Tag: Irritable Bowel Syndrome

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Book Review IBS Free at Last – Second edition Patsy Catsos

Book Review IBS Free at Last – Second edition Patsy Catsos

This recently published book is based on the FODMAPs diet for irritable bowel syndrome. It’s a guide for those wishing to trial a low FODMAPs diet to alleviate symptoms; as such it is comprehensive, explains the diet fully and includes information about who should use this diet. It is safe, explanations about possible other conditions such as coeliac disease, which may be masked by going on wheat free diets, for example, are discussed fully. Dietetic treatment is vital to help with following the exclusion and reintroduction phases to ensure the diet is nutritionally complete and to give advice about eating out and shopping, finding onion and garlic free processed foods can be problematic, for example. Patsy has included common questions that patients have and answers these very well, useful for those following the diet and those who treat them. For USA patients this book does give examples of food plans and recipes – for those outside the US information about converting cups to grams may be useful for following the recipes and some of the medications and supplements mentioned may not be available in all countries. It is important to include information for those who do not get resolution of symptoms using this diet and this is mentioned. The book does not clearly detail other factors for consideration such as stress, anxiety and other areas such as behaviour around mealtimes, as it was intentionally written as a book about diet. Although written for the United States, this book is certainly useful for those who wish to know more about this new treatment for IBS, and would be a good accompaniment to those who are treated with  by their dietitian.  Healthcare professionals wishing to know more will also find it useful and it is fully referenced, it is available on Kindle and hardcopy from good book suppliers.

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This book in Kindle version was provided free of charge by the author

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Fast eating – speedy way to make your IBS worse, the benefits of slow eating.

Why is it suggested to help IBS you need to ensure you relax, take time over your meals and chew food slowly? How does this advice help with reducing symptoms?

If you don’t chew your food well you are more likely to swallow air with your food, this can pass into the intestines and increase bloating. After your mouth your digestive system does not have teeth, your gut moves and squeezes to mix and push food through it, but this not break down tougher foods – you need to chew these foods well, prior to swallowing.

If you are eating whilst working you may experience stress, particularly if you are answering a discourteous email that demands some diplomacy in its response, or dealing with a complaint on the telephone. It does not help your digestion (or your IBS) if your body is experiencing stress whilst you are eating a meal. Stress causes an increase in adrenaline, a hormone that gets the body ready for action, and this hormone slows the digestive tract, slowing down digestion. Adrenaline reduces the amount of digestive juices that are secreted to help digest your food, therefore it is perhaps not surprising that you feel so uncomfortable if consuming food when stressed. Sitting up straight can also help – use gravity to help your digestion and don’t slouch when eating.

Sometimes it is difficult to change what we do, particularly if you feel that you may be penalised in some way if you take a break at work, but it is worth considering. Under the current economic climate it is difficult to insist on taking breaks if your colleagues do not, so perhaps it is time we all support each other and take back our work breaks and lunchtime, to allow everyone time to sit down, relax and ‘rest & digest.’

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Self care for your irritable bowel – worth a look?

This month The IBS Network launched is new interactive on-line self-care plan for IBS, you may be wondering what it’s all about, and possibly not being a member you wouldn’t have access to it to try it out. Well, this blog will give you some more information to allow you to make your mind up before taking the plunge. Some questions you may be thinking of:

Why should I take responsibility for my IBS – surely I pay my taxes or health insurance to pay doctors to sort this out for me? 

So, has this happened then? If your IBS has been helped you probably wouldn’t be looking for answers. IBS is a chronic condition that is poorly understood by the medical profession, and they freely accept this is the case. This condition is very similar to other misunderstood syndromes such as chronic fatigue and fibromyalgia, IBS is a problem of how the digestive system functions, or moves – looking at it using tests and instruments doesn’t lead to a diagnosis, as there is nothing yet that can be seen. This is either because it is caused by something that researchers haven’t yet found or it is purely a dysfunction in the way the gut moves (think of it as being similar to the different speeds your heart can beat.) It does not mean that it’s all in your head, or you do not feel pain or you do not suffer from difficult diarrhoea or constipation. The plan can give you information that will help you think of what else it could be, but sometimes accepting IBS for what it is will allow you to move on and try to help yourself. Everyone’s IBS symptoms are different, you are best placed to be able to help with your own IBS as you understand what makes your IBS flare up.

But I don’t understand what affects my IBS – it’s so complicated! 😦

This is where the self-care plan can help, you can use the symptom tracker for two to three weeks, it is a simple tool that helps you log areas that affect your IBS such as life events, diet, medication, disturbed sleep and exercise. We have kept it fairly simple so that you can focus on general areas initially making it easier to design your self-help package. You can then print a report that will show you when you feel better or worse and what happened to cause a change. This is also a very good report to take along to your healthcare provider, to help them to identify the best course of treatment for you.

For example – So my symptom checker has shown that every time I eat pasta I feel worse and every time I have a meeting with the MD at work I get diarrhoea. You can then use the information contained in the plan to check out how to change your diet to help you feel better and what can be done to relax before your meeting or what medications may help you.

This is fine to talk about but I find it really difficult to change my life!

The answer to this is we all find it difficult to change from time to time. Make one change at a time if you can, this will make it easier for you to use your symptom tracker to see if the change has helped – be SMART with your changes

Specific goals – makes them easier to manage. e.g. “I wish to reduce my levels of stress”, this is not specific enough, how are you going to reduce stress? By doing what?

Measurable – you need to be able to see the effect to feel really great about your achievement – use your symptom checker, or a food & mood diary.

Achievable – How are you going to make the change? Try to choose parts of your plan to change that you feel are much easier to achieve, this will give you lots more confidence to try the harder changes. For each change ask yourself the following question

‘on a scale of 1-10, 1 being very easy and 10 being very difficult – what would I score the ease of making this change?’ Try the ones that score lower initially.

Realistic –  Think about if you can really achieve what you have planned – if it’s just too difficult to do, you will be setting yourself up to fail. Sometimes we can’t change some aspects of our lives, it is fine to accept this and PUT IT TO ONE SIDE, don’t keep focussing on what you can’t achieve. Another question to ask would be, is it the right time for me to make this change?

Time focussed – how long is it going to take? It may take a minimum of three weeks to change some aspect of your life and thinking how long you will need will help you to keep focussed.

Changing our lives, what we eat or how much exercise we do is a challenge, we all behave in a way that makes it easier to live our lives, but think about your symptoms – if you always do the same thing you will always get the same result – ask yourself do you want this to continue? what are you gaining from your IBS? What will changing mean? The care plan will help you think about your IBS and it contains exercises to help you understand your condition. Changing can take time and lapses are to be expected, it is what you do about a lapse that’s important – don’t put yourself down and feel a total failure, put it behind you as something that has happened (and was probably likely to happen!) and try again – small steps! Think and plan what you would do if you have a lapse in your planned changes before they happen and this will help. Don’t allow a lapse to become a relapse. Also plan to reward yourself when you reach each goal this will positively reinforce the changes you have made.

I have heard that having a practitioner actually helps with IBS? How will helping myself work?

All the information contained in the care plan has clinical evidence or experts in health have come to a consensus through experience that the information will help – we don’t yet have evidence that the self-help plan works as a whole, as it has only just been developed – this is something we hope to prove when people are starting to use it. There is a study that on-line self-help for other chronic conditions such as chronic fatigue* works, and whilst this doesn’t directly relate to IBS, with 10 – 20% of the population diagnosed a new way of helping needs to be developed.

If you are interested in the plan follow the link on the right hand side of this page or copy and post the following link

http://www.theibsnetwork.org

*Nijhof, Bleijenberg, Uiterwaal, Kimpen, Putte (2012) Effectiveness of an internet based cognitive behavioural treatment for adolescents with chronic fatigue syndrome (FITNET): a randomised controlled trial The Lancet published on line March 1, 2012

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Probiotics, into ‘au natural’ or domestic goddess? Want to make your own? Check this post first!

Kombucha fermented tea

Probiotics have been around for millennia and are found naturally in certain foods, however does natural always mean safe? This post discusses the various types of probiotics that are home-made and discusses their safety and whether they will actually do what they propose to. This post has been rather challenging to write, it has produced lots of information, but little in the way of clinical evidence to directly prove that home-made products are more or less effective than shop bought, and little direct evidence in how effective they are at reducing gastrointestinal problems. This is perhaps not too surprising.

Home cultured dairy foods including yoghurt, cheese & clabbered milk.

There is nothing wrong in producing your own home-made yoghurts and cheeses, should you wish to. Kits are available on the internet and you may also wish to go on training courses, or review books to get started (will probably help to avoid costly mistakes!) Milk, if left un-refrigerated will sour, some types of milk will take longer to do this depending on the amount of bacteria they contain and the processes they have been exposed too, UHT milk contains very limited numbers of bacteria due to its heat treatment, so it will take longer to sour, for example. Starter cultures are required and can be purchased for this very process, but other ‘live’ milk products can be used as starters.

Kombucha

Kombucha is a Japanese fermented mushroom in tea and sugar, proposed to be taken as a tonic. It contains yeast and bacteria and is anecdotally suggested to reduce constipation and have benefits for myriad of other health complaints. Web & Pinterest searches revealed lots of information about how to make this at home, but it is also available to purchase as a manufactured product. A small number of case studies have reported serious side effects with taking this product as a drink, some of the cases had other medical problems which may have also been implicated, but symptoms have been reported in people who had no health problems too. Kombucha has resulted in jaundice (yellowing of skin and eyes due to damage to the liver,) one case had improvement to the liver after stopping taking kombucha, but one death was mentioned that was attributed to taking this product. We have no evidence that Kombucha improves constipation and although cases of serious side effects are rare and the data is old, it is probably worth avoiding taking home made kombucha as a health tonic, liver damage is a very serious problem that is best avoided. If you do wish to try komucha perhaps try the manufactured products but no evidence is available to suggest it helps with IBS for example.

Sauerkraut

Sauerkraut is a fermented vegetable product based on cabbage its direct translation is sour cabbage! It has reported both prebiotic (food and homes for bacteria) and probiotic actions. It is also a source of vitamin C, which helps your skin, and sauerkraut was used in history as food in winter to prevent scurvy. Sauerkraut also contains a substance called tyramine, some people have problems with tyramine and are informed to avoid this (MAOI diet,) – you will likely know, if you need to avoid this food!!

Sauerkraut has been produced and consumed in European countries for approximately 1000 years, and is widely available as a manufactured product in supermarkets. The bacteria that are found in sauerkraut are lactic acid bacteria and these produce an acid environment leading to its sour taste. When produced correctly it can be kept for several months in an airtight jar but as with all home-made products the possibility of producing pathogenic bacteria should be considered, the not so friendly ones, that can result in illness. unpasteurized (or home-made) varieties will contain more probiotic activity but hygiene and use of a reliable manufacturing method, is very important. Listeria has been found during fermentation of sauerkraut, therefore it may be advisable not to consume unpasteurized sauerkraut during pregnancy or also those people who may be at risk of illness such as those with weakened immune systems, or the very young & the elderly.

Their may be one drawback to this food for your gut, as a consequence of it containing some prebiotic features, due to it being based on cabbage. If you find eating foods containing oligosaccharides (a starchy prebiotic found in beans, cabbage, sprouts, for example!) results in intolerable gas and bloating, then sauerkraut is probably best avoided. But white cabbage has been tested and is low fodmap so sauerkraut based on white cabbage is likely OK to use but do check for other ingredients. However it is a dish that is readily available and is worth eating, if you like it. As for its effectiveness in promoting gut health a search on PubMed (published research papers) did not reveal any direct studies on the effectiveness of this product on gut health, but lots of data on the populations of bacteria and yeasts found in sauerkraut, so an indirect link may be possible, but as with most traditional foods, direct evidence is elusive and needs to be investigated.

Kefir

On a basic Pubmed search an incredible 1,912 studies that mention kefir were found, so for a home manufactured product it seems to have attracted the attention of the scientists and clinical researchers! However in IBS for example non of these research papers have been reviewed systematically, therefore they are likely to not meet the strict criteria for good levels of evidence such as randomised controlled trials. Kefir is a stable cultured dairy product that contains yeasts and lactic acid bacteria of various different types, thirty bacteria species and 15 species of yeast have been identified. It can be purchased as a starter called Kefir ‘grains’ for producing live dairy products at home. Kefir has a large number of bacteria that are suggested to be able to pass into the gastrointestinal tract in beneficial numbers despite passing through the acidic conditions of the stomach (not all bacteria will survive to the small bowel.) It has even been used successfully to replace yeast in producing bread, as a consequence of the yeast species it contains. It is reputed to improve lactose intolerance (increased gas, bloating & diarrhoea when consuming lactose, a sugar found in dairy products) due to the lactic acid fermentation process, but many yoghurts and cheese have lower levels of lactose as a result of fermentation. It is probably best to introduce this food slowly and monitor you symptoms, if you are prone to lactose intolerance and wish to try it. A recent review reported that kefir is an important food and warrants further study, although this review had most of the data from animal studies and in vitro studies (studying the activity in cells, or in test tubes) so the research cannot be related directly to effects in humans. It is certainly and interesting product and does warrant further studies!

Filmjolk

This is fermented milk and is similar to Kefir, it is made using different bacteria lactococcus lactis and Leuconostoc Mesenteroides, and this gives the yoghurt a different taste – less sour than traditional yoghurts. It is also available commercially; searches have not produced much data in English about whether this product is goof for digestive health but if you can read Swedish follow the link to learn more (lots of papers at the bottom of the page)

http://en.wikipedia.org/wiki/Filmj%C3%B6lk

Tofu miso

These are fermented soya foods that do contain bacteria however don’t forget that bacteria may be affected by the cooking process, so how useful the probiotic effect is when these products are exposed to heat, is debatable.

As with all food preparation, food hygiene is vital to produce safe home-made products, ensure you use clean utensils, wash your hands and check the following link:

http://www.nhs.uk/Livewell/homehygiene/Pages/how-to-store-food-safely.aspx

http://www.nhs.uk/Livewell/homehygiene/Pages/Homehygienehub.aspx

Some people are possibly more at risk from taking live products, during pregnancy UK advice is to avoid products containing unpasteurized milk, and soft cheeses that are mould-ripened, such as brie, camembert and chevre and others with a similar rind. Other cheeses you need to avoid are soft blue-veined cheeses such as Danish blue or gorgonzola. These are made with mould and they can contain Listeria, a type of bacteria that can harm your unborn baby. Also if you have been told by your doctor that you have a weak immune system (medically called immunocompromised) you are better to avoid taking live bacteria and food products that contain them.

http://www.ncbi.nlm.nih.gov/pubmed/21390946

Niksic M, Niebuhr SE, Dickson JS, Mendonca AF, Koziczkowski JJ, Ellingson JL  (2005) Survival of Listeria monocytogenes and Escherichia coli O157:H7 during sauerkraut fermentation. JFood Prot. Jul;68(7):1367-74.

Srinvisan R, Smolinski S, Greenbaum D, (1997) Probable gastrointestinal toxicity of kombucha tea J Gen Intern Med 12:643:644

Hertzler, S.R. and Clancy, S.M. (2003). Kefir improves lactose digestion and
tolerance in adults with lactose maldigestion. J. Am. Diet. Assoc. 103:582–
587.

ZEYNEP B. GUZEL-SEYD˙IM1, TUGBA KOK-TAS1, ANNEL K. GREENE2
and AT˙IF C. SEYD˙IM1(2011) Review: Functional Properties of Kefir. Critical Reviews in Food Science and Nutrition, 51:261–268

Oggioni MR, Pozzi G, Valensin PE, et al; Recurrent septicemia in an immunocompromised patient due to probiotic strains of Bacillus subtilis. J Clin Microbiol. 1998 Jan;36(1):325-6

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April is International Irritable Bowel Syndrome (IBS) Awareness Month

April is the International Awareness Month for irritable bowel syndrome (IBS) – a whole month, I hear you say? Wow, does it need a WHOLE month for people to be aware? Well my humble opinion on this matter is it does. Their can be a misunderstanding of this condition as everyone can suffer from upsets to their bowels on occasion from stressful events and IBS is often viewed as trivial by society because, after all, if up to 10 – 20% of the population suffer then surely it can’t be that bad? Irritable bowel syndrome is often played down and yes it isn’t a life limiting disease, but for some people it can have a real detrimental effect on their ability to work and have a good quality of life. It’s often quality of life that matters to people’s mood and ability to enjoy life, so this is important to everyone.

Irritable Bowel Syndrome is a range of symptoms that affect the way the bowel functions, and common symptoms include diarrhoea and/or constipation, pain with or without bloating, but IBS can include symptoms that are not directly related to the digestive tract, such as exhaustion, headaches, dizziness and depression – in fact it perhaps isn’t surprising that people get depressed with having to tolerate a myriad of confusing symptoms that on occasion isn’t managed well. There is no cure, yes there are treatments, but what works is different for everyone. Everyone’s IBS is different, therefore it does need some understanding of ones own symptoms and triggers that is important. This is where the IBS Self Care Plan developed by the IBS Network can help, because it helps to identify people’s individual symptoms and provides explanations of the various treatments that may help.

But we also must increase the profile of this syndrome in society and the devastating symptoms it can produce, a month of promotion to increase people’s awareness of the actuality of living with IBS will help. It would be really cool for you to share your IBS story this month to increase people’s knowledge and improve the image of this syndrome with the general public!  So comments to this blog would be useful and should you wish to share your story with a wider audience then contact The IBS Network and spread the awareness!!

Join the IBS Network – the UK national charity for IBS – who provide a helpline, email responses by health professional, quarterly magazine, monthly newsletter, can’t wait card and coming later this month for members only, The IBS Self Care Plan and symptom tracker, your own personal resource for understanding and managing your IBS. Check out the link on this blog site for further information

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Probiotics – what are they and can they help my gut?

There is a plethora of information about probiotics and we are constantly bombarded with advertisements promoting their use, for gut health, so what should we believe? Probiotics are products or food that contain bacteria, in large enough amounts to alter the number and/or type of bacteria that live in the large intestine (see diagram at the bottom of the page.) Everyone has populations of bacteria in their gut and we know that changes to these natural populations can occur in food poisoning or with any illness that occurs within the digestive tract. This could be irritable bowel syndrome, crohns or ulcerative colitits for example, but other disorders can affect the populations of bacteria. We are only just beginning to understand how these bacteria affect our health; they produce substances called short chain fatty acids from starchy foods, which help feed the digestive tract, keeping it healthy, a real benefit. They also help to produce vitamin K, a vital nutrient that helps our blood to clot and our bones keep healthy. So the relationship with our bacteria is beneficial for both the bacteria and us. These ‘good bacteria‘ also help to prevent some of the more harmful bacteria from developing and causing illness. Our bowels contain huge numbers of bacteria; our bodies contain about ten times more bacteria cells than the cells that make up our body, a good proportion of these are in our gut, an astounding fact.

What are often called ‘good bacteria’ are various types of bacteria commonly found in our bowel, and it is felt that if this natural ecosystem is damaged by illness, then replacing those bacteria helps to reduce symptoms such as diarrhoea, bloating and pain, which often accompany some digestive diseases. The theory is that taking these bacteria in food or drink will replace the bacteria that are missing; however in reality the effects are variable.

These bacteria are produced from dairy foods, such as Lactobacillus, Bifidobacterium and Lactobacillus acidophilus – long names for such cool microorganisms. We have good evidence that taking bacteria at the start of a course of antibiotics can prevent the diarrhoea that can accompany these medicines – antibiotics can reduce the natural populations of good bacteria in our bowel, which slightly alters digestion of starchy foods, resulting in diarrhoea. The case for probiotic effectiveness in reducing episodes of ulcerative colitis is controversial, but probiotics can be effective in reducing occurrence of infections that occur in people who have had reconstructive small bowel surgery (called pouches,) and can prevent diarrhoea that occurs when travelling abroad. For illnesses such as food poisoning, they may reduce the amount of days you are ill and reduce the number of times you need to visit the loo -which is always a benefit!

The products that are available also have varying effects in people with irritable bowel syndrome (IBS,) and the evidence for their usefulness for preventing further attacks of crohns disease is still uncertain. As these products are generally not harmful in most individuals, if you have irritable bowel syndrome UK health professionals advise that you could try them and see if they work for you. If you have crohns disease or colitis, it is probably better to discuss this with your gastroenterologist before you try them out.  Try them for at least a month if you wish and follow the manufacturers instructions, you may need to continue taking them if you find them beneficial, as their effect can be temporary. It is also advisable to store these products as the manufacturer recommends and use them within the date advised, to ensure that the products are effective as they can be.

Some people may be better to avoid taking these bacteria, for example if you have a severe intolerance to lactose (a natural sugar found in dairy foods,) most of the manufacturers products are based on milk, therefore they may give symptoms, as they may contain varying amounts of lactose, depending on the product. However the bacteria will have reduced the amount of lactose naturally found in these foods, so caution is advisable if you wish to try them.  Also if your doctor has told you that you have a weak immune system then you should not take these products.

Again we do not have evidence that probiotics can be helpful in preventing allergies or stopping infections of the bladder in adults, so don’t waste your money! Although I was informed by blogger yesnobananas that there is some evidence for a strain of lactobacillus Ramnosus in protection from developing atopic eczema, which is hard to find, but see her blog for further information

http://yesnobananas.wordpress.com/2013/01/10/can-probiotics-prevent-food-allergy/

But where we know they are effective, or the products are recommended by your registered health professional, they are certainly worth considering. If you wish to try them and are not too sure about your situation, you could always discuss their use with your healthcare provider.

Health professionals can check the links below for evidence base references:

http://www.patient.co.uk/doctor/Probiotics-and-Prebiotics.htm

http://www.cochrane.org/search/site/probiotics

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