4 ways to ease bloating, constipation and improve your gut health beyond diet | Dr Rabia Topan

Dr Rupy: I'm Dr Rupy, and on this show, I help you feel more in control of your health through food and lifestyle medicine. If you struggle with bloating, reflux, unpredictable digestion, or any other gut issues, and you've tried making changes to your diet, maybe even cutting out foods, but nothing helps, the missing piece might not be what you're eating, but actually how your brain and gut are communicating. Today, we're diving into four overlooked tools that improve gut health and have nothing to do with what's on your plate. I'm joined by Dr Rabia Topan, NHS consultant gastroenterologist and PhD researcher specialising in gut-brain disorders like IBS. She helps patients at the functional gut clinic who've struggled with digestive symptoms, sometimes for years, even when their tests come back normal, which actually happens to one in three people in the UK described as having a functional gut disorder. Whether you suffer from gut symptoms or you're just looking to optimise your gut health for better energy and overall wellbeing, these practical tools that we discuss today can benefit you. In fact, what Dr Rabia recommends as a single practice to follow daily at the end of the pod is something new I'm adding to my own routine. Dr Rabia, can you improve symptoms like bloating, constipation, and other digestive issues beyond changing what you eat?

Dr Rabia: When we talk about gut health, most people think about the food that they eat. They think about what they eat, what they should avoid, and what diet to follow. But in clinic, I see all the time that patients really make some fantastic changes beyond diet or when diet hasn't been effective. And the reason that is, is because the gut is not only a digestive organ that responds to the food you eat. It's deeply connected to our brain and our nervous system. And so the way that we feel, the way we process stress, and the way that our body feels safe in the world around us, can all actually change and modulate the way the gut functions. And what that means is that there are powerful tools to care for your nervous system which will influence your gut health beyond diet. And we're going to talk about four of those tools today.

Dr Rupy: Okay, this is I think going to be news to a lot of people, this idea that your gut isn't just a digestive organ and actually it can be influenced by your brain and your environment and how you perceive your environment as well. That's phenomenal. Where should we start?

Dr Rabia: I think we should dive right in and speak to everyone out there who has either got gut symptoms or hasn't got gut symptoms. And I want to start by saying that actually all of the listeners to our conversation fall into one of those two camps. When you're listening, you're either someone who hasn't got gut symptoms. Your gut functions nice and normally, nice and quietly in the background of your awareness. You don't have to think about digesting your food. And for those people, I think they're listening for one of two reasons. I think they're listening either because they want to optimise the function of their gut and the performance of their gut, or they're listening because they want to preempt and make changes now to prevent long-term health issues. If you're not that type of person listening, then you're the type of person who unfortunately is suffering from gut symptoms. And if you have a gut symptom, then your gut is speaking loudly. It's talking to you all the time in the foreground of your awareness, and it's irritable, uncomfortable, fluctuating, and unpredictable. And for those people, you're here because you want your symptoms changed or you want to return to some version of yourself before those symptoms ever were and get back your quality of life. And the thing that troubles me a lot about a lot of information out there on gut health, because it's so trendy, is that the same advice is not always applicable to both those two people. Apart from the first pillar we're going to talk about today, and that is breathwork.

Dr Rupy: Okay.

Dr Rabia: So we all breathe. We're breathing to be alive and vital. And right now, everyone listening is not necessarily conscious of their breath. It's also probably hard to maintain conversation with me, digest what I'm saying, excuse the pun, and also focus on your breathing.

Dr Rupy: Totally.

Dr Rabia: And we're going to go into that in a moment. The breath is conscious and unconscious. So it's occurring as a rhythm in the background to keep us alive and vital, but it's also something we can direct our attention to. And when we do so, automatically the breath slows down. Because attention is powerful, and when it comes to gut symptoms, our attention is a spotlight. And where we shine that spotlight is what we can control. So the breath really has two tools that people can change in their daily life to alter their gut health, whether you have symptoms or not. And we're going to talk about those two in turn. The first is about the rate and rhythm of breathing. So when we breathe and when we focus our attention on the breath, it will naturally slow down. Now, humans breathe roughly at a rate of around 10 to 12 breaths per minute. And so what I'm talking about that's been validated in the research is halving that amount of time. So it's around six breaths per minute.

Dr Rupy: Okay.

Dr Rabia: We're talking about a 10-second breath. So when you slow your breathing down to around a 10-second breath, then you reduce the rate. And what that does is it directly influences a nerve in the body, and the nerve is called the vagus nerve, from Latin meaning vagabond, which means wandering nerve. And it's the longest nerve in the human body, and it forms part of our autonomic nervous system. So our nervous system is split into these branches, and the automatic part means that it's automatic. It's occurring in the background. We don't have to think about beating our heart or moving our lungs or changing our digestion. These are automatic functional processes. And so the vagus nerve is in charge of that autonomic process. And when we breathe slowly at around six breaths a minute, and research has shown that it's the most tolerable number. If we breathed even slower, it would be even better on vagal vagus on for the vagus nerve.

Dr Rupy: I was just thinking like, how can I optimise that even more so? Like, is it better if I breathe like four times a minute? Is there are there even more benefits to to be had?

Dr Rabia: Great question. So the research has looked at different rates of breathing and found that the six-cycle breath induces something called cardio-respiratory resonance. So to break that down a little bit, I mentioned that the vagus nerve is a long nerve. It runs from the base of the brain through the heart, the lungs, it pierces the diaphragm, and it supplies the mid and fore part of the gut. And so with this long nerve, the firing of that nerve or what we call vagal tone is what we're influencing. And of all the numbers, it's easiest to remember six because that induces the best resonance. So if you breathe at a slower rate, it's going to be more uncomfortable, more intolerant, and unlikely to create habit change.

Dr Rupy: Okay, okay.

Dr Rabia: So even though it's it will it will improve things, it's not something that it's not a habit that's going to stick.

Dr Rupy: Sure, got you.

Dr Rabia: So the six-cycle breath essentially is going to increase the vagus nerve firing. And what that will do is it will shift your nervous system into rest and digest, which is the kind of motto we use to describe the parasympathetic nervous system. It's the opposite to our fight-flight nervous system, which is driven by adrenaline and cortisol and which our body uses to manage stress. And we'll come back to that, I'm sure. So this level of breathing has been demonstrated in studies to modulate the vagus nerve. And in that, it it manifests that the gut-brain axis is is is changed. And so regular breathing at this slower rate, and we'll go through a really practical example of how to do that, over long periods of time is said to influence this. Now the gut-brain axis, maybe we should define that.

Dr Rupy: Yeah, yeah, I was going to actually say, so the gut-brain axis you just mentioned there, we've heard it before on this podcast, but how would you describe it to someone in clinic?

Dr Rabia: Really simply, it's the two-way communication between the gut and the brain that's constantly occurring between your hormones, immune system, your microbiome, and the nerves. And this communication is happening all of the time since birth. Our organs are always talking to one another and they're never really isolated. But when this connection starts to become disorderly, you get something called a disorder, disorder of gut-brain interaction. And there'll be people out there listening who suffer from IBS, irritable bowel syndrome. It's the most common disorder of gut-brain interaction, affecting around one in 10 people, and more common about one and a half times in women than men.

Dr Rupy: I think that's due to our hormones and our transit time and our sensitivity as women on a physical level. And so the disorders of gut-brain interaction are really my special interest, the thing I see the most, such as IBS. And there are 33 DGBIs, is the acronym, disorders of gut-brain. spanning six regions of the GI tract with no single cure.

Dr Rupy: 33?

Dr Rabia: 33.

Dr Rupy: Oh my gosh.

Dr Rabia: Um if we split the gut into its sections, um they affect anything from chronic, by which I mean long-term reflux, to dyspepsia, which is discomfort or pain after eating, fluctuating bowel habit, abdominal pain, bloating, and so forth.

Dr Rupy: Right.

Dr Rabia: And um they are governed by the Rome group in Italy, the Rome criteria. Um and so if you're listening and you think you are suffering from any of those symptoms for a long period of time, um you, you know, you may, of course, want to see a see a doctor, your GP, and then maybe a gastroenterologist to exclude a structural issue in the gut. And once we've excluded structural or worrisome issues, it may be that you have a diagnosis of the disorder of this communication between the gut and the brain, which is multifactorial. You know, the hormones, immune system, nervous system, and the trillions of bacteria, viruses, and fungi that occupy the ecosystem of the gut. This is why, you know, most doctors who study the gut and offer gut care don't really know how to manage it because there are so many factors leading to it. So to return to the tool of the breath, I think with with the breath, you know, it's a free, simple, easy way to flip the switch between your nervous system towards a point of regulation. And therefore influence over the long term vagus nerve tone. And um research from around 2018 has demonstrated that patients with irritable bowel syndrome, IBS, have a low vagal tone at baseline. So there is some mechanistic studies that have shown that um if you have IBS, your vagus nerve is probably not optimally firing. And we can go into why.

Dr Rupy: You mentioned vagal tone there actually. I just think, can we clarify exactly what we mean by tone, like that vagal tone?

Dr Rabia: Yes. Um so the vagus nerve is a mixed fibre nerve, and it might interest everyone to know that 80% of that communication is going from gut to brain and 20% from brain to gut.

Dr Rupy: Oh, okay.

Dr Rabia: So more signals are travelling um along the fibres of the afferent system. So from from gut to brain upwards.

Dr Rupy: Upwards.

Dr Rabia: Um and the tone of the nerve is what we call how the vagus nerve fires. And a surrogate marker of that is something that the listeners will probably be familiar with, and it's called um heart rate variability. So HRV, um don't know if you've wear a wearable device, but um HRV is a surrogate marker of of the vagus nerve. So when we talk about tone, we're talking about um it's a it's a medical term, but it's referring to the the the balance in the autonomic nervous system between your fight-flight and your rest and digest. And the the higher the vagal tone, the more you are in rest and digest.

Dr Rupy: Got you.

Dr Rabia: And your HRV will be more more aligned with that. And so if you're into your um data, then um you can use a wearable device to see if your breathing will influence your HRV, and that's one way to see. So to summarise this tool around breathwork, um everyone has also been introduced to the idea of box breathing. I hear it's the most common technique that people are aware of. And it essentially is imagining a box in one's mind. And a box or a cube essentially has four of the same length uh lines. Um I just want to switch it up a little and introduce a rectangle. Um because I talked about rate, but rhythm is also important. So imagine a a a 10-cycle breath. The idea is to prolong the inhalation part, sorry, the exhalation part of the cycle.

Dr Rupy: Okay.

Dr Rabia: So the ratio of breathing is four to six. You want to inhale for a count of four and exhale for a count of six.

Dr Rupy: Ah, okay.

Dr Rabia: And so it's almost more akin to a rectangle breathing. In my mind, I I often in in with my patients will talk about a door. Um and I think that can easily come to mind. So if you are in a situation of heightened stress and you want to down-regulate, imagine in your mind's eye a door. And you inhale across the top of the door for a count of four. You can even hold the breath at the corner of the door for a second and then you exhale for a count of six. And then you inhale along the bottom of the door for a count of four and then exhale again up the door for a count of six. And so rectangle breathing in a ratio of four to six will give you the 10-second breath and that will be resonant for moving your nervous system in that direction and over time upregulate your vagal tone, which we know in IBS is um downregulated.

Dr Rupy: That's awesome. The fact that you can do that with breathwork alone. So we've talked a bit about the mechanism behind how breathwork works. In terms of the dose of how and when we should be doing this rectangular breathing or other breathing exercises that you might have, what are we talking in terms of a time commitment per day?

Dr Rabia: I think sometimes with these exercises which are a little bit more visceral, and by that I mean in the realm of mind-body therapy, it can be really hard to um validate in research what the dose is, unlike the dose of a medication. But I love the idea of applying that same um idea from pharmaceutical into a more psychological um realm. And I think that what's most important is that is and I should caveat by saying that if the rectangle breathing or box breathing is not comfortable for you, again, you're less likely to keep it up.

Dr Rupy: Sure.

Dr Rabia: So any form of slow breathing, um where you're just paying attention to your breath is going to change things. And I would say that um the first step is to bring attention to the breath every day. And what you need to do, um and we'll come back to this, is is find a way for this to integrate into daily life. Because we don't know if five minutes a day or an hour a day or five minutes a week will will definitely improve your gut health over time. Unfortunately, we just don't have the right type of data to validate that assumption yet. But what we can say is we know in principle that that consistency is king.

Dr Rupy: Okay.

Dr Rabia: So a little bit every day, but it starts with paying attention to the breath. And one tip I have is to habit stack, right? And you've probably come across habit stacking. But it's the idea that if you have a habit that you do every day, um whether it's turning the kettle on to make your morning chai, or if it's entering your front door or turning the ignition on in your car before you drive to work, that should be a cue or a trigger, something we use in in hypnosis, which we'll come on to later, um it should be a cue or trigger to take to pay attention to the breath.

Dr Rupy: Yeah.

Dr Rabia: So if you could if you could habit stack on any little thing you do every day to pay attention to the breath, daily integration of breath attention will then lead to daily integration of a of a breathwork technique which consistency daily over time has shown to influence vagal tone.

Dr Rupy: Yeah, that's actually something I've been trying to do with my meals. So I have a habit of whenever the meal is there, I just dive straight in. And I'm taking quite short breaths and I've become more aware of that since my wife pointed it out. Um so I've been trying to take a few intentional breaths before I actually start eating, just to slow down my pace of eating and also um uh the uh just giving myself like a calmer environment in which to eat in as well. And that's actually been having uh quite a good impact on sort of like my digestion as well as walking after meals as well. Um so yeah, I think that habit stacking is a really good tip. Just to sort of like find a nugget uh or a process that you're you're routinely doing every single day and just add some intentional breathing uh to it. It doesn't even need to be a breathwork exercise like you mentioned.

Dr Rabia: I don't think so. I think for this first part of the breathwork, it is about slowing it down and you can do that just by thinking about your breath because automatically it does. And I love what you said about before meals because moving into that part of your nervous system before you introduce food into the digestion um will certainly aid that. Um and unfortunately, we just haven't been able to do the studies that that say how long, but even just a few seconds is enough. So on the breathwork note, we've talked about the rate and the rhythm of breathing, but the last thing I want to mention is the depth of breathing.

Dr Rupy: Oh, okay.

Dr Rabia: And so on breathwork, um you know, we need to appreciate that mostly, and it's just like you've said, Rupy, you know, shallow breathing is the default, um using our upper chest and our neck accessory muscles to breathe. What we want to do is send the breath lower into the belly um by accessing a large muscle at the bottom of the rib cage called the diaphragm. Um and your listeners will be familiar with the diaphragm because we've you've mentioned it before. It's a sling-like parachute muscle at the bottom of the rib cage. I often like to visualise a um jellyfish um dome.

Dr Rupy: Yeah.

Dr Rabia: Because the diaphragm is a dome and it has these connections in the middle, these fibres that form the crura or crux of the diaphragm that actually form the anti-reflux barrier.

Dr Rupy: Right.

Dr Rabia: So the lower the food pipe, the oesophagus, runs through the diaphragm. And the wrap of the diaphragm diaphragm ligaments around it form the anti-reflux barrier.

Dr Rupy: Ah.

Dr Rabia: So some of my research with my PhD was looking into whether breathwork could modulate modulate reflux sensitivity. But but the ultimate thing is that any form of using your diaphragm, and we we underutilise this muscle when we breathe, um and it's not our fault. It's a natural mechanism for efficiency in order to respond to perceived threat in our environment that we breathe quicker. And modern life is full of that. So the idea is to perhaps place your hands at your lower rib cage, thumbs wrapped around the back and fingers around the front. And when you take a deep breath in, ideally through the nose because nasal breathing is is preferable, you can inhale, you can feel an expansion into your rib cage so that the hands are moving up and out and dropping the shoulders away from the ears, relaxing the jaw will lead to more fluid movement in the diaphragm. So deepening the inhalation. And this is called biofeedback. So the very act of just placing your hands on your body is is sending signals to your brain through tactile feedback. Um so I would really encourage as part of that, even before the meal, to just you can either go outwards or what's really nice is you can give yourself a hug and wrap your hands the other way. And then you take a deep inhalation and you feel that expansion and that is your diaphragm working.

Dr Rupy: Oh, yeah.

Dr Rabia: Expanding the ribs up and out and then letting them fall gently back to spine. And and so that brief engagement with the diaphragm will modulate the tone in your belly.

Dr Rupy: That's amazing.

Dr Rabia: And for those of you who suffer from bloating, this is a crucial step to improving the biomechanics of the way you handle gas in your belly.

Dr Rupy: Wow. So how how if I'm suffering from bloating, why is this going to be giving me uh benefits?

Dr Rabia: So bloating is so common. It affects 30% of the population.

Dr Rupy: Yeah.

Dr Rabia: Um but not everyone finds it troublesome.

Dr Rupy: Uh-huh.

Dr Rabia: And it affects 95% of people who suffer from a disorder of gut-brain interaction like IBS. So it's really common. And what we know from the research is that bloating is not necessarily more wind in or more gas in your bowels. So many people think it's because there's more gas there.

Dr Rupy: Yeah.

Dr Rabia: But research, particularly from a group in in 2018, showed that um if we pump a gas mixture into the bowel of of of a of a patient with irritable bowel, the same volume of gas that's been pumped into someone who doesn't have IBS, they will pass that gas through wind and retain less gas. But a bowel that is struggling from irritable bowel will hold on to more gas. So there's more gas retention.

Dr Rupy: Okay.

Dr Rabia: Now coming back to the diaphragm breath, there is a group in Spain, um the lead researcher is Fernando Asprós, and he published a seminal paper in gastroenterology in 2019 that showed that um there's a problem with bloating whereby the normal reflex in response to gas that's produced by bacteria from food is disrupted. And it's called abdomino-phrenic dyssynergia.

Dr Rupy: Okay.

Dr Rabia: So I'm just going to describe that reflex. I think it will help people, particularly help the listener who says this to me. And I get this all the time. I look six months pregnant.

Dr Rupy: Yeah.

Dr Rabia: You know, I my belly's out here, I look six months pregnant. And it's that listener that I want to pay attention right now because you may have a dysregulated reflex. When we eat, a normal amount of gas is produced by the gut. The response to this gas is that the diaphragm, and I'm going to show those who are watching, um relaxes, so it domes upwards, and our abdominal muscles contract. This is the normal reflex response to gas in the bowel. In some patients with IBS, Asprós and his colleagues showed that this reflex is reversed, that what happens is the diaphragm flattens and the abdomen comes out, the abdomen comes out. And that's what you're seeing when you feel six months pregnant, you're seeing distension, which is the belly popping out. And then he showed that biofeedback through diaphragmatic breathing will correct the reflex.

Dr Rupy: Wow, wow. That's a really common thing that I hear people talking about. Brilliant. Okay. We've talked about rate, talked about rhythm, talked about depth. Given people uh a very simple exercise, but it's almost like the Hawthorne effect of just paying attention to your breathwork is going to naturally slow it down. Habit stack. Love it. Should we move on to the next?

Dr Rabia: Let's. Yes, it leads us so nicely onto um the second tool um which I wanted to share today and that we can dive into, which is movement.

Dr Rupy: Mm.

Dr Rabia: So the diaphragm is the dome muscle at the top of the rib cage, but it's mirrored by another dome or a sling at the bottom of the pelvic bowl, and that is the pelvic floor. And I tell you, Rupy, I just feel that this is coming to the forefront in my practice. Um I see so many people with constipation um and bloating, and the two are intrinsically linked. So if you're someone who suffers from constipation and bloating, my my top tip to you is that we need to work on the constipation and the bloating will fix itself.

Dr Rupy: Ah, okay.

Dr Rabia: Because that is the root cause. Um but the pelvic floor is is another muscle in the internal skeleton that really we could focus on, that and shine a light on that we've not done so much before. And so the pelvic floor in movement is is one of the key things that we could um shift and and change because what's happening in in in someone who's suffering from constipation is that the pelvic floor paradoxically is either too weak or it's overtight.

Dr Rupy: Ah.

Dr Rabia: And so that makes it quite challenging because we don't know necessarily in you which one it is. But any movements that strengthen the pelvic floor will strengthen the weak aspect of it. And any movements that relax the pelvic floor will alter the tightness or the unconscious tightening in the body.

Dr Rupy: Okay.

Dr Rabia: And I think this is something that is is a signal to the nervous system, this unconscious tension that we hold in our body all of the time. And if you take away anything from what I'm saying, it's probably this, that all the time we hold unconscious tension in the musculature of our body, from our jaws to our shoulders, through our diaphragms and our pelvis. In anatomy, particularly in in Eastern medicine and in probably the complementary health sector, they refer to this um anatomically as the deep front line of fascia. So it's jaw down the central line of of the neck, diaphragm, soas muscle, um and the hips. And so when it comes to movement, a lot of people who suffer from from gut problems tend to be in overdrive, you know, we are in our modern day lives um prone to being in in a little bit of overdrive um and high achievers or more having a sense of that we have the capacity to control things. And when you're in that mindset, the body is always on, always slightly on. And the pelvic floor is always slightly on. And what I would love is is is a few tips that you can do every day to just turn it a little bit off.

Dr Rupy: Yeah, I love that. I love that.

Dr Rabia: I don't know if that resonates or.

Dr Rupy: It really resonates. I think a lot of people, I mean, I don't know if you've seen trends on social media around cortisol, my cortisol levels are high, I think I'm in cortisol overdrive. And I think that's sort of social media speak for what you're suggesting here, which is we are always on, we have notifications coming at us from multiple different sources. We are bathed in information, we're bathed in bad media and new stories and cycles and all that kind of stuff. Um and you're right, as you were talking about the physical sort of manifestation of that, hunching over a computer workspace, keeping tension in your jaw, the way you sleep at night. I mean, I know personally that I have back pain when I'm more stressed, and it's probably not the inflammatory response of stress, it's probably the way that I'm holding my body throughout the day when I am stressed. So I I think it's going to be resonating with a lot of people who are feeling overwhelmed at just their day-to-day.

Dr Rabia: That's right. And I think, um just to pick up on what you've said, I mean, this is the most common misconception, and I want to speak to this trend as well at the moment a little bit. Stress is not just in the mind. When we have something that is stressing us, the physical body will protect us by responding to that perceived threat, creating a level of hormones in the body such as adrenaline and cortisol. Adrenaline is like a sprinter, cortisol is like a marathon runner.

Dr Rupy: Right.

Dr Rabia: They're both stress hormones, but they work differently. Um and cortisol is not a bad thing. It's it's required in order for us to respond to a perceived threat in our environment in the short term. The critical thing is that cortisol is not meant to be hanging around in the long term, i.e. chronic stress. So chronic stress is the challenge, not acute stress in a way. Um but as you say, there's this micro-tension that is carried in the body through our posture and through the way we hold ourselves um as we go about our modern day living. And it's that micro-tension that the body and the gut is registering as ongoing perceived threat. And so if you can do movement in such a way as to remove micro-tension and let it melt away from the skeleton on a daily basis, I don't care what you do. Dance, sing, um shake, jiggle. It doesn't matter, but remove unconscious held tension in the body and that is the crucial thing. Not going to your spin class, not going to, you know, trying to rush in order to make a yoga class, you know, at the gym at a specific time. It's this. It's actually just movement that communicates a signal to the body that it's okay to unhold yourself.

Dr Rupy: Yeah. I've been leaning to this a lot myself actually because I have been trying to run and do my gym quite in the morning, you know, squeeze that in before I commute to work and like do all this other stuff. And I've just been reminding myself, look, you've only got 10 minutes in the morning now because my son wakes up super early. I'm going to use those 10 minutes to do something that's going to be um calming for my nervous system. So yoga is perfect for this. I'm sure we're going to get into in a sec. Um but also just stretching and just moving my body in some way. It's also the um the perception of that movement as well. That in itself is healing. The fact that I'm reminding myself that I'm doing this and it's sort of the uh how I accept that sort of um that movement uh and and I think that will hopefully compound the benefits for me.

Dr Rabia: Yes, and in no way do I want to demonise high-intensity exercise. It's endorphin creating, but it does move your body into fight-flight. So I think the thing to ask yourself is is is just that pause, similar to tool number one, it's about the pause to check in with your body and say, well, my default is to do this 10-minute run every morning, but what are my energy levels like? How did I sleep? Is this the right 10-minute movement pattern for today? Even though the run will make me feel really good, maybe I need to spend 10 minutes um doing restorative yoga or stretching, as you say. And it's just that choice point. If you can create that choice point, I think it's really empowering to decide that slower movement, and I think that's essentially the emphasis of this tool, is that sometimes slower movement is actually more effective. Um you know, it's like um the rest period in between sets at the gym. We sometimes that is productive.

Dr Rupy: Yeah.

Dr Rabia: Right? The rest period in between a set, you know, my personal trainer always says to me, he says, you need to allow two minutes. Two minutes? I just want to lift my my next set. But that is productive. And if we could see rest as productive, imagine that. Imagine that because it could in the long term reduce chronic stress. And I think that's what we're seeing from from the research. And just to just to talk about our kids briefly, um we have children of I think roughly a similar age. Um it's really important to note that um the ages of zero to three are a formative time for the gut in children. So I'm speaking now to any parents listening um around with kids who are in that age age bracket and children in general. It's a formative time for digestive physiology. We know the microbiome is created around that time. Um and I'm sure many dietary um aspects of of of baby or child-led weaning and all of that has been covered by you um in previous episodes. But there's also an aspect of behaviour where behaviour patterns and our lifelong relationship with movement is crafted at this age. And children, I'm not a paediatric gastroenterologist, but I know that children suffer from the, you know, the most common thing in this age group is functional constipation. And so the question is why, you know, at zero to three, really between two and four, why are children becoming constipated? And how do we as parents um make changes to their behaviour to set them up well for life? And it's really because this is the time of toilet training. And there is a behaviour of unconscious stool holding that can occur in a child as a result of pressure around the toilet, you know, around the behaviour of going to the toilet. Now, I want to caveat that I have not yet toilet trained Aya, my little girl.

Dr Rupy: Yeah, yeah.

Dr Rabia: Um and the reason I want to say that is because I don't know if you'll echo this, but before I became a parent, I was ready to dish out advice about parenting.

Dr Rupy: Yeah, yeah, yeah.

Dr Rabia: Now I'm a parent, I'm not so ready to dish out advice about anything I haven't done yet.

Dr Rupy: Yeah, yeah.

Dr Rabia: So I haven't toilet trained yet because she's she's 19 months, but um when we come to toilet training, there are a couple of things that are quite important for a child's pelvic floor because this functional constipation that is very common around this age that can echo into later life is occurring not because primarily of the food that you're giving your children. It's occurring because of the behaviour of the child on the toilet and the neurophysiology of of their ability to relax the pelvic floor and coordinate emptying. And so if I may, I just some tips around toilet training for parents because I feel like if we could get it right at this age,

Dr Rupy: Yeah, it will carry on into later life.

Dr Rabia: Right. The first thing is similar to food, if I'm not mistaken, child-led. Yeah? When you go to the toilet, we should follow the urge to go to the loo. So the it should be ideally child-led. They feel the urge, they are able to process that information, respond to you and say, I need the toilet, and then you take them to the loo. So child-led rather than any form of pressure. The second would be um again sort of around toilet training would be to encourage them to follow a routine. So sit them on the loo after eating because it capitalises on something called the gastrocolic reflex, which will mean that this reflex is essentially when we put a spoonful of food in our mouth, it triggers hormones and nerves to move the poo along and signals to our rectum it's ready to hold poo and expel poo. So that's the gastrocolic reflex. Do you do you ever come across people who say, um I eat something and it goes straight through me?

Dr Rupy: Yeah.

Dr Rabia: You know, that's the that's the kind of classic fast reflex response. So in children, it's capitalising on the reflex during toilet training and using a toilet stool. So raising their knees above their hips. And the reason this works is because um modern toilets um don't necessarily have um the right angle we need to in order to poo, relax our pelvic floor. Um and so when we raise our knees above our hips by placing our feet on a platform, we correct something called the anorectal angle. So the angle and the the turn that your poo has to make in order to exit is very tight. When you raise your knees above your hips, you open that angle, you relax the puborectalis muscle, and then the poo can pass easily. So use that in your kids because that will relax the pelvic floor. And the last thing I want to say, a little practical tip, is um get them to blow bubbles. So imagine they're blowing bubbles, tell them to, or you could bring bubbles into the loo.

Dr Rupy: Yeah, yeah.

Dr Rabia: But if they blow bubbles, they're doing that the thing with the diaphragm and the pelvic floor to change the mechanics of the of the gut, similar to the tips we've been discussing for adults.

Dr Rupy: Yeah, yeah. I think there's going to be a lot of um similarities uh between toilet training kids and uh getting more comfortable with uh both the pelvic floor and the diaphragm for adults. So I just want to bring us back to this idea of these um uh symmetrical domes that I've never really thought about it like this before. These symmetrical domes of the diaphragm and the pelvis and the pelvic floor. How do I know whether my pelvic floor is too tight or too loose? Is there a a way of figuring that out or some functional testing that I could do?

Dr Rabia: Great question. Um the there's actually, I want to bring your attention to one more dome. There's three domes in and I think this will help because it'll be super practical for for our listeners. But um essentially important to recap that the diaphragm and pelvic floor move in synergy. So as we inhale, both flatten, as we exhale, both dome up. And the third dome is is the roof of the mouth, but it's the jaw.

Dr Rupy: Okay.

Dr Rabia: So so one of the ways to relax your pelvic floor is by relaxing your jaw.

Dr Rupy: Really?

Dr Rabia: Correct. Um and there is there will be someone out there listening who goes who says, I have I have jaw tension. I think jaw tension and pelvic floor tension can often coexist.

Dr Rupy: Wow.

Dr Rabia: And so I would like to raise an experiment, which is something we could all do right now actually. Um and I want to to say that um the pelvic floor is very subtle in terms of bringing attention to it. If I was to say contract your bicep, you can really feel what that's like. You can also see it. That's the biofeedback. We can't see the pelvic floor. It's very hard for people to develop that internal awareness, but it's completely possible. And everyone's pelvic floor awareness will be different. But right now in this moment, I'll invite you to just um gently clench your jaw and notice your pelvic floor. Now many people will notice nothing in their pelvic floor. But I would like you to try this a couple of times in your own time, allowing a bit of space. And what you should notice is a slight lift.

Dr Rupy: Okay.

Dr Rabia: Okay? So in a quiet space, just clench your jaw and there will be a micro lift of the pelvis. And training that biofeedback connection is the first step.

Dr Rupy: Okay.

Dr Rabia: So the first practice is to paradoxically tense your jaw.

Dr Rupy: Right.

Dr Rabia: To connect to your pelvic floor at a subtle level, and that will give you an intuitive way to then when you unhold the jaw, to unhold the pelvic floor.

Dr Rupy: Okay.

Dr Rabia: And you can do something as simple as, if you don't have a lot of pelvic floor awareness, you can do something as simple as um just unholding the jaw.

Dr Rupy: Uh-huh.

Dr Rabia: And that will unhold the pelvic floor. But I will also cite my colleagues, pelvic floor physiotherapists. They are incredible and I couldn't do the work that I do without them. And I think if you have issues with your pelvic floor and you really want to know if they're if it's tight or or if it's so it's overactive or underactive, I would recommend seeing a pelvic floor physiotherapist. What they will do is physically examine your pelvic floor and they will tell you if it's tight and they do biofeedback through physical either using a probe or or their their manual manual biofeedback.

Dr Rupy: Got you. You mentioned a couple of exercises before, like rebounding, dancing, singing, whatever it takes just to get some movement in there. I know you're a qualified yoga instructor. Yoga is obviously a passion of yours. Are there some exercises that you've come across through your study of yoga that are relevant for, you know, introducing movement particularly focused on gut and improving that biofeedback?

Dr Rabia: Yes. I would say if I had one exercise or motion that I would recommend to a lot of people, it would be the deep squat. Um so I don't know if that also resonates with other forms of movement, but we talked about the squat because you're on the modern toilet and you raise your knees up, you're essentially squatting like our ancestors did to open your bowels. So it's in in yoga asana, we we say that um you could either sit on a block or lower your hips, but the idea is is is a deep squat. So that would be one posture you could try, um particularly in the mornings, um to relax the pelvic floor and also move into the hip flexors. For me, a lot of yoga for gut health has moved into the realm of the hips and the pelvic floor and loosening this area of tension that we carry around the anal region um because I work with so many people who who suffer from that. And there'll be more information on on on my platform if people are interested to go there and and look towards that. But the squat would be one. The second would be something called um happy baby pose.

Dr Rupy: Okay, yeah.

Dr Rabia: So um I'll describe that um for everyone listening because it's essentially a squat but on your back.

Dr Rupy: Yeah.

Dr Rabia: So you lie down comfortably on the floor and you raise your knees um towards your chest. Um taking your arms either on the inside of your legs or the outside um and holding on to the sides of your feet and then you raise the soles of your feet to point skyward. And again, this is a relaxing form for the pelvic floor. So happy baby pose and Malasana, which is a deep yoga squat, are two really simple exercises you can do every day. The recommended dose would be for anywhere up to three minutes.

Dr Rupy: Okay.

Dr Rabia: Sounds like a quite a long time.

Dr Rupy: Yeah.

Dr Rabia: With the breath.

Dr Rupy: Okay.

Dr Rabia: Deep breathing because of course that's leading to fluidity of the pelvic floor as well.

Dr Rupy: It's sort of like habit stacking then, isn't it? So you do your breathwork and you could do your happy baby at the bottom. That's brilliant.

Dr Rabia: So I would say those two postures and um you can find um images and videos on my site for that.

Dr Rupy: I've been doing a lot of squats in the morning, um uh as there's nothing else that I can do really because we don't I don't really have weights at home or anything like that and I'm not able to go to the gym as often as I'd like to. So I've been just doing body weight squats in the morning. But one thing I've been trying to do to open up my hip flexors are twists and sort of pigeon pose as well. And those twists I feel like really, really useful. Is there is there anything around like creating like um abdominal twists or motion in the actual abdominal area that actually helps with digestive function?

Dr Rabia: The torsion effect on the abdominal wall muscles um of course will transmit um tension into the gut because our abdominal wall muscles, as we've discussed, transmit tone into the belly. And so twists are are cleansing, and I think from a more Eastern medicine, Ayurvedic perspective, there's certainly a lot of those motions that are encouraged um on an empty stomach in the morning to take. Um I think again, once again, there's no Western research that has validated that these particular postures done for a time period can influence the gut. But I think there's every reason to believe, as we've been discussing and to summarise, that your abdominal tone from the dome of your diaphragm and your pelvic floor and your abdominal muscles and then your back, you know, essentially your core. Right? We're talking about your core, the core of the spine, the rectus abdominus, the ribs, and these domes. This core mechanics can influence your bowel health. And I think all of this and the twisting will influence that irrevocably.

Dr Rupy: Great. So I've got breathwork, I've got movement. Uh where should we go next?

Dr Rabia: On to number three. So we talked about these um the we talked about IBS and the disorders of gut-brain interaction. And this next um tool um is crucial because it's unlike some of some of the other things we've talked about is is purely evidence-based. So it's purely been proven to improve symptoms of irritable bowel syndrome. Um there's been more than 12 randomised control trials as published in a meta-analysis last year. Um and it's made its way into the 2021 guidelines on irritable bowel. And the technique is something called hypnotherapy. Now, when we think of the word hypnosis, we think of Darren Brown and Paul McKenna, and we think of being lulled into a trance-like state where we are told to bark like a dog and made to follow that. And there's so much stigma around hypnotherapy that it's my job to dispel that stigma by telling you exactly what hypnotherapy is and why would this ever work for our digestion. So hypnotherapy is a therapy um whereby you are brought into a state of calm focus in which you are susceptible to positive suggestions about your symptoms.

Dr Rupy: Okay.

Dr Rabia: We give ourselves negative suggestions all the time about our selves, the way we live our lives. You know, the thoughts that run through our mind trillions of times a day relating to things are essentially nervous signals in the body. And these thoughts or these suggestions are almost like throwing a rock into a still lake. So if you imagine a pool and you throw that rock into that lake, there are ripples of that rock. And the ripples from a thought move into the nervous system of the body. So if you think to yourself on repeat as a suggestion, I am a failure, or I can't do this, I think it would be really important to remember that that thought is not benign. That thought is not simply a a nervous signal in the mind, but it is having an effect on the micro-tension in your body.

Dr Rupy: Absolutely. Right? So the way we think influences the way we feel, influences the way our organs function. And I think this is what modern medicine has taken a long time to to evaluate. Um but with hypnosis, when you are in a calm state of focus, you're more susceptible to changing the default mode of thinking. And so how it works is you would arrive, so I'm trained in gut-directed hypnotherapy and I see people for that. They come to my clinic and I will often set some goals with them around their um their gut health, okay? Maybe their goal is to reduce bloating, for example. And in fact, last week I saw a 40-year-old in clinic. She's a teacher. And um she came to see me because she was suffering from sort of constipation. Um and um she developed um she developed bloating and she said, okay, my goal would be to reduce bloating. And of course, in a clinic setting, you're looking to reduce these symptoms and check that they're that they're nothing um sinister, that there's no other cause for them. But ultimately, um in the guidelines, we know that once you've gotten to the point where you've tried diet and it hasn't worked, but you've got these persistent chronic long-term symptoms, that you can move over to to a different um way of thinking. And we'll come back to this case in point number four. So I'm going to park it for a second. But we'll come back to that because the way that we worked with hypnotherapy with her was very effective. And I think that that if you've suffered from those symptoms, hang around to hear what kind of happened to her. But she we were able to work with planting positive suggestions. And the brain doesn't know the difference between imagination and reality.

Dr Rupy: Mm.

Dr Rabia: If you think a certain thing, we know from functional MRI imaging that the same areas of the brain light up as if you were actually doing that thing.

Dr Rupy: Okay.

Dr Rabia: An example is athletes. So marathon runners, I think on their days off, they do rehearse their runs. You know, before a big race.

Dr Rupy: Yeah. Yeah, yeah.

Dr Rabia: Rehearsing your run um will fire the same signallings in the brain as if you were actually running. Because the brain has this powerful way of imagining that you're doing an activity. And in doing so, the body responds as if you were doing. So in in hypnotherapy, we use this term as if. Imagine as if things were different to how they were now. What would that look like?

Dr Rupy: It's a little bit of fake it till you make it.

Dr Rabia: Sure, yeah. But phenomenally, this is the root science of how it works. Um

Dr Rupy: That's incredible. I mean, the fact that there are RCTs, it's made it into the guidelines for the specific type of IBS. You know, it it is really compelling, but it's almost counter-intuitive to how we might think as as medics or even, you know, the population who are not in the science field. It sounds like it's like magical almost. Do you know what I mean?

Dr Rabia: Right. Exactly. And it sounds um it sounds esoteric, it sounds magical, it sounds a bit voodoo, you know, or woo woo, if you like. Um and I think the idea is to break it down into into a principle of what we're doing. And I think if we if we remember that the that the way that we think has a hypnotic, um the term hypnotic is essentially around around inducing a particular type of thinking. If if we say that um our thoughts are powerful, they have a hypnotic effect on us, the more we repeat those thoughts, the more they fire the same and wire the same way in our brain, that we could convince ourselves that there was a root way to change that where we flip a thought on its head and in flipping the thought and repeating that thought as an affirmation, so to speak, and using a visualisation that might help with that, we would be able to um essentially work the aspects of our brain that are really wired for healing, rather than the executive mind, which is wired for doing. And so hypnotherapy is the therapy of re-hypnotising ourselves away from the thoughts that we have habitually about ourselves and the world around us into a more integrated way of being. And it's playful. It really is playful. So to go back to this 40-year-old with bloating, you know, the kind of messaging we would work on is around um visualising bloating like a balloon, you know, in the belly. Um and what would it be like if that balloon was on a string and the balloon was pick a colour, red, and you let go of that balloon and that balloon floated up and up and up into the sky. And there's a sensation of relief and a sensation of deflation. And then that balloon deflated and it floated back down. And some of this imagery um can embed itself in the in the brain as well as hypnotic suggestion. And we'll come on to that with our tip number four about reframing thoughts. But but some of this suggestion is useful. And particularly around around bloating, which we'll come on to, I think, um that's the way forward. So um I would love to leave your listeners with with an actual recording. I think so often it's lovely to hear all of this on a podcast, but what what will I actually do tomorrow, Dr Rabia, to change this? Um so I've designed um you know, a recording around the gut-brain axis. It's it's it's relatively um open. But if you listen to that recording, it's a taste into what it might be like to receive hypnosis. And there are apps out there as well that you can engage with. And they are quite generic. So if you work with someone one-on-one, then you'll be able to plan it bespoke for your symptoms. But the apps are good, you know, for a taster, I think.

Dr Rupy: I would love to empower people to say they could just start practicing today without me. And so what I would say is that the first step to self-hypnosis is noticing again, like the breath, becoming more aware of the thoughts that you have about yourself and about your gut. So if you have a thought about um your belly, um take the thought, uh we've mentioned before, I look six months pregnant. That's a thought. It's a thought and it's an analogy. Okay, so you've had that thought about yourself or I look I look disgusting or I look anyway, in any way a shameful thought. And you flip that thought 180 and instead you say to yourself, um more positive a positive suggestion about yourself. That positive suggestion if repeated often enough will form the new basis of a of a thought that you can then take forward. And so self-hypnosis is actually easy because all you're doing is taking a negative thought you have about yourself and reframing it.

Dr Rupy: Yeah. Which brings us quite nicely into the fourth bit, yeah, reframing. Because uh you know, this is something that I not from a gut perspective, but I try and practice every single day. Like where a negative thought or a shameful thought pops into my head, I try and capture that thought, recognise it, and turn it on its head if it needs to be or like, you know, gradually mellow it in all sort of areas of my life, whether it's to do with business, with to do with socials, with to do with my relationship with my son, the lack of time that I feel I have. Yeah. Uh or feel I don't have. Um so reframing I think is really really interesting as a sort of a broader concept, but I'd love to talk about this in the context of of gut.

Dr Rabia: And how do you catch that thought?

Dr Rupy: I can't I think it's more about being intentionally aware of those thoughts seeping in. So on my commute to work, for example, uh I might say, oh gosh, I've got to go I've got to get back early tonight and make sure I get um back for Raffy's bath time because I keep on missing it this week and I don't want to miss those. Yeah. Uh I don't want to be a bad dad. You know, it's like, okay, well, let's sort of capture that thought and let's flip that. It's like, you know, isn't it great that I'm actually trying to be there to capture those bath moments for him because those are going to be the memories that are cemented in my brain when I'm like 60, 70 and he's like an adult and travelling around the world and all the rest of it. Yeah. So it's just capturing those and just sort of like reframing it from a like a mild negative to like a an incredible positive. So that I try and do that as much as possible. But to to answer your question, it's more about being um intentionally aware of those thoughts as they seep into my brain.

Dr Rabia: Right. And when you do that, do you feel better?

Dr Rupy: Yeah, in the moment, yeah. There's a little dopamine here.

Dr Rabia: A little self-love.

Dr Rupy: Yeah.

Dr Rabia: Yeah, right. Right. Okay. So the way to turn your positive thought into a hypnotic statement is to talk about the present as if it's already happened.

Dr Rupy: Okay.

Dr Rabia: So just a small extension to the practice you're already doing. Um I want to make it home for bath time, bedtime. I don't want to be a bad dad. Then you think, well, you know, I'm a I'm a I'm a good dad. I'm I'm I do X, Y, Z. The hypnotic statement is that I am, so it's as if it's already happened, even if you don't fully believe that thought, the new thought. It doesn't matter. You don't have to fully believe the new thought. I am a conscious father and Raffy knows that daddy loves him.

Dr Rupy: Okay.

Dr Rabia: I'm a conscious father and he knows daddy loves him. As an example. It can be quite broad, um and but it could also be just related to bath time. I'm a conscious dad and I make and I make both most bath times or I will make bedtime. It's the present moment as if I am. And as if it's already happened.

Dr Rupy: Yeah.

Dr Rabia: And I will make bath time. I I make bath time more than I don't make bath time.

Dr Rupy: Yeah.

Dr Rabia: That kind of thing. It's okay if you believe it 60% because the brain doesn't know the difference between imagination and reality. If you're imagining that you are that version of yourself by saying to yourself I am, those are the neurons that will fire and wire together. And that is hypnosis.

Dr Rupy: And I guess to to extend that messaging to the gut, it's that our digestive system is very primitive. You know, it's the part of our our bodies that is the most primitive and and and is really for us, you know, it's it's working for us to digest not only our food, but our thoughts and our behaviours and assimilate those. And I think when we do practices like this, the reason it influences our gut and can change symptoms such as pain, bloating, and a fluctuating bowel habit is because the gut's nervous system is wired to enable us to survive. And so if we take away perceived threat, even if that threat is coming from ourselves, and instead we perceive that the world is less threatening and we code that into our nervous system, it is a form of training.

Dr Rupy: Right.

Dr Rabia: Right? It's retraining. Um and that way we edge ourselves over time, I think, towards um a more healthy and harmonious system.

Dr Rupy: I'd love to know how you've used reframing in your own practice.

Dr Rabia: So we've covered breathwork, movement, hypnotherapy, and now we're on to our fourth way, um which is which is the reframing of cognitions, which are thoughts um that we have. And we've covered behaviour a lot, and CBT, which is cognitive behavioural therapy, is another brain-gut therapy that's been proven over 30 randomised control trials have looked at patients primarily with irritable bowel syndrome and found that CBT, cognitive reframing alongside behaviour therapy has helped gut symptoms. So the evidence is is there.

Dr Rupy: Okay.

Dr Rabia: But in a really pragmatic sense, um probably to take one step back um before I go into um a really lovely um case study of a lady that I'm seeing at the moment, I I want to mention um and give people a really deep understanding of what what's happening in their body um when they're having these thoughts about um bloating or pain or even the pain signal itself. Imagine uh an iceberg in an ocean where the iceberg is the sensations in your body and the ocean is your mind. Above the water line, the iceberg that you can see are the sensations in our body that are in our conscious awareness. Below the water line are the sensations that are in our subconscious, so we're not aware of. Going back to what we mentioned earlier, right now you're not aware of your beating heart or your breathing lungs or moving your digestion along. That is the part of your body sensations, the iceberg that's below the water line, it's below your conscious awareness. Through through long-term dysregulation of the gut-brain axis, maybe because you have an imbalance in your microbiome or through nervous signalling from early early childhood trauma, from immune dysregulation, and so on, these dysregulations over time bring more of our body's subconscious sensations into our conscious awareness. So essentially the water line has gone down. And so more of the iceberg is visible above the water, more of these sensations that we're not normally supposed to be thinking about are in our conscious awareness. So you start to feel a sensation of bloating and that's really uncomfortable or pain as a signal. You know, many people out there are suffering from chronic pain. It doesn't have to be gut-related, it could be in their in their bones, it could be fibromyalgia or whatever. It's really hard for people to understand why this is the type of pain that doctors are saying is in your head because it's not in your head, it's in your nervous system. The reason you have pain is because pain signalling is being brought into your conscious awareness where normally it should be unconscious. And my job is to raise the water line.

Dr Rupy: Right.

Dr Rabia: So how I work with clients is to raise that water line, to to submerge more of the iceberg, more of our bodily sensations back under the water and take pain for is a good example. Yeah. Um because pain is in our conscious control. If we take our attention away from pain, are we in pain? The answer is no. You're only in pain because you're aware you're in pain. And so pain is a very complex topic, but I think for people who have suffered from chronic pain, the idea of distraction feels a little bit like dismissal. When actually it's a tool that I use quite regularly to change the way that you that you perceive your pain and you can turn down the volume on your pain. And it's the same for anxiety. So I'm seeing this um this lady at the moment in in for hypnotherapy and um she's a 34-year-old who um is is is, you know, really bright and um um high functioning and high achiever and um and she's an ITU nurse by background.

Dr Rupy: All right.

Dr Rabia: She came to see me because she's been having mucus in her poo. Um and mucus is um a kind of slime that we see surrounding our stool and it um is a lubrication that is normal. The bowel produces mucus in order to lubricate the passage of poo. But it can become abnormal. So again, it can become a a sensation that's above the water line because you're noticing it more. Whether there's actually more mucus, in the case of this this patient, um she was very consciously aware of the mucus in her stool. She was always looking at her poo, which we're designed and we should check our stool from time to time. But she was checking it every day, every time she wiped. And as we uncovered um this, we we found that she had quite significant health anxiety in general. And being an ITU nurse by background, imagine working with people at the most extreme end of of illness and ill health every day and knowing, I think, that things just tend to go wrong and that's where they end up in in intensive care unit. That of course played into plays into her framework of thinking.

Dr Rupy: Totally.

Dr Rabia: So she came to see me and of course the first thing to do is check that the mucus is not representative of an underlying problem and so we did stool samples to exclude cancer and inflammatory bowel disease, um which is Crohn's or colitis. We did blood tests and so on. But after we'd done the medical workup, we were left with this idea that mucus is a normal symptom from time to time. There was in fact no excess mucus, but it was the fact that it was noticeable and her mind would spin out of control and think the worst.

Dr Rupy: Got you.

Dr Rabia: And so we began to use um cognitive reframing techniques to reposition the view of mucus. We also used behavioural techniques to change the way of the constant checking of the stool, and we used hypnosis to plant positive suggestions about her bowel functioning normally. So to give you some examples, really concrete examples, when it comes to reframing, we talked about the human her body as an organism that exists as nature. You know, an organism is a is an entity that can function in and of itself, you know, autonomously. And so we talked about the fact that um that we are part of nature and that we can't always fix everything. Um we have to let go of control and allow the body to naturally return to a level of harmony given the chance to. And that I think, you know, she emailed me um a few days ago following last week's session and and said that there was something about this idea of allowing our bodies to return to natural harmony that really resonated with her because it meant that well, I can't control everything. I can't necessarily control this. I know it's nothing serious because I've seen a doctor and I've had this excluded. My tests are normal. A normal test does not mean there's nothing wrong with your gut.

Dr Rupy: Sure.

Dr Rabia: People have normal tests and they and they equate a normal test to mean there's nothing wrong with my gut or my symptoms are all in my head. But actually, maybe it was the most appropriate test but not the right test, or maybe no one took the time to explain what your symptoms actually were, which is a variant of normal. And so once she understood that this is a variant of normal and she accepted that, it was a really crucial pivot for her, I think, in her mind. And then alongside avoiding checking, so avoiding overchecking, so we would it would be a practice behaviour where she would open her bowels, wipe, shut the lid and walk away. You know, a wipe and walk away was what she would say to herself. Wipe and walk away to to break that cycle of overchecking, um helped. And then the hypnotic statement um around health anxiety generally was, my body knows how to function. It knows how to sleep at night and it knows how to wake up in the morning. And it knows how to do these things without me interfering. And as she repeated that statement in hypnosis, so we I take her into hypnosis by giving her a state of calm focus. And so something like a body scan is what we would do at the start to down-regulate, and then we would plant these suggestions like rocks into a pool of water, and we would let that ripple through, and then she would listen to the recording every day.

Dr Rupy: Yeah.

Dr Rabia: And so she's doing quite well because we're just edging towards that. And that's I guess an example of reframing around something that I think otherwise gets catastrophised and blown out of proportion.

Dr Rupy: Absolutely. And and the same techniques can be used for um pain, for bloating, for all a whole myriad of different uh issues that people might have with their digestive system. The same it's the same process, would you say?

Dr Rabia: It is. And I think all symptoms occur in a narrative of and a story of our lives. They all occur in the context of that. So taking account pain in the context of the story of our life, which is I guess why it's nice to work with people one-to-one, is that we can find out what that pain means to you or what that bloating means to you and we can reframe it differently. But you can do that yourself. You can journal and explore the idea of, well, when did this start? What was happening in my life when this symptom began? When I take people in their journey back to the beginning, they tell me about a time when their parents got divorced or they had a bad relationship or they were in a situation where they were preparing for exams. Um and they noticed that these symptoms, like the iceberg, started to drift above the water line where they weren't in their conscious mind before. And so, yes, the same principles apply to raise the water line of cognitive reframing, behaviour modification, and positive suggestion, but bespoke for your um particular context, I think, and your narrative. Um my therapist, and I I see a therapist, I think it's important to to especially when I'm giving therapy to others to manage my own mental health. My therapist said to me um a few weeks ago, a beautiful quote, um which was, and I'm paraphrasing, but when an organism receives the right information, it will reorganise itself towards health.

Dr Rupy: Huh.

Dr Rabia: So when an organism receives the right information, it will reorganise itself towards health. And I think we're used to thinking that information is food for the gut because food is information though.

Dr Rupy: Sure. Yeah, yeah.

Dr Rabia: I guess it's signalling, isn't it?

Dr Rupy: Yeah, absolutely.

Dr Rabia: Um but there are other forms of information that we digest. And I believe that the root of that quote is um is from Rolf, who is a female um um physiotherapist and does mechanical Rolfing, which is a behaviour technique in the mind-body realm. But um I really like that quote.

Dr Rupy: I love that. I love that quote. I'm learning so much from this conversation. We never really talk about this kind of stuff. And even though I do some of these practices, I don't think I fully understand the mechanism behind it and having someone someone such as yourself explain it to to myself and the audience is brilliant. Um because it just clarifies it more and it makes me a lot more intentional about actually practicing these things. You know, uh hypnotherapy, reframing, uh breathwork and and uh movement. Um you know, if there's if someone's listened to this and they they're like, okay, great. Uh I'm totally bought in to these practices and strategies beyond diet. I want to start. And they're putting down their AirPods or whatever. Like what what do you want to leave them with? What where should they start?

Dr Rabia: If there was one thing I want to leave people with, I would say it's around this idea of of micro-tension in the body. I think that if we could become aware that stress not only lives in the mind, but it lives in the body, and that and that there's this awareness of how our body is our posture um from our from our diaphragm to our jaw to our pelvic floor and the tone in our core is holding onto a thought or onto a particular behaviour and how we're holding ourselves. If we could become maybe aware of registering that, and then if we could somehow let go of that micro-tension, I think that would really shift the needle. And so I call I call this technique the the first sit down technique. Um but it could be anything. Um we've talked about the habit stacking, so it could be the first time you sit in your car to drive, the first time you sit down at your desk to work, the first time you sit at the breakfast table with your kids, but the first kind of sit down after the bed, if that could be your cue or your trigger to take one fully felt deep breath, to notice jaw tension or just relax the jaw, drop the shoulders, breathe deeper into the belly, and just scan the body from crown of head to tips of toes and send a message to just soften. That micro movement of registering tension and releasing it would be, I think, the move I would make that would shift the nervous system and empower self-regulation on a daily basis.

Dr Rupy: I love that. I love that. The first sit down. I'm going to remember that. Dr Rabia, thank you so much. That was awesome. I really, really appreciate that conversation. It was so, so much fun to have you back.

Dr Rabia: Thank you so much for having me. It's been delightful and and just lovely to go back and forth on this.

Dr Rupy: Let's get some lunch. Thanks so much for listening to this episode of The Doctor's Kitchen podcast. Remember, you can support the pod by rating on Apple, follow along by hitting the subscribe button on Spotify, and you can catch all of our podcasts on YouTube if you enjoy seeing our smiley faces. Review show notes on the doctorskitchen.com website and sign up to our free weekly newsletters where we do deep dives into ingredients, the latest nutrition news, and of course, lots of recipes by subscribing to the Eat, Listen, Read newsletter by going to the doctorskitchen.com/newsletter. And if you're looking to take your health further, why not download The Doctor's Kitchen app for free from the App Store. I will see you here next time.