Tag Archives: Clemency Nicolson

What are the ‘milk’ choices that suit bowel function?

Many people are unsure whether or not they are better off using dairy milk or a dairy alternative. A number of options exist now with more appearing all the time. Dairy milk provides a range of nutrients that other non-dairy milks do not have. Many products add vitamins and minerals to improve the nutrient profile of their product and many don’t so don’t assume you are getting an alternative with a similar nutrient profile.

As a general rule if you are not opposed to drinking dairy milk there are significant nutritional benefits to doing so and lactose-free milk and yoghurt are readily available. There is negligible lactose in hard/yellow cheese such as chedder or parmesan so these can be eaten by those who consider themselves lactose-intolerant.

Lactose-free dairy milk is regular dairy milk with the lactose pre-split by added lactase enzyme so you don’t have to do this in your gut making for easy digestion of this milk. Lactose-free milk meets the digestibility requirement for the low FODMAP diet.

For those who prefer a non-dairy milk there are a range of options that will also meet these digestibility criteria at the serve size listed below though each differs in terms of nutrients like protein and calcium. Take a look at the nutrients per 100 gm on the nutrition information panel and compare the milks you are interested in so you can choose the one with the higher protein and calcium values.

Soy milk made from Soy protein, not whole soy bean  – 250 ml

Almond milk – 250 ml

Coconut milk(UHT) – 125 ml

Macadamia Milk – 250 ml

Oat milk – 30 ml

Quinoa milk – 250 ml

Rice milk-200 ml

Compare the nutrient information for each in the nutrients per 100 gm column on the label to determine how your choice stacks up compared with dairy milk. You may also be surprised at the long list of ingredients on the label of the dairy alternatives that are needed to make these products similar in texture and look to dairy milk.

Some people report that they find A2 milk more digestible than regular milk however it does not meet the digestibility levels required for inclusion on low FODMAP diet lists.

Fancy recipes for dietary tolerances

If you are struggling to make something delicious, different and a little bit fancy to share with friends and family or just enjoy yourself try the ‘intolerant cooks’ website(google intolerant cooks). Think Green Pork Curry, Crispy Pasta with Hot Smoked Trout and Peppered Strawberries and pan seared Chicken to name just a few of the special dishes.

This is the website of the television program ‘The Intolerant Cooks’ that focuses on dishes that are gluten free, lactose free and/or low FODMAP. The restaurateurs/foodies Karen Martini and Richard Barassi share the recipes form Series 1 and 2 online complete with pictures and series 3 is soon to start on television so check you TV quides. The episodes can be watched via the youtube links for each so you can see how to make the recipe so it comes together perfectly. The program is endorsed by the Coeliac Society and the FODMAP friendly program and provides a welcome set of instructions and recipes so those with dietary-requirement-fatigue can get some fresh ideas. Thanks Karen and Richard!

 

Some ‘bowel action’ chat

Lets have a chat about assessing the toilet contents from our bowel as most of us regularly look in there. From now on we will call this call this ‘poo’ for want of a better word as ‘feces’ or ‘stools’ are doctors terms and not what most of us use.

There is so much variation in what is normal that we need to focus on what is normal for us COMBINED with information about how easy our poo is to pass and whether we have regular diarhoea or constipation or odd coloured poo.

Poo will vary from one individual to another in terms of the shape, consistency and colour. Using the four steps below lets look at how we can use this information to assess our bowel habits when having concerns.

Step1.Consider: Form

This gives us an idea about whether or not we may be having constipation or too frequent stools. The Bristol Stool Chart was developed by Dr. K.W Heaton in the late 90’s to help us with this assessment, take a look and see how your bowel habits rate.

Reference: Heaton, K W & Lewis, S J 1997, ‘Stool form scale as a useful guide to intestinal transit time’. Scandinavian Journal of Gastroenterology, vol.32, no.9, pp.920 – 924.

The Bristol stool chart van be used for us to get an idea of how quickly our gut contents are moving through the bowel. Take a look and see where your poo, the end result of travels,  usually fits. Numbers 3-4 are the easiest poo types to pass and suggest an optimum processing/digestion time in our bowel. The lower numbers suggest constipation and the higher numbers suggest more rapid gut transit with less formed stools or diarrhoea.

Step 2. Consider Pain or Discomfort.

Think about whether you are having pain when you pass your poo, experiencing excess gas before you go or whether instead the whole event is unremarkable.

Step 3. Consider Colour.

Take a look at the colour of the poo. This is largely determined by the addition of  greenish bile salts from the liver, a digestive aid, which gradually change to brown as they do their job in the bowel while passing along. So brown is the ‘regular’ colour but lighter poo can occur and darker poo too as well as red poo.

Light poo suggests potentially insufficient bile salts being added to your gut contents.

Red tinged poo usually includes some blood from the large bowel and a visit to the dr is required to discuss/investigate where this blood is coming from. Black poo also can indicate blood but from a source higher up the bowel and needs investigation.

Dark poo will also be seen if you are taking an oral iron supplement, have eaten a lot of beetroot or blueberries due to the natural colours they contain. Artificially coloured foods such as licorice, bubble-gum icecream and the like may also do this.

Step 4. Consider frequency

Actually, how often you go is less important than what you are doing. For example one person may have four poos a day that are easy to pass and a number 3 on the Bristol Stool Chart, nothing worth noting there. Another person may have four poos a day that involve pain and discomfort and are number 1 on the chart, this is indicating constipation and small amounts of poo are being passed each time.  The constipated individual can get help to improve bowel function.

Step 5. Temporary or long-term changes?

Consider whether these changes such as light colour, dark colour, mucus, excess gas, constipation or diarrhea are just occurring briefly or if they are regular occurrences. Brief changes that pass can be quite normal but If you are having long-term problems with your bowel it is time to get some reassurance by investigating potential causes and solutions with your Doctor and an Accredited Practising Dietitian specialising in the gastrointestinal system http://www.digestiondietitian.com.au/. It could be that you need to adjust your dietary fibre intake http://www.digestiondietitian.com.au/2016/05/29/fibre-and-your-bowel/, trial a low-FODMAP diet http://www.digestiondietitian.com.au/2016/05/24/what-are-fodmaps/, take a few blood tests etc http://www.digestiondietitian.com.au/accurate-diagnosis/

 

 

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.

Prebiotics and Probiotics

Are you confused by the flood of information about your gut bacteria? You are not alone. Let’s take a look at the research so far and some sensible recommendations that we can follow long-term to increase our levels of beneficial gut bacteria.

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Prebiotics and Probiotics

You will hear the terms prebiotic and probiotic bandied about. A prebiotic is the food that feeds particular beneficial gut bacteria in the large intestine and maintains/increases their activity. For a molecule to be called prebiotic it has to survive digestion and get to the large intestine where the majority of gut bacteria reside.  In addition to the natural sources it is also possible to extract the prebiotic molecules and add them to a range of products such as yoghurts, cereals and beverages. You may have seen the some of these prebiotic ingredients on food labels e.g. inulin. Be wary of claims made on food containers as these have been found to overstate the research in terms of potential benefits the prebiotic on gut bacteria.

Probiotics are live organisms and in the bacterial class of these there are a number of organisms that appear to be beneficial health.  Improving digestion, protecting against disease and enhancing the immune function role are methods by which health is improved. The particular foods that contain probiotics that cause these results are some fermented foods and they have also have been isolated and can be used as dietary supplements.

Optomising Gut Bacteria

Optimising our gut bacteria populations is thought to be a way we can positively influence health. The aim is to have low numbers of less beneficial or harmful/pathogenic bacteria and a higher level of the most beneficial bacteria such as strains of Lactobacillus and Bifidobacterium. Our individual gut bacteria profile is unique so there is no one-size-fits-all approach. Including a range of fermented foods such as yoghurt, sauerkraut and fetta cheese in your diet will help to build up and manage our populations in a positive way. A high fibre diet is the key to maintaining these populations and the research also suggests highly processed foods (high fat/salt/sugar), alcohol and artificial sweeteners will negatively impact the populations. Some people take probiotic supplements, if you choose to do this use one type of supplement for a month and then try another as the beneficial bacteria you get that way will be different.

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If you have the digestive symptom of bloating then it is not the time to use a probiotic supplement as the symptom suggests there is a lot of bacterial action already in your large bowel and adding extra bacteria will worsen this situation.

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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Coffee and digestion – what is the story?

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Some folk with digestive upset swear that coffee does not affect them and others found they had to give up that delicious beverage to reduce some symptoms. Those who experience only constipation find a morning coffee has a beneficial laxative effect.

So your relationship with coffee probably all depends on the type of symptoms you experience.

It is not just caffeine that is the issue so just changing to decaffeinated coffee is not the answer usually. There are a myriad of naturally occurring chemicals in coffee that make it taste as it does and many of these may act on secretion processes in the gut, increase inflammation and intestinal content movement. Remember too that our love of coffee and strong coffee at that has increased enormously in the last five years and many guts are feeling the consequences.

Actual scientific evidence is variable though probably due to the different effects on different gut segments. It is known however that drinking coffee makes stomach symptoms worse in general – it can lead to inflammation of the stomach (gastritis) as well as making reflux (gastro-oesphageal reflux) worse. The laxative effect of coffee makes those with rapid gut transit /diarhoea symptoms worse though as mentioned above constipated individuals benefit from this. Coffee itself is however low in FODMAP’s it may be that you can include some in your daily plan…so again, it depends on your individual symptoms.

I am often asked ‘How do I know if coffee affects my symptoms?’ . The simple answer is to do a two week trial and see what happens, a diary helps. This is not as hard as it sounds as because chances are you are feeling off with digestive symptoms and a if a limited time without coffee could see some improvements most people manage this. If that is too much try just one fairly weak cup per day and have it with food, not on an empty stomach. Alternative hot beverages include black/milk tea , lemon and ginger tea or chamomile tea for example.

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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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