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.