Do we understand or listen our gut enough? Shall we give our Gut 5 min of our time and go through this article in order to understand how our Gut is feeling?
Last year I was invited for the first time to give a lecture at King's College in the IBS course. Due the great feedbacks, I was invited again this year for this class.
On June 6th of this year, I was again present there to give an interesting lecture about The importance of Exercise and Nutrition on controlling inflammatory bowel syndrome (IBS) condition. This course is designed for nutrition students, registered dietitians and gastrointestinal specialist doctors who currently manage, or are keen to develop knowledge in managing, patients by learning new techniques and exercise as treatment.
My participation brings more insight on different natural antibiotic and parasites treatments. Also about certain bacterias and parasites that can cause IBS in a long run or make the treatment very difficult. Also how specific exercises can help patients to decrease the stress in the Gut. I took the time to summarise all the articles and sources of information used for my lecture to put it in this article.
Although the benefits of exercise are well documented for both adults and children, new research has demonstrated that exercise in the early years of development has a significant impact on the diversity of your gut microbiome.
This diversity of bacteria has an impact on everything from your metabolism to your emotional health. I believe that as scientists continue to study the balance of bacteria in the gut, they will find it has an impact on almost every bodily system and plays a role in most illnesses or diseases.
IBS Background
IBS occurs in 10-20% of the population in the UK, but prevalence is thought to be higher than this as many people with the disorder do not seek medical advice.
Irritable bowel syndrome (IBS) is a relapsing functional bowel disorder in which abdominal pain or discomfort is associated with defecation or a change in bowel habit. Bloating and distension are often associated
IBS has a significant negative impact on quality of life and social functioning in many patients, but it is not associated with the development of serious disease or with excess mortality. IBS is associated with increased levels of psychiatric distress and poor coping strategies.
Do you want to find out if you have IBS?
Accordant to National Institute for Health and Care Excellence (NICE) positive diagnostic criteria for IBS:
Patients must give at least a six-month history of either:
Abdominal pain or discomfort.
Bloating.
Change in bowel habit.
Consider positively diagnosing IBS only if abdominal pain is either relieved by defecation, or associated with altered bowel frequency or stool form;
AND at least 2 of the following are present:
Altered passage of stool (straining, urgency, incomplete evacuation).
Abdominal bloating (women >men), distention tension or hardness.
Symptoms aggravated by eating.
Passage of mucus rectally.
Lethargy,
Nausea,
Backache
PS: Bladder symptoms may be used to support diagnosis.
You can test it using a stool test directly via a laboratorium such as this one here in the Netherlands:
Food Protocols
General dietary advice
Drink plenty of fluids (at least eight cups per day) but restrict tea/coffee to three cups or so per day.
Reduce intake of alcohol and fizzy drinks.
Consider limiting high-fibre foods (eg, wholemeal flour or bran), and resistant starches (often in processed or recooked foods, and fresh fruits - limit to three portions per day).
For diarrhoea - avoid sorbitol.
For wind - consider increasing oats and linseeds (one tablespoon/day).
Fibre
Review fibre intake and adjust this in line with symptoms. Those with constipation as a predominant symptom may need to increase fibre intake, whereas those with diarrhoea may find the opposite helpful.
The results of the most recent meta-analyses of the benefits of soluble and insoluble fibre for IBS contradict each other. A Cochrane review found no benefit for either. Another review, however, found a benefit for soluble fibre, as ispaghula.
Fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs)
Recently there has been interest in the role of FODMAPs in causing symptoms of IBS.
Foods high in FODMAPs, such as apples, cherries, peaches, nectarines, artificial sweeteners, most lactose-containing foods, legumes, and many green vegetables (broccoli, Brussels sprouts, cabbage, and peas) may have fermentation and osmotic effects, increasing symptoms.
Diets low in FODMAPs have therefore been advocated in helping symptoms. There is evidence to support this approach. Up to 86% of people with IBS are said to report an improvement in symptoms, specifically bloating, abdominal pain, flatus and altered bowel habit, when using a low-FODMAP diet.
Dietician
For those who find diet plays a significant role in their symptoms, referral to a dietician may be helpful for advice about exclusion protocol, etc.
Probiotics
There is some evidence for probiotics being helpful in alleviating symptoms of IBS, but further studies are needed to make more specific recommendations about optimal regimes and products. NICE guidelines suggest if used, they should be taken for four weeks at the dose recommended by the manufacturer, while monitoring the effect.
Sources
Faecal calprotectin diagnostic tests for inflammatory diseases of the bowel; NICE Diagnostics Guidance (Oct 2013)
Guidelines on the Irritable Bowel Syndrome: Mechanisms and Practical Management; British Society of Gastroenterology (May 2007)
Irritable bowel syndrome in adults; NICE Clinical Guideline (February 2008)
Dalrymple J, Bullock I; Diagnosis and management of irritable bowel syndrome in adults in primary care: summary of NICE guidance. BMJ. 2008 Mar 8 336(7643):556-8.
Georgina L Hold; The gut microbiota, dietary extremes and exercise; http://gut.bmj.com/content/early/2014/04/29/gutjnl-2013-306541
Ruepert L, Quartero AO, de Wit NJ, et al; Bulking agents, antispasmodics and antidepressants for the treatment of irritable Cochrane Database Syst Rev. 2011 Aug 10 (8):CD003460.
Ford AC, Talley NJ, Spiegel BM, et al; Effect of fibre, antispasmodics, and peppermint oil in the treatment of irritable bowel syndrome: systematic review and meta-analysis. BMJ. 2008 Nov 13 337:a2313. doi: 10.1136/bmj.a2313.
Ong DK, Mitchell SB, Barrett JS, et al; Manipulation of dietary short chain carbohydrates alters the pattern of gas production and genesis of symptoms in irritable bowel syndrome. J Gastroenterol Hepatol. 2010 Aug 25(8):1366-73. doi: 10.1111/j.1440-1746.2010.06370.x.
Gibson PR, Shepherd SJ; Evidence-based dietary management of functional gastrointestinal symptoms: The FODMAP approach. J Gastroenterol Hepatol. 2010 Feb 25(2):252-8. doi: 10.1111/j.1440-1746.2009.06149.x.
Shepherd SJ, Lomer MC, Gibson PR; Short-chain carbohydrates and functional gastrointestinal disorders. Am J Gastroenterol. 2013 May 108(5):707-17. doi: 10.1038/ajg.2013.96. Epub 2013 Apr 16.
Barrett JS; Extending our knowledge of fermentable, short-chain carbohydrates for managing gastrointestinal symptoms. Nutr Clin Pract. 2013 Jun 28(3):300-6. doi: 10.1177/0884533613485790. Epub 2013 Apr 24.
Moayyedi P, Ford AC, Talley NJ, et al; The efficacy of probiotics in the treatment of irritable bowel syndrome: a Gut. 2010 Mar 59(3):325-32. Epub 2008 Dec 17.
Cash BD; Emerging Role of Probiotics and Antimicrobials in the Management of Irritable Bowel Syndrome. Curr Med Res Opin. 2014 Mar 26.