We’ve all experienced some telling signs that our gut is connected to our mood. Think butterflies in your stomach before a big presentation, that last minute urge to pee before going on stage. And if you’re someone with SIBO or other digestive issues, you might be dealing with some of the other downwind symptoms that occur when we let our anxiety get out of control.
On today’s episode, I’m joined by Dr. Megan Riehl, a GI psychologist (yes, it’s a thing) who specializes in tactical approaches to relieving visceral hypersensitivity, food fears, and anxiety related to our gut. We talk about how anxiety around your meals or symptoms can become a self-fulfilling IBS prophecy, and explore a really powerful data-backed approach: hypnosis for anxiety, IBS, and other digestive issues.
If you’re someone who’s prone to both anxiety and gut issues, this conversation is a must-listen.
Also, I have a BIG announcement about a secret project I’ve been working on all spring and ways for you to get involved. Don’t miss it.
A quick taste of what we’ll cover:
- Cognitive Behavioral Therapy and how it helps with anxiety and gut issues
- Breathing exercises to dial down our body tension
- Gut-directed hypnotherapy for IBS, IBD, GERD and other issues
- Why people get visceral hypersensitivity from nerve endings
- Why you should see a GI doctor in addition to a therapist, and vice versa
- Cognitive restructuring around food fear and anxiety
- How to tell the difference between SIBO-induced food fear and disordered eating
- Strategies for approaching a meal when you have food anxiety
Resources, mentions and notes:
- Where to find Dr. Megan Riehl
- North Carolina protocol for hypnotherapy
- Kate Scarlata episode on SIBO diets
- Amy Shah episode on meal spacing
- Become a recipe tester for the SIBO Made Simple BOOK!!
- Join the SIBO Made Simple Facebook Community Page
- Subscribe to receive a free download of the episode transcript
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THE IBS ANXIETY CONNECTION
PHOEBE: Megan Riehl, thank you so much for joining us on the podcast today for a topic that has been highly requested by our listeners.
MEGAN: Thank you. I’m very excited to be speaking with you.
PHOEBE: You are a GI psychologist; something that I didn’t even know existed prior to learning about your work through another podcast guest of ours, Kate Scarlata. Can you explain what that title means? I think I know what it is from what it sounds like, but go ahead and tell us a little bit about your work.
MEGAN: Sure. Don’t feel bad, a lot of people have never heard of a GI psychologist. Whether I’m with family or socializing when people inevitably ask what do you do and I say GI psychologist, there’s always a little bit of a look. I’m a clinical psychologist by training and got my doctorate degree and decided to do GI health specialized fellowship post-doc. I spent two years at Northwestern University in their GI behavioral health program, training with Drs. Laurie Keefer and Sarah Kensinger. Really, during that time I got to hone my clinical psychology skills with a blend of really becoming expert in gastrointestinal issues. Because of the strong brain-gut connection, the application of behavioral interventions and psychological therapies really have a natural fit. As a GI psychologist, I’m a clinical psychologist with expertise in gastroenterology.
PHOEBE: That’s amazing. I feel like very psychologist and every GI doctor should have both of these qualifications or training because they really do go hand in hand. I think by now most of our listeners are vaguely familiar with the gut-brain connection. The idea that the gut can dictate our mood and, conversely, that our stress and anxiety levels can affect our gut health. Which comes first in your opinion, and how can you tell where your problems are stemming from, if they’re actually stemming from your mid-section or your head?
MEGAN: Well that’s a very complex question. I guess I look at it as it’s a bidirectional pathway. The gut is constantly sending signals up to the brain and the brain is constantly sending signals down to the gut. In patients and people that don’t have GI problems, this dialog isn’t very loud. We don’t pay attention to it. We really aren’t bothered by it, with the exception of what most normal, healthy, high-functioning people have felt, that occasional butterflies in the stomach. That’s a reminder of that brain-gut connection. If you’re somebody that occasionally has to give a talk at work or at school, you might feel that urge to run to the bathroom right before going on stage or giving the presentation. You might go once and feel better and get up on the stage and everything is fine.
We all have that brain-gut connection, but in patients that develop bowel dysfunction and these GI conditions that communication between the brain and the gut becomes dysregulated. The brain starts to have a hard time down-regulated pain signals and different sensations from the gut and that’s when it begins to feel a lot more like a problem.
PHOEBE: What are some of the root causes of that dysregulation usually?
MEGAN: Sometimes we can pinpoint it. Sometimes people have traveled and picked up a bug and come back and are having very frequent diarrhea and abdominal pain that they did not have before. It can alter the microbiome in the gut in a way that might lead to a diagnosis of post-infectious irritable bowel syndrome. In those cases, we can tie it back to something. Other times, people can endure prolonged periods of stress, where their body holds out and it gets them through what they need to get through, and eventually, the body just gets to this threshold where you begin having symptoms. It might not be one particular event where we’re able to say because of this, you’re having this. That can be a big frustration with some of the patients that I see, they’re looking for a root cause. I always point to, we’re going to waste more time and energy trying to find that needle in the haystack, but right now, we’re confident that you do have a bowel issue. You either have been diagnosed with IBS or SIBO and so now, we need to address it from a present-focused perspective and get you going on some of these brain-gut therapies that are very effective.
PHOEBE: I assume you probably don’t have data on this, but what rough percentage would you say of people who have serious stress or anxiety end up developing some sort of GI issue?
MEGAN: Well I think the reality of the prevalence of irritable bowel syndrome for example is between 1 in 5 and 1 in 10 people. It’s a very prevalent diagnosis and we all have stress. It’s just a matter of how stress and how lifestyle and different behavioral manifestations of how we exercise, how we eat, how we sleep is going to contribute to people being more susceptible to these types of diagnoses. There’s also literature about patients with a history of trauma are more susceptible to bowel issues. I think that really the prevalence of IBS is indicative of the level of stress that we as Americans are under and the importance of managing that stress to mitigate the role that it has on our health.
PHOEBE: What is the definitional difference between anxiety and stress? I think people sometimes have a hard time parsing through their own experiences to put it in one camp or the other.
MEGAN: Yeah, I think a way to look at that is we all have different stress. How we manage it is going to make a big difference on how both our mental and physical health is impacted. If you can identify your stressors and recognize that in a given week I like to exercise a couple of times a week; I like to engage socially with some of my friends or family; I like to take time for self-care and that helps me to manage my stress then that becomes a way that you adaptively manage the stressors that are usually present in a person’s life.
Anxiety is a bit more pervasive in that, again, we all can have anxieties, and oftentimes, mild level of anxiety can be quite adaptive. It can help us to prepare for things, to get jobs done, think ahead, so a baseline level of anxiety is not a bad thing. When it becomes more problematic and you find yourself unable to manage the worries, or you recognize that you’re catastrophizing or constantly worrying about things, you’re changing your day-to-day life based on worries or fears of the unknown or things that you can’t control, then we’re leaning more toward that moderate to severe level of anxiety that may fall into more of a classic anxiety disorder that would require mental health care.
PHOEBE: How do your patients find you? What stage of their journey are they on? Are they the people who are diagnosed with a GI issue and just can’t figure out some of those techniques and lifestyle interventions to improve their mental health? Tell me a little bit more about the various scenarios you see.
MEGAN: I’m in a bit of a unique role as I’m a fully integrated faculty member at the University of Michigan in our GI department. Our patients get into my office after they have been working with the gastroenterologist, and together the gastroenterologist and patient decide that they’d like to incorporate these GI behavioral health principles, so a referral is placed. A lot of my patients already have some insight into some of the strategies that I might be working on with them. They’re folks that maybe have not responded well to traditional medical treatments. More recently, we’ve had patients presenting to Michigan Medicine to say to a gastroenterologist, I really want the referral to GI behavioral health because medication isn’t working for them. People can be very early in their journey, where a gastroenterologist is informing them that these types of therapies can be very helpful or they’ve been suffering for years and come across an article or research about brain-gut therapies and are really seeking out that specific type of treatment.
HYPNOSIS FOR ANXIETY AND IBS
PHOEBE: What are some of these techniques that you use and work with people on?
MEGAN: There are two that are very common and there’s a lot of evidence and research around using these types of brain-cut psychotherapies for GI disorders. The first is cognitive behavioral therapy. I’m sure that most of your listeners have heard of this. It’s, again, an evidence-based type of psychological therapy that’s commonly used in medical settings. It really helps patients to learn new, more adaptive ways of thinking about their health, thinking about their symptoms. Thinking about the way in which their behaviors impact how they feel and behave. It helps people to look at their maladaptive or unhelpful thought processes and come up with different ways of thinking differently.
Also, it provides patients with more psychoeducation around that brain-cut connection and the importance of other self-care, relaxation-based interventions to help calm down the mind and the body. There’s CBT and we incorporate into CBT, like I said, these relaxation interventions. I teach everybody that I work with diaphragmatic breathing and that’s an excellent tool that people love to just – they recognize they can keep it in their back pocket because it’s always with them. Any time we’re able to slow the breathing down, it can activate our body’s peri-sympathetic system, which is our relaxation response and can help with the digestive process so we can actually feel a physiological change in our body tension and urgency. Also even having more complete bowel movements by using diaphragmatic breathing.
PHOEBE: When does someone use this and for how long? Is it basically just breathing deep into your abdomen?
MEGAN: It’s belly breathing and I like to talk about it as it’s a great tool for anybody that has stress. If you’ve ever been driving and maybe you’re running a little late and you can feel your heart rate start to increase and you can feel the mind starting to race, am I going to be able to make it my appointment and I hate being late. If you’re somebody with GI problems, you feel that in your gut. You might have that sense of oh great, now I need to use the bathroom! Immediately starting to slow y our breathe down as you recognize you’re in a stressful situation, breathing in through your nose about four seconds, feeling the belly rise and exhaling out through your mouth for about six seconds, feeling the belly fall.
The amazing thing about this type of breathing is that as you’re diaphragm is activated, it starts to internally massage your intestines and your colon and your stomach in a way that we don’t get from normal chest breathing. In fact, the chest breathing that we do when we’re stressed is counterproductive. It’s clenching and tensing other muscles in your body, which is just going to further exacerbate digestive problems. When people feel like they have a tool that they can reach for and immediately know that it’s helping to calm their body down, it’s very empowering. That goes along with learning other relaxation strategies, like body relaxation or muscle relaxation, such as progressive or passive relaxations. Then even further than that takes us into the idea of gut-directed hypnotherapy, which is another way of relearning how to relax the body but a little bit more sophisticated in terms of working at that brain-gut level.
PHOEBE:Yeah, I’m so excited to hear more about this. First, I love what you just said about the breathing. I think it sounds so simple to people sometimes that this could be a real game changer. I remember, I saw a talk at a conference, I can’t remember what the topic was, but one of the things that I’ll never forget is that the speaker was talking about how when we inhale for a shorter amount of time than we exhale, basically when we focus on the exhale that’s what’s going to wind us down. If we want to ramp up our energy, then we’re going to breathe in these big breaths and just exhale for a shorter amount of time. I don’t know if that works definitively but I thought it was really interesting to think about, and actually, it’s something that’s always stuck with me. When I’m feeling overwhelmed, I’m, like, okay, just box breathing but exhale for longer.
MEGAN: Yeah, the good old box breathing or four-square breathing. It’s remarkable, I always tell people, I don’t do rocket science. It’s not the hardest work in the world but this is really hard stuff to implement when behaviorally we’ve been conditioned to respond to stress in certain ways or maladaptive ways over the course of our life. Even though diaphragmatic breathing shouldn’t necessarily rock your world, it really can because you’re relearning how to do something that we were innately born doing. We were born as diaphragmatic breathers
If you watch an infant sleeping, they’re little bellies so peacefully rise and fall when they’re sleeping. It’s really once they become toddlers and we start to move and run and be in the upright position that we shift our breathing to this more chest breathing. When we return back to that more relaxed state, it’s the one technique that my patients over and over and over say is really life changing and empowers them to feel like they have a little bit of control when things are starting to become uncomfortable for them.
PHOEBE: I love that. Hypnotherapy, I think a lot of people out there may think this sounds very woo-woo but I know that there’s actually a lot of great evidence and data for it, for IBS. Can you explain what it is exactly, what it entails and then why it works?
MEGAN: If you would have told me, again, before I got into GI that I would spend a lot of my week doing hypnosis with people, I would have probably told you that you were nuts. It’s a really beautiful intervention and it’s extremely effective for our GI patients because it targets a concept called visceral hypersensitivity. In our digestive tract, we all have these nerve endings that are helping to send those signals to our brain. In patients that have IBS, we know that those nerves are a lot more sensitive than those that do not have IBS. Our medical work-ups, though, do not account for that. You can have very sensitive nerve endings that are causing a lot of pain and urgency or constipation, but you can go through your complete medical workup and be told that everything is fine. This is really frustrating for our patients because in their life, things are not fine.
Hypnosis really gets at decreasing the brain’s awareness of that visceral hypersensitivity in the gut and the motility disturbances that people have. There’s also, in addition to the hypersensitivity from the nerve endings, we have this phenomenon of hypervigilance to also either the anticipation of having symptoms or maybe feeling a little bit of gas in the system and wondering, oh, I felt that, now whites going to happen. The more we think about it, the more it rubs up our system. Hypnosis really helps through teaching patients how to more deeply relax your body and also then very tailored, targeted suggestions to help correct the way in which the brain is interpreting the sensations from the body.
There are two very well-known protocols that have been highly research: there’s the North Carolina protocol, that’s a 7-session protocol, and then the 12-session Manchester protocol. By way of research, they both have been proven very effective for patients with refractory IBS, meaning that these are patients that have failed everything else. They’re really struggling. Where I practice is using the North Carolina protocol. Typically, patients will come for an initial consultation with me. We’ll talk about their treatment plan. We’ll talk about their symptoms. Based on the patient being interested in the hypnotherapy, being open to it, being willing to do the home practice that’s required, and also them just meeting criteria of IBS and strong hypervigilance and awareness of the visceral hypersensitivity, we’ll schedule the follow ups for the protocol.
The actual hypnosis intervention takes about 30 minutes in session with me. In between our sessions, we usually book those one time every other week. They have audio recordings that they will use at home to continue to learn and practice the process of hypnosis. Each week, the imagery is a little bit different, and we incorporate a lot of really peaceful nature imagery with the suggestions of improving functioning in the gut. By the mid-way period, patients are typically reporting improvements in symptoms. I always set people up that this is a brand new skill that they’re learning so it may take longer to really observe improvements. Sometimes, people experience improvements after one session, but ultimately, we aim to complete the seven sessions of the scripted protocol, and people really find it enjoyable. Any staged hypnosis or any of the wonkiness that you’re describing that might make people go, I don’t know about hypnosis, we really frame it as a medically based intervention that’s highly validated for these GI disorders.
PHOEBE: What makes it hypnosis versus a guided meditation?
MEGAN: There’s some really interesting articles out there answering that question. The idea is that it’s a deeply facilitated level of relaxation, following the structures of hypnosis. Our goal is try and facilitate a hypnotic trance and that’s done through a focusing of the eyes initially and then the eyes close. Then walking the patient through a muscle relaxation and deepening that state of relaxation by, again, some [panting] and imagery. Then facilitating that description of a peaceful image with the tailored suggestions about the functioning of the gut. Sometimes, patient will say this is a lot like guided imagery, and I don’t disagree with that, but those tailored, targeted suggestions at that stage of the relaxation practice, I think are what differentiate it as more of a hypnotic intervention.
HOW TO FIND A PRACTITIONER WHO USES IBS HYPNOTHERAPY
PHOEBE: Do you have to do it in person or are there programs that are online hypnosis or taped hypnosis?
MEGAN: There are some home-based programs that are being validated. The problem so far with some of that is that insurance coverage has been difficult and also, you want to be careful where you’re getting those home-based services from. Certainly, I would love to see this as an area of growth in our field because it would offer patients – or I guess it would offer a lot more patients access to this really helpful intervention. Right now, it’s something that’s unfolding in literature and in availability for patients. It’s in the pipeline, it’s happening, it’s just not as accessible as we would like it, so far.
PHOEBE: Well someone’s got to change that! We’ll talk offline, Megan.
MEGAN: Something to be done, yes. Well, some of my colleagues are really working hard on that and really, it’s just about making sure that the providers that are delivering, even the home-based services, that they’re experts in GI and they’re very familiar with this. We also have to be very careful about who we deliver this to. I had a friend who had bowel problems and as she’s describing, “Oh, my psychologist has started to do hypnosis with me for my IBS.” I said that’s great. That’s an evidence-based intervention and that’s what I do. I said are you working with a gastroenterologist as well. She said, “Well, no.” I said, well with the symptoms that you’re having, I really would recommend that we just make sure you have the proper medical diagnosis.
Unfortunately, she was diagnosed with inflammatory bowel disease and that requires as totally different treatment plan that can include hypnosis. If she wouldn’t have seen a gastroenterologist and been properly diagnosed, her health really could have progress to something far more severe. We want to be responsible for adequate and appropriate diagnosis before we do any of these interventions.
PHOEBE: If the biggest, I guess, risk is not getting a proper diagnosis, could you say that had she gone through just these hypnotherapy sessions and had, as she did, inflammatory bowel disease, she probably wouldn’t have got better just from the hypnotherapy, right.
MEGAN: Well, depending on the stage of her disease, if she had been working with the provider long enough, she may have been in a period of remission and so maybe her symptoms were more functional and ebbing and flowing so this was a great tool or strategy to help with that. We know with IBD that patients can feel okay but if they’re scoped, they can still have inflammation going on. Patients can do pretty well but have these flare-ups of functional bowel overlap but still have active disease that we wouldn’t know about unless they were properly worked up. It really is important that no matter what your GI symptoms are, you have a really thorough medical evaluation. That’s a part of the psychoeducation that I provide to patients in terms of before starting any psychological therapy for your medical issues, make sure that you have the right diagnosis.
PHOEBE: Right. That makes perfect sense. Are there any other risks in the hypnotherapy besides what we just discussed?
MEGAN: Not really. If a patient has untreated trauma history, then we don’t tend to recommend gut-directed hypnosis until they have established care with a trauma-focused provider and that trauma is better addressed. From a general perspective, the beauty of these interventions are very low risk and the effects of them are positive in the long run, so oftentimes, the effects last for years.
PHOEBE: Wow! Does the hypnosis take on different forms, depending on what the patient is dealing with, or it is a pretty standard set of images and flow?
MEGAN: We have different protocols for different diagnoses. There’s a protocol that we can use for upper GI symptoms, such as GERD and heartburn and functional heartburn. We have a script for globus, which is an esophageal symptom where it feels like there’s a lump in the throat or a lump stuck in the esophageal region. We have a protocol for dysphasia, functional dysphasia, which is a difficulty swallowing, again, despite there’s no structural abnormality in the esophagus. We have the IBS protocol and then there is a protocol that’s been tailored for inflammatory bowel disease. When you ask about the structure and flow, they’re pretty much the same. We’ve just adapted them to some of the different symptomology. Most of the other protocols that I mentioned were all adapted from the IBS protocol.
PHOEBE: Going back to visceral hypersensitivity, we’ve mentioned it, I think, once or twice on the podcast. I’m curious because some people have also asked about how gut health impacts the nervous system in terms of our conversation today. I’m just curious, especially in the context of SIBO, what causes those nerve endings to become sensitive in the first place?
MEGAN: Yeah that’s one of those needle-in-the-haystack questions. Sometimes we can pinpoint it and sometimes we can’t. Certainly, changes in our microbiome can impact it. What we eat can impact it. The quality of food, the types of food that we eat, that’s where my buddy, Kate Scarlata’s work is so important. It’s really a multifactorial system that can be impacted. As I said, acute stress, chronic stress, trauma, travel, diet, there’s a lot that can impact those nerves. I had one patient with upper GI problems with swallowing, and the same kind of visceral hypersensitivity that happens in the gut can also happen in the esophagus. This gentleman had swallowed a tortilla chip wrong, one time, and that was enough for him to really alter the hypersensitivity in the esophagus. Again, he could pinpoint it and other people can’t.
PHOEBE: For that example in particular, is it the nerve endings that are actually being damaged or, again, that kind of feedback loop of fear for when you feel a certain sensation?
MEGAN: Both, especially in the esophageal patients. There was some nerve sensitivity damage, not visible on a scope because it was healed but that sensation, that awareness, that fear, those all tie together and that’s why these comprehensive psychological therapies work so well. For that particular patient, I combined esophageal-directed hypnosis to help retrain the comfortability and the way he was thinking about sensations in the esophagus. I connected that with cognitive behavioral therapy, where we really worked on the fears that had developed about swallowing and the eating and the fear that it could happen, or that he would be in so much discomfort, again. That concept of, even though something was uncomfortable in his body, it was not indicative of danger. That’s a big concept that I work on with patients from a CBT perspective. That’s a good example of the way we combine the two types of therapies.
PHOEBE: Then does the CBT – are you basically, kind of, creating mantras for people to remind themselves when they feel a certain sensation, just to interrupt those thoughts or are there actual journaling exercises. How does it work?
MEGAN: Both. With CBT, a mantra or – we like to call it cognitive restructuring. Taking our maladaptive thinking and coming up with more rational and adaptive types of thinking are ways that we target that change and thought. In order to get to that point, some people can reiterate those thought with repetition and that changes, but other times we use what are called thought records, where people would, essentially, be journaling during stressful periods of time. What’s on their mind and then using different questions to challenge their thinking. For example, if somebody is invited to go to lunch and they really want to go, but right before they’re leaving they’re starting to feel nervous and anxious about eating in public or being in public and what if I need to go to the bathroom. We would have them take a brief pause to write out those worries and challenge those worries with, what’s the worst-case scenario here and can you handle that. What advice would you give to a friend if they were in the same situation that you’re in? How could you calm them down and how would you aid them in recognizing that they’ll probably be able to manage the stress of the situation. We use different interventions to help them build skills to change that thought pattern.
TREATING FOOD FEAR AND ANXIETY VERSUS DISORDERED EATING
PHOEBE: Amazing! Wrapping things up a little bit, I get tons of questions from people with SIBO who ask about how I deal with food fear and also dealing mentally with setbacks. I think the food fear is such a big one, especially with all of the adjustments that a lot of people make with their diet and their healing plan. How do you deal with patients who have really serious anxiety around food, not just because of their gut health issues but in some ways because of the treatment that they’ve gone through?
MEGAN: Assessment is really important. Sometimes, these patients have been misdiagnosed as engaging in disordered eating because they’re avoiding food so much because they’re afraid of symptoms but it can be misinterpreted. I try to do a really thorough assessment of those points. What is it that’s causing the fear and what’s the severity of that fear? Are they experiencing nutritional deficiencies? Are they experiencing significant weight loss? Has it start to impact their body image? If a patient is really just highlighting that there’s some confusion about what to eat or they’re having trouble reincorporating food, I might work together with a dietician to make sure that they have a food plan that feels healthy and appropriate for them. Then we would utilize some cognitive behavioral therapy to explore the thoughts and the fears that they’re experiencing and challenge some of those thoughts through, maybe, some exposure of trying a small portion of food and reincorporating. Sometimes it’s out of my area of expertise and I have to bring in somebody that maybe specializes in disordered eating, if it’s become too far to one spectrum, if, again, those people are at a very low BMI or need some help with getting their meals stabilized.
From a general perspective, even just normalizing for patients, if they’ve been avoiding certain foods or restricting foods or following even a low FOBMAP diet, this is hard. It’s something that can be very stressful and time consuming, and certainly not something that they want to be doing on their own. Making sure that they have a great GI dietician or a dietician that’s very familiar with bowel problems and dietary barriers. Then me jumping in to support the emotional side of things.
PHOEBE: I love that! Before we leave you, is there any piece of advice or tactic that someone can try at home, right now, if they are currently dealing with SIBO, feeling a lot of anxiety around their food? Is there anything you would tell them to do, maybe around meals or even just as an everyday practice?
MEGAN: Breathing and acknowledging that for you food is a stressor. Going into a meal in a more relaxed state is going to help you significantly, in terms of both how your body is preparing to accept that meal. Also checking in with how you’re talking to yourself about your food. Are you using really negative self-talk about, I have to eat and it’s just going to cause pain. Are you negatively predicting what’s going to happen before it even happens. If you find that you’re really approaching your food and your meals from a negative perspective, trying to shift that a little bit and use some constructive self-talk. Focus on times where food has been pleasurable or has been something that you’ve enjoyed.
Also, maybe spend a few minutes before your meal just engaged in some slow, deep breathing, some guided imagery around your gut accepting that food and letting it digest in a healthy way. Then maybe after a meal, again just relaxing the body and allowing yourself to breathe deeply to facilitate that digestive process. Then just from a behavioral perspective, not eating too closely to going to bed. Talking with a dietician about how to space out meals because sometimes you might be somebody that needs to eat smaller more frequent meals instead of three meals a day.
I guess the highlights are approaching your meals with positivity and constructive self-talk; implementing relaxation; and working with a treatment team.
PHOEBE: I love it! Just so people fully understand, when you have that kind of negativity going into a meal and that real internalized fear, what is your digestive system actually going to do as a result of those messages? You mentioned that you’re really not preparing your body to be able to process the food properly, simply with these thoughts.
MEGAN: Well, it’s coming from the stress model. If we’re experiencing a lot of anxiety and stress, our body internalizes that and can impact our immune system. We know that stress activates our sympathetic system, which is our body’s fight, flight or freeze response. When we’re stressed, our heart rate increases, our breathing gets shorter and shallower, and our digestion is impacted. When I say approaching it with a little bit more positivity, it’s really approaching it with the best stress management skills that you can.
PHOEBE: Well thank you so much, Dr. Megan Riehl for coming on the show and chatting with us. I will link to you where people can find out more of you and definitely link out to some of the resources and concepts that you mentioned.
MEGAN: Great! This has been so fun. I’m really excited to have talked to you.
Disclaimer: The information shared in this podcast is not meant to provide medical advice, professional diagnosis, or treatment. The information discussed is for educational purposes only and is not a substitute for medical or professional care.