is at all times focused in helping patients reach their optimum level of health and wellness
Increasing research is pointing to the important links between gut health and the health of the heart, immune system, hormonal balance, along with mental health and much more!
An individual’s overall health and in particular, gut health, is impacted by the gut microbiome, a complex ecosystem of microorganisms that live on, and in us. Roughly 40 trillion microbes inhabit the gut, and all individuals have their own unique ecosystem containing around 1,500 different bacteria.
Up to 70% of an immune system is concentrated in the gut, The gut also holds up to 90% of the body’s Serotonin, the neurotransmitter responsible for mood.
It is now known that microbes have an influence on the:
- Physiological function
- Digestion
- Metabolism
- Mood
- Inflammation
- Immunity
An imbalance of the normal gut microbiota has been linked with gastrointestinal conditions such as Inflammatory Bowel Disease (IBD) and Irritable Bowel Syndrome (IBS)
It is not surprising that when the gastrointestinal ecology is altered, it can affect our health.
Inflammatory bowel disease (IBD)
Inflammatory bowel disease (IBD)
Inflammatory bowel disease (IBD) is an umbrella term used to describe disorders that involve chronic inflammation of the digestive tract. Types of IBD include Ulcerative colitis and Crohn’s disease.
Inflammatory bowel disease symptoms vary, depending on the severity of inflammation and where it occurs.
Symptoms that are common to both Crohn’s disease and Ulcerative Colitis include:
- Diarrhoea
- Fatigue
- Abdominal pain and cramping
- Blood in your stool
- Reduced appetite
- Unintended weight loss
Risk factors
- Most people who develop IBD are diagnosed before they’re 30 years old
- Family history
- Cigarette smoking is the most important controllable risk factor for developing Crohn’s disease
Non-steroidal anti-inflammatory medications
These include ibuprofen (Advil, Motrin IB, others), naproxen sodium (Aleve), diclofenac sodium and others. These medications may increase the risk of developing IBD or worsen the disease in people who have IBD.
Treatment
- Anti-inflammatory drugs
- Immune system suppressors
Biologics is a new category of therapy in which the treatment is directed toward neutralizing proteins in the body that are causing inflammation. Some are administered via intravenous (IV) infusions and others are self managed injections including:
- Infliximab (Remicade)
- Adalimumab (Humira)
- Golimumab (Simponi)
- Certolizumab (Cimzia)
- Vedolizumab (Entyvio)
- Ustekinumab (Stelara)
Antibiotics
Depending on the severity of IBD, doctors may recommend one or more of the following:
- Anti-diarrheal medications and fibre supplements — such as psyllium powder (Metamucil) or methylcellulose (Citrucel)
- Pain relievers – for mild pain, acetaminophen (Panadol, Tylenol, & others)
- Vitamins and supplements
- Nutritional support
- Surgery
Dr Rachel Wyndham
IBS
IBS
IBS is a very common gastrointestinal “gut” disorder. In Australia 10-15% of the population have IBS, which is equivalent to 1 in every 7 people. The prevalence of IBS worldwide is between 10-23% with many people still undiagnosed or unaware they have IBS. IBS is more prevalent in women, although men also are diagnosed with IBS. Once known as ‘spastic colon’, the most common symptoms are abdominal pain and cramping, abnormal bowel habits (constipation, diarrhoea or a mixture of both), bloating, distension, excessive gas, the urgency to defecate, nausea and fatigue.
The cause of IBS is still unknown. There are, however, certain risk factors that can predispose someone to IBS, including:
- Diet
- Smoking
- Alcohol consumption
- Genetic factors
- Small intestinal bacterial overgrowth (SIBO)
- Stress, anxiety and other psychological states
- Intolerances or severe infections.
Additional factors thought to play a role include gut sensitivity sometimes called ‘visceral sensitivity’, altered gut motility and an imbalance of ‘good’ and ‘bad’ bacteria in the gut.
Women with endometriosis are approximately twice as likely to develop IBS than women without endometriosis,
A large number of treatments are available to manage IBS symptoms. These treatments will not cure IBS, they simply help manage and relieve the symptoms of IBS. For most people, diet and lifestyle changes are the best options for long-term relief.
Therapies sometimes used to manage symptoms of IBS include:
- Low FODMAP diet (fermentable oligosaccharides, disaccharides, monosaccharides & polyols)
- Gluten-free diet
- Modifying fibre intake
- Fat restricted diet
- Coffee and caffeine restriction
- Alcohol restriction
- Restriction of spicy foods
- Prescription medications such as antispasmodics, low doses of antidepressants, prosecretory agents, laxatives and anti-diarrheal agents, antibiotics, serotonin agents
- Over-the-counter medications, such as herbal remedies like peppermint oil, nutritional supplements and probiotics
- Exercise such as yoga
- Gut directed hypnotherapy
- Cognitive behaviour therapy
- Stress management
Research at Monash University has shown that a low FODMAP diet improves IBS symptoms in around 3 out of 4 IBS sufferers. A New Zealand study found that 72% of women with both IBS and endometriosis who undertook the low FODMAP diet for 4 weeks showed an improvement greater than 50% in bowel symptoms.
The Low FODMAP diet
The Low FODMAP diet
FODMAP is an acronym that stands for fermentable oligosaccharides, disaccharides, monosaccharides & polyols. FODMAPs are a collection of short-chain carbohydrates and sugar alcohols found in foods naturally or as food additives. FODMAPs include fructose (when in excess of glucose), fructans, galacto-oligosaccharides (GOS), lactose and polyols (eg. sorbitol and mannitol).
High FODMAP foods include garlic, onions baked beans, cauliflower, mushrooms, peas, many fruits such as apples, apricots, avocado, ripe bananas, cherries, dates, figs, lychees, mangos, nectarines, paw paws, peaches, plums and watermelon; wheat containing products such as biscuits, cakes, bread and wheat, pasta, muesli bars, foods that contain lactose and as well as many additives.
The LOW FODMAP diet does not ‘cure’ IBS, but it does help a person with IBS work out the HIGH FODMAP foods that trigger their symptoms and how much of them can be tolerated.
The FODMAP diet is established in 3 stages.
- Substitution or the “low FODMAP” phase: usually 2-6 weeks where high FODMAP foods are substituted with those with a lower FODMAP content.
- Re-challenge phase: can take 6-8 weeks, depending on responses. This phase will help to determine which FODMAPs cause symptoms for you and also how much you can eat without triggering those symptoms.
- Personalisation: this is where your dietitian develops a plan moving forward on how to maintain a healthy, nutritionally adequate diet, whilst avoiding IBS trigger symptoms with FODMAP-containing foods.
In most cases, people are able to reintroduce many HIGH FODMAP foods back into their diet but may not be able to eat them as often or in the same quantity as previously.
Monash FODMAP produces a range of resources suitable for patients, consumers and health professionals. The Monash FODMAP App provides access to hundreds of LOW FODMAP foods, LOW FODMAP recipes and it even allows the creation of a LOW FODMAP diet plan.