Tag Archives: diarhoea

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.

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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Diet for Digestion-the internet version of dietary restrictions-help!

An internet search for a few minutes on the topic of digestive health suggests your diet is to blame for many of your gut symptoms. The list below shows some of the common food and drink items that are to blame, according to ‘Dr Google”. The internet is a wonderful source of information and mis-information and the dietary restrictions list below came from my brief search on this topic.

Excluding coffee, tea, alcohol, fibre, meat, soy, carbohydrate, dairy/lactose, honey, fruit/fructose, wheat, rye, yeast, legumes, onion, garlic, sugar,processed foods, artificial sweeteners are general results.

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Many people with digestive symptoms start omitting one food or group of foods and when symptoms don’t improve they omit another food group and so on until their diet includes a very small range of foods. Eating such a small range of foods makes meals repetitive and not very enjoyable. Nutrient needs will not be met and over time health deteriorates further.

Is there another way to ease digestive distress?

Yes, get an organised diagnosis plan to exclude underlying disorders and take it from there. An Accredited Practising Dietitian(APD) with a digestion interest will help you put this together and work out which dietary restrictions may be required to manage your symptoms and for how long the restrictions should be followed. If you live in Perth come contact me for an appointment or

 

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Accurate Diagnosis

Vector-Entrepreneurship-WomanAccurate Diagnosis of the problem is the opposite to random diet trials which sufferers may be experimenting with.

Diagnosis is essential because just improving symptoms through dietary restriction may just be a band-aid measure. Incomplete investigation can hide serious intestinal or other  problems and these need excluding. Unnecessary restrictive diets also threaten nutritional status and overall health, definitely something we want to avoid.

Diagnosis will usually involve an Accredited Practising Dietitian specialising in digestive issues, your Doctor, and in many cases a referral to a Gastroenterologist (Gastrointestinal Specialist) whose specialist knowledge can determine essential tests and interpret the results.

Putting a finger on the exact digestive issue can be surprisingly difficult in many cases and needs a concerted plan to escape the treadmill and frustration of unstructured trial and error.

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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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Your initial appointment

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A Digestion Assessment and Planning appointment with Clem will look in detail at your:

Your Perth digestion dietitian appointment includes:

Full medical and symptom history.

Quality of Life with this condition.

Diet history and Food frequency.

Test results and test planning.

Discussion of Dietary approaches for the short term while any underlying disorder is excluded and the long-term best approach once a diagnosis is made.

Meal and snack ideas to suit your dietary needs, intestinal needs and preferences.

How to practically manage your best diet in your day-to-day life, with your individual family and social commitments. This realistic and supportive approach is the key to being able to comply with the diet you need and feeling well.

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Allow some time as our initial appointment is one hour long. Contact your Perth digestion dietitian now.

 

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Veggies- the low FODMAP varieties

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Veggies

Veggies are good for us right? Yes, nutritionally they are one of the best group of foods we can eat in large volumes for good health and reducing our disease risk. This doesn’t mean that all veggies are easy to digest and individuals with symptoms of nausea, bloating, excess wind, abdominal pain, constipation or diarrhoea (big list!) may need to get eat only the most digestible vegetables that have lower levels of the FODMAP’s.

This list includes green beans, potato, carrot, capsicum, asian greens, jap pumpkin, tomatoes  and zucchini. Trialing the removal of other vegetables such as onion and garlic and limiting serve size of broccoli, sweet corn, snow peas and butternut pumpkin are some of the changes used in the test-phase of the low FODMAP diet.

Meals made with low FODMAP ingredients, as shown in the Lunch ideas post can help ease Irritable Bowel Syndrome symptoms and enhance your low FODMAP diet compliance. An Accredited Practising Dietitian with a Digestion specialty can help you put together a menu that will suit your preferences, home and work life so that you can trial this revolutionary diet approach.

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My Digestion Interest

 

How I became a Perth dietitian specialising in digestive issues.

My interest in this area stemmed from suffering with some digestive issues of my own- it is amazing how some pain and discomfort focuses the mind!

Now I regularly see people who have had a long history of digestive issues. Symptoms may include gastric reflux, nausea, burping, bloating, abdominal pain and cramping, flatulence, diarrhoea or constipation or all of the above.

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Symptoms may have bothered them for a short time or a longer time but the common factor is how much these symptoms interfere with them enjoying their daily life – family, social, work and play. To reduce symptoms they may have tried omitting one or more dietary components, talked briefly (short appointments) with their GP about it, seen a specialist once, read widely on the internet, bought expensive products and supplements and for all this effort still feel unwell and very frustrated.

A visit with me allows time(first visit is one hour) to get the full medical and dietary history, look at any recent test results and dietary trial results as well as see what underlying causes need excluding –some tests can be done through your GP and others , if required,  may need to be performed by a gastroenterologist.   This methodical plan is what gets results, results that are very difficult to achieve with an ad-hoc approach.

I have worked as a Dietitian for over twenty-five years in a range of health settings and am an Accredited Practising Dietitian. I now work at The Nutrition Specialists, Perth, with individuals needing to better manage their health and digestive difficulties .Keeping the focus on diagnosing the problem, avoiding unnecessary restrictions and finding practical ways for each person to maintain the diet changes they need results in increased digestive comfort . I am also a total food lover enjoying simple , minimally processed, delicious food.

Posts will be added to this monthly so just check the archive and click on the latest month to reveal new posts.

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For an Appointment

Come and see Clemency, a Perth Accredited Practising Dietitian with a special interest in digestion. You can call or email, details below.

Please call reception:    Ph 08-92042588

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or send us an email:   admin@thenutritionspecialists.com.au

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Address :Suite 2/39 King George St,  Innaloo. Perth WA 6050

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