Insight | Bloating, Constipation and IBS: What Four Doctors Try First
Robynne Chutkan starts with water, movement, fiber and a look through the medicine cabinet, Rajsree Nambudripad with magnesium, a motility aid and digestive enzymes, and Brennan Spiegel with exercise and posture, while Sara Gottfried reads constipation as a signal of stress, thyroid and hormone trouble. They agree on getting the bowels moving every day and on looking for a cause before settling for a label, but their first steps are not identical.
What question do these doctors ask first about bloating? Show answer
How often and how completely you have bowel movements, because bloating usually starts with constipation.
How often should a healthy gut empty, according to Chutkan, Nambudripad and Gottfried? Show answer
Every day, with a feeling of complete evacuation. They reject the textbook threshold of one movement every three days.
What three habits does Robynne Chutkan give first? Show answer
Hydration, movement and fiber.
What is Chutkan's water rule of thumb? Show answer
At least half your body weight in ounces of plain water daily, without flavorings or electrolytes.
What did the American Gut Project find, as Chutkan cites it? Show answer
The diet's label did not matter, but eating 30 or more different plant foods a week did.
Why does Chutkan review the medicine cabinet before treating? Show answer
Prescriptions, over-the-counter drugs and supplements often cause gut symptoms. She says to talk to the prescriber, not to stop on your own.
What does Rajsree Nambudripad start every patient on at the first visit? Show answer
Magnesium at bedtime and a ginger and artichoke supplement for motility, plus digestive enzymes with meals.
What does Nambudripad say about the IBS diagnosis? Show answer
That it is a label for symptoms, not their cause. She cites a figure that about 70 percent is caused by small intestinal bacterial overgrowth.
What does Brennan Spiegel call the most effective therapy for IBS? Show answer
Exercise, citing randomized trials of tai chi, yoga, strength training, swimming and running.
Why does Spiegel ask IBS patients about their back? Show answer
A weak back and slouching compress the abdomen, which he compares to a kinked garden hose that backs up.
What does Sara Gottfried say constipation can signal in women? Show answer
Borderline thyroid function, high perceived stress, or an imbalance between estrogen and progesterone.
When can more fiber and water make bloating worse? Show answer
When the problem is a learned holding pattern with a clenched sphincter, or a fiber-sensitive gut.
