You may have heard the term ‘2nd brain’ in reference to your gut. This is really referring to the guts own nervous system called the Enteric Nervous System(ENS) which is wrapped around the length of the intestine. This nervous system has 50-100 million nerve cells and is connected to our brain(in our head!) by nerves and the gut sends signals to the brain about conditions and goings on in the gut and the brain sends some signals back.
The ENS manages to move food along the gut as it is digested, nutrients absorbed and waste eventually eliminated. In between meals it performs housekeeping by waves of contraction that keep gut function in tip-top shape.
The ENS, or ‘2nd brain’, is part of the system of gut communication with the brain.
The other ways the gut and brain communicate is through other cell types in the gut which include:
Immune cells that release cytokines that enter the blood stream and thus reach the brain and other systems. Immune cells are cited here as they are exposed to bacteria, viruses and other potentially harmful pathogens from the outside world
Endocrine cells(15 types) throughout the gut which release a range of hormones into the bloodstream including gastrin, histamine, serotonin, cholecystokinin (CCK), somatostatin and glucagon-like peptides. These cells are thought to be essential regulators of digestion, gut motility, appetite, and metabolism
The gut microbes – the guts microbes digest remaining food components and produce metabolites. These affect the nerves and immune cells of the gut and enter the bloodstream signalling the brain and other organs in a way we are only just starting to understand
In future posts we will look at these communication channels further.
I was thrilled to complete this week the specialist certification course on the low FODMAP diet through Monash University. This course provided an in depth coverage of all the scientific evidence, mechanisms, research and implementation techniques on this valuable diet tool for managing gastrointestinal symptoms for diagnosed Irritable Bowel Syndrome. Early research also suggests a role in aiding symptom control in cases of diagnosed Endometriosis and potentially Small Intestinal Bacterial Overgrowth and maternal diet where breastfed infants have Infantile Colic, this exciting research continues.
Fructans are made up of many fructose units (a type of sugar) joined together with a glucose unit on the end fructans are made. Humans are unable to break the bonds between the fructose units as we lack the enzyme needed to do this. The regular human process is for fructans to travel through the bowel undigested and unabsorbed and when in the large bowel the bacteria present ferment them. This process creates some gas/wind and is completely normal but individuals with IBS can have an extra-sensitive gut or a gut that acts differently when some wind is present and bloating and pain may be experienced.
Fructans are found in a range of foods including onion, garlic, leek and wheat-based foods as well as some fruits including watermelon, peaches, bananas and dried apricots.
I have just been reading a recent article examining Diverticular disease. I am surprised to discover that it is one of the most common gastrointestinal diseases in the Western world. Chances are folk in the western world are looking for it a bit more than others but it seems those living in the more developed countries have a higher risk of this condition. Some of the reasons for this include Dietary fibre deficiency, Overweight and obesity, Vitamin D deficiency and often a lower physical activity levels.
If a genetically susceptible individual has a number of these risk factors then the likelihood of diagnosis is considerably elevated.
So what is happening in the bowel with this diagnosis?
With this condition small pouches or Diverticular sacs have formed on the wall of the colon. These sacs generally are not problematic unless matter gets caught in them and inflammation of the lining of the colon occurs. When this happens the result can be pain, diarrhoea and severe cases may need hospitalisation.
So what should you do if you get a diagnosis of Diverticular disease?
Talk to your specialist, doctor and dietitian about the best treatment for the disease at your particular stage …dietary changes may be required and at times medication and general monitoring of the condition. Minimising straining when using your bowels is essential and strategies to prevent straining may be needed.
Original article: Diverticular Disease: An Update on Pathogenesis and Management
Mona Rezapour1, Saima Ali2, and Neil Stollman. Gut and Liver, Published online May 12, 2017
Well this is an area of a lot of interest currently and it is important to separate the science from the speculation/internet sensation.
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.
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.