Category Archives: Digestive Conditions

Coeliac Disease and Non-Coeliac Gluten Sensitivity

Well this is an area of a lot of interest currently and it is important to separate the science from the speculation/internet sensation.

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Many people the world over find report that they have symptoms ranging from bloating, wind and abdominal distension/pain to diarrhoea and altered bowel habit when they consume a diet rich in wheat-based foods. Wheat (and grain relatives),Rye and Barley contain both gluten and fructans which are both hard to digest for some. It is commonly assumed by most folk that it is the gluten that is the problem because they are unaware of fructans and their potential role.  The assumption is made by these individuals that they have a gluten sensitivity.

The symptoms described above are seen in a range of gut disorders including Coeliac Disease, Diverticular disease or Chrohn’s disease as well as Irritable Bowel Syndrome for example. It is tempting for sufferers to start removing wheat from their diet however the exclusion of Coeliac disease is the important step they miss before doing this. The tests for Coeliac disease will only be accurate if wheat remains in the diet and the body reveals it’s reactions to the wheat in screening blood tests and if required,  biopsies. This will show up as abnormal blood antibody levels which will suggest a biopsy is needed and abnormal biopsy histology results can be discovered if they exist. Without the wheat going through the body the reactions won’t be there in either blood or biopsy and a diagnosis can be missed.

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Once these diseases have been excluded It may be that a trial of a low-wheat/rye/barley diet as part of a more more comprehensive low-FODMAP diet may be used to see if symptoms can be resolved.

It was once thought the exclusion of wheat in non-Coeliacs may aid symptom reduction due to the lower level of fructans. There is now suggestion in the science that it may be a reaction to gluten, different to that shown in Coeliac disease, that may worsen some gastointestinal symptoms in non-Coeliacs and this has been given the term non-Coeliac gluten sensitivity(NCGS).

Watch this space as the story unfolds. Well conducted research trials are few and far between but in the last few years a couple have appeared using subjects with self-reported NCGS that have been well designed to ensure all other causes have been accurately excluded.

The BOTTOM LINE- make sure Coeliac disease is accurately excluded before altering you diet.

If Coeliac disease is confirmed after abnormal blood test results and subsequent biopsy there is a very strict dietary protocol to follow to maintain a 100% gluten-free diet, 99 % is not enough removal for this healing of the gut with this condition.

If excluded the other dietary trials can be started in earnest.

Sorting out Chronic Constipation

For those who have felt the effects of constipation for a large part of their lives knowing the type of constipation they have will help find a long-term solution.

There are primary (also called functional constipation) and secondary types of constipation. Primary constipation is due to a problem with the bowel resulting from nerve and muscle dysfunction in the bowel. An example of this is pelvic floor dyssynergia where there , at bowel action time, there is an abnormal increase of pelvic floor muscle activity  rather than the normal decrease necessary for a normal bowel movement. Other types of primary constipation and called normal-transit and slow-transit constipation where nerve and muscle dysfunction causes the changes in the movement of bowel contents.

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Secondary constipation results because of something else happening in the body such as constipation dominant Irritable bowel syndrome or hypothyroidism for example. It can also be due to use of medications to treat medical conditions that have a side-effect that alters bowel habits.

Just to make things difficult there is significant overlap between the sub-types so a mixture of solutions may be needed!

Depending on the type there are different treatment options including:

  • Medications to alter bowel nerve and muscle function
  • Increasing fluid intake
  • Increasing dietary fibre to reach fibre target goals
  • Using some non-fermentable commercial fibre supplementation
  • Non-stimulant laxative use – stool softeners and stool lubricants
  • Stimulant laxatives
  • lowering the intake of FODMAP-rich foods in the diet

Making the changes recommended to you by your Gastroenterologist or Accredited Practising Dietitian day in and day out will give long-term improvements to bowel function and improve quality of life.

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Diverticular Disease

 

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Diverticular Disease is a common disorder of the large bowel and is usually diagnosed after middle age. It is thought to occur where aging muscles weaken in the large bowel and small bulges develop where the intestine wall starts pushing out into the weakened areas, these bulges may be called pouches. Many people only find out they have this condition after a routine colonoscopy rather than from developing symptoms as they do not get inflamed diverticular pouches. Others find that the pouches formed in the intestinal wall get faeces trapped in them and infections develop. This is called diverticulitis or inflammation of the diverticular and can causes diarrhoea and pain. Recovery from this painful condition may involve a special diet and antibiotics.

With the general condition condition, in the non-inflamed state, having a regular and easy-to-pass stool is essential as straining puts pressure on the intestinal wall pouches and can make them larger and more likely to trap food. Maintaining a high fibre diet as your regular diet when your diverticular pouches are inflamed is the best way to reduce the likelihood of this occurring. If you experience the inflamed pouches known as diverticulitis however a reduction in fibre intake and medical treatment is commonly required. An Accredited Practising Dietitian can help you with this, ask your GP or Specialist to refer you.

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‘Heartburn’ a.k.a. Gastro-oesophageal reflux (GORD)

Once we swallow food/fluids they passes down our throat/oesophagus and through a valve/sphincter to the stomach where it mixes with acid stomach digestive juices. If some of the stomach contents flow back into the throat/oesophagus and results in a burning sensation in the throat. If this happens regularly the lining of the throat becomes inflamed.

If it is just occasional then an antacid can be used to relieve the condition but if you are regularly reaching for the antacids it is time to get some help as long-term this condition has some serious consequences. If you are pregnant it is a special case where the baby can push your stomach contents higher and into the oesophagus so see your GP.

Help comes in the form of :

  • Dietary change to reduce meal size and make it more easily digestible until the inflammation subsides- temporarily lowering fat intake in particular is important as well as minimising alcohol, chocolate and coffee intake.
  • avoiding peppermint flavoured sweets/gum/tea etc as this relaxes the oesophageal sphincter more.
  • managing anxiety if your symptoms are worse duet to this.
  • Sleeping with your head/neck elevated to reduce ‘back-wash’ to the oesophagus.
  • possibly medication to assist till symptoms reside as the inflammation reduces
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  • Reducing/Quitting Smoking and losing weight if overweight is also be very helpful.

An Accredited Practising Dietitian can get you started on the road to increased comfort.

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Gastritis

Gastritis is the name given to the inflammation of the stomach lining and is a very common condition.In some cases there may be no symptoms and people find out they have it after a routine biopsy. In most cases though individuals are aware of pain in the upper abdomen, nausea, indigestion and loss of appetite and at times vomiting.

Gastritis can be caused by a variety of factors including:

  • regular taking of aspirin or other non-steroidal anti-inflammatory medications
  • a bacterial infection called Helicobacter pylori
  • excess/regular alcohol or coffee
  • protracted vomiting
  • when there is an overproduction of gastric juices

It can be that people notice this when they are stressed or anxious as for some this is the time they will have some excess gastric juice production.

Treatment for this condition may include medication to reduce the gastric juice production or treat helicobacter infection if present. Reducing alcohol and coffee intake will usually help and for some the introduction of a temporary low fat, easy to digest diet will result in the required relief. Talk to a GP and an Accredited Practicing Dietitian about resolving your condition.

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What is Irritable Bowel Syndrome?

Irritable Bowel Syndrome (IBS) is a condition where a set of symptoms, including abdominal bloating and pain, wind and altered bowel movements affect sufferers’ lives. It is a common condition affecting up to 15% of the general population and is called a Functional Gastrointestinal Disorder. This means that the nerves and muscles of the gut may not be working in combination optimally causing digestive upset and bowel issues.

Depending on your symptoms a diagnosis of IBS is best made after other, more serious conditions, are excluded. Some tests organised by your GP or a Gastroenterologists can help to rule out Helicobacter Infection, Coeliac Disease, Diverticular Disease to name a few of the organic gut disorders .

Getting some control back over your bowel symptoms will mean you can spend more time on the fun things in life and less time in the bathroom! This is where a change in some aspects of your diet including some difficult to digest/absorb foods, food volume and timing can help. It is best done in an organised manner to ensure that the minimum number of restrictions results and the maximum amount of comfort.

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Why is my Digestion Dodgy

As you see from the digestion image there are many parts and processes digestion partsinvolved in digestion between the mouth and the anus. Given the complex nature of digestion it is no surprise that a large percentage of the population experience poor digestion on a regular basis.

Gastrointestinal(GI) disorders occur when one or more parts of the GI tract work poorly and may result in  nausea/ reflux, early fullness, altered intestinal transit time(diarrhoea/constipation), bloating, excess passage of wind, pain and discomfort. Ouch!

There may be an underlying disorder such as Coeliac Disease, Diverticular disease or Chrohn’s disease for example or it may be that the symptoms are not explained by any of these disorders and Irritable Bowel Syndrome is thus diagnosed- a functional GI disorder.

Improving your digestive comfort and quality of life will occur once diagnosis is confirmed and careful investigation of your individual gut response to dietary food components is determined. As an Accredited Practising Dietitian Specialising in Digestion Issues I see the benefit of a targeted plan for diagnosis daily and encourage you to go this path for eventual better control of your symptoms and get back to some of the activities you used to enjoy.

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