Probiotics and its Health Benefits

Wіth аll thе hype аbоut hоw probiotics аrе thе “new health miracle”, уоu mіght bе wondering іf it’s nоthіng mоrе thаn а Nеw Age gimmick, but dіd уоu knоw thаt thе word “probiotic” асtuаllу means “for life” аnd thеѕе lіttlе microorganisms саn bе powerful еnоugh tо knock thе socks оff оf ѕоmе ѕеrіоuѕ ailments? Nоt оnlу dо probiotics hеlр tо prevent disease, but thеу offer а multitude оf health benefits аѕ well.

Welcome to-The Cost of Common Constipation

Constipation is common and affects male and female of all ages.

A regular bowel pattern can vary massively between individuals, anything from three times a day to every three days can be regarded as normal.

A change in bowel habit, hard pellet like stools and difficulty or straining can be suggestive of constipation.

This can be a short lived episode which resolves or for some people a chronic condition that affects quality of life.

Its estimated that 1 in 7 adults are constipated at anyone time in the UK at a cost of £101million in prescriptions per year(coloplast.co.uk).

Although this figure does not take into account the cost of over the counter laxatives which would easily exceed the prescription cost.

Its difficult to imagine exactly how much the cost of common constipation actually amounts too.

Welcome to Understanding Irritable Bowel Syndrome

You are reading this because you have IBS or you know someone that does!

If your asking yourself “Do I know someone with IBS” the answer is most likely “Yes”. 

With almost 1 in 5 people suffering from IBS its likely that some of your close family or friends do!

Once you’ve had a camera up your bottom and various blood tests it can come as a relief that your diagnosis isn’t something more life threatening. 

Anxious,Overwhelmed, Confused and Worried are common terms expressed by some of my patients. 

You’re likely to have a lot of questions that your tapping into search engines. 

• What actually is IBS?
• How do I manage IBS?
• What do I eat? 

The additional anxiety and worry is unlikely to make your symptoms any better!

Understanding Irritable Bowel Syndrome does exactly what it says on the tin. 

This post will help you understand IBS and hopefully answer some of those burning questions. 

Lets begin.

What is IBS?

“Irritable Bowel Syndrome is a gastrointestinal disorder characterised by altered bowel habits in association with abdominal discomfort or pain in the absence of detectable structural and biochemical abnormalities”.(1)

Irritable Bowel Syndrome can be characterised by the presence of the following symptoms:

• Diarrhoea
• Alternating bowel habit
• Abdominal discomfort
• Bloating and distension
• Urgency to visit the loo
• Faecal Incontinence

Symptoms range from diarrhoea to constipation, a combination or the two along with abdominal pain and discomfort existing alongside abdominal distension(2).

IBS is sub grouped into predominant bowel pattern –

(Figure1)

The degree of symptoms along with variety and frequency varies immensely between individuals.

Some may suffer excruciating chronic pain whilst others have intervals which can last from weeks to months(3).

For example episodes of constipation followed by urgent, explosive diarrhoea.

Diagnosing IBS

There is currently no biochemical, histological or radiological diagnosis of IBS, while the diagnosis of IBS being based mainly on symptom assessment(2).

Rome IV Criteria. 

Recurrent abdominal pain, on average, at least 1 day per week in the last 3 months, associated with  ≥2 of the following: 

1. Related to defecation 
2. Associated with change in stool frequency 
3. Associated with change in stool form (appearance)

Criteria should be fulfilled for at least 3 months with symptoms onset ≥6 months prior to diagnosis. 

Upon presenting these symptoms, your Gastroenterologist may want to investigate further if you have any of the following red flag indications.

• Weight Loss
• Rectal Bleeding
• Anaemia
• Inflammatory markers

The above symptoms are NOT suggestive of IBS and must be investigated further by your Specialist Gastroenterologist.

A routine assessment can include a Colonoscopy, stool tests and blood tests which identify whether there is any inflammation.

Hopefully these investigations will rule out more serious conditions including:

• Inflammatory Bowel Disease
• Coeliac Disease
• Cancer
• Diverticulitus

Following these investigations, your consultant may come to the conclusion that there is no structural abnormalities to identify your symptoms.

This is likely to come as a sigh of relief when you’re told that your diagnosis is IBS and not life threatening.

It’s only weeks later when your symptoms return and you think of all the questions that you should have asked your consultant.

Who does IBS effect?

Irritable Bowel Syndrome is one of the most common gastrointestinal disorders. The percentage of patients seeking health care related to IBS approaches 12% in primary care practices and is by far the largest subgroup seen in gastroenterology clinics[1].

Figure2. Prevalence of IBS from Rome criteria.

This is a lifelong condition that can appear out of nowhere with no clues to what initially caused your symptoms. 

An estimated 5%-20% of the world population suffer from IBS, almost 1 in every 5.

More than twice as many women than men are affected by IBS although this prevalence could be down to women generally reporting more symptoms to their Doctor than their male counterparts. 

“Although a minority (10%-50%) of IBS patients seek healthcare, they generate a substantial workload in both primary and secondary care”[2]. COST OF IBS IN UK(REF).

Although age is not a contributing factor toward IBS, most presenting complains are between the age of 20-30 years. 

Why Do I Have IBS?

This is a difficult question to answer. 

No one actually knows exactly what causes IBS, however we do know that some factors can trigger or worsen symptoms.

• Gastrointestinal infection 
• Psychological
• Increased sensitivity/ Visceral hypersensitivity
• Altered gastrointestinal motility
• Brain-Gut Interactions
• Gut Flora Alterations
• Intestinal Inflammation
• Diet 

Gastrointestinal Infection or Post Infective IBS is thought to affect 3-17% who have undergone an episode of gastroenteritis(5).

Most cases resolve after 6 months, however approximately 10% report persistent symptoms over this time(4).

Clinical features of Post Infective IBS include bloating, loose watery stools and urgency to defecate.

Psychological– Anxiety and anger can induce small bowel transit enhancing stool frequency.

Whereas depression and fear have the opposite effect and is more likely to delay colonic transit.

The “Brain-Gut Axis” refers to the interaction between the brain (central nervous system) and the intestinal tract.

Stress, emotions, and psychological problems can affect gut sensation, motility, and secretion.

Sensations within the gut can also affect the central nervous system leading to pain or to changes in mood or behaviour.

Abusive history, exaggerated consciousness, perfectionism and neuroticism is commonly reflected in personal features(5).

Visceral Hypersensitivity is the increased sensitivity of pain within internal organs.

This means that any changes in the gut including the buildup of gas or a large bowel motion can cause increased pain.

Diet and lifestyle

I don’t mean to disappoint , but diet is NOT the cause of IBS. 

Lets say for example, we had two people living in the same house, working at the same job, eating the same, one of those people could easily have IBS with the other having no problems at all. 

So what is causing IBS? No one really knows and therefore we can’t give you a definitive answer. 

What we do know is that there are a group of contributing factors, when managed can help symptoms and improve quality of life. 

Diet manipulation can significantly improve symptoms and advised by NICE as first line management of IBS. 

Adopting a balanced diet with regular meals and structure would be this first thing to implement. 

Over eating with large portions can result in stretching of the intestine causing pain, bloating as does going long periods without eating. 

Diet and nutrition should be assessed for people with IBS and the following general advice given.

• Have regular meals and take time to eat.
• Avoid missing meals or leaving long gaps between eating.
• Drink at least 8 cups of fluid per day, especially water or other non caffeinated drinks, for example herbal teas.
• Restrict tea and coffee to 3 cups per day.
• Reduce intake of alcohol and fizzy drinks.
• It may be helpful to limit intake of high fibre food (such as wholemeal or high fibre flour and breads, cereals high in bran, and whole grains such as brown rice).
• Reduce intake of ‘resistant starch’ (starch that resists digestion in the small intestine and reaches the colon intact), which is often found in processed or re cooked foods.
• Limit fresh fruit to 3 portions per day (a portion should be approximately 80 g).
• People with diarrhoea should avoid sorbitol, an artificial sweetener found in sugar free sweets (including chewing gum) and drinks, and in some diabetic and slimming products.
• People with wind and bloating may find it helpful to eat oats (such as oat based breakfast cereal or porridge) and linseeds (up to 1 tablespoon per day). [NICE,2008]

 How Do I Manage my Symptoms?

That all very much depends of YOUR symptoms. 

The free diet and symptom diary along with the symptom severity tool will help you identify the following:

•  Identifying your symptoms
•  Frequency of your symptoms
•  Severity of your symptoms
• Trend in your symptoms

There is no “one size fits all” approach towards managing IBS, therefore self-management should be encouraged.

Once you have identified your symptoms, you may want to steer your approach towards managing constipation which could include eating more fibre and drinking more fluids. 

Alternatively if constipation were an issue, the approach may be towards eating less fibre or less insoluble fibre and remain drinking fluids to minimise dehydration. 

Caffeine, milk products, wheat and various fruits can be known to worsen some symptoms. 

A Registered Dietitian can help go over your diet in more detail, increasing or decreasing fibre as well as caffeine, fatty foods and alcohol. 

Some people may require simple alterations to their diet whilst others may benefit from a more exclusive diet such as the low FODMAP diet.

The low FODMAP diet is an exclusion diet designed by Monash University in Australia. 

IBS sufferers are advised to make simple (first line) dietary changes which before considering the FODMAP diet. 

The FODMAP diet can be challenging as it excludes variety of foods and can be more costly when doing the weekly shop.  

Despite this, the FODMAP diet boasts a 76% improvement in overall symptoms, the FODMAP diet should be carried out alongside a Registered Dietitian.

Your Dietitian will help you adhere to the low FODMAP diet to ensure the best outcome whilst remaining nutritionally adequate.

Have you got a question? We want to help!

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Welcome to – Are You Getting Enough Vitamin D?

I decided to cover this topic for two reasons.

Reason 1- Vitamin D is essential for Calcium absorption.

Reason 2- Vitamin D deficiency is a global problem.

Reason 3- If you’re avoiding dairy in your diet, you may be deficient in Calcium.

I decided to cover this topic because vitamin D is essential for Calcium absorption, Calcium being another Micronutrient deficiency is a global he

Over a billion people worldwide are vitamin D deficient or insufficient

Vitamin D is an extremely important vitamin for your skin and beauty, bones and strength, and overall health and immunity.

When an estimated 1 billion people worldwide have a vitamin D deficiency, it’s important to know what vitamin D is, how to know if you are lacking this vital vitamin, and what you can do about it.

WHAT IS VITAMIN D?

Vitamin D is a fat-soluble vitamin, meaning it can travel into your blood circulation and be stored in your body’s tissues.

It is the only vitamin that can be produced in the body on its own, making it more of a hormone than a vitamin.

It does so when your skin has direct sun exposure, and it can also be found in some food sources as well as Vitamin D supplementation.

Vitamin D, also described as “the Sun Vitamin” is a steroid with hormone like activity.

It regulates the functions of over 200 genes and is essential for growth and development. There are two forms of vitamin D.

Vitamin D2 (ergocalciferol) and vitamin D3 (cholecalciferol).⁽²⁾

Vitamin D status depends on the production of vitamin D 3 in the skin under the influence of ultraviolet radiation from sun and vitamin D intake through diet or vitamin D supplements.

Usually 50 to 90% of vitamin D is produced by sunshine exposure of skin and the remainder comes from the diet.

Natural diet, most human consume, contain little vitamin D.

Traditionally the human vitamin D system begins in the skin, not in the mouth as Dietary sources of Vitamin D are limited.

However, important sources of vitamin D are egg yolk, fatty fish, fortified dairy products and beef liver.⁽³⁾

Foods fortified with vitamin D are the main sources of dietary vitamin D in some industrialized countries but such programs are practically nonexistent in most low- and middle-income countries.

In the absence of food fortification programs, a majority of the populations in the world solely depends on the sun for their vitamin D nutriture.

However, sunlight alone is not considered a reliable or adequate source as production of vitamin D in the skin minimizes in winters.

In the UK there is not enough ambient sunlight between the months of October- April for the skin to synthesise vitamin D.

Dark skin color exacerbates the problem of low endogenous vitamin D production.

Religious body-covering habits, staying indoors for the majority of daytime (particularly children, women, and the elderly), and lack of open spaces and direct access to sunlight in high human density habitations have resulted in the high prevalence of vitamin D deficiency, even in countries close to the equator where sunshine is abundant.

With this background, vitamin D can easily be classified as a “problem nutrient” with the potential of high risk of its deficiency in a large proportion of the human population.

Vitamin D3 deficiency can result in obesity, diabetes, hypertension, depression, fibromyalgia, chronic fatigue syndrome, osteoporosis and neuro-degenerative diseases including Alzheimer’s disease.

Vitamin D deficiency may even contribute to the development of cancers, especially breast, prostate, and colon cancers.

Vitamin D3 is believed to play a role in controlling the immune system (possibly reducing one’s risk of cancers and autoimmune diseases), increasing neuromuscular function and improving mood, protecting the brain against toxic chemicals, and potentially reducing pain.⁽⁵⁾

Exposure to sunshine each day helps human body to manufacture the required amount of vitamin D.

However, due to fear of developing skin cancer most people avoid the sun exposure.

To prevent vitamin D deficiency, one should spend 15 to 20 minutes daily in the sunshine with 40% of the skin surface exposed.

High concentration of melanin in the skin slows the production of vitamin D; similarly aging greatly reduces skin production of vitamin D.

Use of sunblock, common window glass in homes or cars and clothing, all effectively block UVB radiation – even in the summer.

People who work indoors, wear extensive clothing, regularly use sunblock, are dark skinned, obese, aged or consciously avoid the sun, are at risk of vitamin D deficiency.

Despite the abundance of sunshine in the Middle East allowing vitamin D synthesis all year round, the region registers some of the lowest levels of vitamin D and the highest rates of hypovitaminosis D worldwide.

This major public health problem affects individuals across all life stages, especially pregnant women, neonates, infants, children and the elderly.

Furthermore, while rickets is almost eradicated from developed countries, it is still reported in several Middle East countries.

These observations can be explained by limited sun exposure due to cultural practices, dark skin color, and very hot climate in several countries in the gulf area, along with prolonged breast feeding without vitamin D supplementation, limited outdoor activities, obesity, and lack of government regulation for vitamin D fortification of food, in several if not in all countries.⁽⁷⁾

Risk Groups (NICE, 2014)

• Infants and Children under 5 years
• Pregnant and breastfeeding women, particularly teenagers and young women
• People who have low or no exposure to sun, for example, those who cover their skin for cultural reasons, who are housebound or confined indoors for long periods
• People of darker skin, for example, people of African, African-Caribbean or South Asian family origin

Suitable supplements should be available for people with particular dietary needs (for example, people who avoid nuts,  are vegan, or have a halal or kosher diet).

Identify Your IBS Subtype

Irritable Bowel Syndrome is a Functional Bowel Disorder meaning there is no diagnostic test.

Blood tests, stool samples and radiological scans may have been arranged by your Doctor although these are to rule out other conditions such as Coeliac, Crohns, Colitis and Cancer.

Diagnosing IBS is dependent on the profile of presenting symptoms.  For example – bloating / constipation / diarrhoea / pain.

With no way of diagnosing IBS, assessing symptoms can be vague when a patient complains of bloating or diarrhoea.

Fortunately a diagnostic criteria exists for Irritable Bowel Syndrome, another reason to thank the Romans.

IBS is not a new disorder affecting people today with busy lifestyles and convenience foods.

It’s highly likely that people have been suffering from IBS for centuries.

In 1989 a group of Physicians got together in Italy and decided to lay down some criteria for diagnosing IBS- the Rome Criteria was born.

The Rome Criteria outlines the frequency, and duration of specific symptoms aiding in the diagnosis if IBS.

Over the years the criteria has been adapted with a total of 4 being published.

Rome I Criteria- 1989

Rome II Criteria- 1999

Rome III Criteria- 2006

The most recent version being Rome VI Criteria May 2016.

Don’t worry if you were diagnosed before the new criteria were published.

Rome criteria are used globally to diagnose IBS and little is changed other than the wording in the latest revision.

The recent update is more accommodating to terminology rather than symptoms.

Diagnostic Criteria for Irritable Bowel Syndrome

Recurrent abdominal pain, on average, at least 1 day per week in the last 3 months, associated with 2 or more of the following criteria:

1.       Related to defecation

2.       Associated with change in frequency of stool

3.       Associated with change in form (appearance) of stool.

Criteria fulfilled for the last 3 months with symptom onset at least 6 months before diagnosis.

The criteria states symptoms must be persistent at least 1 day per week within the last 3 months and over 6 months since onset.

Short lived symptoms of travel diarrhoea or food poisoning would not fit the Rome Criteria.

The symptom profile of IBS can vary between individual.  The prominence of IBS symptoms can categorise sufferers into 1 of the three main subgroups including:

1.       Diarrhoea Predominant (IBS-D)

2.       Constipation Predominant (IBS-C)

3.       Mixed Predominance (IBS-M)

IBS with predominant constipation: More than onefourth (25%) of bowel movements with Bristol stool form types 1 or 2 and less than one-fourth (25%) of bowel movements with Bristol stool form types 6 or 7. Alternative for epidemiology or clinical practice: Patient reports that abnormal bowel movements are usually constipation (like type 1 or 2 in the picture of Bristol Stool Form Scale (BSFS), see Figure 2A).

IBS with predominant diarrhea (IBS-D): more than onefourth (25%) of bowel movements with Bristol stool form types 6 or 7 and less than one-fourth (25%) of bowel movements with Bristol stool form types 1 or 2. Alternative for epidemiology or clinical practice: Patient reports that abnormal bowel movements are usually diarrhea (like type 6 or 7 in the picture of BSFS, see Figure 2A).

IBS with mixed bowel habits (IBS-M): more than on fourth (25%) of bowel movements with Bristol stool form types 1 or 2 and more than one-fourth (25%) of bowel movements with Bristol stool form types 6 or 7. Alternative for epidemiology or clinical practice: Patient reports that abnormal bowel movements are usually both constipation and diarrhea (more than one-fourth of all the abnormal bowel movements were constipation and more than one-fourth were diarrhea, using picture of BSFS, see Figure 2A).

IBS unclassified (IBS-U): Patients who meet diagnostic criteria for IBS but whose bowel habits cannot be accurately categorized into 1 of the 3 groups above should be categorized as having IBS unclassified. For clinical trials, subtyping based on at least 2 weeks of daily diary data is recommended, using the “25% rule.” a IBS subtypes related to bowel habit abnormalities (IBSC, IBS-D, and IBS-M) can only be confidently established when the patient is evaluated off medications used to treat bowel habit abnormalities.