If eating has become a source of fear because of digestive symptoms, you're not alone. For many people living with IBS, IBD, and other GI conditions, repeated eating-related symptom flares create powerful food–symptom associations that make avoiding certain foods feel like the safest choice. Over time, however, this understandable protective response can become restrictive, limiting nutrition, social connection, and overall quality of life.

In this episode, we're joined by digestive health and eating disorder dietitian expert, Janelle Smith, RDN, and GI psychologist Dr. Madison Simons to explore the overlap between gastrointestinal disorders, food fear, and disordered eating.

Together, we explore how fear around eating develops, how healthcare providers tell the difference between healthy caution and fear that's limiting daily life, and how people can gradually rebuild confidence with eating through compassionate, evidence-based care. We also explain why working with a team—including a gastroenterologist, GI dietitian, and GI psychologist—can make all the difference in helping people feel more comfortable with food, expand their diets, and get back to living life more fully.

In this episode, we discuss:

• Why progressively restricting foods can worsen fatigue, anxiety, nutrition, and overall quality of life
• Why avoiding foods because of GI symptoms can be an adaptive response, your brain is trying to help you, and this isn't inherently "pathological"
• How the amygdala, your body's alarm system, and visceral hypersensitivity create powerful food-symptom associations
• Signs that food avoidance is no longer serving you and may be driven by fear
• How clinicians use open-ended conversations and screening tools to identify disordered eating and ARFID risk
• When dietary therapies like the low FODMAP diet are appropriate and when they're not
• Least-restrictive nutrition strategies, including gentle food swaps and stepwise reintroduction
• Which evidence-based supplements may help manage symptoms without adding unnecessary diet restriction
• How exposure ladders, "micro-dosing" feared foods, and coping strategies can reduce anticipatory anxiety
• Why reframing symptoms as sensations and separating discomfort from danger is a powerful part of recovery
• How a collaborative care team can help people regain confidence, nourish their bodies, and expand their lives—not just their diets.

f you or someone you love has ever felt overwhelmed by food fear because of digestive symptoms, this conversation offers reassurance, practical strategies, and hope. While some dietary changes may be appropriate to manage GI conditions, recovery is about learning to distinguish necessary restrictions from fear-driven avoidance, rebuilding trust in your body, and finding the right support so food can become a source of nourishment and enjoyment again.

This episode has been sponsored by Ardelyx.

Reference:

Simons M, Issokson K. From Food Fears to Food Freedom: How Do We Best Manage Restrictive Eating in Inflammatory Bowel Disease? Crohns Colitis 360. 2025

Scarlata K, Zickgraf HF, Satherley RM, et al. A Call to Action: Unraveling the Nuance of Adapted Eating Behaviors in Individuals With Gastrointestinal Conditions. Clin Gastroenterol Hepatol. 2025;23(6):893-901.e2. doi:10.1016/j.cgh.2024.11.010

Riehl ME, Scarlata K. Understanding Disordered Eating Risks in Patients with Gastrointestinal Conditions. J Acad Nutr Diet. 2022;122(3):491-499. doi:10.1016/j.jand.2021.03.001

Learn more about Kate and Dr. Riehl:

Website: www.katescarlata.com and www.drriehl.com
Instagram: @katescarlata @drriehl and @theguthealthpodcast

Order Kate and Dr. Riehl's book, Mind Your Gut: The Science-Based, Whole-body Guide to Living Well with IBS.  

The information included in this podcast is not a substitute for professional medical advice, examination, diagnosis or treatment.  Always seek the advice of your physician or other qualified health care provider before starting any new treatment or making changes to existing treatment.

Gut health trends are everywhere, but which ones deserve a closer look, and which ones need a reality check?

In this episode, we break down the biggest gut health trends getting clicks, likes, and follows online. From our "hard no" to "I'm curious," we share where each trend lands on our hype scale and explain the science, physiology, and gut-brain connection behind our take.

We explore what actually helps symptoms like constipation, bloating, and digestive discomfort without fueling anxiety, wasting money, or creating unnecessary health risks.

From viral wellness trends to evidence-based advice, here's what we're discussing:

• Does the viral chia seed "internal shower" actually cleanse your colon or is that just clever marketing?
• Are colonics and coffee enemas detox heroes, or do they go against how your gut is designed to work?
• Can lemon water and apple cider vinegar really "wake up" your digestion first thing in the morning?
• Can a simple self-care routine improve your gut symptoms, even if it doesn't "heal" your digestive system?
• Are fermented foods always packed with probiotics or is there more to the story? (Tune in for a revisit of Episode 20!)
• Can you make colonoscopy prep more tolerable with "prep mocktails" without interfering with the procedure?
• Can you have too much of a good thing? What happens when "fibermaxxing" goes too far?
• Are gut-healing protocols and at-home microbiome tests helping you understand your gut or making you more confused and anxious?
• Do lactose intolerance patches actually work, or does the science tell a different story?
• Are castor oil packs a legitimate digestive therapy?

Whether you're tempted to try the latest gut health hack or just wondering what's worth your attention, this episode will help you separate science from social media. 

Resources:

Chia seeds (Salvia hispanica L.): A therapeutic weapon in metabolic disorders. Food Sci Nutr. 2022 Dec 15;11(1):3-16. doi: 10.1002/fsn3.3035.

Guide to Utilization of the Microbiology Laboratory for Diagnosis of Infectious Diseases: 2024 Update by the Infectious Diseases Society of America (IDSA) and the American Society for Microbiology (ASM). Clin Infect Dis. 2024. doi: 10.1093/cid/ciae104.

Fermented Foods via ISAPP

Misselwitz B, Butter M, Verbeke K, Fox MR. Update on lactose malabsorption and intolerance: pathogenesis, diagnosis and clinical management. Gut. 2019 Nov;68(11):2080-2091. doi: 10.1136/gutjnl-2019-318404. Epub 2019 Aug 19. PMID: 31427404; PMCID: PMC6839734.

Learn more about Kate and Dr. Riehl:

Website: www.katescarlata.com and www.drriehl.com
Instagram: @katescarlata @drriehl and @theguthealthpodcast

Order Kate and Dr. Riehl's book, Mind Your Gut: The Science-Based, Whole-body Guide to Living Well with IBS.  

The information included in this podcast is not a substitute for professional medical advice, examination, diagnosis or treatment.  Always seek the advice of your physician or other qualified health care provider before starting any new treatment or making changes to existing treatment.

MCAS is one of those diagnoses that can make it feel like your body is telling a dozen stories at once—and no one is listening. If you're experiencing GI symptoms alongside flushing, hives, brain fog, fatigue, palpitations, medication sensitivities, or a persistent "fight-or-flight" feeling, this episode is designed to help connect the dots without oversimplifying your experience.

In this episode, we sit down with gastroenterologist Dr. Zachary Spiritos to unpack mast cell activation syndrome (MCAS) and explore the connections between immune activation, the gut-brain axis, and symptoms that can affect nearly every system in the body. We discuss why patients are often dismissed, how stress and hormonal changes can amplify symptoms, and what a realistic, stepwise treatment approach looks like when the evidence base is still evolving.

In this episode, we discuss:

• What mast cells do and why MCAS can affect multiple organ systems 
• Why MCAS is often missed in siloed medical care and mislabeled as anxiety 
• Barrier dysfunction, environmental triggers, and intestinal permeability as a useful framework 
• Histamine as one mediator among many and why antihistamines are not a perfect treatment for all
• Links between MCAS, IBS, visceral hypersensitivity, dysautonomia, and POTS 
• Hypermobility, pelvic floor dysfunction, and neck tension as common clinical clues 
• Treatment principles including start low and go slow, informed consent, and layered individualized plans 
• Dietary approaches patients commonly explore, including low-histamine, low-FODMAP, and gluten-free patterns 
• Hormonal influences across the menstrual cycle and during perimenopause
• The role of sleep, nervous system regulation, and stress reduction in decreasing symptom reactivity 

If you've ever felt like your symptoms don't fit neatly into a single diagnosis, this episode will help you make sense of the bigger picture and explore what healing can look like when the gut, immune system, and nervous system are all part of the conversation. 

References:

Ford AC, Staudacher HM, Talley NJ. Postprandial symptoms in disorders of gut-brain interaction and their potential as a treatment target. Gut. 2024;73(7):1199-1211. Published 2024 Jun 6. doi:10.1136/gutjnl-2023-331833

Walker MM, Warwick A, Ung C, Talley NJ. The role of eosinophils and mast cells in intestinal functional disease. Curr Gastroenterol Rep. 2011;13(4):323-330. doi:10.1007/s11894-011-0197-5

Pasricha PJ, Talley NJ. Functional Dyspepsia. N Engl J Med. 2026;394(2):166-176. doi:10.1056/NEJMcp2501860

Find Dr. Spiritos on IG @drzacspiritos

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Don't forget to subscribe, rate, and leave us a comment. 

Learn more about Kate and Dr. Riehl:

Website: www.katescarlata.com and www.drriehl.com
Instagram: @katescarlata @drriehl and @theguthealthpodcast

Order Kate and Dr. Riehl's book, Mind Your Gut: The Science-Based, Whole-body Guide to Living Well with IBS.  

The information included in this podcast is not a substitute for professional medical advice, examination, diagnosis or treatment.  Always seek the advice of your physician or other qualified health care provider before starting any new treatment or making changes to existing treatment.

Part 3 of the Women's Health Series

Bloating, gas, urgency, abdominal pain, and that relentless “what if something happens?” loop can turn sex from a close connection into stress fast. 

Digestive symptoms can quietly impact some of the most vulnerable parts of our lives...including intimacy, relationships, and self-esteem. And often, the shame surrounding those experiences feels heavier than the symptoms themselves. If you’ve ever pulled away from connection because your gut felt unpredictable, this conversation is for you. In this episode, we’re opening up an honest and empowering discussion about gut health, confidence, and reclaiming intimacy without fear or embarrassment.

We dive into this topic with our expert guest, Dr. Alyse Bedell, GI psychologist and Certified Sex Therapist, covering: 
• Why digestive functions feel taboo in sexual relationships 
• How IBS and IBD symptoms can impact desire, relaxation, and satisfaction 
• Myth-busting the idea that sex must be spontaneous to be pleasurable 
• Scripts and “reset” strategies for handling symptoms in the moment 
• Redefining intimacy so closeness does not always imply intercourse 
• Flexible planning around meals, energy, triggers, and symptom patterns 
• Partner support that reassures without becoming patronizing 
• The circular sexual response cycle and starting from sexual neutrality 
• Rebuilding sexual self-esteem with stigma work and acting with "as if” confidence 

This episode has been sponsored by Ardelyx. 

References: 

Ballou S, McMahon C, Lee HN, et al. Effects of Irritable Bowel Syndrome on Daily Activities Vary Among Subtypes Based on Results From the IBS in America Survey. Clin Gastroenterol Hepatol. 2019 Nov;17(12):2471-2478.e3. 

Fretz KM, Hunker KE, Tripp DA. The Impact of Inflammatory Bowel Disease on Intimacy: A Multimethod Examination of Patients' Sexual Lives and Associated Healthcare Experiences. Inflamm Bowel Dis. 2024 Mar 1;30(3):382-394. doi: 10.1093/ibd/izad106. PMID: 38206426; PMCID: PMC10906359.

Wang J, Varma MG, Creasman JM, et al. Pelvic floor disorders and quality of life in women with self-reported irritable bowel syndrome. Aliment Pharmacol Ther. 2010;31(3):424-431. doi:10.1111/j.1365-2036.2009.04180.x

Dubinsky MC, Potts Bleakman A, Schreiber S, et al.. Impact of moderate-to-severe ulcerative colitis and Crohn's disease on sexual activity: United States and European patient perspectives from the communicating needs and features of IBD experiences (CONFIDE) survey. Curr Med Res Opin. 2025 Jun;41(6):1017-1030. doi: 10.1080/03007995.2025.2530736. Epub 2025 Jul 17. PMID: 40635574.

Come As You Are: Revised and Updated: The Surprising New Science That Will Transform Your Sex Life by Emily Nagoski Ph.D.  

Becoming Cliterate: Why Orgasm Equality Matters--And How to Get It by Laurie Mintz

The American Association of Sexuality Educators, Counselors and Therapists (AASECT) (great resources as well as a place to find a certified sex therapist)

Give us a follow us on social media @TheGutHealthPodcast, where we'd love for you to share your thoughts, questions, and experiences. 

Learn more about Kate and Dr. Riehl:

Website: www.katescarlata.com and www.drriehl.com
Instagram: @katescarlata @drriehl and @theguthealthpodcast

Order Kate and Dr. Riehl's book, Mind Your Gut: The Science-Based, Whole-body Guide to Living Well with IBS.  

The information included in this podcast is not a substitute for professional medical advice, examination, diagnosis or treatment.  Always seek the advice of your physician or other qualified health care provider before starting any new treatment or making changes to existing treatment.

Part 2 of the Women's Health Series

Your digestion suddenly feels different, your sleep is falling apart, your mood and patience are all over the place — and you start wondering whether it’s stress, aging, or something bigger. Joined by two extraordinary Mayo Clinic experts, Drs. Chrisandra Shufelt and Jami Kinnucan, we pull back the curtain on perimenopause and menopause, explaining how shifting estrogen and progesterone can ripple through the entire body — from constipation and bloating to metabolic health, cardiovascular risk, and even the gut microbiome. Most importantly, this episode reminds women that these changes are real, common, and worthy of attention.  

• Defining perimenopause versus menopause as a life stage and why symptoms vary so much 
• Linking estrogen and progesterone changes to motility, constipation, bloating, and visceral sensitivity 
• Discussing microbiome shifts, dysbiosis, and how gut health may influence estrogen recycling 
• Outlining cardiometabolic changes including central weight gain, lipid changes, blood pressure, and insulin resistance 
• Clarifying brain fog, sleep disruption, and increased anxiety and depression risk during perimenopause 
• Reviewing SSRIs and SNRIs as options that may also reduce hot flashes 
• Covering bone loss timing, hormone therapy limits, and when DEXA scanning makes sense 
• Summarizing what is known about IBS symptom severity and what is less clear in IBD 
• Debunking hormone panels in perimenopause and pointing to menopause-trained clinicians 
• Breaking down soy, supplements, placebo effects, and lifestyle factors like weight loss and exercise snacks 
• Detailing vaginal estrogen for dryness, painful sex, and recurrent UTIs, including how to use it correctly 

This episode has been sponsored by Ardelyx.

References for this episode:

The 2022 hormone therapy position statement of The North American Menopause Society

The association between metabolic dysfunction-associated steatotic liver disease diagnosis and vasomotor symptoms in midlife women

Impact of Menopause and Clinical Considerations in Patients With Inflammatory Bowel Disease

Understanding the sexual concerns of older women presenting for care to women's health clinics: a cross-sectional study

Find a Menopause Practitioner: Menopause.org

Learn more about Kate and Dr. Riehl:

Website: www.katescarlata.com and www.drriehl.com
Instagram: @katescarlata @drriehl and @theguthealthpodcast

Order Kate and Dr. Riehl's book, Mind Your Gut: The Science-Based, Whole-body Guide to Living Well with IBS.  

The information included in this podcast is not a substitute for professional medical advice, examination, diagnosis or treatment.  Always seek the advice of your physician or other qualified health care provider before starting any new treatment or making changes to existing treatment.

Part 1 of the Women's Health Series

Endometriosis can show up like a gut disorder, and that confusion keeps many people stuck for years without answers. We map the overlap between endometriosis and IBS, explain what symptoms should raise suspicion, and share practical ways to build a care plan that supports both digestion and quality of life. 

• Endometriosis prevalence, symptoms and why it is often missed 
• IBS-like symptoms explained, including inflammation, adhesions, and visceral hypersensitivity 
• Hallmark signs beyond pelvic pain, including heavy periods, pain with sex, and pain with urination 
• Why diagnosis can be delayed and how updated guidance supports symptom-based evaluation plus imaging 
• Fertility considerations, diminished ovarian reserve risk, and why early treatment can matter 
• Low FODMAP as a short-term tool for GI symptoms, not a cure for endometriosis 
• Mediterranean-style and anti-inflammatory eating patterns as a less restrictive foundation 
• Stress, sleep, and gut-directed hypnotherapy as nervous-system support for pain and gut symptoms 
• Gluten-free and dairy-free myths, plus why celiac screening matters before cutting gluten 
• Supplement reality check, when to correct deficiencies, and why third-party testing matters 
• The “dream team” approach, including medical doctor, dietitian, pelvic floor physical therapy and mental health support 

This episode has been sponsored by Ardelyx.

References for this episode:

2023 narrative assessment on gluten and endometriosis

2025 meta-analysis on endometriosis and supplements

2023 UK survey dietitian support for endometriosis

Exploring the Nutrition‐Related Healthcare Experiences of Individuals With Endometriosis: Qualitative Interviews With Consumers and Dietitians

Rachelle’s delicious spaghetti & meatballs recipe 

Find Rachelle Mallik on Instagram

Consumer Lab

You can also follow us on social media at the Gut Health Podcast, where we'd love for you to share your thoughts, questions, and experiences.

Learn more about Kate and Dr. Riehl:

Website: www.katescarlata.com and www.drriehl.com
Instagram: @katescarlata @drriehl and @theguthealthpodcast

Order Kate and Dr. Riehl's book, Mind Your Gut: The Science-Based, Whole-body Guide to Living Well with IBS.  

The information included in this podcast is not a substitute for professional medical advice, examination, diagnosis or treatment.  Always seek the advice of your physician or other qualified health care provider before starting any new treatment or making changes to existing treatment.

Part 2 of the IBS-D Series

We sit down with GI dietitian Beth Rosen to talk about her lived experience with IBS-D, and how the absence of a clear diagnosis and effective treatment plan early on led to frustration and unnecessary food restriction. 

With the right diagnosis and support, she was able to shift toward a clearer path, building a sustainable, flexible approach to eating and symptom management. 

We share real-world strategies for identifying triggers, eating enough without panic, and using gut-brain tools so symptoms don’t run the show.

• Beth’s IBS-D origin story after C. diff and the missteps that delayed care
• Why “everything looks normal” needs context plus a plan
• Building an IBS story document to speed up appointments and strengthen self-advocacy
• Common IBS-D triggers and why broad food cuts can backfire
• Fructans, lactose, gluten, and the value of a targeted approach
• Coffee variables to consider including caffeine dose and acidity
• Digestive enzymes as practical support when appropriate
• Dining out tactics like menu scouting, calling ahead, and simple safe orders
• Travel and social scripts that protect privacy and reduce stress
• Beth's IBS toolbox picks: adequate + regular meals, targeted fiber, hydration, modified low FODMAP, gut-brain strategies
• Diaphragmatic breathing for urgency (Check out Dr. Riehl's video on diaphragmatic breathing, here.)

Other resources from our guest, Beth Rosen MS, RDN:

Hot off the press: Gut Goals - the book for IBS patients, by Beth Rosen!

The EDGI Training Project - the book and resources for practitioners on the intersection of ED and GI 

Learn more about Beth: Beth Rosen's website  

This episode has been sponsored by Salix Pharmaceuticals. 

Don’t forget to subscribe, rate, and leave us a comment. You can also follow us on social media, instagram @theguthealthpodcast, where we’d love for you to share your thoughts, questions, and experiences. 

Learn more about Kate and Dr. Riehl:

Website: www.katescarlata.com and www.drriehl.com
Instagram: @katescarlata @drriehl and @theguthealthpodcast

Order Kate and Dr. Riehl's book, Mind Your Gut: The Science-Based, Whole-body Guide to Living Well with IBS.  

The information included in this podcast is not a substitute for professional medical advice, examination, diagnosis or treatment.  Always seek the advice of your physician or other qualified health care provider before starting any new treatment or making changes to existing treatment.

Part 1 of the IBS-D Series

We map out a clear, practical way to understand IBS-D, from what it is, to how clinicians rule out the conditions that can look like it. With Dr. Anthony Lembo, we move from science to real-world next steps so you can feel more confident about diagnosis, treatment options, and hope for improvement. 

• How IBS-D is defined using stool form and pain patterns 
• When diarrhea needs more workup using alarm features 
• Common IBS-D mimickers including celiac disease, IBD, bile acid malabsorption, microscopic colitis, sucrase isomaltase deficiency and Giardia 
• What post-infectious IBS may change in the gut including immune activation, permeability, microbiome, and hypersensitivity 
• What the L-glutamine permeability study suggests and what remains unknown 
• How to approach it  a stepwise treatment IBS-D plan using lifestyle, loperamide, antispasmodics, neuromodulators, rifaximin, and other prescriptions 
• Why brain-gut behavioral therapy helps even without severe anxiety or depression 
• How we avoid the trap of endless “root cause” chasing with a confident diagnosis 

Rome V will include an update of the Rome Criteria (publication available around May 2026). 

This episode has been sponsored by Salix Pharmaceuticals. 

Follow us on social media, instagram @theguthealthpodcast, where we’d love for you to share your thoughts, questions, and experiences. 

References: 

Black CJ, Ford AC. An evidence-based update on the diagnosis and management of irritable bowel syndrome. Expert Rev Gastroenterol Hepatol. Published online January 21, 2025. doi:10.1080/17474124.2025.2455586

Marasco G, Cremon C, Barbaro MR, Stanghellini V, Barbara G. Journal of Clinical Gastroenterology Lectureship Dubai 2022 : Management of Irritable Bowel Syndrome With Diarrhea. J Clin Gastroenterol. 2024;58(3):221-231. Published 2024 Mar 1. doi:10.1097/MCG

Congenital Sucrase-Isomaltase Deficiency: What, When, and How?

Foley A, Halmos EP, Husein DM, et al. Adult sucrase-isomaltase deficiency masquerading as IBS. Gut. 2022;71(6):1237-1238. doi:10.1136/gutjnl-2021-326153

Learn more about Kate and Dr. Riehl:

Website: www.katescarlata.com and www.drriehl.com
Instagram: @katescarlata @drriehl and @theguthealthpodcast

Order Kate and Dr. Riehl's book, Mind Your Gut: The Science-Based, Whole-body Guide to Living Well with IBS.  

The information included in this podcast is not a substitute for professional medical advice, examination, diagnosis or treatment.  Always seek the advice of your physician or other qualified health care provider before starting any new treatment or making changes to existing treatment.

Tired of hearing “it’s just stress”?  IBS experts Drs. Laurie Keefer and Darren Brenner join Kate Scarlata and Dr. Megan Riehl to set the record straight on irritable bowel syndrome.

IBS is a real, biologically based disorder involving the gut–brain axis, the microbiome, immune function, and nervous system signaling. Understanding how these systems interact reshapes how we diagnose, personalize treatment, and support long-term symptom relief.

If you’ve felt dismissed, confused, or stuck in trial-and-error care, this episode will help you feel validated, informed, and empowered with a clearer, science-backed path forward.

Together we break down:

• The value of a positive diagnosis (not endless testing)
• The impact of trauma and adverse childhood experiences (ACEs) on gut sensitivity 
• Using diet to support symptom relief without unnecessary food restriction
• How to comprehensively match treatment to your triggers

Support & Professional Resources

If you’ve experienced ACEs or trauma and want support from a GI psychologist or trauma-informed provider, these directories can help: 

• GI Psychology (virtual services available)
• Rome Foundation GastroPsych Provider Directory
• Trauma-Informed Mental Health Provider Directory

Partnering with a clinician trained in gut–brain disorders and trauma-informed care can safely address both physical symptoms and nervous system patterns. 

• Aggeletopoulou et al. Unraveling the Pathophysiology of Irritable Bowel Syndrome: Mechanisms and Insights. Int J Mol Sci, 2025.
• Keefer L et al. The Role of Resilience in IBS and Other Chronic GI Conditions. Clin Gastroenterol Hepatol, 2021.
• Chang L et al. Sex, Anxiety, and Resilience in the Association Between Adverse Childhood Experiences and IBS. Clin Gastroenterol Hepatol, 2025.
• Dong et al (UCLA Church Lab). Experiences of discrimination are associated with microbiome and transcriptome alterations in the gut. Front Microbiol, 2024.
• Scarlata K et al. Utilization of Dietitians in the Management of Irritable Bowel Syndrome by Members of the American College of Gastroenterology. Am J Gastroenterol, 2022.
  •  How Kate Does It: Low-FODMAP Diet (AJG)

This episode is sponsored by Ardelyx. 

Learn more about Kate and Dr. Riehl:

Website: www.katescarlata.com and www.drriehl.com
Instagram: @katescarlata @drriehl and @theguthealthpodcast

Order Kate and Dr. Riehl's book, Mind Your Gut: The Science-Based, Whole-body Guide to Living Well with IBS.  

The information included in this podcast is not a substitute for professional medical advice, examination, diagnosis or treatment.  Always seek the advice of your physician or other qualified health care provider before starting any new treatment or making changes to existing treatment.

Fiber isn’t one-size-fits-all and for some people, more isn’t better. In this episode, we explore why most people under-eat fiber, why certain fibers can worsen symptoms, and how to personalize intake in a way your body can actually tolerate. Dr. Heather Armstrong shares emerging insights on fiber function, microbiome capacity, and practical strategies for going low and slow. We also unpack new science explaining why fiber supports gut health in some individuals, while triggering issues in others with reduced fermentative activity. 

In this episode, we discuss:
• The fiber gap, health risks, and minimum intake targets
• How solubility, viscosity, and fermentability guide fiber choice
• Matching fiber types to IBS, diarrhea, and constipation
• Why whole foods matter more than isolates
• Citrus peel pectin and simple kitchen hacks
• Why “low and slow” dosing reduces gas and pain
• How long microbiome changes and symptom relief actually take
• When fiber supplements help (and when they don’t)
• Individualized fiber needs in IBD (and implications for IBS, MS, and liver disease)
• Why dietitians are essential for precision nutrition

This episode is especially relevant if you’ve been told to “just eat more fiber”—and it didn’t go well.

Learn more about Dr. Heather Armstrong's novel research:

Gut feeling: new test and precision diet could boost health for people with IBD. U of A research team in clinical trials for their innovative AI-powered tool that could reduce inflammation by “rewiring” the gut microbiome.

References:

Ramezani F, Pourghazi F, Eslami M, et al. Dietary fiber intake and all-cause and cause-specific mortality: An updated systematic review and meta-analysis of prospective cohort studies. Clin Nutr. 2024

Chang SC, Cassidy A, Willett WC, Rimm EB, O'Reilly EJ, Okereke OI. Dietary flavonoid intake and risk of incident depression in midlife and older women. Am J Clin Nutr. 2016 

Armstrong HK, Bording-Jorgensen M, Santer DM, et al. Unfermented β-fructan Fibers Fuel Inflammation in Select Inflammatory Bowel Disease Patients. Gastroenterology. 2023

Armstrong H, Mander I, Zhang Z, Armstrong D, Wine E. Not All Fibers Are Born Equal; Variable Response to Dietary Fiber Subtypes in IBD. Front Pediatr. 2021

Gao J, Lee AA, Abtahi S, et al. Low Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols Diet Improves Colonic Barrier Function and Mast Cell Activation in Patients With Diarrhea-Predominant Irritable Bowel Syndrome: A Mechanistic Trial. Gastroenterology. 

This episode is sponsored by Activia.

Learn more about Kate and Dr. Riehl:

Website: www.katescarlata.com and www.drriehl.com
Instagram: @katescarlata @drriehl and @theguthealthpodcast

Order Kate and Dr. Riehl's book, Mind Your Gut: The Science-Based, Whole-body Guide to Living Well with IBS.  

The information included in this podcast is not a substitute for professional medical advice, examination, diagnosis or treatment.  Always seek the advice of your physician or other qualified health care provider before starting any new treatment or making changes to existing treatment.