IBS

Oh shit!

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https://www.telegraphindia.com/1170116/jsp/knowhow/story_130445.jsp

Your Health - Dr. Gita Mathai

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IBS (irritable bowel syndrome) is an irritating and sometimes incapacitating disease. It produces painful abdominal cramps, bloating, explosive watery diarrhoea, or, conversely, constipation with pellet-like stools. These symptoms can occur at any time during the day. This makes people fearful about leaving the house. As they near the door, a feeling of incomplete evacuation of stool, or an overwhelming desire to return to the toilet delays departure. This can be a life-changing delay when examinations, interviews or timed departures (planes, trains) are scheduled.

Fifty per cent of India is between 20 and 50 years of age. A conservative estimate is that around 10 million of these people suffer from IBS. More women than men are affected. All of them are not symptomatic all of the time. The illness has spontaneous exacerbations and remissions. The uncertainty of if and when IBS will occur interferes with a tension-free lifestyle in young adults during their most productive years.

In order to diagnose IBS, abdominal discomfort should last at least three days a month for three months. Passing stool should relieve the pain. The frequency and consistency of the stool should be altered. There may be a feeling that bowel movements are incomplete. Mucous may be present in the stool. This confuses the picture and often leads to an erroneous diagnosis of amoebic dysentery.

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Most of the time the diagnosis of IBS is made clinically. A few simple tests to rule out amoebae, giardia and other parasites in the stool may be done and are usually enough. Other tests such as endoscopy, barium studies, X-rays, CT scans, lactose tolerance tests and breath analysis may be done if there are other findings, like onset after the age of 50, weight loss, bleeding from the rectum, nausea, vomiting, abdominal pain or diarrhoea at night or anaemia. This may show that the symptoms are due to more serious illnesses such as ulcerative colitis, Crohn's disease or cancer.

The exact reason for IBS is not known. It tends to run in families, though that may be a combination of genes and environment. For some reason, the nerves supplying the colon become hypersensitive and respond inappropriately to even mild stimulation. Instead of slow, steady, progressive contractions and relaxations, the movements become uncoordinated. This produces spasms and pain. The movement may slow down, causing bloating and constipation. There may be intestinal hurry with diarrhoea. There may be overgrowth of bacteria in the intestines with release of toxins, causing the bloating. Since it is commoner in women, it may be due to female hormones. There is an intestine-brain nexus under the control of chemicals such as serotonin and gastrin. The chemicals may be out of sync. All of these are merely theories - none have been proved.

The symptoms improve:

• If you eat on time, with short gaps between each meal

• If you drink at least eight cups of water a day

• If you restrict caffeinated and aerated drinks

• If you avoid processed foods with additives, colours and preservatives

• If you do not eat the seeds or skin of fruits

• If you give up some syrups and artificial sweeteners that contain sorbitol, which aggravates the symptoms.

Certain foods may be a trigger for the disease and are best avoided (this is a very individual phenomenon). Stress too can worsen symptoms. Aerobic exercise for 20-30 minutes a day, vigorous enough to build up a light sweat, combined with relaxation (yoga) and meditation also help.
 

Dr Gita Mathai is a paediatrician and author of Staying Healthy in Modern India. Mail your questions to yourhealthgm@yahoo.co.in

gut feeling

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Gut feeling

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Your Health - Dr. Gita Mathai

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January 1 is the time people make resolutions - to be a better person, to work harder, diet better, exercise regularly, stop drinking or smoking, and to remain in touch with friends. All these are worthy ambitions, decisions that will help you to live a longer, healthier and happier life.

Unfortunately, no matter how enthusiastically you take your resolutions, 80 per cent of them fall by the wayside within four months. Usually, because the resolutions were too unrealistic or you decided to change too many things at once. The other thing is that while resolutions usually focus on our mind and body, we tend to forget the largest organ we have - our intestinal tract and the "brain-gut axis" that influences almost all other behaviour. We are more likely to succeed in all our resolutions if we start by resolving to have a "gut makeover". That will also be a long term investment as a healthy gut results in a healthy body.

The small and large intestines together are about nine metres long. They lie coiled up in our abdomen and are lined with micro-organisms. These bacteria live symbiotically with the cells lining the intestine. Unless there is a breach in the cell wall of the intestine, they do not enter the body or cause disease. They secrete chemicals, which get absorbed into the blood stream and influence our bodily functions such as digestion, absorption, immunity, illness, mood and disease.

The particular mix of bacteria living in our intestines is unique. It is established during the birth process (that is why the bacteria are different in babies born by Caesarian section), and later by our genes, whether we are bottle or breast fed, and even later by diet and environment. The microbes are as unique to each individual as a fingerprint.

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After analysing the gut bacteria of healthy people and those with diseases, researchers found that significant differences existed. It was not just in the case of gastro-intestinal diseases such as peptic ulcer, irritable bowel syndrome (IBS), ulcerative colitis, colon cancer but also diseases like obesity, diabetes, depression as well as autoimmune diseases like rheumatoid arthritis. This can be explained by the fact that ultimately it is inflammation that causes most of these diseases. Gut bacteria release many inflammatory agents. They also release chemicals such as serotonin that tackle depression. It is not the presence or absence of a single organism that increases the risk of developing a disease, but the proportion of the various bacteria.

A high-fibre diet, with at least six helpings of fruits and vegetables, results in genetically diverse healthy bacteria living symbiotically in the gut. The gut is also likely to have "good bacteria" if whole grain products are substituted for refined wheat or polished rice. Disease causing bacteria are more likely to thrive if the food is highly processed, contains chemicals (preservatives and artificial colours), is deep-fried or charred and highly salted or sweetened.

Overeating overloads the digestive tract. Food is not digested well, there is bloating, neither the gut bacteria nor the digestive enzymes are able to keep pace, and cell damaging chemicals and fat globules are formed. Calories should be restricted to 2000-2500 per day for the adult male and 1800-2000 calories per day for the adult female if they are moderately active. (Moderate activity is roughly the equivalent of walking 4-5 km per hour per day). Calories need to be adjusted upward or downwards depending on level of activity.

Moderate activity from childhood (playing actively outside for an hour a day) helped growth of healthy gut bacteria and this continues into adult life.

To promote healthy gut bacteria

• Detox your body by fasting at least once a month

• Eat healthy bacteria in freshly made curd once a day

• Avoid antibiotics (unless specifically prescribed for an illness) as they kill the good gut bacteria.
 

Dr Gita Mathai is a paediatrician and author of Staying Healthy in Modern India. Mail your questions to yourhealthgm@yahoo.co.in