April 19th is World IBS Day. According to Beyond Celiac, the prevalence of celiac disease is four times greater in people with IBS than it is in the general population. Whether you’re struggling with IBS on its own or living with both celiac and irritable bowel syndrome, there’s hope.
For today’s newsletter, I interviewed Marica Gaspic-Piskovic, an Ontario-based pharmacist and the founder of Gut Wellness by Marica, who specializes in helping people with IBS find relief from their symptoms. Marica is an IBS coach living with the condition herself. In addition to working with clients, she shares a ton of helpful tips on her Instagram account, which is how I first met her.
Below, see what Marica has to say about the most common IBS symptoms, what foods can trigger IBS flare-ups (hello, gluten!), and what you can do to find relief from bloating and discomfort in your gut.
Q: What is IBS, exactly?
A: Irritable bowel syndrome, or IBS, has to do with the bowels and your gut function. Normally, it’s about abnormal bowel motility. What that means: You’ll either have diarrhea or constipation—or sometimes both—and there’s a lot of pain associated with it. A lot of people complain about bloating too.
The hallmark of IBS is that you experience symptoms more than once a week and for an average of three months. It’s the up and down of not having normal bowel movements—and the gas, bloating, discomfort, and pain lasting for at least three months.
Q: What are some other potential IBS symptoms?
A: The part that’s not often talked about is the emotional/psychological side of things, which is really important and does come up—especially when people have had IBS for a while.
This includes things like mood changes, becoming depressed, frustration and anxiety around having continued symptoms that you can’t control, and not feeling comfortable in your body because you’re bloated all the time.
Q: There are studies that show a connection between the brain and the gut. It seems like there’s this vicious cycle where the digestive symptoms of IBS lead to anxiety, and then the anxiety makes the digestive symptoms worse. Is that what’s happening here?
A: Exactly. It’s hard to imagine, but the brain and the gut are connected. They’re talking all the time to the vagus nerve, which I call hard wiring. Then there are the neurotransmitters, which are produced in the gut by the microbiome.
That’s a whole other entity that makes us healthy and supports our gut wellness, as well as other parts of our health. There are approximately 100 trillion microbes in the gut—these are parasites, viruses, and bacteria. They’re healthy and meant to be there. They actually produce a high level of happy hormones like serotonin, dopamine, and GABA.
When the gut isn’t well, and when we’re not taking care of our gut, those decrease—and that affects your mood. I like to illustrate this with a couple of scenarios to drive this point home: You notice when you have the stomach flu, your mood is down, right? And when you’re anxious, you feel that tension and stress in your gut. Those are visible things we feel when those events are happening.
Q: How does IBS affect someone’s quality of life?
A: According to research, 70% of people with IBS say it interferes with their everyday lives, and about 46% of people report missing work or school due to IBS.
The unpredictability of bowel movements is a big one. That’s what derails people’s lives, whether it’s going to school, going to work, going to a party, or going on a date—those are examples of when people won’t go because of their IBS.
The other one that’s huge in terms of side effects is fatigue. 54% of people with IBS do report being fatigued. It’s not surprising because they’re in agony and they’re probably not eating and not sleeping. You’re bound to be tired.
Q: I’ve heard it can be very tough to get an IBS diagnosis since there’s no definitive test for it. What does the diagnosis process look like?
A: Part of the initial diagnosis is the symptoms. We talked about having the change in bowel movements and the pain associated with that, lasting more than three months. There’s something called the Rome IV Criteria that defines that. Physicians may use that as a guide in deciding whether to send someone to a gastroenterologist.
And you’re right—unfortunately, there’s no diagnostic that says, “You have IBS.” It could mean going through blood tests to rule out a number of things. For example, I’ve had bloodwork to test for celiac disease several times. But I’m gluten intolerant, not celiac.
You could find yourself going through a colonoscopy or endoscopy. What that’s supposed to do is rule other things out. That’s the process. It’s not fun, it’s not simple.
For people who are diarrhea-prone, you’re probably looking to see that they don’t have an infection, especially if they traveled somewhere recently. Doctors want to make sure they’re treating the right thing. That’s why you have to go through all of these tests.
It usually takes four to six years for people to get diagnosed. It’s a long journey. People go to the doctor, and they may attempt to do some treatment, but it’s not successful. Then there’s the waiting time. In Canada, the wait time for specialists can be pretty long. It might take you a year to see a gastroenterologist.
Q: What are some ways someone with IBS can get relief from their symptoms?
A: It’s complicated and can vary from person to person. There might be medications involved.
A more holistic approach to eating is certainly key. Tying back to the microbiome and the microbes and what they need to support the fact that the gut itself needs strengthening from eating proteins, whole foods, and vegetables. Having a good amount of fiber in your diet is essential.
But it’s also a double-edged sword because if people have food intolerances and aren’t aware of them, then it becomes a vicious cycle: I ate something and then I’m sick. The unfortunate part of that is that you might not get sick right away.
With gluten, I’ve had a couple of those experiences where the next day I was in severe pain. So you can’t always tie it into that moment. It’s not an allergy, it’s the inability of the body to digest properly. And there’s a lot of gas sitting in there causing that pain, cramps, and discomfort.
When you have a food intolerance, like gluten or dairy, you have the same type of symptoms as you do with IBS. It compounds it and makes it doubly worse. So it’s really important to find out what your triggers are.
The gold standard would have to be to keep a diary of what you eat. I have a tracker that I’ve developed that encompasses a lot of things in it, including mood and energy. It’s not that simple. What I do to guide clients is, from a simplicity perspective, I will try to rule out gluten and dairy.
Those are actually the two highest intolerances in IBS patients. About 6% of people in the world may have gluten sensitivity, but about 20% of IBS people do. That’s pretty high, so the chance of it being gluten intolerance is pretty high.
The other food group to look at is FODMAPs. The way I put it simply is that these are foods that are high gas-producing. Cabbage is a good example. Other common triggers are onions and garlic. So it’s looking at what you ate and understanding the relationship to food.
When it comes to food, alcohol is another common irritant. I drink wine, but if I’m in an IBS flare-up, I will not touch alcohol. It makes things worse. Spicy food can also be a trigger, and so can caffeine.
The FODMAP aspect is a little bit more confusing and difficult because sometimes it’s about quantities. For example, if a banana is firm, it’s still low FODMAP, but when it ripens, it changes to sugar and then it becomes high FODMAP.
The expert behind FODMAP grading of foods is called Monash University down in Australia. They have an app you can use as a good reference point if you’re ever wondering how much to eat of something.
The general rule is to do an elimination and then to reintroduce. I think the general fear with elimination diets is that people may not get all the nutrients they need if they don’t do it properly. I think it’s important to work with a professional to make sure you’re doing it properly and that you’re reintroducing foods so you don’t become nutrient-deprived.
The other part of the whole process is changing eating habits. We’re ingrained through our upbringings to eat certain foods, so when you do have food intolerances, it becomes very difficult to make changes. I’ve had people make comments such as, “I’d rather be in pain than not eat this food.” There’s a lot of emotion tied to the food we eat.
I had a favorite pasta of my grandmother’s that I would make when I wasn’t feeling well. I put it in soup and had to give it up because it was made of flour and cheese. I became more creative and thought about how I could make it with gluten-free flour. And I can tolerate sheep and goat cheeses to a certain degree.
Unfortunately, a lot of people with IBS end up not knowing which foods bother them. You end up not feeding yourself and doing the opposite. One of the triggers of IBS symptoms is actually not eating.
It’s important to note that food isn’t the cause of IBS. It’s a key factor in that if you do have intolerances, then it becomes more of a challenge. But not everybody does, and that’s the interesting part. The key thing is keeping your gut healthy and that microbiome balanced.
Something else to consider is not heeding your bodily needs to go to the bathroom. It’s not good for you to do that. Eating and listening to your body can help offset IBS symptoms. Your body works on an internal time clock called circadian rhythm. We need to listen to it and respond.
Stress management is also huge in treating IBS. Stress is a big trigger for a lot of people. If they don’t have food triggers, then they definitely have stress triggers. Learning how to manage stress is essential.
I talk often about tips and tricks on mindset management. One of them is deep breathing. It does amazing wonders to clear your mind and relax. I’ve used it in the moment, on the spot.
I also like journaling for gratitude. A million amazing things can happen in a day, but there will be that one thing that isn’t so positive. And then what you’re going to focus on is that less positive thing. So at the end of the day, if you focus and journal for gratitude and reflect and dissect your day down, you’ll realize that it wasn’t actually that bad. This practice really works and changes your perspective on life.
A positive mindset impacts the messaging going to the gut, and that calms things down. It all goes back to the gut-mind connection—how we react to things is key.
Exercise, too, has actually been proven to change the microbiome to a more positive composition of microbes. There was a study done in Calgary not too long ago where they noticed that happens. But it’s not intense exercise. It’s not being a marathon runner—it’s maybe going for a 30-minute walk. Going for a walk after a meal improves motility and helps to reduce stress.
Sleep is important too. It’s about making boundaries and creating behavior patterns that are going to support you for better sleep. Quiet down your phone, make sure the temperature of your bedroom is conducive to sleep, and meditate or practice deep breathing at night are strategies to help get a restful sleep.
Q: Tell me about your IBS journey.
A: There are a few factors that I think caused me to develop IBS. I have family members, like my great uncles, who had digestive issues. There’s definitely a familial link to it. I almost died as a baby, so there’s trauma that could be a part of it.
There are a few other things, like having bronchitis when I was young and having to be on antibiotics, which upset the microbiome. My rock bottom moment was in my early 20s. I was at university and was extremely bloated with severe constipation. I dropped a lot of weight and just couldn’t eat.
I was on the other side of Canada and chose not to go home. I remember sitting in a hospital waiting room for a colonoscopy and endoscopy. I remember feeling a lot of fear and not knowing what to think of all this. I was told I had IBS and to take a pill. At that time it was Motilium, which is more for upper GI motility, and Metamucil, which I wasn’t fond of.
So it started that way, but there wasn’t a lot of support. I was figuring it out on my own. My experience with IBS was typical. It was not always bad, it was cyclical. What that means is that sometimes life was good and then flare-ups started.
The next phase was lactose intolerance, for which I saw a gastroenterologist. It was diagnosed by dairy elimination for two weeks. But then I realized it wasn’t just lactose—it was dairy, and then it was gluten and then it was FODMAPs. All of these things happened over a long stretch of time at different points. Just when you think you’ve got it sort of under control, it snowballs.
There was a period when I thought I had the stomach flu often. My stomach was just mildly upset and I wasn’t feeling good. I think the makers of Pepto Bismol must’ve loved me because I was taking it a lot.
When I realized what all of my issues were—and I think the biggest challenge was learning I was gluten intolerant, as well as the FODMAPS—then I had to really focus on what I ate. That was a key point.
I did go for a colonoscopy when things were really bad. The results confirmed it was IBS, realizing it was stress-related. I was in a bit of a toxic situation work-wise, so I left the job. I learned how to manage stress better.
My path to getting back on track with IBS was stepwise. First was feeding myself. I never used to eat breakfast, but now I eat a good breakfast. If I have to travel for work, I pack my lunch with me. The thing about being a pharmacist in retail is that it’s very demanding. I never used to eat, but now, I’m like, “No, I’m hungry,” and find the time to feed my body. I give myself that space, whereas in the past I did not.
I’ve been at it for a long time, so I have the comfort of setting boundaries. All I need is 10-15 minutes to eat. That has done wonders. I also exercise first thing in the morning. By the time it gets to the evening, I’m ready to sleep.
Q: Has your professional background as a pharmacist helped you navigate life with IBS?
A: Yes and no. Part of it is the fact that I’m talking about it now, and I’m the one who’s surprised by that—because professionally, you’re taught not to be about you. You don’t put yourself out there. There’s this veil. I didn’t want to talk about it at first because it was too personal.
In terms of how it’s helped me, I think I probably have advocated for myself better because I had access to gastroenterologists. I never had any problem getting good care. It is this journey that led me to become a health and wellness coach—there isn’t support available on a one-on-one basis to help people maneuver through it all.
My own timeline of getting here was years. I’ve been doing well for 15 years, but it took a long time to get here. And I know why it takes a long time—sometimes, people don’t want to talk about it. They’re uncomfortable talking about things related to poop and gas. Everyone makes fun of people who fart, and there’s a lot of stigma around the gut.
Then there’s the whole issue of eating—if you go to someone’s house, I can’t tell you how many times I’ve been hungry because I refuse to eat things that are going to make me sick.
I’ve started to be more open about my IBS and food intolerances. If I’m going to someone’s house, I’ll tell them I can’t eat gluten or dairy. What does that mean? I give them guidelines. I tell them things like grilled meat, vegetables, and potatoes are fine. When I tell them that, they say, “Oh, that’s easy.” If you don’t give them guidelines, it gets very stressful.
When people don’t have these issues to deal with, they don’t understand what that looks like. The event that led me to talk about it more was a holiday party I was invited to from my husband’s work. The person who organized it was sitting across the table, and they ordered pasta as one of the courses.
I declined and she looked at me and asked why. I told her I couldn’t eat it and she was so upset. I was upset because she was upset. As a result of that, she now asks people if they have any food allergies or intolerances. And now I offer that information voluntarily when I’m invited somewhere. I now have less stressful encounters.
Q: Why did you launch your IBS coaching business?
A: I have a passion for helping people with IBS, so I decided to launch my own coaching business about three years ago. I started early on in the pandemic. I saw that as an opportunity to be more portable in where I work. People are more inclined to do Zoom calls now, and most people actually prefer this method of communication these days.
Over my years as a pharmacist, I’ve done a lot of cool things. I actually got to train clinically at a teaching hospital here in Hamilton, and I work with all sorts of specialists and have learned a lot about drugs. I moved into business roles, I worked for a pharmaceutical company.
But I always went back to the one thing I loved, and that was working with people and making a difference. It’s about enabling them to take care of themselves.
The other part is the fact that IBS is a difficult and complex condition. It has many different facets to it. Food, stress, exercise—they all play a role. It’s about unraveling that and making a game plan for people.
It’s also about individuality. My IBS is going to be different than somebody else’s. And triggers will vary by person. So by doing one-on-one coaching with a person, I can really focus on helping them maneuver and support them.
Your doctors may be able to diagnose and prescribe or recommend treatments, but they don’t have the infrastructure to provide one-on-one support.
Q: Is there anything else you’d like to add about IBS?
A: I think it’s important to talk about IBS and share your story with people for awareness and understanding. A lot of people say they feel invisible, and the invisibility is due to not being understood or heard.
In Canada, it’s actually fairly more prevalent than anywhere else in the world. About 18% of people have IBS here versus 11% of people in other places. It’s more common than people realize.
Reach out so you can get help and support sooner. It’s not normal to be bloated all the time. Getting that help and advocating for yourself is key.
Don’t shy away because it’s a gut health thing and you think it’s embarrassing. It’s not embarrassing. It’s okay to talk about these things.
Fantastic info and resource!!