Me and my GI (gastroenterologist)
It’s not just what you eat. It’s how it gets there.
This Eater’s Digest, from functional nutritionist Andrea Nakayama is one eater’s reflections on the journey of her food.
this month: discussing digestion with a gastroenterologist
‘Tis the season of good cheer, indulgent food and frequent festivities. . .
Ho ho ho, so much fun!
Yet sometimes the jolly times come with a not-so merry belly.
It may be the amount of chow or the curious combination of cuisines in one sitting. It could be a tad bit more of the goodies that you usually leave for special occasions. (Those “special occasions” sure are coming one on top of another right now!)
Or, if you’re among the 60 to 70 million Americans that suffers from reported digestive distresses each year, this may, unfortunately, be a season not unlike any other.
Recently I had an open conversation with my dear friend Venu Julapalli M.D., a gastroenterologist in Houston, Texas. He’s not really my GI, but if I had one, it would be him. I wanted to discuss how a medically trained doctor considers the role of food and nutrition in digestive health, since everything seems to be coming up guts these days.
As you’ll see, Dr. Julapalli had some questions for me too!
Go ahead and read excerpts from our discussion below!
Digestive Wellness Discussion Between Andrea Nakayama & Venu Julapalli M.D.
diet does matter
Andrea: Most of the time I now find that many physicians will work with what we’re doing nutritionally with our clients and actually believe in it’s virtues because there is more of an influx of a functional and integrative medical approach, which has a keen understanding of the power of diet. I mean, for a gastroenterologist to say diet doesn’t matter is. . . I just don’t understand it! There’s this tube in your body that’s feeding your cells, and how could it not matter? And I’d love to ask you that question Dr. Julapalli: how do you see diet as a factor in overall health? And if somebody’s working with a physician that’s saying diet doesn’t matter, and they’re in some sort of pain, they’ve likely experienced on their own that diet does matter. . . that when they take something out of their diet they feel better, or they notice some symptom get worse after they eat a certain food, so that when their doctor says diet doesn’t matter, they’re likely starting to question their doctor, not the role of diet in their health and healing. Do you find this to be the case?
Dr. Julapalli: Yeah, no doubt. First of all, saying diet doesn’t matter. . . it’s frankly absurd, and on a practical level, I would venture to say that 90% of physicians know that diet doesmatter. They know this fundamentally. It’s just a question of “What am I going to do about it as a physician?” So yeah, diet does matter. I get it. Obviously, everything that you eat is going to contribute to your health, but the physician either doesn’t care – that’s kind of the arrogant stance – or doesn’t have the time or doesn’t have the knowledge to point the patient in the right direction of how diet does matter. So, it’s just not something the conventional medical physician is trained in.
. . . So, diet gets diminished. Yes, it’s obvious that diet matters, and even the patient ultimately knows deep down that what they eat matters. It just gets back to “Yeah, I got it doc, but can you give me something to just fix it, and then I’ll just continue to do what I can, and let’s just fix the problem.”
quick fixes vs. addressing the underlying problem sustainably
Dr. Julapalli: . . . in the adult medical world. . . and probably similar things apply for kids with respect to their parents, but really, in adult medicine people want the quick fix, and they’re much more likely to take a medicine in the faith and hope that that medicine is going to make their symptoms all go away fast.
Dr. Julapalli: And quite frankly, I’m also into quick fixes. I would love quick fixes if they’re available. So, if there is a quick fix that can easily be done, I’m all for it. But much of the time there isn’t a quick fix for IBS (irritable bowel syndrome), or something, and so that kind of leaves me to my next question which is how soon would somebody expect to get or feel results because that’s a nice motivator too? When you know or when you have faith that this isn’t going to take a year necessarily, I may feel better pretty quick by making some of these fundamental changes.
Andrea: I’m all for a quick fix too. Unfortunately, a lot of the quick fixes don’t address the underlying problem so the challenge there is that the symptom may be alleviated, but the damage below is not. How is that (damage) going to crop up in different ways? Like, “Great. I don’t feel that bloating anymore” or whatever it is. . . “I’m pooping normally,” but what’s happening at an immune level, at a mental health level where those problems are not being addressed? (Especially since digestive troubles are so related to these other areas — immunity, mental health, skin issues and toxic overload.) So, I see it as a many pronged system of healing where there’s no way that you and I eradicate each others’ jobs. They go hand in hand.
If there’s a need for a quick fix, don’t assume it’s addressing the cause of the symptom, which may be presenting elsewhere in the system.
But the answer to your question about how long does it take is really dependent on the individual. We see this all the time. People can come in and feel better in a week, or they can feel worse to begin with when you take them off of the inflammatory foods that are actually causing some opiate response and some adrenal response when they eat those foods, especially if they have a leaky gut — which I would venture to say most people in our modern day society do. And especially if they have any GI issues then they may have something that feels like a positive response to eating these foods that they’re sensitive to and those will feel challenging to remove.
. . . So, it’s a dance and a process for each individual that is really about finding their way. Because of that dance, if they don’t feel better right away, they have to understand the whysand the hows of it, otherwise they’re not going to stay engaged, precisely because it’s not that quick fix.
Dr. Julapalli: I’ll show a list of foods to be removed and it has all these things on there and invariably the patient will say, “That’s everything I love.”
Andrea: Right. Exactly. Yeah, it really is a dance with each individual and it involves helping them to find the smaller moments instead of, “Well, everything’s better now. It allgotten better”. At first it may be that something gets better. You know, we’re always looking at some major factors to see how people are doing. Poop. Sleep. Those are some major factors that we’re looking at, and if we can look at improving those first and foremost, so much starts to feel better in turn. That’s how we all sustain motivation; through the small successes, while we’re persistently working on the larger issues. (And there’s so much more to love than the foods that make us feel bad.)
digestive symptoms around the holidays
Andrea: Are there times of year when you see or receive more patients with acute GI issues?
Dr. Julapalli: Yeah. I have noticed there are a couple of times a year including the autumn and around the holidays. I think there’s a lot of physiological issues that come into play. So, around the holidays I tend to see more of these chronic symptoms of upset stomach, irritable bowel-type symptoms.
Andrea: Yeah, it’s interesting. I think (the holidays are) really tough for people, even if they have made dietary changes through our programs. First, they’re not necessarily experiencing any symptoms that they’re aware of because (of what I refer to as a) cloudiness between themselves and what they’re feeling, and yet they do a detox with us and find that they feel so much better. But then they go into the holidays, and all of a sudden symptoms (they barely felt before) feel pronounced to them because they’re actually more clear, the cloudiness has been lifted.
I like to remind people that sensitivity is a good thing. It means we’re in communication as opposed to, “Why didn’t I feel that before and now I do?”
But I see this happen a lot during the holidays because people feel deprived or they feel pressured by family. I’ve been in that situation myself where it’s, like, there’s certain things I’m not going to say yes to, but there might be that kind of middle ground and I don’t want to make somebody feel bad and so I eat something that doesn’t agree with me, and then therein starts the process (of sensitivity).
Dr. Julapalli: I personally run up against that. The other major thing that I will run up against as a challenge is that human challenge of how do you help somebody? It’s not really even about motivation or willpower. How do you help somebody see a different way to live? How do you end up doing that? I mean, we go through this in the house, me and my wife!
This is a human dilemma: you may intellectually or cognitively know what to do or how to go about doing things, but that’s not enough. That’s not even close to being enough.
To me, that’s where the rubber meets the road. I mean, how do you believe people get motivated to do this when their habits are ingrained, they don’t see that this is going to connect to feeling better when their whole identity — you know, the way they view themselves, their relationships with their families and friends is built around a certain lifestyle. When your family or friends, when they’re starting to eat around you during the holidays, for example, and they’re seeing you trying to do something else, they say “What’s the big deal?” That’s really where the rubber meets the road. How does that actually play out?
Andrea: Yeah, I think that’s where our work really comes into play. The first part of my answer to that would be education, which is why I think we make a difference in peoples’ lives because we’re really educating as we’re changing. So, we’re helping people to understand why; not just telling them what (which food) has to come out, this needs to be removed, period. We’re really explaining why, and I think that’s my passion and my love. (I also believe in it’s success in fueling motivation.)
But I also know for a fact that people need to have a very strong, motivating factor to make dietary change and things like weight loss or “I’m on a detox” aren’t (necessarily) big enough to make sustaining change. What is big enough to make sustaining change is a pain point, and that pain may be a physical pain, but to be honest, I see that not to be the case with adults; that’s more so with children. If children have a physical pain when they eat something, they’re pretty much done with that food once they identify it. They make that association really quickly. Adults are much more caught up in that social component that you’re talking about — you know, the emotions that come up when we eat something, or making sure that we’re not inconveniencing somebody else, whether it be a family member, friends, or even a waiter!
There are all these aspects associated with food that make it very difficult to change our diets, and so that’s where there’s a lot of work to be done to tap into what is the motivating factor for somebody to make dietary change and stick with it. And that is the piece that you and I are passionate about.
It goes beyond the physical signs or symptoms, and it goes into really what do you want in your life, what is that worth to you, and helping to make those connections.
For a lot of people, one of the simple things we see is “I want to feel like myself again.” Especially for women “I want to feel like myself again” is something people say to us often. What is it that we each want to be doing/achieving/feeling in our lives, and how is it thatthat becomes a motivating factor for each of us so that the dietary change goes well beyond the physical symptoms, whether they be discomfort or added weight. (It’s ultimately a vehicle to something much bigger.)
This is why in our online programs, even with hundreds of people in them at a time, one of the most important things for us is our Message Board or support forum. I’m there everyday and I’m writing about the practical and the tactical. And then there’s a lot of motivational writing on there as well. So, when somebody’s struggling with what’s going on for them, that’s where I’m really coming in with the whole different perspective to support them (perspective beyond the mere tactics of what to do). It’s more about shifting our perspective to our habits and patterns, recognizing them and learning a new level of resilience. And other detoxers are going to chime in with their support as well! It becomes a real community of making this change work, and eliminates that feeling of loneliness that can happen when you show up at a party and you don’t eat like everyone else in your community.
To stay motivated and make sustainable change we need both mentors and community.
Dr. Julapalli, I’m so glad to be part of a community that includes you and other like-minded health practitioners. Thank you for bringing loving our guts with gusto!
Dr. Venu Julapalli is founder and president of Integral Gastroenterology Center, P.A., an active private practice in gastroenterology in Houston, Texas. He is passionate about bringing an integral approach to patient care, with a mission to consciously evolve the practice of medicine. He and his brother, cardiologist Vinay Julapalli, M.D., are the founders of the growing movement Conscious Medicine.
I hope you will hear more from me and Dr. Julapalli as I help support his mission!
Your comments and feedback are always welcome.
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