Latest / Love Your Gut / Ep. 131: When Low FODMAP Stops Working: Your Next Move With Complex GI Clients

Transcript

Ep. 131: When Low FODMAP Stops Working: Your Next Move With Complex GI Clients · Love Your Gut

• 0:03
  Dr. Heather Finley: Welcome to the Love Your Gut Podcast.
• 0:05
  Dr. Heather Finley: I'm your host, Dr.
• 0:06
  Dr. Heather Finley: Heather Finley, registered dietitian and gut health specialist.
• 0:10
  Dr. Heather Finley: I understand the frustration of dealing with GI issues because I've been there and I spent over two decades searching for answers for my own gut issues of constipation, bloating, and stomach pain.
• 0:21
  Dr. Heather Finley: I've dedicated my life to understanding and solving my own gut issues.
• 0:25
  Dr. Heather Finley: And now I'm here to guide you.
• 0:28
  Dr. Heather Finley: On this podcast, I'll help you identify the true root causes of your discomfort.
• 0:33
  Dr. Heather Finley: So you can finally ditch your symptoms for good.
• 0:36
  Dr. Heather Finley: My goal is to empower you with the knowledge and tools you need so that you can love your gut and it will love you right back.
• 0:43
  Dr. Heather Finley: So if you're ready to learn a lot, gain a deeper understanding of your gut and find lasting relief.
• 0:48
  Dr. Heather Finley: You are in the right place.
• 0:50
  Dr. Heather Finley: Welcome to the love your gut podcast.
• 0:55
  Welcome back to the Love Your Gut podcast.
• 0:58
  This is part one of a really fun practitioner series that I am going to do for the next couple of weeks.
• 1:05
  I think it's gonna be three parts.
• 1:07
  I might add a fourth.
• 1:08
  We'll see how it goes.
• 1:09
  I would love to have feedback on this.
• 1:12
  If you are a regular listener of this show and you're not a practitioner, I still would encourage you to listen because I think that it still will actually help you maybe understand what might have been missing, or it might help you to know what to look for in the next practitioner that you hire for your gut issues.
• 1:32
  So I'm really, really excited about this series.
• 1:36
  I was going way back into the archives and what I actually did is I looked at every single application that I have received for women and practitioners looking to join Gut Practitioner, and I was looking for the common threads.
• 1:51
  I was looking for what are people saying, what are people struggling with, so that I could really figure out what holds practitioners back from advancing in their careers, from getting clients results, from feeling confident, like, what is it?
• 2:06
  So today is part one of that series, and I'm so excited to take you along.
• 2:12
  So please send me a DM with feedback or email, whatever.
• 2:16
  I would love to hear what you take from this episode.
• 2:19
  So when I was looking through these applications, more than a third of the clinicians who have applied to work in Gut Practitioner wrote some version of the same sentence, and it actually has nothing to do with how smart these practitioners are.
• 2:37
  Smartness and intelligence is not the issue here.
• 2:40
  Most dieticians and practitioners have tons of training, years in practice, tons of continuing ed.
• 2:48
  They know low FODMAP inside and out.
• 2:50
  They know fiber research.
• 2:52
  They can read a stool chart.
• 2:53
  They can do all the things and still the same thing showed up, which was,"I don't know where to start." So I'm wondering if you have ever had that thought too.
• 3:04
  You have a client in your office, you're looking at all the things going on, and you're like,"I don't even know where to start." Because I think that if you have had that thought, you probably are gonna feel a lot less alone after you listen to this episode.
• 3:20
  Most clinicians, when they have that thought, they take it as proof that they are not good enough yet.
• 3:26
  So what do they do?
• 3:27
  They keep consuming information.
• 3:29
  They keep going to random CEU trainings.
• 3:32
  They keep trying to learn more.
• 3:35
  And I'm not here to tell you to never learn more information.
• 3:39
  That is not the point.
• 3:40
  You do need to continue because research changes.
• 3:43
  But what I am going to tell you is how you can learn better and learn more effectively.
• 3:50
  So I want you to picture your last complicated client.
• 3:54
  You probably don't have to think very hard.
• 3:56
  Probably was a client that you had yesterday.
• 3:58
  Maybe this client came in with bloating, constipation, fatigue.
• 4:03
  Her labs were normal.
• 4:04
  She already cut out gluten, already cut out dairy, um, already did a lot of stuff before she found you.
• 4:10
  Maybe you decided, I'm gonna start with low FODMAP.
• 4:12
  You adjusted her fiber, you talked about hydration.
• 4:15
  Maybe you added in a probiotic, maybe some magnesium.
• 4:19
  Every single one of those things is an evidence base and can be defensible.
• 4:23
  You could defend why you chose to add all of those things in, right?
• 4:29
  So maybe this client felt better for a few weeks and then maybe had stalled progress.
• 4:33
  maybe the bloating started creeping back.
• 4:35
  Maybe she started reacting to foods that were fine a month ago, and now you're sitting across from her at the follow-up with just that sinking feeling because you're like, I've given every move I know." Right?
• 4:50
  "I've done everything that I think I can do." And then the doubts start creeping in.
• 4:56
  Do I cut out more foods?
• 4:58
  Do I refer her?
• 4:59
  Do I try a different probiotic?
• 5:01
  What am I missing?
• 5:03
  Here's what I want you to think about, and think about how you feel in that moment.
• 5:08
  You did not run out of knowledge because you already know a lot.
• 5:11
  You probably know a lot more about GI than every provider that she has seen before.
• 5:18
  You probably have a huge vocabulary when it comes to GI.
• 5:22
  Low FODMAP, soluble, insoluble fiber, motility, prokinetics, strain-specific probiotics.
• 5:28
  You know all the words.
• 5:30
  what most of us were never handed is the grammar.
• 5:33
  So what do I mean by that?
• 5:36
  The rules for putting those words in order so that they make sense and how that actually makes sense for that specific client.
• 5:46
  Here's the thing.
• 5:47
  If you've ever taken a foreign language, you can know a thousand words of Spanish, and you can still freeze when you try to order dinner in Mexico City.
• 5:57
  You have the vocabulary, you have the words, but the fluency comes from knowing how to put it together in real time with a real person in front of you.
• 6:08
  That is exactly what happens when you're working with complicated GI patients.
• 6:14
  that's that feeling of like,"I don't know where to start." you have the words.
• 6:19
  You don't have the grammar.
• 6:21
  So here is the distinction I would love to make and to help you carry into maybe your next session.
• 6:27
  Maybe you're seeing this client today Low FODMAP is a tool.
• 6:31
  Fiber is a tool.
• 6:33
  Hydration, probiotics, magnesium, all of those things are tools, and all of those things can be good ones, and you already know how to use them.
• 6:42
  What a tool cannot do is tell you when to use it.
• 6:46
  That part is your clinical judgment, and a framework is what gives you, your judgment something to stand on.
• 6:53
  It helps you decide which tool for which client in which order, when to put it down.
• 6:59
  You can think of this like a skilled contractor.
• 7:02
  So maybe this person has a great hammer, a great drill, a perfect level, all the hands to use all of them.
• 7:10
  But if you do not have a blueprint, you can do beautiful work, every straight nail, and still end up with a staircase that runs into the ceiling because the skill is not the issue.
• 7:22
  You need the blueprint.
• 7:23
  You need the plan for what you are building.
• 7:27
  So this is where I see, now having worked with hundreds of clinicians and gut practitioner, where really capable clinicians are right now.
• 7:36
  You, you go to another conference, I'm about to leave for, FNCE, and I guarantee you there's gonna be so many talks at that conference, right?
• 7:44
  You're gonna take like a tiny piece from this GI talk, and a tiny piece from this perimenopause talk, and a tiny piece from this probiotic talk, and I know we have one of our gut practitioner gals, she's giving a talk, so maybe you're gonna take something from her talk.
• 7:58
  She's talking about body image.
• 8:00
  Okay, all of that is great, right?
• 8:03
  But you still might not feel like you know exactly when to apply that and how that actually works in real time.
• 8:11
  Learning does not equal knowing how to implement.
• 8:15
  You can read about another protocol.
• 8:17
  You can learn about another supplement.
• 8:19
  You can add more tools to a toolbox that's actually already full, and that complicated patient is still sitting in front of you because what you were actually looking for is a blueprint I have a lot of thoughts about low FODMAP, and I'm not gonna get into those on this episode, but let's just take low FODMAP, for example.
• 8:37
  Low FODMAP is the perfect example, so let's just pick on it a little bit.
• 8:41
  Not a lot, a little bit.
• 8:42
  Think of symptoms like a smoke detector.
• 8:45
  So bloating, pain, urgency, that is the alarm going off.
• 8:50
  Your client wants it to stop, and honestly, so do you, right?
• 8:54
  You want your clients to feel better because you know how much better their life is gonna be when they don't have symptoms.
• 8:59
  Low FODMAP can be the equivalent of just pulling the battery out.
• 9:03
  The house gets quiet.
• 9:05
  Everybody relaxes.
• 9:06
  Nobody has gone looking for the fire yet.
• 9:09
  So I'm not here to say that sometimes you just don't need to pull the battery out.
• 9:14
  sometimes you do.
• 9:15
  Sometimes your client needs quick relief.
• 9:17
  I remember a client that we had where she was a couple weeks out from her wedding.
• 9:22
  She was so bloated.
• 9:23
  She's like, I feel like this is a time for a quick fix." And I'm like,"I'm not a huge fan of quick fixes, but sometimes you do just need a little relief." That's where a tool like low FODMAP can come in.
• 9:35
  You're not fixing the issue.
• 9:36
  You're just using a tool, right?
• 9:38
  So sometimes it actually can be a great first move because a client who is miserable honestly can't do much else, right?
• 9:46
  They're so miserable.
• 9:47
  They feel disorganized.
• 9:49
  They feel stuck.
• 9:50
  They feel frustrated.
• 9:52
  Their motivation is lower.
• 9:54
  So sometimes they need to feel better before they can take action, and that's okay.
• 9:58
  So your instinct to pull the battery out to give relief can be good.
• 10:03
  The opportunity is to actually keep going because taking the battery out, quieting the smoke alarm is different from resolved and finding the fire The clinician who goes looking for the fire is the one whose client stays better.
• 10:18
  And you already think this way in other parts of healthcare, right?
• 10:22
  Nobody splints a broken finger while the patient can't breathe.
• 10:26
  Airway, breathing, circula- like, you'd never question that order.
• 10:30
  GI cases have a triage order, too, and when you can see it, your first move stops being a guess and becomes a decision that you can explain to yourself and to your client.
• 10:43
  That is what the five systems that I use in Gut Practitioner and in my practice with clients is for, and is just a helpful roadmap because they are a map that you look at before you pick up a tool, so you can see what's upstream, what is driving that, what the client can handle right now.
• 11:04
  On November 6th, I am hosting a practitioner webinar.
• 11:08
  I'm gonna show you what this looks like in a real case.
• 11:11
  But today, I want you to see why your instincts have been asking for this.
• 11:15
  Because the line that I think most of us need to just, like, tattoo on our forehead is, like, many failed protocols are sequencing failures.
• 11:26
  Think about what that means for you.
• 11:27
  The tools that you choose can be good.
• 11:30
  Your reasoning can be sound.
• 11:33
  They sometimes are just at the wrong time.
• 11:35
  So fiber is a classic one.
• 11:37
  Obviously, we all have fiber.
• 11:38
  We know the benefits of fiber.
• 11:40
  There are many benefits, right?
• 11:42
  You know that fiber feeds bacteria to make butyrate.
• 11:45
  You know that butyrate keeps the colon happy.
• 11:47
  True.
• 11:48
  But if you add a big fiber load to a gut with slow motility and not much butyrate production is happening yet, they bloat, they feel worse.
• 11:56
  This client now decides she hates fiber and that she's never gonna get better, right?
• 12:01
  It's like putting frosting on a cake before it goes in the oven.
• 12:04
  The frosting is great.
• 12:05
  Everybody loves frosting.
• 12:07
  Most people like frosting.
• 12:08
  I know my kids would prefer to just eat the frosting off of a cupcake, The timing is the problem.
• 12:13
  So once you start seeing sequencing, you will see it everywhere, in your old cases, in the protocols clients bring to you from someone else, maybe in something that you've tried on yourself even years ago.
• 12:26
  So many of us, myself included, get into this work because of our own stuff, and we know that health constantly shifts and changes, and we're always working on ourselves, right?
• 12:38
  So maybe you're seeing, once you learn the sequencing process, you learn, oh, this is why that didn't work.
• 12:46
  That makes so much sense.
• 12:47
  The good news is sequencing is a skill that you can build.
• 12:53
  So I wanna talk to you about compliance for a minute because I know how hard that is for yourself and for your clients.
• 13:00
  When you put real, thought into a plan and your client doesn't follow it, that can be so frustrating, right?
• 13:06
  But I wanna give you just a different way to think about this because I know that it can be so hard.
• 13:11
  Here is a different way to look at this, and I think it helps you to feel a little bit more empowered.
• 13:17
  When your client doesn't follow the plan, the plan is often asking for more than your client had capacity for.
• 13:24
  So think about a good physical therapist.
• 13:27
  If you've ever had to go to physical therapy, maybe you had ACL surgery.
• 13:31
  It's not something I've ever had, but I know that the recovery can be so intense, right?
• 13:36
  You have someone with fresh out of ACL surgery, maybe they're in a marathon training plan, and they start running way too soon, right?
• 13:45
  You're gonna call them non-compliant, for not running So maybe this PT is gonna start with what the knee can actually tolerate today, right?
• 13:55
  Range of motion, then weight bearing, then strength, then running.
• 14:00
  The patient does the work because the work fits, Our clients are often handed the GI version of a marathon training plan, right?
• 14:08
  A new diet, five supplements, a fiber target, hydration goals, sleep goals, a stress practice all at once to a woman who is already probably exhausted and probably low on minerals.
• 14:20
  So a good question to ask yourself is, is this possible right now?
• 14:25
  Lots of things can be good for clients.
• 14:28
  The skill is knowing which of them the body can handle, and what juice is gonna be worth the squeeze, right?
• 14:34
  what is gonna give her the most bang for her buck so that she can start feeling better and possibly start implementing some of these other things?
• 14:42
  Maybe there's some, nice to have, but not some, must-haves, right?
• 14:47
  So this is where you get to be the calm one in the room.
• 14:50
  When you can see what comes next and what can wait, you can stop feeling the pressure to throw everything at your client in week one.
• 15:00
  You can go low and slow because you know where you're headed.
• 15:03
  Your clients follow a plan that fits them.
• 15:06
  That is a sequencing skill, and it is yours to develop.
• 15:12
  I wanna tell you about two clinicians who stand out to me so much in Gut Practitioner.
• 15:18
  Obviously, there's way more than two, but two for today.
• 15:20
  I'm gonna share more in this series.
• 15:23
  First clinician that I think about is Tyler.
• 15:25
  So Tyler, before she was in Gut Practitioner, during Gut Practitioner, she was working in primary care, which means just a steady stream of patients walking in after doctors couldn't figure out their GI issues or maybe told them nothing was wrong.
• 15:41
  What Tyler said, this is like verbatim, she said,"I feel stuck in day-to-day practice, like the toolbox from school wasn't enough for the people showing up." Now, what she says is,"My toolbox expanded from just a hammer and nails to hammer, nails, screwdriver, drill, level." And that is the part that I love so much.
• 16:03
  Tyler felt confident recommending what she was recommending because she was understanding which one was the right fit, and knowing which thing was right for every person.
• 16:15
  That is having a blueprint, knowing what tool to use at what time.
• 16:19
  You can use a hammer to do the job of a screwdriver.
• 16:24
  It's just not gonna be as effective, right?
• 16:26
  What Tyler got back was bigger than a toolbox.
• 16:29
  In Tyler's word, she said,"There is a renewed sense of excitement to practice dietetics and a drive to advocate for patients and the profession." That's amazing, right?
• 16:41
  the next clinician is Krista.
• 16:42
  So Krista, a little bit different of practice.
• 16:45
  She worked with athletes and a lot of athletes who had gut issues that nobody could figure out.
• 16:50
  Before, she said she was barely comfortable taking these clients.
• 16:54
  Today, she's seeing huge shifts in her clients.
• 16:57
  She said she can clearly explain what she offers, how she helps.
• 17:02
  She's getting new clients.
• 17:03
  She landed a speaking gig, and the way she sums it up kind of gives me a little bit of chills.
• 17:09
  She said,"I really feel like an expert in my field now." Part of what got her there wasn't necessarily more information.
• 17:17
  It was practicing on real cases, talking through them, getting feedback, trying again.
• 17:23
  That's how the order of operations become second nature, not by just attending more FNCEs and more talks.
• 17:31
  And look, I'm going to FNCE, so I'm not telling you not to go.
• 17:35
  I'm just saying that you're not gonna get anywhere if you just keep consuming information.
• 17:41
  Tyler and Krista both started with that same sentence in the back of their minds.
• 17:45
  They kept growing, and now they're clinicians that their patients were hoping to find.
• 17:51
  So what I want you to take from this episode, if you are listening to this and your belief in yourself is a little shaky right now, you can borrow my belief.
• 17:59
  You can borrow Tyler's belief.
• 18:01
  You can borrow Krista's belief.
• 18:02
  I have watched clinician after clinician sit where you are and come out on the other side feeling confident in cases that they used to dread.
• 18:12
  All you need is a little belief to take the next step.
• 18:15
  all you need is actually not more information, just more practice and that blueprint that we were talking about.
• 18:24
  a lot of times we try to just, like, buffer our own, insecurities by consuming, thinking that it will make us feel better.
• 18:33
  It's like an Instagram doom scroll.
• 18:35
  We're actually tired and we should go to bed, but instead we doom scroll.
• 18:40
  Same thing.
• 18:41
  You think it's gonna make you feel better by just consuming, consuming, consuming, but you actually need to put it in practice.
• 18:48
  So to tie this all together, that sentence at the beginning,"I don't know where to start," the clinicians who wrote that, like I said, it was in over a third of the applications, none of these clinicians were beginners.
• 19:01
  Beginners don't usually feel stuck because the basics work for the cases that they're seeing.
• 19:07
  A new dietitian with a straightforward IBS client starts low FODMAP, the clients improves, and everybody's happy, That's a good outcome, and it's something that all of us have been there, right?
• 19:18
  We've all had that client that was like a one-hit wonder.
• 19:21
  I will never forget, I had this one client years ago, probably 12 plus years ago, and this was in the beginning stages of really understanding GI.
• 19:31
  And she came to me, she was an eating disorder client, and she was having horrible diarrhea I think is what it was.
• 19:39
  And I remember recommending some enzymes for her, and she came back the next time I saw her, and she's like,"That was life-changing." And the way that I felt so confident after that, but then the next patient I had, I recommended the same thing.
• 19:53
  Of course, not the same reaction, right?
• 19:55
  So you learning the sequencing, learning the blueprint, sometimes you get those quick, easy, easy wins, but we all know that that's not always the case.
• 20:05
  So if you're feeling stuck, if you feel like you start just getting more and more complex clients, the client who's already on low FODMAP, the client who has normal labs, a folder full of failed protocols, the clients that come to you with like a stack of everything that they've done, the one who reacts to everything.
• 20:25
  The reason those things are showing up is because your clinical eye has become sharper to notice something upstream that's being missed even before you can name it.
• 20:35
  That, I think, is what growth feels like from the inside.
• 20:38
  It feels like being a little lost.
• 20:40
  I think that means you've leveled up.
• 20:42
  You know how a hermit crab outgrows its shell?
• 20:45
  The shell starts to pinch right when the crab has grown.
• 20:49
  So that discomfort is the cue to move into something bigger, and staying put just means staying cramped.
• 20:56
  So if you have had that thought I want you to hear it as your practice telling you that you have outgrown the toolbox that you currently have, and you are ready for the blueprint.
• 21:08
  You have always been capable of this work.
• 21:11
  The only question is whether you will keep using the toolbox for a job that needs a blueprint or give yourself the next level of skill that your clients are asking for.
• 21:24
  So if you are ready for that next level, I invite you to join me live on November 6th, 12 o'clock, Central Time.
• 21:33
  We are going to dig into a lot more, where this came from.
• 21:38
  We're gonna take real cases.
• 21:39
  We're gonna talk about sequencing.
• 21:42
  you're gonna practice how to look for deciding what's next.
• 21:46
  I did this training a couple months ago.
• 21:48
  It was very popular.
• 21:49
  clinicians loved it.
• 21:51
  I want you to leave with a way of thinking that you can use on your very next complicated client.
• 21:56
  We're gonna dig into minerals.
• 21:58
  We're gonna talk all about, where that fits into the blueprint.
• 22:03
  So the link to register is in the show notes.
• 22:05
  I would love to see you there.
• 22:08
  And I hope that you enjoyed this episode.
• 22:10
  So, send me a message.
• 22:11
  Let me know what you think.
• 22:12
  Let me know what beliefs you have or what things you feel like are inhibiting your growth as a clinician, because I would love to incorporate some of that into some of these episodes.
• 22:22
  So look forward to seeing you on November 6th if you are a clinician, and have a great rest of your day I'm giving your gut a thumbs up because you just finished another episode of the Love Your Gut podcast.
• 22:39
  You know that in order to live a life free from uncomfortable bloating, you need to figure out why you're actually bloated, right?
• 22:46
  Well, the best way to do that is by taking my free quiz.
• 22:50
  Take the next steps towards determining your root causes by visiting drheatherfindley.co/quiz and learn what it is that's causing your bloating.
• 23:00
  Soon enough, you'll be transforming your gut issues, and I can't wait to help you.
• 23:05
  Be sure to tune in next week for the next episode of the Love Your Gut podcast.