Wrestling the Octopus IBD

Rachel Sawyer (The Bottom Line IBD) and Nigel Horwood
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  • Medicine

Two long-term IBD patients, Rachel and Nigel, share their experiences and perspectives on living with inflammatory bowel disease (Crohn's disease and ulcerative colitis).

  1. 1d ago

    #46 Understanding GLP-1 drugs in IBD - with Dr David Rubin, University of Chicago

    Send us Fan Mail GLP-1 drugs have transformed the conversation around weight loss, but could they also play a role in managing inflammatory bowel disease (IBD)? In this episode of Wrestling the Octopus IBD, we are joined by a world leader in gastroenterology, Dr David Rubin, professor of gastroenterology, hepatology and nutrition at the University of Chicago. He educates our listeners on what these medications could mean for people living with Crohn's disease and ulcerative colitis.  Dr Rubin explains how GLP-1 drugs work beyond appetite suppression, including their effects on gut motility, metabolism, inflammation and overall gut health. The discussion looks at why obesity and excess body fat have become increasingly common in people with IBD, and how reducing inflammation associated with fat tissue may potentially benefit long-term health.  The conversation explores emerging research into GLP-1 drugs such as semaglutide and tirzepatide, including studies investigating whether they may help reduce intestinal inflammation alongside traditional IBD treatments. Dr Rubin shares insights from his own clinical practice, where these medications are already being used in selected patients with Crohn's disease and ulcerative colitis.  One of the most fascinating themes in this episode is the emerging field of immunometabolic health. Dr Rubin explains how metabolism, body fat and the immune system are closely connected, and why improving metabolic health may help reduce inflammation in people with Crohn's disease and ulcerative colitis. The discussion explores whether GLP-1 drugs could offer benefits beyond weight loss, potentially becoming part of a broader approach to inflammatory bowel disease care. Dr Rubin also discusses important practical considerations, including side effects, nutritional monitoring, exercise, muscle loss and the need for careful medical supervision. The episode addresses who may benefit from GLP-1 treatment, who may need additional caution and why symptom improvement does not necessarily mean underlying inflammatory bowel disease is under control.  Along the way, the discussion covers rapid gut transit in people with ileostomies and J-pouches, mesenteric fat, intestinal ultrasound, immunometabolic health and why comprehensive care should focus on the whole person, not just the bowel. There is even time for a lively diversion into bile acid malabsorption, one of Nigel's favourite topics.  Whether you are considering GLP-1 drugs for weight loss, curious about the latest Crohn's disease and ulcerative colitis research or interested in the future of gut health and IBD care, this episode offers a balanced and evidence-based look at one of the most talked-about developments in gastroenterology.  In this episode: Why GLP-1 drugs are generating so much interest in IBDHow GLP-1 medications affect appetite, digestion and gut motilityThe links between obesity, inflammation and inflammatory bowel diseaseWhether GLP-1 drugs may help people with Crohn's disease and ulcerative colitisCurrent research into semaglutide, tirzepatide and IBDPotential benefits for people with ileostomies and J-pouchesSide effects, safety considerations and monitoringThe importance of nutrition, exercise and preserving muscle massNew developments in intestinal ultrasound and personalised IBD careWhat the next five years of GLP-1 and gut health research might look likeFollow Rachel at @bottomlineibd Follow Nigel at @crohnoid

  2. Nov 1

    #45 Treating pain in IBD - with Dr Jessica Sheehan from University of Michigan Health

    Send us Fan Mail Living with pain is a common and debilitating aspect of inflammatory bowel disease (IBD), including Crohn's disease and ulcerative colitis. In this episode of Wrestling the Octopus IBD, we are joined by Dr Jessica Sheehan, IBD specialist at the University of Michigan Health in Ann Arbor. She gives us excellent advice on how IBD patients can manage pain. Dr Sheehan explains that abdominal pain does not always mean your IBD is flaring. While active inflammation can certainly cause pain, symptoms may also arise from complications such as strictures, infections, fistulas or changes in how the gut and nervous system process pain signals.  A major focus of the discussion is visceral hypersensitivity and central sensitisation, where the gut and brain become more sensitive to pain after repeated periods of inflammation. This can leave some people with significant symptoms despite normal tests and well-controlled disease. [ The conversation also challenges common misconceptions about pain in Crohn's and ulcerative colitis. Dr Sheehan explains that the gastrointestinal tract contains an extensive nervous system and that pain can result from stretching, distension, gas and other stimuli, not just active inflammation.  Pain Management Options Discussed The episode explores a range of pain management approaches, including: Treating underlying inflammation where presentAppropriate use of paracetamol and discussion of evolving views on NSAIDsMedications used for chronic pain sensitisationLow FODMAP dietary approaches for IBS-like symptoms in quiescent Crohn's diseaseWorking with specialist dietitians to support gut healthGut-directed cognitive behavioural therapy and other psychological therapiesImproving sleep and addressing fatigueAcupuncture and other complementary approachesPelvic floor assessment and therapy where appropriate Dr Sheehan emphasises that effective pain care often requires a multidisciplinary approach involving gastroenterologists, dietitians, psychologists and other specialists working together.  Key Message for Patients One of the most powerful messages from this episode is that pain remains real, even when tests look normal. Dr Sheehan encourages patients not to feel dismissed if inflammation is under control but symptoms remain. Instead, she advocates for ongoing conversations about symptoms, quality of life and treatment options, highlighting the importance of patient-centred care.  Looking Ahead Dr Sheehan also shares details of upcoming research aimed at identifying which patients are most likely to continue experiencing abdominal pain after their inflammation improves. The hope is that earlier identification will allow clinicians to introduce supportive therapies sooner and improve long-term outcomes for people living with Crohn's disease, ulcerative colitis and other forms of inflammatory bowel disease.  If you live with IBD and struggle with ongoing pain, this episode offers reassurance, practical insights and a hopeful look at how understanding of pain in inflammatory bowel disease continues to evolve. Watch Dr Sheehan's IBD School YouTube video on IBD and pain. Follow Rachel at @bottomlineibd Follow Nigel at @crohnoid

  3. Oct 22

    #44 How an ulcerative colitis diagnosis led to a career in health research - with Dr Sue Blackwell

    Send us Fan Mail n this episode of Wrestling the Octopus: The IBD Patient Podcast, Nigel and I speak with Dr Sue Blackwell, whose journey with ulcerative colitis began in 2002 and eventually led her into the world of colorectal research. Sue shares her experiences of severe disease, life-changing surgery, living with a stoma and multiple parastomal hernia repairs, and explains how those experiences inspired her to pursue a PhD and help shape future research for patients. Sue discusses the realities of living with a stoma, why honest conversations matter and how patient perspectives can improve outcomes for people with inflammatory bowel disease. She also explains her work on PROMISE IBD, an innovative study exploring patient-reported outcomes after IBD surgery, designed to put patient-centred care at the heart of research. The conversation also explores obesity, GLP-1 weight loss medications, quality of life after surgery and the importance of involving patients not just as research participants, but as partners in designing and delivering studies. Whether you live with Crohn's disease, ulcerative colitis or a stoma, or you're a healthcare professional interested in improving patient-centred care, this episode offers valuable insights into the power of lived experience and research working together. In this episode: Sue's ulcerative colitis diagnosis and early treatment journeySurgery, colectomy and adapting to life with a stomaUnderstanding parastomal hernias and their impact on quality of lifeWhy patient perspectives matter in healthcare researchHow lived experience inspired Sue's PhD and research careerThe PROMISE IBD study and patient-reported outcomes after surgeryThe growing role of patient-centred care in inflammatory bowel diseaseGLP-1 weight loss medications and their impact on life with a stomaHonest discussions about stoma surgery, internal pouches and shared decision-makingOpportunities for patients to get involved in researchAbout our guest Dr Sue Blackwell is a researcher at the University of Birmingham whose work focuses on colorectal surgery, parastomal hernias and patient-reported outcomes.  Follow Rachel at @bottomlineibd Follow Nigel at @crohnoid

  4. Oct 13

    #43 Discussing our IBD survey responses - and how they will shape our podcast!

    Send us Fan Mail SURVEY LINK What topics should our Wrestling the Octopus IBD podcast cover next?  In this episode, we review the feedback from our recent podcast survey and discuss how your suggestions will help shape future episodes of this podcast - a show we absolutely love recording! Along the way, I share an update on my treatment with ustekinumab, while Nigel discusses his return to blogging following his recovery from a cystolitholapaxy procedure.  Most importantly, this episode highlights the value of listening to the patient experience and ensuring that future content reflects the questions and concerns that matter most to people living with Crohn's disease and ulcerative colitis. We offer honest conversation, practical information and our own very personal patient reflections. Topics discussed Steroids in inflammatory bowel disease and their modern role in treatmentAzathioprine and combination therapiesSmall bowel Crohn's diseaseGLP-1 weight loss medications and IBDLiving with a stomaJoint pain and extra-intestinal manifestationsIntimacy and inflammatory bowel diseaseAdvocacy, diet and IBS in IBDIBD surgery and patient educationFatigue and pain managementThank you to everyone who completed the survey and helped shape the future of Wrestling the Octopus IBD. Your ideas continue to guide the conversations, experts and patient stories featured on our podcast. Follow Rachel at @bottomlineibd Follow Nigel at @crohnoid

  5. Oct 8

    #42 Hakeem's story: how a Crohn's diagnosis shaped a career change to mental health nursing

    Send us Fan Mail What happens when a future mental health nurse spends 17 years searching for answers before finally being diagnosed with Crohn's disease? In Episode 42 of Wrestling the Octopus IBD, Rachel and Nigel speak with Hakeem, a London-based mental health nurse living with Crohn's disease, about his long and difficult journey to diagnosis, major surgery, life with a temporary stoma, and the lasting psychological impact of living with inflammatory bowel disease (IBD).  Hakeem shares how symptoms that began in childhood were repeatedly dismissed as anxiety, leaving him to navigate years of pain, abscesses and worsening illness before finally receiving a diagnosis. He explains the concept of diagnostic overshadowing, where existing mental health labels can influence how healthcare professionals interpret physical symptoms.  The conversation explores a life-changing surgical experience, including emergency complications, blood transfusions, an unexpected ileostomy and the challenges of adjusting to life with a stoma. Hakeem speaks candidly about recovery, trauma and the importance of specialist stoma support.  Drawing on his professional experience as a mental health nurse, Hakeem also reflects on the often-overlooked relationship between gut health and mental wellbeing. He argues that IBD care should take a more holistic approach, paying greater attention to the emotional impact of living with a chronic condition such as Crohn's disease or ulcerative colitis.  The episode also covers career choices, workplace adjustments, patient advocacy and the importance of maintaining an identity beyond illness. Through honest patient reflections and deeply personal patient stories, Hakeem highlights the challenges faced not only by patients but also by their families and loved ones.  Whether you live with IBD, Crohn's, Crohn's disease, ulcerative colitis, have undergone surgery, are considering a stoma, or simply want to better understand the emotional realities of chronic illness, this episode offers valuable insight, empathy and hope.  In this episode: A 17-year journey to a Crohn's diagnosisDiagnostic overshadowing and delayed diagnosisEmergency bowel surgery and recoveryLiving with a temporary stomaTrauma, PTSD and mental health after surgeryBile acid malabsorption following bowel surgeryBecoming a mental health nurse while living with IBDWhy mental health support should be embedded within gastroenterology servicesSupporting families affected by long-term illnessFinding balance beyond inflammatory bowel diseaseFollow Rachel at @bottomlineibd Follow Nigel at @crohnoid

  6. Sep 23

    #41 Getting the most out of primary care when you have IBD

    Send us Fan Mail Welcome to Episode 41 of Wrestling the Octopus IBD. This time, we're talking primary care and inflammatory bowel disease - how to get the best from your GP when treating your IBD and how we as Crohn's disease and ulcerative colitis patients can help too. Our guest is north London GP, Dr Lindsay Samaan. She tells us how GPs can help IBD patients with everything from flare symptoms and investigations ,to vaccinations and bone health,. Our discussion highlights the importance of collaborative, patient-centred care. Topics covered The role of the GP in inflammatory bowel diseaseWhen to contact your GP, IBD team or A&EBlood tests, stool tests and faecal calprotectinVaccinations and biologic medicinesBone health and osteoporosis riskPatient portals and healthcare communicationAI in healthcare lettersPreparing for consultationsManaging mental health and other conditions alongside IBD Key takeaways Your GP can do more than you might think! GPs are often the best first point of contact when symptoms change. They can help determine whether symptoms are related to IBD or another condition and arrange many initial investigations. They also take a broader view of health, helping to manage other medical conditions, mental wellbeing and overall health needs. Investigations available in primary care Your GP can often arrange: Blood testsAnaemia and nutritional deficiency screeningFaecal calprotectin testsStool tests to rule out infectionCertain scans and investigationsDEXA scans for bone health assessment When to seek urgent help Go to A&E if you develop: Severe or rapidly worsening abdominal painAbdominal swelling or distensionFever with gastrointestinal symptomsPossible bowel obstruction symptoms such as severe cramping, not passing wind or not opening your bowels [Vaccinations matter! Patients taking biologics or immunosuppressants should discuss vaccinations with their GP practice. Vaccines mentioned include: Annual flu vaccineCOVID vaccinePneumococcal vaccine If you are unsure whether to attend a vaccination appointment when unwell, your GP practice or practice nurse can advise. Don't overlook bone health People with inflammatory bowel disease who have received repeated steroid treatment may be at increased risk of osteoporosis. Your GP can arrange DEXA scanning and provide advice on vitamin D, resistance exercise and lifestyle measures to help protect bone health. Know your baseline One of Dr Samaan's biggest tips is to understand what is normal for you: Typical bowel frequencyUsual symptomsCurrent medicationsPrevious test results and treatmentsBeing able to explain what has changed since your usual baseline helps your GP assess whether symptoms may represent an IBD flare or another gastrointestinal condition. [ Use patient portals Hospital portals can provide quick access to: Clinic lettersTest resultsAppointment detailsTreatment informationHaving this information available can be particularly useful if communication between hospital and GP systems is delayed. Final thought Good patient-centred care relies on partnership. While your specialist team manages treatments such as biologics, your GP can help with investigations, monitoring, vaccinations, mental wellbeing, bone protection and wider gut health concerns. Understanding your own condition and communicating changes clearly can help you get the most from every consultation. We vow to keep our podcast non-commercial: this means no ads and no sponsorship. If you enjoy what you hear, please pay it forward by telling other IBD patients or healthcare professionals about our podcast. Please also consider subscribing and rating us on your podcast platform. Thank you. Follow Rachel at @bottomlineibd Follow Nigel at @crohnoid

  7. Sep 15

    #40 IBD health updates from Rachel and Nigel

    Send us Fan Mail SURVEY LINK:  https://docs.google.com/forms/d/1xJHV1TuTi5SKTU11wXdzqAGcXLURU6AOrWu_L4NVbtU/edit Just a quick episode from Rachel and Nigel to give some health updates about our IBD. If you have Crohn's disease or ulcerative colitis - or care for anyone who does - please do take our survey via the link above. It will help us hugely as we plan our future set of episodes on living with inflammatory bowel disease.  Thank you! Follow Rachel at @bottomlineibd Follow Nigel at @crohnoid

  8. Sep 6

    #39 Help shape the future of our IBD patient podcast!

    Send us Fan Mail SURVEY LINK:  https://docs.google.com/forms/d/1xJHV1TuTi5SKTU11wXdzqAGcXLURU6AOrWu_L4NVbtU/edit Now we’re 18 months into our Wrestling the Octopus IBD podcast, Nigel and I would love to canvass your opinion on what you’d like to see in future episodes. Whether you’re an IBD patient like us, a healthcare professional, pharma / charity or anyone looking after someone with Crohn’s disease or ulcerative colitis, this is your chance to chip in your two penneth! We are committed to keeping our podcast non-commercial. This means no ads, no promotions, no monetisation of any kind. It was set up to be – and will certainly remain – a voluntary endeavour from Nigel and me. The survey should take no more than five minutes, and will help us to further help our inflammatory bowel disease community. Many thanks. Follow Rachel at @bottomlineibd Follow Nigel at @crohnoid

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About

Two long-term IBD patients, Rachel and Nigel, share their experiences and perspectives on living with inflammatory bowel disease (Crohn's disease and ulcerative colitis).

Information

  • Creator
    Rachel Sawyer (The Bottom Line IBD) and Nigel Horwood
  • Years Active
    2025 - 2026
  • Episodes
    47
  • Rating
    Clean
  • Copyright
    © 2026 Wrestling the Octopus IBD
  • Show Website
    Wrestling the Octopus IBD

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