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.