The Gut Health Podcast

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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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.