Improving gut health doesn’t have to be complicated. By making small, manageable changes to your daily routine, you can support your digestive system and promote long-term health. These steps focus on nutrition, lifestyle, and simple habits that benefit your gut.

Focus on a Balanced Diet

What you eat directly impacts the health of your gut. A diverse diet filled with fruits, vegetables, whole grains, and lean proteins helps nourish the beneficial bacteria in your digestive system. These foods provide essential nutrients that promote good digestion and a balanced gut microbiome.

Including fermented foods in your diet is another great way to support gut health. Fermented foods like yogurt, kimchi, sauerkraut, and kefir contain probiotics, which are live bacteria that help maintain the balance of microorganisms in your gut. Adding these to your meals regularly can improve digestion and support your immune system.

Increase Fiber Intake

Fiber is a key component of gut health. It supports regular bowel movements and feeds the good bacteria in your gut, promoting a balanced microbiome. Foods like beans, lentils, oats, and berries are rich in fiber and can be easily incorporated into your diet.

If meeting your daily fiber requirements through food alone is challenging, consider supplements like Village FiberLEAN Capsules. These capsules offer a convenient way to boost your fiber intake, especially for those with busy lifestyles or limited access to fresh produce. You can get these high-quality supplements from Village Discount Drugs, making them an accessible option for maintaining gut health.

Stay Hydrated

Drinking enough water is essential for healthy digestion. Hydration helps move food through the digestive system and prevents issues like constipation. Aim to drink water throughout the day and include hydrating foods like cucumbers, celery, and watermelon in your meals.

Proper hydration also supports the absorption of nutrients, helping your body function more efficiently. Make it a habit to carry a water bottle with you to encourage consistent hydration.

Limit Processed Foods

Processed foods and added sugars can harm your gut health. These foods often lack the nutrients your digestive system needs and can disrupt the balance of bacteria in your gut. A diet high in processed foods may lead to inflammation and other digestive issues over time.

Instead of reaching for packaged snacks, try replacing them with natural, nutrient-rich options. Fresh fruits, nuts, and whole-grain crackers are satisfying alternatives that support gut health. Cooking meals at home with simple, whole ingredients is another way to cut back on processed foods while giving your body the nutrition it needs.

Making small swaps, like choosing whole-grain bread over white bread or snacking on plain popcorn instead of chips, can make a big difference over time. These changes benefit your gut while also supporting overall health.

Manage Stress Levels

Stress impacts more than just your mental well-being; it also has significant effects on your digestive system. The gut and brain are intricately linked through a network known as the gut-brain axis. When you’re stressed, your body produces hormones that can interfere with digestion, leading to issues like bloating, cramps, or even changes in bowel movements.

Finding ways to manage stress can help protect your gut health. Simple practices like mindfulness meditation, deep breathing exercises, or even taking a short walk can reduce stress levels. Physical activity, in particular, helps your body release tension and promotes healthy digestion.

Spending time on activities you enjoy, such as reading or gardening, is another effective way to lower stress. The goal is to create moments of calm in your day, giving both your mind and gut a chance to recover.

Incorporate Regular Exercise

Exercise isn’t just good for your muscles and heart—it’s also great for your gut. Physical activity helps improve gut motility, meaning it keeps food moving through your digestive system more efficiently. This can prevent common issues like constipation and bloating.

You don’t need to engage in intense workouts to benefit your gut. Activities like walking, yoga, or light jogging can be just as effective. Aim to move your body for at least 30 minutes most days of the week. If possible, include family or friends in your activities for added motivation and enjoyment.

Exercise also supports the growth of beneficial gut bacteria. Studies suggest that people who are physically active tend to have a more diverse gut microbiome, which is a key factor in overall gut health. By making exercise a regular part of your routine, you can improve digestion and boost your energy levels.

Prioritize Sleep for a Healthier Gut

Sleep plays a crucial role in maintaining gut health. During restful sleep, your body repairs and balances essential processes, including those in your digestive system. Poor sleep disrupts the gut microbiome, potentially leading to issues like inflammation or poor digestion.

To support both your sleep and gut health, establish a consistent bedtime routine. Avoid heavy meals, caffeine, and screens at least an hour before bed to improve sleep quality. Incorporating relaxing activities like reading or light stretching can also prepare your body for restful sleep. Better sleep habits promote a healthier gut and improve overall well-being.

Improving gut health is about making intentional, manageable changes that benefit your body in the long run. Reducing processed foods, managing stress, and staying physically active are practical steps that support a healthier digestive system. When combined with a balanced diet, hydration, and fiber intake, these habits create a strong foundation for wellness.

Taking care of your gut isn’t just about feeling better today—it’s about creating a healthier future. Start small, stay consistent, and enjoy the benefits of a well-functioning digestive system that supports every aspect of your health.

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Dr Sunni Patel

Earlier this year, I had the privilege to give the 2020 Miss Universe GB Finalists a brief session on gut health and bloating and as we approach the time of year where stodgier foods are more frequently appearing in our diets, I thought it could be useful to revisit.  Many of us may worry about bloating , be it from IBD or IBS, but especially at social events.

Firstly, let’s cover the misconceptions around bloating. Bloating isn’t water retention but in fact air pressure that builds up in the intestines as a by-product from the gases created by gut bacteria. For that very reason it means bloating doesn’t have a one-size-fits-all approach to alleviating; as we are all so different in terms of our gut bacteria composition. Finally, and most importantly of all, it’s not just about eliminating, or increasing foods that are known to cause or reduce bloating respectively. There is much more to beating the bloat than meets the eye.

It really is important to look at gut health as a whole in this instance. It has been shown that the imbalance in gut bacteria; known as dysbiosis, and small intestinal bacterial overgrowth (SIBO) underlies bloating and gastro-intestinal issues (1). Therefore, maintaining gut health and balance will in turn help keep gut gassiness in check.

So, here are a few tips and reasonings to beat bloating.

1. Understanding allergies and intolerances

Certain intolerances may lead to bloating, so it is important you seek medical or diet advice to understand if the bloating (only if it is long term as opposed to intermittent) is due to certain dietary issues.

2. Look at what you are eating (and drinking)

Ensure you are getting adequate fibre in your diet; the recommended daily intake is 30g per day. This not only helps to support gut health as a prebiotic for the gut bacteria, it also helps to avoid constipation; known to affect bloating and worsen symptoms (2).

As well as fibre, ensure you are achieving optimal gut health by adding appropriate sources of probiotics to your diet. This can come in the forms of kimchi, sauerkraut, fermented foods like tofu as well as kefir water.
Some advocate taking on the low-FODMAP (FODMAP stands for fermentable oligo-, di-, mono- saccharides and polyols which are short chain carbohydrates and sugar alcohols that can’t be absorbed well or are poorly digested by the body) diet over some time, which excludes gassy foods like garlic, onions, bananas, artichokes, beans and pulses to name a few and have proven its efficacy in combating IBS symptoms (3).

Keep hydrated but be sure to reduce and avoid carbonated drinks and sugar alcohols. Water is always best.

3. It’s also about how you eat

As tempting as it is this time of year, listen to your body and try to avoid the indulgence of gluttony and overeating When you do eat, ensure you are chewing thoroughly to aid digestion and transit of food through the gut. Small and regular portions throughout the day can help to maintain digestion. There is also some research on chronobiology and circadian rhythms, i.e. your natural body clock, and around time-restricted eating, but ensure you allow for three hours digestion time before sleeping where possible (4).

4. Stay gut healthy by focussing on you

Gut health and beating the bloat isn’t just about the food you eat, but the lifestyle you lead.  Ensure you make time to minimise stress, keep active, get adequate rest and sleep as well as avoid long periods of wearing tight clothing.

Words By: Dr Sunni Patel – Dishdashdeets

Instagram www.instagram.com/dishdashdeets 

1. 1. 1. GB Saffouri et al., Small intestinal microbial dysbiosis underlies symptoms associated with functional gastrointestinal disorders. Nature Communications. 2019 May; 10; 2012 

      2. A Agrawal et al., Bloating and Distension in Irritable Bowel Syndrome: The Role of Gastrointestinal Transit. Am J Gastroenterol. 2009 Aug;104(8):1998-2004.

   2. 3. WM Wong. Restriction of FODMAP in the management of bloating in irritable bowel syndrome. Singapore Med J. 2016 Sep; 57(9): 476–484.

   3. 4. A Chaix et al., Time-Restricted Eating to Prevent and Manage Chronic Metabolic Diseases. Annu Rev Nutr. 2019 Aug 21; 39: 291–315. 

Dr Sunni is a clinician-scientist, business director and trained fitness instructor with an MBA. He also has been diagnosed with Chron’s disease and switched to a plant-based diet that is supported with medication to improve some of the symptoms associated with the disease.

Dr Sunni’s PhD studied the risk factors and biomarkers (inflammatory and otherwise) for Type II Diabetes and Cardiovascular Disease which extended out to neurological diseases in his post-doctoral fellowship.

He has a special interest in plant-based nutrition and enjoys talking around the scientific evidence to support it to a wide range of audiences that would otherwise not have access to the information (BAME, younger generations and less affluent communities).

Dr Sunni is an advocate for well-being in chronic conditions, extending beyond the physical, medical and therapeutic to the mental, emotional and psychological considerations. He has launched an Instagram and website platform called dishdashdeets which focuses on the ‘art of being gut healthy’ through the creativity of plant-based dishes as well as the education, awareness and championing the issues around IBD and IBS.

The post How to beat bloating appeared first on Wellbeing Magazine.

Hydra is very unusual. Primarily because it has no cars and it’s a small island of only about 2,000 inhabitants. Think St Tropez but in the 1950’s, with echoes of elegant days gone by. The architecture is mostly 18th century with strict regulations on building and painting, to stay in keeping with it’s age and beauty. It’s like walking into a Farrow and Ball catalogue! Well known for the birth place of Leonard Cohens’ Bird on a Wire (he has a house there), Sophia Loren’s film Boy on a Dolphin, the back drop for a Bond film and more recently Kate Moss seen walking round its’ streets, the island has in interesting history. It’s the most understated place I’ve been to, cohabited and visited by artists, writers and lots of elegant people floating around in linen. It‘s quiet there as well and I’ve found a peace and tranquillity much needed to balance my busy lifestyle. Apart from the beautiful architecture and beaches what I really love about the island is the food. I’ve spent the past three weeks living off fava beans, black eyed bean salad, zucchini balls, eggplant salads, halloumi, sardines, calamari, cuttle fish, tomato fritters washed down with barrel loads of rose wine. An hours swim every morning has kept me fit as have the miles of daily walking. It is so unusual not having any cars, motorbikes or even bicycles but you soon get used to walking everywhere. Any heavy lifting is done by donkeys who move anything from local shopping to fridges and washing machines up and down the hills. The only hint of any moving vehicle is the one dirt truck that collects the waste and the tiny ambulance nestled next to the cottage hospital.

Greek hospitality is charming – they cannot do enough for you. Generous portion sizes not only with the main dishes but overflowing carafes of their finest wine. They want you to enjoy yourself. I’ve written about this countless times but its important to reiterate. The Mediterranean diet is really quite wonderful. It is one of the most researched diets in the world and has the best outcomes for Alzheimer’s, cancer, and inflammatory health issues, particularly the Cretan diet which boasts one of the few places in the world with the most centenarians.

Two of my favourite dishes were Fava beans and Eggplant (aubergine) salad. Here are the recipes if you’d like to try them at home:

Fava beans

500g yellow split peas
2 chopped red onions
2 cloves of chopped garlic
1 litre of warm water
1/3 cup of olive oil
Thyme
Salt and pepper

Rinse the split peas in plenty of water. Heat a large pot over medium high heat, add 2-3 tbsps of olive oil, chopped onions, garlic and thyme and sauté. As soon as the onions start to caramelise add the peas and blend. Pour in the warm water and the olive oil, turn the heat down to medium and season well with salt and pepper. Simmer with the lid on for about 40-50 minutes until the split peas are thick and mushy. While the split peas boil, some white foam will probably surface on the water. Remove the foam with a slotted spoon. When done pour in the lemon juice and transfer the mixture to a food processor. Mix until the peas become smooth and creamy like a puree. Serve the fava with a drizzle of oil, a tbsp of diced onion and some chopped parsley. You can add more garlic and lemon juice according to your preferences!

Eggplant Salad

4 large purple eggplants (aubergine)
1/2 red onion
1 clove of garlic
125ml olive oil
4 tbsps of lemon juice
3 tbsps of parsley

Bake the eggplants in a preheated oven at 200c for about an hour. You can bake them whole or sliced depending on the time available. If you choose to bake them whole use a fork to make some holes on the eggplants place on a tray and bake for an hour. You only need to use the flesh of the eggplants and dice and pulp. Place the pulp and other ingredients in large bowl and mix with a wooden spoon (you can mash using a fork). Let the dip cool down in the fridge to allow the flavours to mingle. You can use as much garlic and lemon juice to suit tastes. I would use three cloves in this for my personal preference.

I found on Hydra loads of mountain greens being served (a cross between chard and spinach), plenty of pulses and garlic and drank 2-3 litres of water daily due to the heat and increased exercise. When patients and clients of mine travel they are often encumbered by sluggish bowels or constipation. Eating different sorts of food can change your daily bowel patterns as can the local water (if you can drink it).  Generally it’s good advice to keep moving, travelling can mean a lot of sitting around. Keep hydrating and eating soluble fibre where and when you can get it – even if it means carrying around some oatcakes, nuts and carrot sticks. For every alcoholic drink you consume, equal that with water and you won’t go far wrong. You could also travel with a stool softener, probiotics (keep them in the fridge if you can) or those travelling further afield Biocare do a great product called Travelguard. There is nothing worse than feeling bloated in swimwear. In the Mediterranean I’m not sure why you wouldn’t eat the local food as it’s so healthy, high in Omega 3 and 9 fatty acids, protein, fibre and low in sugar and processed foods. Unless you don’t eat fish what better way to pass the evening talking with friends over grilled sardines and huge salads while toasting with chilled rose!

To help manage constipation whilst you are on holiday and to make sure it doesn’t get in the way of your plans Dulcolax has a free guide including tips and health swaps at myconstipationrelief.com/uk

Kate does not endorse Dulcolax or any other medicine. To contact Kate please call on 01323 737814/310532 or go to www.katearnoldnutrition.co.uk

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The traditional way to kick start your digestion back into healthy functioning is through bitter herbs, such as dandelion leaf, artichoke, wormwood and hops. Bitters stimulate bitter taste buds to cause the release of saliva and stomach juices, and to encourage the pancreas to release digestive enzymes and the liver to release bile, which helps the breakdown of fats. Improving the digestion with bitters will help absorption of essential nutrients, as well as improving digestive symptoms to have you bouncing back in no time.

Medical herbalists use a combination of herbs with dietary and lifestyle advice to gently coax the body back to wellness. Herbs have been used for healing for hundreds of years and modern clinical science has helped to back up many of the traditional uses. The holistic approach taken by herbalists is a gentler way to heal that aims to get to the root of a problem, with the focus on supporting the different organs of the body to help them work more effectively.

Herbalism can treat a broad range of conditions, and there is evidence to support the use of herbal medicine to treat: IBS and functional dyspepsia, premenstrual syndrome, back pain and osteoarthritis, mild to moderate depression, acute respiratory infections such as rhinosinusitis, colds and ‘flu, as well as migraine.

At Brighton Apothecary, the friendly herbalists are always on hand to advise you about the best remedy or supplement for your specific health needs. They offer free mini-consultations for minor health complaints and can tailor make herbal remedies.

Brighton Apothecary
Unit 6, The Open Market Marshalls Row
Brighton, BN1 4JU

07477 886 777

10am-5pm Mon-Sat (excluding Tues)

brightonapothecary.co.uk
@BrightonApoth
facebook.com/brightonapothecary

The post The herbal route to healthy digestion appeared first on Wellbeing Magazine.

Alflorex, a daily food supplement developed by Alimentary Health Ltd, is now available in the UK for the first time and is the only product in Europe which contains the unique PrecisionBiotic 35624 culture, part of the B. infantis strain family, which has been specifically selected to work where it is needed in the human gut. Backed by over 15 years of clinical research, with the findings appearing in over 50 scientific journals, the unique 35624culture is the number one gastroenterologist recommended strain in the U.S.

Commenting on Alflorex, Professor Fergus Shanahan, a world-leading clinical gastroenterologist, said, “This is one of the few products available in the UK that has the scientific clout behind it because it has been tested in high quality clinical studies. Research shows us that not all probiotic cultures are the same, and that we can select the most appropriate culture for the particular problem Alflorex is unique because it is an elite and natural precision strain which addresses specific issues, rather than simply relying on the generalised effect of conventional probiotics.”

Alflorex contains an elite and natural ‘smart targeting’ PrecisionBiotic strain which delivers benefit exactly where it’s needed and has been specially selected for a particular task.

“While everyone’s gut microbiota is different, research has shown that many digestive complaints, including IBS, can be linked to a bacterial imbalance in the gut. Maintaining and enhancing gut microbiota is important, not only to digestive health, but can also have beneficial effects on general health. Good eating practices, a healthy lifestyle and the inclusion of a daily PrecisionBiotic in your diet will ensure that the gut remains healthy and thriving, giving people the freedom to enjoy their lives,” said Dr. Eileen Murphy, Research Director at Alimentary Health.

Alflorex is very convenient and easy to take with or without food. It is gluten free and no refrigeration is required. Available online at alflorexbiotics.com or through independent pharmacies nationwide.

The post Avoid a bloating stomach appeared first on Wellbeing Magazine.

So the human micro….what? Ok so the human microbiome is housed in your gut and other areas of your body e.g. mouth, nose and genitals. You will know that one of the biggest mysteries in studies of diet and exercise is how people differ on the same treatment with such differing outcomes. Some people drop weight by doing relatively little, improve circulating triglycerides, total cholesterol and biomarkers of inflammation, and some struggle. Is our DNA to blame? Partly yes, but we generally share more than 99% genetic similarity with other people. The huge driver in the difference of outcomes, particularly with weight gain and loss, might be driven by the bacteria in our gut which can be more than 90% different between varying people.

In addition to the genomes (genetic material) we inherit from our parents we all have trillions of microbes each with their own genomes. Thanks to research like the Human Microbiome Project our understanding of microbial bodies has been revolutionised. Throughout our lives our microbes can change depending on diet, medications, hygiene and even how we entered the world.

“ We’ve had this perception of microbes as germs and pathogens as disease bearing organisms” says Lita Proctor of the Human Microbiome Project. “Much of the scientific literature for decades and decades has been completely focused on pathogens and that has also framed our point of view about microbes. But it has also become clear that the vast majority of microbes we come in contact with on a daily basis are not pathogenic, they are either benign and could not care less that there is a human nearby or actually provide benefit”

We know that C sections versus vaginal births impact on the initial level of microbes we receive and further during breast feeding vs. formula. We also know that globally more traditional societies have vastly different microbes than those in the westernised populations and that diet can play a role in this.

Changes in the microbiome have been linked to obesity, inflammatory bowel disorders (IBD) allergies, and asthmas. A study in Science found that differences in the microbiome might help explain instances in which one individual in a pair of twins is obese while the other is not. Microbiome samples taken from obese twins and delivered to mice led to the animals gaining weight in a way the microbiome from their leaner siblings did not.

The Western microbiome has changed dramatically in the last 100 years and not for the better. The recent microbiome changes might explain in some cases the rise of certain types of western disease. David Siskin a paediatrician and gastroenterologist at Seattle Children’s Hospital says

“If you look at a lot of the disease issues of the 20th and 21st century a lot of them have to do with nutrition and autoimmune processes“.

He attributes arthritis, gum disease, obesity and cardiovascular disease on this list. His primary interest is IBD, Crohns, ulcerative colitis, and their relating symptoms. IBD is usually considered an autoimmune process attacking the GI tract and other organs but humans have been around for millennia and IBD is a relatively new disorder noticed by doctors about 50 years ago. Since then the incidences have risen. In the New England Journal of Medicine 2014, research published a report of a donor faeces that can be a miracle cure for some patients with c. difficile – faecal transplants may well have a place in overcoming some disease states in the future.

So where does this leave us?

Well I’ve been conducting stool tests, analysing gut bacteria for nearly 20 years and it’s the most fascinating subject. So many of my patients with inflammatory disorders have gut bacteria issues: These include IBD, IBS, RA etc. I get very excited when I see what’s going on in their microbiome, pseudomonas, klebsiella, enterobacter, and other such bacteria’s as lactobacillus and bifidus. Most of my patients are fascinated by this vast hidden landscape that never knew existed.

Today an unbalanced microbiome is common. Years of following diets high in processed foods, sugar, excess antibiotics and chronic stress have impaired our gut health. There has also been an increase in C sections and formula feeding which has impacted on the gut health in children. (This is no way saying that the mother is at fault, these are often necessary procedures, however education needs to be put into place and measures taken to overcome a potential low gut flora start in life).

The good news is you can change your gut microbiome for the better. As the average bacterium lifespan is about 20 minutes you have plenty of time to turn things around. There are a host of factors that deplete the gut flora – your environment, the amount of exercise you take, sleep, stress and diet, the last being the most important.

EAT THE RIGHT FOODS
Your gut responds to what you feed it. Feed it junk and it wont flourish. Remove sugar, processed foods and refined carbohydrates. Eat carbohydrates from vegetables and low sugar fruit, loads of dark green leafy vegetables, radishes, Jerusalem artichokes, leeks, asparagus, carrots garlic, onions and turmeric. Include fermented foods like pickles, sauerkraut, defer and yoghurt (all probiotics).

OPEN A WINDOW
We spend so much time indoors in front of our laptops protecting ourselves from the elements and other so called dangers. This has changed the environment in the home and office. Let the air in, let your children play in the mud and dirt. Get your hands dirty in the soil if you are a gardener.

REDUCE STRESS
Easier said than done but never underestimate the amount of stress can have on your gut. I’m not talking obvious gut spasms here I‘m talking high levels of cortisol over long periods of time effecting the micro biome. Try and get some kind of daily stress reduction regime going as part of your routine.

TAKE A HIGH QUALITY PROBIOTC
This is more tricky than its sounds, as what is high quality and what actually works? Firstly don’t buy them from a supermarket. Even if its pricey it might not work. Get expert advice as this in the one supplement that people self prescribe and get totally wrong. Probiotics start as low as 1 billion and go to 450 billion so you need to know what you are doing.

AVOID ANTIBIOTIC
Save them for the life threatening times you might need them or where there is an active bacterial infection. Otherwise avoid them.

If you would like further information on stool testing for gut flora, for IBD, IBS, RA or any other condition or any other point raised in this article, please contact Kate on 01323 737814/310532. www.katearnoldnutrition.co.uk

The post Listen to your gut appeared first on Wellbeing Magazine.

What is the low FODMAP diet?

FODMAP is an acronym referring to Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols. These are complex names for a collection of molecules found in food, that can be poorly absorbed by some people. When the molecules are poorly absorbed in the small intestine of the digestive tract, these molecules then continue along their journey along the digestive tract, arriving at the large intestine, where they act as a food source for the bacteria that live there normally. The bacteria then digest/ferment these FODMAPs and can cause symptoms of Irritable Bowel Syndrome (IBS). Symptoms of Irritable Bowel Syndrome include abdominal bloating and distension, excess wind (flatulence), abdominal pain, nausea, changes in bowel habits (diarrhoea, constipation, or a combination of both), and other gastro-intestinal symptoms.

The low FODMAP diet was originally developed in Australia by a team at Monash University in Melbourne. It has been researched for a number of years and been shown to be effective in treating IBS related symptoms. Researchers at Kings College London have successfully adapted the diet to the UK where it has been implemented at Guy’s and St Thomas’ NHS Trust in London. The diet involves restricting high FODMAP foods for at least eight weeks and replacing them with suitable low FODMAP alternatives. Following this period, FODMAPs are slowly reintroduced step by step in an attempt to understand which FODMAPs are less likely to trigger symptoms.

In a recent study 76% of patients that tried a FODMAP diet reported an improvement in symptoms. That is quite substantial and cannot be ignored. However the low FODMAP diet is quite a complex approach and so it is important that you receive good quality advice about how to follow the diet.

Where are FODMAPs found?

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Excess Fructose

• Honey
• Apples
• Mango
• Pear
• Watermelon
• High Fructose Corn Syrup

Galacto-Oligosaccharides (GOS)

• Legume beans (eg. baked beans, kidney beans, Lentils, Chickpeas)

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Fructans

• Artichokes (Globe)
• Artichokes (Jerusalem)
• Garlic (in large amounts)
• Leek
• Onion (brown, white, Spanish, onion powder)
• Spring Onion (white part)
• Shallots
• Wheat (in large amounts)
• Rye (in large amounts)
• Barley (in large amounts)

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Fructo-oligosaccharides

• Lactose
• Milk
• ice cream
• custard
• dairy desserts
• condensed and evaporated milk
• milk powder
• yoghurt
• soft unripened cheeses (eg. ricotta, cottage, cream, marscarpone)

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Polyols

• Apples
• Apricots
• Avocado
• Cherries
• Nectarines
• Pears
• Plums
• Prunes
• Mushrooms
• Sorbitol (420)
• mannitol (421)
• xylitol (967)
• maltitol (965)
• Isomalt (953)

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The pros and cons

The interesting point about the FODMAP diet is that many of the foods eliminated are the foods that from gut instinct (excuse the pun!) my patients avoid anyway – the lactose free, dairy free, grain free diets are the most common in reducing some IBS symptoms. The idea behind FODMAP is excellent and backed up by some great science and it can be a huge help to people suffering from gut problems. However, there are some drawbacks. The diet is quite hard to stick to, especially if you are vegetarian or the foods that you don’t like are on the list of foods to eat. Also what happens when you return to normal eating – a diet is a diet no matter what – normal eating resumed – problem back whether its weight or IBS. I only suggest this as a last resort – in the last year I’ve put about 20 patients on the FODMAP diet most with good results. What needs to come before this is a thorough investigation as to the cause of the IBS in the first place. Rule out any IBDs (inflammatory bowel disease), lactose intolerance and SIBO, assess the possibility of low gut flora and ask yourself if you might have picked up a parasitic infection after recent travel. If all these are not coming up as your cause then by all means try the FODMAP diet – you will need some help to go through the diet as it can be a little complex and you will need recipes as well and a full explanation as to why these foods may cause symptoms.

This is a comprehensive list of low and high FODmap foods.

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Common High FODMAP Foods

• Apples
• Apricots
• Cherries
• Mango
• Pears
• Nectarines
• Peaches
• Pears
• Plums and prunes
• Watermelon
• High concentration of fructose from canned fruit, dried fruit or fruit juice
• Grains
• Honey
• Milk products and soft unripened cheese

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Level of FODMAPs is increased when these foods are eaten in large amounts

• Rye
• Wheat
• Custard
• Ice cream
• Margarine
• Milk (cow, goat, sheep)
• Soft cheese, including cottage cheese and ricotta
• Yogurt
• Legumes
• Baked beans
• Chickpeas
• Lentils
• Kidney beans
• Fructose
• High fructose corn syrup
• Maltitol
• Mannitol
• Sorbitol
• Xylitol
• Artichokes
• Asparagus
• Avocado
• Beets
• Broccoli
• Brussel sprouts
• Cabbage
• Cauliflower
• Garlic
• Fennel
• Leeks
• Mushrooms
• Okra
• Onions
• Peas
• Radiccio lettuce
• Shallots
• Sugar snap peas
• Snow peas

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Common Low FODMAP Foods

• Banana
• Blueberry
• Grapefruit
• Grapes
• Honeydew melon
• Kiwi
• Lemon
• Lime
• Mandarine oranges
• Orange
• Raspberry
• Strawberry
• Artificial sweeteners that do not end in -ol
• Glucose
• Sugar (sucrose)
• Butter
• Hard cheese, brie and camembert
• Lactose-free products, such as lactose-free ice cream and yogurt
• Gelato
• Rice milk
• Sorbet
• Bell peppers
• Bok choy
• Carrots
• Celery
• Corn
• Aubergine
• Green beans
• Lettuce
• Parsnip
• Sweet potato
• Tomato
• Oats
• Gluten-free products
• Spelt products

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If you would like help with the FODMAP diet or any exclusion diet please do contact me on 01323 737814

The post FODMAP Diet appeared first on Wellbeing Magazine.

What is SIBO?

Small Intestinal Bacterial Overgrowth is a chronic bacterial infection of the small intestine. The infection is due to bacteria that normally live in the gastrointestinal tract but have abnormally overgrown in a location not meant for so many bacteria. The bacteria can interfere with our normal digestion and absorption of food. It can also lead to deficiencies in iron and vitamin B12, causing certain anaemias.

After eating food, the bacteria produce gas within the small intestine which in turn can cause abdominal bloating, abdominal pain, constipation, diarrhea or both. This can get confusing because of course these are the symptoms of irritable bowel syndrome (IBS). SIBO has been shown to exist in up to 84% of IBS patients. However for my part, I have not seen this higher percentage and I find about 30% of IBS patients have a positive SIBO test. Apart from IBS, SIBO has been linked controversially to a whole host of other conditions. These include:

Other symptoms

• Heartburn (Reflux or GERD)
• Weakness
• Weight loss
• Nausea
• Food Sensitivities
• Headaches
• Joint Pain
• Fatigue
• Skin symptoms (such as eczema or rashes)
• Respiratory symptoms (such as asthma)
• Mood symptoms (such as depression)
• Steatorrhea (fatty stools)
• Anaemia (Iron or B12)

How do I get SIBO?

The gastrointestinal tract is a continuous muscular tube which digesting food travels along on its way to the colon. Normally, the coordinated action of the muscles of the stomach and small intestine propels the food from the stomach, through the small intestine and into the colon. This muscular action also sweeps bacteria out of the small intestine and limits the numbers of bacteria in the small intestine. However when a condition interferes with the normal activity in the small intestine this can result in SIBO. By allowing bacteria to stay longer and multiply in the small intestine the lack of normal muscular activity also may allow bacteria to spread backwards from the colon into the small intestine. Possible causes are:

Long term use of PPI’s (proton pump inhibitors eg omeprazole)

Batriatric surgery
Chronic pancreatitis
Blind loop syndrome (after stomach surgery)
Scarring from previous surgery and crohns disease.
Diverticuli (small pouches) of the small intestine that allow bacteria to multiply inside diverticuli.
Disorders of the immune system can cause bacterial overgrowth

“It is mandatory to consider SIBO in all cases of complex non-specific dyspeptic complaints (bloating, abdominal discomfort, diarrhea, abdominal pain), in motility disorders, anatomical abnormalities of the small bowel and in all malassimilation syndromes (malabsorption, maldigestion).”J.Bures et al 2010.

Getting Tested for SIBO

SIBO is measured by a breath test. This measures the hydrogen and methane gas produced by bacteria in the small intestine that has diffused into the blood, then lungs, for expiration. The gas is graphed over a transit time of 2 or 3 hours and compared to a baseline. Patients drink a sugar solution of lactulose after a 1 or 2 day preparatory diet. The diet removes much of the food that would feed the bacteria, allowing for a clear reaction to the sugar drink. The test is performed either at home with a take home kit or a breath testing machine in hospital, doctors office, or lab. It takes 1-3 hours in the morning after a 12 hour fast the night before and a special diet needs to be adhered to the day before the test.

Who should get tested?

If you have IBS symptoms that have not got better despite seeing your GP and are also suffering from a range of unexplained symptoms, acne rosacea, fibromyalgia etc it may certainly be worth ruling SIBO out as a cause for your symptoms.

Breath tests are available for those with private medical insurance with Dr Adam Harris, Consultant Gastroenterologist in Tunbridge Wells (GP referral only). Please see here for more information www.westkentgastroenterology.co.uk. If you don’t have medical insurance and are happy to self fund I can supply the breath test kit to do at home – these are priced at £150.

What happens if the test is positive?

If the SIBO test is positive the best approach is antibiotic therapy taken over 7-10 days. The antibiotics will vary but this is usually enough to stop the problem and will mean you will be able to eat a normal diet again, if you have been eliminating suspect foods. Antibiotics used can include: tetracycline, amoxicillin, metronizadole, neomycin, cephalexin, and trimethoprim-sulfamethoxazole.

There is only one study using herbal “antibiotics” for the treatment of SIBO, which used enteric coated peppermint oil (ECPO). Besides this, herbal antibiotcs have not been studied for the reduction of SIBO. The question is whether they will target the bacteria that is overgrown. However, it has been suggested that some herbal antimicrobials do not kill our beneficial bacteria, certainly a unique and desirable quality. Herbal antibiotic formulas abound in the supplement industry. These include: Garlic, Cinnamon, Oregano, Goldenseal, and Barberry.

What about special diets?

Patients who come to me with suspected SIBO issues are already on severely restricted diets – avoiding wheat, gluten, dairy, lactose, large amounts of carbohydrate and all manner of different variations of elimination diets. It is advisable to eradicate SIBO quickly and get back to eating as normally as possible rather than staying on restricted diets long term which may lead to different health issues. It is commonplace for patients to think they have multiple food intolerances and lists of foods they cannot eat when in fact it may be only a few foods and the problem they are suffering from is SIBO not from the food itself. Often people with SIBO tell me it does not matter what they eat – even a glass of water can make them feel bloated. This should ring alarm bells, if it’s not the food there is something going on in the gut. Time to get tested. There are a few diets that can help symptoms of SIBO and IBS as well. These include the Specific Carbohydrate Diet and Low FODmap diet which I will be discussing in the next issue as well as the GAPS diet which has found huge popularity recently.

For more details on tests and consultations visit www.katearnoldnutrition.co.uk or call Kate Arnold on 01323 737814 for more details.

The post What is SIBO? appeared first on Wellbeing Magazine.

What is Lactose intolerance?
The ancient Greek physician Hippocrates (born 460 B.C.) first noted gastrointestinal upset and skin problems in some people who consumed milk. However, it has only been in the last few decades that the syndrome has been more widely described by modern medicine. Lactose intolerance is the inability to metabolize the sugar found in milk and dairy products. This is due to a lack of the enzyme lactase.  Most adults in northern Europe and North America are able to absorb lactose. However, the majority of the world’s population are lactose intolerant, and as we get older our ability to digest lactose lessens. Globally a staggering 70 per cent of adults are lactose-intolerant (Gastroenterology, 1971; 61: 805-13).

Babies’ bodies make lactase so they can digest milk, including breast milk. Premature babies sometimes have lactose intolerance. Children who were born at full term usually do not show signs of lactose intolerance until they are at least 3 years old. Lactose intolerance can begin at different times in life. In Caucasians, it usually affects children older than 5 yrs old. In African Americans, lactose intolerance often occurs as early as 2 yrs old. Lactose intolerance is more common in people with Asian, African, Native American, or Mediterranean ancestry than it is among northern and western Europeans. Approximately 30 million American adults have some amount of lactose intolerance by 20 yrs old.

What are the symptoms?
Without lactase, lactose cannot pass through the gut wall into the bloodstream. This accumulation of undigested sugar causes gut bacteria to switch to lactose metabolism, resulting in abdominal symptoms such bloating, flatulence, cramps and, sometimes, diarrhoea. Symptoms often occur 30 minutes to 2 hours after you eat or drink milk products.

Causes

• Bowel surgery
• Infections in the small intestine from viruses or bacteria which may damage the cells lining the intestine
• Intestinal disorders like coeliac disease
• Children weaned in non dairy consuming societies
• A genetic disorder from birth – usually diagnosed in early infancy

LACTOSE TOLERANCE TESTS

You can simply avoid eating foods that contain lactose for a couple of days and then drink two to three glasses of milk. If you get stomach ache or diarrhoea within half an hour, you might be lactose intolerant. If you would like it confirmed then the tests available are:

The lactose tolerance test.
Your doctor/consultant measures your blood sugar levels before and after you drink a liquid containing lactose. The lactose tolerance blood test looks for glucose in your blood. Your body creates glucose when lactose breaks down. For this test, several blood samples will be taken before and after you drink the lactose solution described above.

Stool ph.
If the stool is acidic this can indicate an infection of e. coli or lactose intolerance. This is done with children born with the condition.

The hydrogen breath test
This is the preferred method. It measures the amount of hydrogen in the air you breathe out. You will be asked to breathe into a balloon-type container, or gastrolyzer. Then, you will be asked to drink a liquid containing lactose. Samples of your breath are collected at set time periods and the hydrogen level is checked. Normally, very little hydrogen is in your breath. But if your body has trouble breaking down and absorbing lactose, breath hydrogen levels increase. There can be issues with getting this test on the NHS as it’s quite expensive and it won’t necessarily be the first test your GP will use to diagnose your symptoms.

Where do I find lactose?
Lactose is also a commercial food additive used for its texture, flavour and  adhesive qualities, and is found in foods such as processed meat, sausages, sliced meats, pates, gravy stock powder, margarines, sliced breads, breakfast cereals,  processed foods, medications, pre-prepared meals, meal replacements (powders and bars), and  protein supplements (powders and bars).

A comprehensive list includes all these ingredients:
Avoid
Butter
Butter Oil
Calcium caseinate
Casein
Cheese
Cream
Demineralised whey
Lactalbumin
Milk powder
Skimmed milk powder
Milk solids
Non fat  milk
Non fat milk solids
Sodium caseinate
Sweet whey powder
Whey
Whey protein concentrate
Whey Solids
Ammonium caseinate
Caramel colouring
Caramel flavouring
Dried milk
Dried milk solids
Hydrolysed casein
Hydrolysed milk protein
Lactoferrin
Magnesium casein ate
Potassium casein ate
Rennet casein

NB: nearly all prescription medication has lactose in from senna tablets to painkillers. If you are lactose intolerant and are needing daily medication its worth talking to your GP or pharmacist and see if there is another option.

Can I supplement with Lactase?
When lactose avoidance is not possible, or on occasions when a person chooses to consume such items, then lactase supplements may be used. Lactase enzymes similar to those produced in the small intestines of humans are produced industrially. The enzyme, -galactosidase, is available in tablet form in a variety of doses, without a prescription. Unfortunately, too much acid can denature it, so it needs to be taken on an empty stomach. Lactase supplementation may have an advantage especially in children where the avoidance of all dairy food might be difficult. However personally for me, I’ve never found this affective in adults although this is about personal choice and what works for you.

So what’s Casein?
Casein (from Latin caseus “cheese”) is the predominant phosphoprotein in dairy food and accounts for nearly 80% of proteins in cow milk and cheese. It has been documented to break down to produce the peptide casomorphin, an opioid that appears to act primarily as a histamine releaser. One theory is that this casomorphine aggravates the symptoms of autism. Autism is complicated and is never caused simply by one problem but generally parents feel their children respond better to a casein free diet. As casein has a molecular structure that is quite similar to that of gluten, some gluten-free diets are combined with casein-free diets. Casein is often listed as sodium caseinate, calcium caseinate or milk protein. These are often found in energy bars, drinks as well as packaged goods.

What can I eat?

If you cannot eat dairy food for whatever reason you will need to look for alternatives. Twenty years ago it was difficult finding substitutes to milk products but now all supermarkets stock a good range of soya products – go tomwww.alprosoya.co.uk.

Soya products are low in cholesterol, trans fat and high in omega 3, 6, and 9 and help lower serum cholesterol. Rice dream and oat milk are also available in some supermarkets and health food shops if you don’t like the taste of soya. Goat, sheep and buffalo products can sometimes be tolerated better than cows milk, however please note they still contain lactose – many of you are getting confused and thinking it’s just cow’s milk – its not!. Lactose free milk, yoghurt and cheese are now widely available – go to www.lactofree.co.uk for more information.

Most people with low lactase levels can drink 2 – 4 ounces of milk at one time (up to one-half cup) without having symptoms. Larger (more than 8 oz.) servings may cause problems for people with lactase deficiency. However as its so individual it will differ from person to person – I can eat organic butter and feta cheese – I’ve no idea why but I can and that makes life a lot easier for me!

These milk products may be easier to digest
Buttermilk
Fermented milk products, such as yogurt (particularly organic ” live” yogurt)
Goat’s milk
Ice cream, milkshakes, and aged or hard cheeses
Lactose-free milk and milk products
Soy formulas for infants younger than 2 years
Soy or rice milk for toddlers

If for whatever reason you are omitting dairy foods from your diet you will need other sources of calcium, so i you use soyal milk, do choose the calcium enriched soya milk. In order of greatest first here are some calcium rich foods to incorporate into your diet.  You need 1,200 – 1,500 mg of calcium each day:

Calcium sources:
Whitebait
Canned sardines
Tofu
Black beans
Pinto beans
Spring greens
Molasses
Raw spinach
Sesame seeds
Prawns
Baked beans
Canned pilchards
Chickpeas
Shrimps
Canned salmon
Almonds

For more information contact Kate Arnold 01323 737814 www.katearnoldnutrition.co.uk

The post Are you lactose intolerant? appeared first on Wellbeing Magazine.