Amanda Wilde (Host): Welcome to the Iowa Specialty Hospital and Clinics ISH Dish podcast, practical Health Advice from Iowa Specialty Hospital experts. We connect the members of our communities with the latest healthcare information that's understandable, relatable, and useful to your daily life. I'm Amanda Wilde, your host on this episode. Gastroenterology Leader Caitlin Larson fills us in on some amazing new ways the Functional GI program is helping people get their lives back.

Caitlin, thank you so much for being here. Welcome.

Caitlin Larson, RD, LD, CDCES: Thank you. Thank you for having me. This is exciting to have an opportunity to talk about new things.

Host: Well, it's very relevant as two thirds of Americans are living with gut issues. What specifically are functional gastrointestinal disorders, which is the focus of our conversation today, is that functional as opposed to structural GI disease?

Caitlin Larson, RD, LD, CDCES: Yeah, that's a good way to look at it. So when we are thinking about our GI tract, we're doing anything from our mouth all the way down the esophagus, into the stomach, the small intestine, the large intestine, and then down into excretion. So if something quite simply is not functioning as it should, we think that as a functional GI issue. It is a non-organic problem, meaning it is not structural. It is not something we define as an inflammatory bowel disease like Crohn's or ulcerative colitis. Maybe the best way to describe a functional disorder is one that we typically don't see in a scope, with labs or in a traditional sort of diagnostic, but the symptoms are real. So,

you end up with this broad category of functional GI disorders. They can also be called disorders of gut brain interaction.

Host: Since there are no traditional diagnostic methods, what are some common symptoms of functional GI disorders that we should be aware of?

Caitlin Larson, RD, LD, CDCES: The way that we do, quote unquote diagnose them is exactly that. It's by the symptoms and by the length of the symptoms themselves, and then how long that's been going on. So things that we see are chronic diarrhea, chronic constipation, stomach upset, cyclic vomiting, altered bowel habits in general, nausea, throat clearing, or chronic coughing.

So really it's something uncomfortable that's happening between the esophagus and that large intestine. And it's something that maybe we don't have a name for.

Host: Why do so many people suffer from gut issues. Do we know?

Caitlin Larson, RD, LD, CDCES: We don't totally know, but what we are learning about this subset of gut issues is that they truly are linked right back to our gut-brain interaction. That kind of gut-brain highway. And there's a lot we know about it, but a lot that we're still learning. So one of the things that we're really trying to do in the Functional GI program at Iowa specialty is focus on different therapeutic techniques that target different avenues of that gut-brain connection to kind of get to the bottom of why some of these symptoms are so severe, so chronic, and so widespread.

Host: So Caitlin, you led right into that. How does the Functional GI program at Iowa Specialty aim to improve patient's quality of life?

Caitlin Larson, RD, LD, CDCES: So our goal really is to give patients the quality of life that they desire. So every patient's going to have a different goal. Some people might have a goal to simply feel better. Some might have a goal to be able to do a certain activity without bowel habits interrupting. So at the core, we meet the patient exactly where they're at, figure out what their goal is and what sort of symptom management they desire, and then we try to get them there.

Host: And having a dedicated program for that obviously gives you some advantages.

Caitlin Larson, RD, LD, CDCES: Absolutely. So our program is led by our gastroenterologist, Dr. Adams and our two nurse practitioners, Amy Faga and Carrie Potter. So they are at the core of our Functional GI program and all patients that come into our program start with a visit with a provider. It gives us a good baseline from the GI standpoint, and we really enjoy having the provider kind of give that clinical background and backbone to the program. Because we are evidence-based and we are science rooted. So while our different techniques might come from many different specialties, which I'm sure we'll get into kind of that interdisciplinary team that we have, the backbone is our providers and their deep gastrointestinal knowledge.

Host: What feedback have you received from patients utilizing the Functional GI program?

Caitlin Larson, RD, LD, CDCES: I think patients are really enjoying the targeted services that we have. We have dieticians as part of our Functional GI program. We have mental health specialists as part of our Functional GI program. We also have speech therapists, physical therapists and medication psych providers. The thing that's different is when you see these providers, you are seeing them specifically from that Functional GI lens. So your mental health provider is doing specific cognitive behavioral therapy to rewire that gut-brain connection. When you're seeing the dietician, they're doing very specific techniques and diet modification and lifestyle management for your gut health.

So they're not services that have never been heard of in the healthcare world, but we're looking at them and offering them a little more pinponted to that Functional GI patient.

Host: Yeah, it really goes back to what you started with, which is individual goals and meeting people where they are. You talked about that brain-gut connection being so key. How significant is the role of mental health in managing Functional GI disorders?

Caitlin Larson, RD, LD, CDCES: It is almost the most important, and I would say maybe, maybe it's tied with the nutrition or the dietician portion of it. And of course every patient's going to be a little bit different, and I know mental health gets kind of that stigma, but figuring out what's happening in our gut, how that impacts our brain, and then what's happening in our brain and how that impacts our gut. It is truly probably one of the most needed therapies for this patient base.

Host: So it is really important to recognize that mental health and stress in managing these disorders. Can you share some examples on how the Functional GI program has significantly improved patient outcomes?

Caitlin Larson, RD, LD, CDCES: Absolutely. I would say one of the things that stands out for me the most is when a patient enters the program and can't leave their home because they don't want to be without a bathroom. They don't know how they might respond to food at a restaurant, and so they don't want to put themselves in that public situation.

Their bowel habits and their altered bowel function has become so severe that it's interrupted their activities of daily living. They can't go out and do what they want to do anymore. So there is so much success when we are able to either manage that stress and anxiety to calm down that gut, or we are able to eliminate trigger foods to allow a patient to more confidently choose off a restaurant menu. And somebody that maybe hasn't been out to eat with friends in years is able to do that. That is truly such a success, and it seems small, but put yourself in those shoes and think about how meaningful that would be to you.

Host: Yes, Caitlin. It's so encouraging to hear there are so many ways that you can offer relief and help people regain quality of life through the new Functional GI program. Thank you for sharing your insights and sounds like you have an amazing team to visit as well, at Iowa Specialty Hospitals and Clinics.

Caitlin Larson, RD, LD, CDCES: Absolutely. It is definitely a team approach at the core. We can't treat these patients one-sided, and we have so many professionals that have really invested in our Functional GI program. They believe in it and they believe in helping these patients. So we are lucky to have them in our circle.

Host: Yeah. Such a supportive and educational undertaking. For more information, visit IowaSpecialtyhospital.com/services/gastroenterology. Then click on Functional GI program. You can read a transcript of today's episode or previously aired episodes, as well as get the latest news from Iowa Specialty Hospitals and Clinics, and explore all of the services that we offer@iowaspecialtyhospital.com.

This is the ISH Dish Podcast. Thanks for listening.