician, they’re working with their PCP, they’re working with, you know, someone that specializes in gastric conditions, but you come in with another set of tools that can help ameliorate a lot of things on the, on the psychology, psychological end as well.

Megan Riehl 12:58
That’s right. That’s right. And sometimes the psychological therapy is basically so like, gut directed hypnotherapy is something that I specialize in. And it, it helps patients that have been refractory to other IBS types of treatments. So patients that have failed medication, they failed nutrition therapy, they’re just not getting better. Gut directed hypnosis is effective in between 66 and 80% of those patients.

Derek 13:25
Holy cow.

Natalie 13:25
Wow. So meaning it’s just, you’re saying gut directed hypnosis, but it’s just hypnosis that’s focused toward the gut.

Megan Riehl 13:32
Correct, correct.

Natalie 13:34
Wierd. That’s so crazy.

Megan Riehl 13:35
Well the brain and the gut. So giving, suggestion…

Natalie 13:38
Right, right of course.

Megan Riehl 13:38
Exactly.

Natalie 13:39
Yeah. Wow, that’s so fascinating. Okay, we want to dive in, you know, to some details here, but maybe just take a moment for our listeners to help them understand- help all of us understand why gut health and gut microbiome and all of this is so important. You know, maybe, you know, um, because I’m guessing there can be varying levels of the intensity of some of these conditions that, you know, somebody is feeling some discomfort or noticing, you know, regularly having these issues, but it’s not enough to like really put them out. So like ‘Eh, no big deal.’ But maybe explaining why, why it’s so important for us to have good gut health.

Megan Riehl 14:15
Yeah. So, you know, gut health matters for all of us, and things that can impact our gut number one are things that we all do we have to eat, right? So if you’re finding that, you know, maybe you’re not pooping regularly, or maybe if you’re going too much, that may be a sign.

Natalie 14:34
That’s a good question, though. Because there’s a lot here a lot like what is ray- what is regularly, right?

Megan Riehl 14:39
Now, that varies for everyone. But most people ideally are going to get up in the morning and within about the first 30 to 60 minutes, they probably are going to get an urge to go. Especially like if you’ve had that first morning coffee, and you get an urge to go that’s normal. That’s healthy. That’s um, your gastro colic reflex that’s working for you. And so it’s really important to not ignore that. So for anybody that’s a little bit shy, and they’re in the office, and they get that urge. And they’re like, No, I don’t want to go in. That’s really- we dissuade you from doing that. Because that’s just your body giving you its signal and that you want to go and you know, get the job done and on with your day. Now, some people might go back for a second bowel movement, maybe after lunch, or maybe after dinner, and that’s, that’s fine. That’s fine. But if you’re going multiple times a day, and you have abdominal pain, that’s not, we want to get that checked out.

Natalie 15:38
Yeah.

Megan Riehl 15:38
If you’re not going, so if you go 3, 4, 5 days without going to the bathroom…

Natalie 15:44
I cannot fathom.

Derek 15:45
I can’t even imagine.

Megan Riehl 15:46
That’s not also normal. Some people can go…

Natalie 15:49
That’s got to be uncomfortable.

Megan Riehl 15:50
Some people can go three days, actually. And that’s their normal, they go once, you know, but But I, again, for speaking generally, if you’re going multiple days, without going to the bathroom, we want you to get checked out. And it’s it’s colorectal cancer awareness month.

Derek 16:08
Oh really!

Megan Riehl 16:09
Yes. 45 is the new 50.

Derek 16:11
And that’s the month of March, just to just to clarify, right? Because I think this is probably going to be…

Natalie 16:16
Yeah. Posted. So the month of March? Good to know. Yeah?

Derek 16:16

[giggles]

Megan Riehl 16:17
So I’ll say that again for you. So the month of March, highlights the importance of colonoscopy. So you may be hearing about that in recent months that, you know, colorectal cancer awareness is so important. It’s a preventable type of cancer. And it’s preventable by getting your colonoscopy, right?

Natalie 16:37
Wow.

Megan Riehl 16:37
So if you’re somebody of an average risk, meaning that, you know, you don’t have a family history of colon cancer, you’re having pretty normal bowel movements, you have no alarm symptoms, such as blood in your stool, or, you know, nausea, vomiting, then 45 is the new 50. 50 used to be when we get our first colonoscopy, it’s now 45. And if you do have a family history of colon cancer, then you really want to talk with your doctor about when you should get that, that colonoscopy. So, you know, I think that gut health matters for all of us, because what we eat, what surrounds us, our environment, it all impacts our gut microbiome. And gut microbiome diversity is important for all of us.

Natalie 17:25
Diversity in all things. [giggles]

Megan Riehl 17:26
Exactly. Exactly. So we want to be eating nutritious foods, we want to be mindful of, you know, how we treat our body, we only have one. And and also just generally, stress can impact us not only our gut, but our immune system. And so by no means am I like an a-hole who says Just don’t be stressed. Because how do we live in this world without being stressed?

Derek 17:51
Right.

Natalie 17:51
Right. For real.

Megan Riehl 17:52
But have you no awareness of your stress? And if it’s really high, and you’re having bloating and abdominal pain and follow fluctuations, that may be an area that maybe you want to kind of look into.

Natalie 18:06
Yeah, that tracks. It totally makes sense. Okay, so now I’m trying to think how do we dive, where do we go first, right? Next…

Derek 18:14
I do, I do have a question. So one of the things that you talked about-I had a friend a while back, I won’t name him. He told, like at one point, he told me he’s like, Yeah, I can only, I can only you know, use toilet, I can only poop at home. And he’s been, he told me he’s like, there’s times where, like, I’d be out camping, or I’d be on some like, school thing and I wouldn’t use. Yeah, I wouldn’t even poop for like three days. And I’m like, Dude, that’s, that’s insane! I can’t, I can’t imagine that. And so, so I’m guessing that this is, I don’t know how common this is for people to experience that type of discomfort. You know, obviously, it’s like, there are times when like, you’re on a road trip, and you’re going into the, into the gas, bathroom station, and you’re like, this is nasty. And you’re like, maybe I’ll go to the next one. But like, you know, for the most part, I think that a lot of people can kind of go through that. But as a, as a psychologist in this field, how would you work with someone with that type of condition to kind of like help them overcome that?,

Megan Riehl 19:18
So that’s a perfect example of things that we help patients with. Is, you know, anxiety drives avoidance. And so what he’s describing is he’s anxious to go into the bathroom, and he doesn’t, it’s embarrassing sometimes. Or we can perceive that it’s going to be embarrassing to, you know, have the things that happen in a bathroom happen in public. And, and so we’ll work with people to identify, you know, did they ever have a really negative experience where they went to the bathroom and like, did somebody make fun of them? Or, you know, is it a really small office setting or, you know, we work through “How are you thinking about this stressor?”

Natalie 19:57
It’s stressful.

Megan Riehl 19:57
And, and How do we maybe think a little bit more flexibly around how to cope with it? And so also organically, you know, is there any medical issue that we can address from a medical perspective? Are there any medications that he may benefit from to make his bowel movements a little bit more regulated. But in that instance, it’s oftentimes more so about addressing the GI specific anxiety, and giving them tools and strategies and resources to manage, you know, what we think could be really anxiety provoking, and helping them to recognize, you know, actually, I could handle this and, you know, if it’s a classroom of 26 kids, guess what 26 out of 26 are pooping, and your teacher poops too. And your boss poops. And you know, the Pope poops. Everybody poops.

Derek 20:46
Who is it? There’s a book by Trevor Noah, Born a Crime and in it, he actually says that the exact same thing. He’s like, everyone has to poop, even the Queen of England, right? And I love that like that that image burned in my mind. I’m like, great. Now, I’m just gonna be thinking about that for who knows how long. Yeah, but yeah, everyone does it. It’s something that connects us all.

Megan Riehl 21:10
I’ve never though about it as something that connects us all. That is a wild thought.

Derek 21:16
Yeah. Yeah.

Natalie 21:16
That we’re all connected. [laughing]

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Megan Riehl 21:58
And you know, it’s something that we just-We don’t talk about enough. And we certainly talk about it in my home. I have three little kids, two boys and a girl.

Natalie 22:07
Sure.

Megan Riehl 22:07
And you know, they’ll, they’ll fart, or they’ll talk about “I gotta go potty.” And I’m like, “Yes, buddy!” Like we all do it. Yeah, but yet, I see so many patients that have come in feeling embarrassed to talk about it. They’ll say like, “Oh, I know, you probably talk about this all the time. But I don’t talk about this ever. This is embarrassing. This is something we never talked about my family, this is something I feel shame about.” And so if people are carrying this around, imagine just the tension that that might produce…

Natalie 22:40
Sure.

Megan Riehl 22:41
In your poor little stomach. Especially if that’s as a child, and then we carry that as adults and, and so for some of my patients, just the opportunity to normalize that look, like, go to the bathroom. Don’t hide this. If you’re with a partner who makes you feel bad about going to the bathroom, that’s not the right partner for you.

For real.

You know? So we can still have modesty about ourselves, but like let’s not, you know, pretend like we’re not humans that have a digestive process.

Natalie 23:13
Yeah.

Derek 23:14
Yeah.

Natalie 23:14
Okay, so we’ve obviously talked a lot about poop. And like, you know, that being an indicator, maybe you don’t have good gut health, depending on how much or how infrequently you’re doing this. But I’m curious what are like some of the other markers for people to pay attention to, to suggest maybe they need to get their gut health checked out? And I want to, I think this is going to be really important for people to hear, because, in my experience, a lot, a lot of times people have been progressively deteriorating and how they feel at such a rate that it’s, it by the time it’s like, you know, almost bad or really bad, they’re so used to not feeling well, that it doesn’t stand out as something that could be a problem, right? And because I’ve heard so many people that are like, when they get a diagnosis, or they start, they change their diet and cut out gluten or whatever. And they’re like a new human because they’re like, “I did not realize how bad I felt.” So I want to make sure we take a moment to you know, beyond poop. And I think we’ve mentioned one or two other things, to talk about, like what are some of the markers that people should pay attention to? To know, hey, you know, it’s time for me to go get checked out and see, see what else might be going on here.

Megan Riehl 24:22
Yeah, you brought up a big one. So if you have started to restrict your diet, and now you’re eating only, you know a few things because X, Y and Z makes your tummy hurt, or you get bloated or it sends you to the bathroom. If your diet has become extremely limited, then that’s definitely a sign. And a lot-it makes sense. A lot of times food is perceived as a culprit to deep GI issues. We have to eat too. So it’s this the connection right? We have to eat. We have to fuel our body. And especially if you’ve looked On the internet, there’s 1000 Different restrictive diets out there, there’s 1000 Different supplement regimens, there’s 1000 different recommendations on how to manage digestive issues. And when we look at the science, yes, there are some nutritional remedies out there that are science based, but you really should be doing that under the care of a registered dietitian who specializes in gastrointestinal health, and also that you have received a proper diagnosis by a doctor. So, you know, definitely restricted diet. The other thing is, if you’re having any blood in your stool, or if the color of your stool is very different, so very dark stool, or very, very light stool…

Unless you just had a blue slushie from the 7-Eleven because then it’s really normal for it to not look right.

Or a Cap’n Crunch?

Or beet.

Natalie 25:40
I mean also, though, not great things for you. [laughing]

Derek 25:51
No. No. That’s part of the issue. [laughing]

Megan Riehl 25:55
Well, but you know, what, there’s some really nutritional foods out there, too. The beets, cherries…

Derek 26:02
True!

Megan Riehl 26:02
You know, so, but yeah, that is, that is a good marker to that, if you otherwise are doing just fine. And like you have all of a sudden you look down at the toilet or like holy cow. What is that? Like…

Derek 26:13
What is going on?!

Megan Riehl 26:14
Take a quick assessment of what did I eat yesterday?That might be important.

Derek 26:17
Yeah. Yeah. Yeah. For sure. So I, I’m just because I’m kind of percolating now. Because I was just thinking about all of the ways that the gastrointestinal tract intersects with psychology and one of the big ones that I think is an obvious one that stands out to me, and I don’t know if this intersects into your realm of work, but like disordered eating, and body image issues. And, you know, body dysmorphia? Could we touch it on those topics a little bit.

Megan Riehl 26:51
So, the literature shows us that about 50% of patients that have eating disorders also have IBS. Wow. So this is interesting, because eating dis- like an eating disorder, like anorexia is a- we diagnose that because people are restricting their food to address their body image, it’s to to lose weight, it has to, there’s a psychological component of it. And, and so then that can lead to alterations in your digestive system, right? When you’re restricting so much food and basting, depending on the type of eating disorder that you have, that can really impact your your motility and can lead to a diagnosis of a gastrointestinal issue. But then we also see this is a newer area of research in GI this diagnosis called avoidant restrictive food intake disorder. And it used to be predominant…

Natalie 27:50
Avoidant Restrictive Food Intake Disorder.

Derek 27:53
That’s a mouthful.

Megan Riehl 27:55
Also known as ARFID.

Natalie 27:59
Okay! Very cool.

Megan Riehl 28:00
There you go. Um, so ARFID, historically, was a childhood diagnosis for kids that were really picky about their food. And so they wouldn’t restrict, restrict restrict, they were really picky about their food, that then they could have very limited amount of food. And they also would say, because it hurts, it hurts, I’m limited, I don’t- Well, when you think about that, we’ve now researched it. And really, we’re in the earlier stages of researching this and GI issues. But we see this in a lot of our GI patients, they’re not restricting food because they want to lose weight, or because of their body image specifically. They’re restricting foods, because it hurts. And so there are cognitive behavioral therapy protocols now to help patients that have been diagnosed with ARFID in the GI patient population. And what is critically important is that both you as a patient need to talk with your doctor about your relationship with food, because a lot of times our patients are saying like “I want to eat, I don’t want to be, you know, restricting so much. I really want to expand my diet. I just don’t know what to eat.” And then a gastroenterologist or primary care doctor can hear that and say, “Okay, great. Let’s get on top of this now, before this develops into a full blown eating disorder.”

Natalie 28:00
Yeah, for sure.

Megan Riehl 28:16
It’s a slippery slope. And so if you as the patient are talking with your doctor about this, they’re now in the know, they’re looking at, you know, have we developed any mal nourishment? Is there any supplementation we need to be looking at? Do we need to make sure that everything is is checking out, okay. And then also, let’s work with a dietitian. Let’s work with a gastroenterologist because even people that don’t have a full blown eating disorder, they still might have anxiety as they’re expanding their diet again, even under the direction of the gastro- or a GI dietitian. So that’s, I put on the patient a little bit but then if you have any, you know, medical professionals that are Listening to this, also important for us to ask patients with GI conditions, what’s your relationship with food? You might do an eating disorder screener. But I find just having open conversations with people to then guide their treatment planning gets a lot of good information about what they’re eating, when they’re eating. A lot of times patients will also restrict food all day. So like they don’t eat, because when they eat, they get bloated or gassy or their symptoms perk up, and then it’s hard to get to work, it’s hard to get to school, they have to use the bathroom, they don’t want to. So they make it all day long. Then they come home, and they eat a ton. And then they go to bed. And so I always say, you know, the digestive process likes to happen in the upright position, let’s let gravity work with us.

Natalie 30:48
Yeah.

Megan Riehl 30:49
So if you’re eating a lot right before bed, and you’re eating the majority of your calories before bed, and then you’re laying down, it’s no wonder you’re gonna have worse GI symptoms later that next day. So we want to help patients to kind of have this empowered perspective of knowing the right ways to kind of go about their nutrition, so that we don’t see things progress into more of an eating disorder, as they you know, are trying to navigate food and their symptoms.

Natalie 31:20
Sure, sure. That makes sense to me. Okay, so I kind of these things might go ahead in case they want to talk about your book, right? And, and, and what that’s all about, and why it’s important for people to read. And I also kind of want to, like have a picture and understanding of like, when you sit with the patient, like what you’re actually doing and like what are you walking, walking them through? And I’m just so fascinated with the whole connection between the brain and the gut in general. I am and now in this specific area, um, like, you know, like dancing around in this room, like where do we go first? Right. So you pick where do you want to start with the book or like what it actually looks like walking through things with the patient.

Megan Riehl 31:58
I think I can cover it along the way. Right?

Natalie 32:01
Okay, perfect.

Megan Riehl 32:02
So the reason I co-wrote this book with a registered dietician. She is world renowned expert in GI nutrition, Kate Scarlata. And I, I approached her because I’m fortunate to work with GI dieticians, where I’m at and, and so our patients do have the opportunity to see a gastroenterologist, a GI psychologist, a registered dietitian, who is expert in many of these nutrition therapies, and patients get better. But our program is one of a handful in the country. I’m one of about 400 GI psychologists in the world. And so when you think about IBS, specifically, there are about 45 million Americans that have IBS.

Wow. That’s not a good ratio.

Derek 32:54
No.

Megan Riehl 32:54
No. So and those are just the ones that we know about it. So we think about one in five people that do have IBS have never talked to a medical professional about it. One and four, are managing their symptoms just with over the counter medication and hoping for the best. So there’s a lot of people out there that are living with these symptoms, and they just don’t have the roadmap to get better. So knowing that there’s also a limited number of Gi dieticians, I thought What about if we partner, you cover all the nutrition stuff, I’ll cover the behavioral, we’ll work together to help people understand the diagnosis of IBS, as well as IBS mimickers. So things to kind of be considering, you know, like inflammatory bowel disease, or sucrase isomaltase deficiency. These different…

Natalie 32:55
Say that one five times fast.

Megan Riehl 33:03
Yeah, lots of different things to think about. So we outline those IBS mimickers for people too and we encourage, get that proper diagnosis. And then consider these different tools for your toolbox so that you can live a life that is, you know, is not staying away from the things that you’ve been missing out on. So that you can travel so that you can go to work. So that you can eat with your friends. So that you can date people avoid things and we just wanted people to know that they can live well with that diagnosis.

Natalie 34:31
I love that. That sounds really, I just had no idea how, I mean, I guess it makes a little bit of sense now with you saying there’s only 400 like you in the world. And now it makes me a little bit of sense why this is something I’d never even heard of. Because you know, Derek and I both are, you know, very into, you know, listening to podcasts on health and wellness and reading books and having conversations and follow lots of those people on social media. And so there’s a point where you feel like you’ve you’ve heard of something for sure by now after years and years and years of being interested in this in this field, so it makes sense now hearing that number, but it’s it’s a little startling to hear the ratio with four did you say 45, did you say 45 million?

Megan Riehl 35:13
45 million Americans. Yep.

Derek 35:16
Americans.

Natalie 35:16
Americans. Not even in the world, just Americans.

Megan Riehl 35:18
Globally the prevalence is about 10%, too.

Natalie 35:21
Wow.

Derek 35:21
That’s incredible.

Megan Riehl 35:22
So it varies from six to 10%, depending on the literature of the presence, but, you know, it’s, it’s prevalent, and, and people’s approach to it historically, has been medication. And, you know, in recent decades, it’s shifted to looking at nutrition and the role of nutrition and seeing that, wow, people can get better following certain, you know, nutritional regimens. But now, you know, we’ve entered this sphere of brain gut behavioral therapy. And, and now, you know, people are more interested in going more of a holistic route than having to feel like they’re only reliant on a medication.

Natalie 36:11
Yeah. Which I think is good.

Derek 36:12
Yeah. I think that’s absolutely fantastic. I think that it’s such a wonderful thing for you to have put this book together, you know, obviously, there’s so much need for it, and so little resources for it. So I think, I think it’s absolutely phenomenal, and makes me excited that we’re having this conversation.

Natalie 36:26
Yeah, me too. To get the word out.

Derek 36:28
Yeah!

Natalie 36:28
Let people know, like, I can also imagine if you’re living, you know, with or without the diagnosis, right? Like whether or not someone’s told you, this is the issue, or you’re just dealing with the symptoms with no diagnosis, I can imagine that it would feel debilitating at times.

Derek 36:44
Hopeless? Yeah.

Natalie 36:45
Especially if it’s, you know, it worsens, and it just really kind of takes over your life, right? And, you know, like you said, like, wanting to be able to date and like, go do these things, and go camping and all these things without, you know, facing these issues. Can feel hopeful to get a book like this in your hands. And…

Derek 37:02
Well and I would imagine, it’d be like, I’m trying to think it’d be like if you went and got some sort of diagnosis. And you know, if you get the IBS diagnosis, and there is no supporting, you know, resources to go with it, you’re like, hey, yeah, there’s something wrong with your gut, we don’t really know what. You’re just gonna have to figure it out on your own. It’s like the kind of the helplessness of like, Okay, shoot, I need to figure this out. And I have to go and sift through all this information. There’s all these influencers that are saying X, Y, and Z, apple cider vinegar is gonna cure my gut.

Natalie 37:30
I’ll just do the Carnivore diet, then I’ll be fine.

Derek 37:31
I’m just gonna be carnivore diet. There’s all this kind of information bundled with misinformation, like the fact that that there’s a registered dietician that helped you write this, that you’re an expert in your field. And that if you’re doing what you’re doing, I think is absolutely phenomenal. So with that being said, something that I’m really interested in is getting into what some of the actual therapies of this would look like. You’ve already mentioned, cognitive behavioral therapy CBT. And I think…

Natalie 38:02
Hypnosis.

Derek 38:02
…and hypnosis as well. I would be interested to dive a little bit more into the CBT of like, what does that process look like? And if there’s any other tools that you recommend.

Natalie 38:02
Yeah. I would be too because I feel like it’s, you think about psychology and like it, just imagine like someone sitting in the chair and just being like, Well, my tummy hurts a lot. And I’m not pooping.

Megan Riehl 38:19
Tell me how you feel.

Natalie 38:20
Tell me more. Tell me how you feel, right? Because that’s what we associate psychology to be.

Derek 38:24
Tell me about your relationship with your mama. [laughing]

Natalie 38:29
I’ve seen, even if that is applicable, but I just mean that like, it’s a limited view on what psychology is. So I want people to understand what role this is actually playing in the healing process.

Megan Riehl 38:39
Yes. So there’s no couch. There’s no bell going off and clucking like a chicken. I don’t own a pocket watch.

Derek 38:46
Is there a bust of Sigmund Freud in the corner? [laughing]

Natalie 38:48
I don’t own a pocket watch.

Megan Riehl 38:51
Okay, so cognitive behavioral therapy and gut directed hypnosis have the most evidence to support their use in working with patients. Predominantly, the research focuses on an IBS, but we’ve found you know, they’re they’re applicable to other diagnoses as well, that fall along the brain-gut access. So with CBT, one of the ways that I like to help patients start to see how we incorporate this is by describing something called the GI stress cycle. So this is something that’s outlined in our book and if you start at the top of our cycle, it’s like you get a gurgle, a cramp, a spasm, maybe you’re going to the bathroom for a bout of diarrhea. So you have that symptom. And for a lot of our patients, that then leads to this cognition of, oh God, here we go again. I, like, I gotta get out the door. I can’t be late. My boss is gonna think I’m unreliable. This is embarrassing. So those thoughts, those unhelpful in the CBT world, we call them automatic thoughts- those unhelpful thoughts start to get wrapped up that then leads to these feelings of embarrassment, anxiety, frustration, negative emotions are not going to be good emotions.

Natalie 40:07
Yeah.

Megan Riehl 40:07
Now, that then leads to an increase in our sympathetic system. So this is where our brain gut connection really starts to get kind of amplified. We feel our heart rate increase, our breathing gets shorter and shallower. Our muscles kind of clench and tense. And that’s when then you probably feel it more intensely in your stomach. You might run to the bathroom more. And that arousal of the sympathetic system, then leads to worsened GI distress, which then kicks us into this cycle.

Natalie 40:41
Cycle. Yeah.

Megan Riehl 40:42
So when I describe this early in sessions with patients, to get the head nods, and they’re like, Yes, that’s me. That if I didn’t have those symptoms, I wouldn’t be having all these thoughts, I wouldn’t be having all these problems. It’s the symptoms that kick off the cycle. And so we’ll talk about how with CBT, which is really kind of outlined very simplistically with how you think impacts how you feel, which impacts how you behave, if you change how you think it’s going to change how you feel, which is going to change how you behave. If you change how you behave, that’s going to change how you feel, which is going to change how you think. So if we jump in at any of those factors, and work on, you know, flexibility, cognitive flexibility, giving you different ways to relax your system, that’s going to impact how you cope with these symptoms when you feel that gurgle, cramp or spasm. So CBT is pretty structured in terms of first helping people identify their thinking, identify their thoughts associated with feelings, physical feelings in the body, and then also giving very tangible resources around, um, we call it modifications of arousal. So basically teaching them relaxation strategies, that when you’re ramped up, when you’re feeling that cramp or spasm, one of the first things I teach people to do is diaphragmatic. Breathing.

Okay,.

So I can get into that for a second, just because it’s a nice takeaway for any of your listeners.

Natalie 40:49
Yes please!

Derek 40:50
Yeah.

Megan Riehl 40:50
So the reason I teach diaphragmatic breathing to pretty much everybody is that we all-that sympathetic system that we all have built into our body, which is meant to keep us safe, but unfortunately, it’s like an alarm system. So it goes off at times when it’s really not life or death. So it was built in to keep us safe from the lions, the tigers and the bears, but it now might go off with a gurgle, cramp or a spasm. So that sympathetic system kicks off. Well, what can we do about it? Well, we have the beautiful parasympathetic system that is counterpart. And that’s your body’s relaxation response. So we could activate that relaxation response by calming our system. And diaphragmatic breathing is one of the things that does that. So it’s a four second, nice inhale through the nose, your belly will rise. And then a nice six, second, exhale through the mouth, your belly will fall. Now, a lot of times my patients have said, Oh, yeah, a therapist taught me breathing techniques at some point. I don’t use them, they don’t work. Or it’s a temporary band aid. And I’m like, okay, but but hear me out. So yes, number one, it can serve as a little bit of a distractor. So if you shift from those unhelpful thoughts and start to calm your breathing down, that’s great. I will caution, that’s not treating anxiety management. So diaphragmatic breathing is a band aid, it is. It’s not getting at the root of why you’re anxious. But I’ll take it in the beginning of our sessions, because I want to, I want you to feel some wins here. Okay?

Natalie 43:48
Well, and you can’t be like really be therapised well when you’re in a state of alarm. Like we had to, like, get into calm and relaxation in order for any of this to stick.

Derek 43:56
Right? Well, it’s a powerful tool to be able to move from a more alerted state to just becoming calmer. And like, yeah, just like Natalie said, that’s absolutely necessary for any type of treatment.

Megan Riehl 44:09
But get this. So our normal chest breathing doesn’t move our diaphragm. When we move our diaphragm, it actually produces a calming, soothing massaging sensation on our digestive organs.

Natalie 44:23
Interesting. Oh, an internal massage. I love it.

Megan Riehl 44:28
So. From a GI perspective, it can help if you’re having cramping and urgency. So if you get that, Oh, crap moment when you’re driving and you feel like you have to go but you’re five minutes are miles away from the nearest bathroom. The best thing that you can do is shift into that diaphragmatic breathing because you’re gonna get this nice little internal massage. And instead of activating further high levels of cortisol and adrenaline in your system, because you’re worrying and you’re stressing, you’re out actually regulating some of those stress hormones. So it can produce this nice, you know, resolution in a way to the urgency. And you might still have to go, but you can at least get to the bathroom, and you’re not making the situation worse.

Derek 45:16
It calms it down.

Megan Riehl 45:16
On the other end of the spectrum, so if you’re constipated, being seated on the toilet, a lot of times if people are constipated, they’re, they’re bearing down, and they’re holding tension. Doing diaphragmatic breathing on the toilet will actually help again, relax those muscles so that you can have a more productive bowel movement.

Derek 45:37
Interesting.

Megan Riehl 45:37
So teaching something like that, a behavioral strategy that relaxes the system and like session one with people helps with that buy in of like, oh, my gosh, I felt so hopeless and helpless to manage these symptoms. And now I have this one technique, but she’s told me I have to practice for the next two weeks, many times a day. But time and time and time again, people come back, and they’re like, Oh, my God, it worked. It was helpful. Again, it’s not going to be the end all be all. But it’s a nice kind of introductory tool. To help you see that, look, we can calm your system down, you do have some strategies that you can turn to in the moment, it’s just do we panic? Or can we implement something that’s a bit more productive for the moment?

Derek 46:26
Yeah. Oh, I was just gonna say I think it’s, it’s absolutely incredible that you touched on that, because it’s such a simple tool, but it’s incredibly powerful. And like, you talked about the diaphragm, I feel like the diaphragm doesn’t get as much love or limelight as some of the other organs. But you talking about how it kind of like, can rest and kind of give us a massage to the intestines, it reminded me of now, for all those people listening, this is where I’m going to mention Huberman. He actually I think on his Instagram, he actually had like a gift or a video showing the diaphragm, that when you’re breathing in it, literally it puts pressure on your heart. And so it actually causes your heartbeat to go faster?

Natalie 47:06
Interesting.

Derek 47:07
Something along those lines. So it’s like when you, when you take a deep breath in, and you hold that, it’s just it’s making your heart like kind of pound faster. And it’s really activating that that sympathetic system, like making you more nervous. And so by allowing yourself to breathe out and really relax, and then in turn also have the diaphragm massage your instestines, like…

Natalie 47:25
Well and you just get a deeper breath when you do that. Like I learned, like diaphragmatic breathing in vocal lessons in high school.

Megan Riehl 47:33
Yep. So my singers are really good at this.

Derek 47:36
For me it was swimming.

Natalie 47:36
Yeah. Literally, my vocal coach taught me how to inhale without actually feeling like I was inhaling specifically just on moving everything in my gut down and out, creating space for the diaphragm to expand. And as the diaphragm would expand, it was almost like creating a vacuum in my legs and they would naturally expand. So I was able to get air at the bottom of my lungs, which was necessary to create pressure to hold and put out a good note.

Derek 47:36
Yeah.

Natalie 47:37
For good tonal quality. But like, I think we walk around like tight abs, like, let’s keep it tucked in, you know, and then but when you’re doing that, you’re like, limiting to just up here and you really don’t get a full, complete breath without doing that. But not to think about when I’m doing that. I’m also like, living on my insides and give them a little massage. Like I love that. That’s a great, that’s a great little bit of self care right there.

Megan Riehl 48:20
That’s right. And you know, you you also bring up another important point that so many of us are just comfortable being uncomfortable.

Natalie 48:29
Oh my gosh.

Megan Riehl 48:29
And I’ll point out, hey, drop your shoulders. Just what does that feel like?

Natalie 48:34
Mmmm. Relax your jaw. Ya know?

Megan Riehl 48:35
More times than not people who are just, you’re having a general conversation with them. They’re like, huh, I didn’t even know. Like I, I didn’t even know I could do that. So, you know, passive muscle relaxation is something that we teach our patients and actually passive muscle relaxation, where you, you start at one part of the body, I always start at the hands, and you kind of work your way through the different muscle groups is built into hypnosis. So the gut directed or other big, big guy in the show, so gut directed hypnosis is a another strategy where we build in some relaxation, but then we use very tailored and targeted suggestions about the calming, the soothing, the functioning of the digestive tract, often incorporating imagery related to nature. So we give people kind of this nice peaceful scene. And, and then while the conscious mind is, you know, really open and and suggestible, we give those, those suggestions that help with the management of IBS and restoring the way the brain and the gut are communicating.

Natalie 49:45
I’m glad you brought up the hypnosis again, because I was like, I’m like, I’m like, Okay, we’re running short on time, but I wanna make sure we talk about it. Yeah. Because it’s such a such an interesting, I think hypnosis in general is something that people are like, ooh, really, what’s that? But like in this context is even is even more interesting. And I can am imagine you’re talking about visualizing things, it’s going to be a little bit difficult. And, you know, probably it’s necessary to have this guided hypnosis session. Because like you don’t know, like, what your guts feel. I mean, it’s like an internal thing. But right, but it’s totally different than me like knowing what it feels like to extend my arm and bring it back in or to roll my my head on my shoulders, you know, thinking about what’s moving inside my digestive tract is just, I wouldn’t even know how to like have a frame of reference for that

Megan Riehl 50:26
You don’t have IBS.

Natalie 50:28
[laughing] Oh, sweet! Good to know.

Derek 50:33
Diagnosis for free this time.

Megan Riehl 50:35
No, i’m just, i’m just kidding.

Natalie 50:35
I know you’re teasing.

Derek 50:36

[laughing]

Megan Riehl 50:36
A lot of people that do have these diagnoses, they are so hyper aware of the happenings inside their gut. And the term for that is actual visceral hypersensitivity. So what that means is that like, let’s say I have IBS and you and I go out and we have lunch. We have a salad and pizza and a cocktail. And so if I have IBS, immediately, as we’re ordering, I might be going, “Oh, God, I don’t know if this is a good idea. Like, this might not be the best idea for us. But I’m going to eat it because I’m here with my friend and it’s gonna be fine. It’s gonna be fine.” Well, we’re done. And we’re kind of chatting. And I’m starting to feel this gurgle, gurgle. And what I’m now focusing on is the gurgle. There’s actual nerve sensitivity in my gut, that’s also now sending signals up to my brain saying, “Hey, did you feel that?” And my brain is saying, “Oh, yeah, I felt it. Want me to turn it? I’ll turn it up.”

Natalie 51:35
We know what’s comin’. Danger Will robinson.

Megan Riehl 51:37
And then that’s where our kind of nerves and also something called GI specific anxiety or visceral anxiety, where the sensations are now causing anxiety, ramp up, and I’m then in the bathroom, and you’re fine, you’re like, “Okay, like, let’s go out, let’s go! Like, wanna go to the movies?”

Natalie 51:59
Pizza was good. Let’s go get margaritas.

Megan Riehl 51:59
And so the person with IBS is able to probably also have a gurgle, maybe pass some gas, but you’re not thinking about it in the same capacity, because your stomach sensitivity is not the same. So so the hypnosis gets at that. It gets at those sensations in a really beautiful way. And, and a lot of us that do this are using scripted protocols that have been time tested in research. So these are evidence based science backed strategies.

Natalie 52:33
It’s not just a bunch of mumbo jumbo, folks.

Megan Riehl 52:35
No, no. And, and in fact, the good news…

Not witch craft.

…again, for listeners is that we’ve found these protocols to be just as effective virtually, and also delivered via Apps.

Natalie 52:47
Oh good!

Megan Riehl 52:48
So the Nerva app is a gut directed hypnotherapy app. And if you don’t have access to a GI psychologist, I think it’s worth a try. In terms of their using, again, science back to, you know, strategies, I have no financial ties to Nirva. But we mentioned them in our book, because we think it’s a good alternative for somebody that might not have access to this type of treatment. And you can download it…

Natalie 53:12
Because clearly, not everyone does.

Megan Riehl 53:13
Right. You can download it right from an app store. So you know…

Natalie 53:16
Thank you for mentioning that.

Megan Riehl 53:16
…there are products in development, the world of Gi and digital health is aware that we need patients to have more access. And so more products are out there on the market and more are coming to the market. So hang tight. Good.

Natalie 53:32
Okay. All right. So we’re getting close to end of time, but I want to make sure we get to our section of fact or fiction. It’s my best gameshow intro.

Megan Riehl 53:40
All right!

Natalie 53:41
There’s a reason I do a podcast and not a game show. And I was just thinking of a factor fiction that we don’t even have on here. Let’s do it. Okay. So fact or fiction. If you’re burping or farting a lot, it’s a sign of GI problems.

Megan Riehl 53:59
Probably fiction, because you know, burping and farting is pretty normal. We all are going to pass gas. But if you’re doing I would say excessively and or if it comes with a lot of really stinky, stinky stinky burps or farts, then I might say…

Like something died.

…I would have I would I would consult with your doctor but you know if it’s happening after your meal and you know you move on from it. That’s, That’s normal.

I’m a big burper after a meal.

Derek 54:25
Oh yeah.

Megan Riehl 54:26
Yeah! Let that out.

Derek 54:32
Do you take the Shrek approach?

Natalie 54:34
Oh, I let it rip.

Derek 54:35
“Better out than in, I always say.”

Natalie 54:39
I have to catch myself sometimes. And my mom used to make us put quarters in a jar when we belched because I was so tired of it.

Derek 54:46
Oh that’s funny. That jar would be able to find the treasury.

Natalie 54:47
Yeah, and I get it now because now my daughter’s doing it which it’s partially my own fault because I do and my she just and she has no shame right?

Megan Riehl 54:55
No! No.

Natalie 54:55
Now she’s a sixth grader and she’s just letting-and her friends think it’s hilarious. But I even still do it just walking. It’s just me and my friends. We’re on a walk. I’ll let her rip because I want to see how far I can get which is so ridiculous. I’m a 38 year old woman I have not grown up.

Derek 54:55
Oh my gosh.

Natalie 55:09
Okay, you do the next fact or fiction.

Derek 55:11
All right, let’s see. So some of these are, it sounds like might not be right in your wheelhouse. But if you want to answer it the best you can, we’ll, we’ll take it. So factor fiction. You must take probiotics when you take antibiotics.

Megan Riehl 55:25
So the, the thing that makes this fiction is that you must. Not everybody needs to take a probiotic period. Not everybody needs to take a probiotic when they take an antibiotic. If you’re somebody that is on an antibiotic, and you are having horrendous GI symptoms with your, your antibiotic, I’d talk with a doctor. They may recommend probiotic supplementation. But the, the important thing is that they they’d likely recommend a certain strain, depending on what antibiotic you’re on and the symptoms that you’re having. So I caution definitely if like you’re at the pharmacy, and like there’s a probiotic stand right there when you’re getting your your antibiotic. That’s not for everybody.

Natalie 56:11
Okay, good to know.

Derek 56:12
Awesome.

Natalie 56:13
Okay, this one might be a little more in the dietitian realm as well. But fact or fiction, consuming raw vegetables is better for gut health than cooked vegetables.

Megan Riehl 56:23
Okay, this is also kind of a fact or fiction. Because I say, vegetables are important period.

Natalie 56:32
Get vegetables in your diet.

Megan Riehl 56:34
So if you can, you know, some days have cooked, great. If sometimes it’s raw, great. So I think ultimately, there are going to be some vegetables that might cause you to have some more, you know, GI symptoms than than others. Sometimes if people eat like a ton of broccoli or cauliflower, they’re like, whoa, but I asked how much they had. And they’re like, Well, I had the head of cauliflower. And I’m like, okay, so moderation is the key. So, I would say that, you know, the more important thing is that you’re eating the rainbow when you think about your vegetables.

Derek 57:08
And not Skittles.

Megan Riehl 57:08
So the more diversity and color that you can have, I don’t care if it’s raw, or it’s, it’s, you know, cooked. Let’s work on that. And then if you’re really struggling with certain sometimes people have a harder time digesting the raw vegetables. Then, then we might have to make some alterations, but ultimately, I just want people eating their, their wide range of, of vegetables.

Natalie 57:34
Yeah, I used to- I love broccoli. steamed broccoli with butter is like my favorite side vegetable. And I really do enjoy it raw like with I like to make my ranch dip at home. It’s good way to get the kids to eat their veggies. But I realized in the last year or two, I can only have a few pieces of raw broccoli. If I have like- because I’ll just keep going and going because I love it. It I am not well afterwards. I’m just like, like pain like just that. I’m like what is happening? “Lots of pain.”

Megan Riehl 58:02
Yeah. Yep.

Natalie 58:02
Sorry, that’s just A Night’s Tale quote.

Derek 58:02
Dude, I like. A Night’s Tale is my favorite movie.

Natalie 58:05
Shut up!

Derek 58:06
Striaght up. My favorite movie.

Natalie 58:07
Anytime I say pain, I’m always like “Pain. Lot’s of pain.” [laughing] That’s me and broccoli probably.

Derek 58:11
“Your in-trails will be your x-trails.”

Natalie 58:13
Haha. Yes!

Derek 58:14
“You’re x-trails will be your in-trails!”

Natalie 58:15
[laughing] We geek out on way more than just awesome nutrition.

Derek 58:19
Awesome. Awesome. Um, Last fact or fiction here. I’m gonna modify slightly, eating fermented foods every day can improve gut health

Megan Riehl 58:28
Can improve gut health. Yeah, it can. Fact, again, it’s about finding the things that work well for your body. So you know, if you are eating kimchi every day, now great. That’s you know, for live cultured, fermented foods are great for diversifying your gut microbiome. But if it is too spicy, or hurts, you know, and then we want to modify but I think…

Natalie 58:59
Or if cruciferous vegetables make your tummy hurt.

Megan Riehl 59:02
You know, you want to modify a little bit there. So I think, you know, just being mindful of how the product is made, and how you feel with it. And you know, always consult with a registered dietitian if you have specific questions about expanding your diet and you know how you can play with your food to help your gut feel better.

Natalie 59:25
It’s funny because your mom always told you not to play with your food. Yeah, but here we are.

Megan Riehl 59:30
Here we are! Play away.

Natalie 59:31
You get to play with your food, kids.

Megan Riehl 59:33
There’s a lot of play with food around our house. And that’s okay.

Natalie 59:38
I love it. Thank you so much for taking the time to chat with us today. This was so illuminating. I’m sure our listeners are gonna find it illuminating as well. And I want to say thank you for recognizing the need for this book, and filling that gap for people that may not have access to the kind of care that you’re able to offer with your team. Where can people find you and your book?

Megan Riehl 1:00:00
Yeah, so the book is available where all books are sold on Amazon. I’m hoping it’s in some small bookstores too, because I love to support the small bookstores.

Natalie 1:00:10
Ah, I love that. I’ll have to go check it out in my Walla Walla bookstore.

Megan Riehl 1:00:12
Yeah, yeah. Ask them! You know, that’s the other thing. YIf you go looking for it, ask them to bring it in. But it’s available internationally. So I actually just got the copy of what’s going to be available in Europe…

Ah! Congratulations.

…and Australia and New Zealand. So.

You’re global, girl.

Yeah. So it’s available, you know, worldwide. And, and then, let’s see what else. Kate Scarlata. I mentioned her. We have a podcast as well called The Gut Health Podcast.

Natalie 1:00:43
That tracks because you were very natural here. Not everybody. Not everybody who’s really smart at the things they’re teaching and writing about is also really comfortable on mic and on camera. So it tracks that you do your own podcasts.

Megan Riehl 1:00:55
Okay. Well, thank you. Thank you. We’re very new at this. We just launched and we have new episodes once a month.

Natalie 1:01:00
That’s exciting. Congratulations.

Megan Riehl 1:01:02
And we’re having fun with it. So it’s, it’s very science based, but we like to have fun and kind of talk about real life.

Natalie 1:01:09
Not us.

Derek 1:01:10
No we don’t.

Megan Riehl 1:01:10
Exactly. That’s what I felt very comfortable with you two.

Natalie 1:01:16
Good, good. Okay. Social media? Where people can go to find you

Megan Riehl 1:01:19
@drriehl. So D R R I E H L on Instagram, X. That’s where I hang out the most I think is Instagram,

I still have not gotten used to Twitter being X. When people say X, I’m like, “What platforms that? I haven’t heard of that one.”

I know. I know.

It’s weird. Yeah. Okay. Anything else, Derke, that you wanted to add in?

Derek 1:01:39
No, I just wanted to say thank you so much, again, for the incredible work and the undertaking that you’re that you’re doing to provide this information to people because I can just imagine, you know, like I said earlier people that are in this, that have received this diagnosis, and there not being that many tools readily accessible for them just having another tool like that, like this is this is science backed, verified evidence. Verified by experts. It’s like, absolutely phenomenal. So thank you so much for for joining us. And we’re excited to be able to share this message with with our platform.

Natalie 1:01:39
Spread the word. Yeah. Absolutely.

Megan Riehl 1:02:07
Thank you so much for having, having me on. And, you know, I greatly appreciate the opportunity.

Natalie 1:02:20
Wonderful.

Derek 1:02:22
Thanks for tuning into the Invigor Medical Podcast.

Natalie 1:02:24
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Derek 1:02:28
Your feedback matters. So feel free to share questions for future episode ideas in the comment section.

Natalie 1:02:33
For more information about our prescription strength treatments for weight loss, Ed and overall wellness, all from qualified doctors and reputable pharmacies, visit us at Invigormedical.com. And don’t forget to use code PODCAST10 for a 10% discount on your first treatment plan. Until next time, stay well.

Podcast Guests

Dr. Megan Riehl
PSYD

Podcast Guests

Derek Berkey
Host
Natalie Garland
Host
5226 Outlet Dr, Paso, WA 99301
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