Coeliac disease

What is coeliac disease?

Coeliac disease is an autoimmune condition in which consumption of gluten – a protein found in wheat, barley and rye – triggers an immune response. The immune system mistakes the gluten for a hostile organism and causes an inflammatory reaction, damaging the lining of the small intestine and interfering with the absorption of nutrients.

What are the symptoms?

The symptoms of coeliac disease vary from person to person and can range from very mild to severe. Potential symptoms include any of the following:

  • Diarrhoea (more than three loose stools per day)4574
  • Constipation
  • Excessive wind
  • Persistent, unexplained nausea
  • Recurrent stomach pain, cramping or bloating
  • Vitamin deficiencies
  • Tiredness and/or headaches
  • Mouth ulcers
  • Weight loss

The affected area of the intestine may be patchy, leading to only very mild symptoms or even no symptoms at all . Many adults with subtle disease experience only mild fatigue or anaemia. Due to the wide range of potential symptoms and overlaps with other common digestive complaints (such as irritable bowel syndrome and wheat intolerance), large numbers of coeliac cases remain undiagnosed or misdiagnosed.

In babies, symptoms may appear shortly after they have been weaned onto solid foods, including cereals which contain gluten. The baby may fail to gain weight after previously growing well and start show signs of muscle wasting in the arms and legs. As their food is not being absorbed properly, their stools may become pale and bulky and diarrhoea might occur. The abdomen may become bloated and swollen and the baby may experience repeated vomiting.

Causes

The cause of coeliac disease is unknown, although it is thought to be associated with a mix of genetic and environmental factors. 23256-1_nIt is most common in individuals who have a close family member with the disease and those who suffer from other autoimmune diseases – such as hypothyroidism, type-1 diabetes and rheumatoid arthritis. It is more prevalent in women than in men. It is not currently known whether intolerance to gluten is present at birth or develops later on in life.

Diagnosis

In cases where coeliac disease is suspected, a blood test to detect a specific antibody may be suggested in order to confirm a preliminary diagnosis. It is important that a diet including gluten is followed for at least six weeks before this blood test is performed in order for the antibodies to be detected. Professional guidelines recommend that a positive blood test is followed by an endoscopy (visual examination using a long tube) and tissue biopsy. Further investigations may also be performed to identify related complications such as anaemia, calcium deficiency and hypothyroidism.

A small proportion of patients with symptoms of IBS have underlying coeliac disease, and screening for coeliac disease is therefore recommended by NICE for those with IBS symptoms.

Treatment

The only known effective treatment for coeliac disease is a lifelong gluten-free diet, which prevents the damage to the lining of the intestines and reduces associated gastrointestinal symptoms. Symptoms should improve considerably within weeks of starting a gluten-free diet, 3although it can take up to two years for the digestive system to completely heal. It is important to comply to the diet strictly, as even consuming small amounts of gluten can sensitise the gut and cause symptoms to return.

In addition to avoiding gluten you may be advised to take vitamin supplements such as iron, calcium and vitamin D following diagnosis (depending on the level of deficiency and grade of the diagnosis) in order to address any deficiencies and ensure that you obtain sufficient nutrients whilst the gut lining heals. Testing may be repeated several times in the first year following diagnosis, along with bone scans and biopsies to track progress and monitor risk of complications.

Foods to avoid

If you have been diagnosed with coeliac disease, you should always check the ingredients on any pre-prepared foods that you buy. Many processed foods contain gluten in additives, such as malt flavouring and modified food starch.

You must not eat any of the following unless they are labelled as gluten-free:

  • Bread
  • Pasta
  • Cereals
  • Biscuits or crackers
  • Cakes, pastries and pies
  • Foods in batter or breadcrumbs
  • Alcoholic drinks containing barley (such as beer and lager)

Wheat must be avoided, as well as wheat sub-species (such as spelt, semolina and durum) and related species such as barley and rye which will also induce symptoms. Some coeliac patients also react to oats as they are often contaminated with wheat during processing. Maize (corn), millet, amaranth, rice, and wild rice are safe for patients to consume, as well as quinoa and buckwheat.

oh3435p19-grains-flours-starches-mYou can buy special gluten-free flour, pasta, bread and other snack foods to eat as alternatives; look for the ‘Free-From’ ranges in your local supermarkets. You may also be able to obtain the basics on prescription following a confirmed coeliac diagnosis. However, it is important to be aware that these pre-prepared ‘convenience’ products can be expensive and highly processed, meaning they are often low in nutritional value. Health food shops and specialist online companies may be able to offer more reasonably priced, wholesome alternatives.

Prognosis

If successfully diagnosed, the outlook for coeliac disease is generally good. However, the prognosis for untreated coeliac disease can range from moderate to poor. Without treatment, coeliac disease can cause a wide range of potential long-term complications such as malnutrition, osteoporosis, infertility and growth defects. Some research has also suggested that having coeliac disease can increase your risk of developing certain types of cancer, including cancer, intestinal lymphoma and cancer of the oesophagus.

It is important to seek advice from your GP if you suspect you are suffering from coeliac disease. Do not simply attempt to treat yourself with a gluten-free diet unless you have received a confirmed diagnosis; is important to ensure you receive the appropriate medical follow-up and support in order to make a full recovery.

© Sarah West Nutrition

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How to stop calorie counting and prevent overeating

A lovely client of mine recently cracked her complicated relationship with food and a few months on has kindly emailed me to thank me for my support and let me know what particularly worked for her. I am so delighted for her and wanted to share her techniques as I think they’re spot on and very inspiring.

Happy-WeightThis approach really works to help extract yourself from a miserable cycle of disordered eating (rigid calorie counting interspersed with overeating and guilt) – although it takes a strong will and determination to change!

Tried and tested tips:

  • Rather than rigorously calorie counting and obsessing over your ‘allowed’ foods all day long, listen to your body. Do you really want it? WHY do you want it? Are you really hungry or are you just bored? If you’re hungry, eat it. If you’re not, choose not to eat it (rather than deny yourself it).
  • Think about how you’ll feel after you’ve eaten something – happy? Or guilty? If you want something – and really want it, don’t just want it as a distraction – then have it, and savour it. Don’t make the anticipation of you dinner more enjoyable than the food itself.
  • Allow yourself to get hungry rather than panicking about feeling your stomach rumble. It’s OK to feel hungry between meals – you don’t need to constantly snack to ward it off. Allow yourself to work up an appetite and then really enjoy your meals when you eat them.
  • If you’re full before you’ve cleared your plate, stop eating; don’t mindlessly carry on just because it’s there in front of you. Alternatively, stop eating just before you feel full – even if there is more food available to you. This might kick against any “clear your plate/waste not want not” instincts but it means you will eat less and will also feel less bloated and uncomfortable when you’ve finished.
  • Look at the nutritional content of items rather than just instinctively eating or buying them – being more aware of what you’re putting into your body may cause you to reassess!
  • Give yourself specific meal times and plan what you’ll eat, rather than being caught short and having to grab something on the run.

© Sarah West Nutrition

How to increase your chances of conceiving

Fertility challenges

Fertility problems have increased dramatically over the past 20 years, with a quarter of all couples planning a baby experiencing trouble conceiving (Glenville, 2010). Infertility can often be classified as ‘unexplained’; with no specific medical problem able to be identified. In these cases it may be as simple as poor diet and lifestyle choices that are impacting upon a couple’s chances of conceiving naturally. Establishing a healthy diet early on can improve chances of conception, set the stage for a healthy and successful pregnancy and give your baby the best possible start in life.

elegant-maternity-photos-vintage-1960s-styleWhen to start

It takes a minimum of 3 months for eggs to mature sufficiently for release during ovulation and for sperm cells to develop fully (Marieb, 2004). This means that when trying to improve your fertility it is worth setting aside a 3 month period to make positive changes before aiming to conceive. It is as important to take care during this period as it is during the pregnancy itself.

Basic principles

The key to preconception nutrition is to eat a balanced and varied diet, rich in a vitamins, minerals, proteins and complex carbohydrates. This means eating the freshest, healthiest food you can afford with a focus on fresh fruits and vegetables, whole grains (including bread, cereals, pasta and rice), nuts and seeds, beans and lentils, lean meat, oily fish, dairy products and eggs.

It is important to avoid high sugar and high fat foods which can lead to weight gain. It is well documented that body fat content has an impact on fertility and women who are closer to their healthy body weight have less chance of suffering hormone imbalances and therefore better chances of conception (Glenville, 2010).

If using the contraceptive pill, you should also aim to stop taking it at least 3 months before conceiving. Contraceptive pills can deplete many vitamins and minerals (including vitamin B2, B6, C, A and zinc) (Pelton, 1999) and may therefore have a detrimental effect when trying to boost the nutrient-density of your diet.

Essential nutrients

Vitamins and minerals are generally best absorbed and utilised by your body when obtained from foods rather than in supplement form (with the exception of folic acid). It is also easy to inadvertently overdose on certain vitamins from supplements, which can cause more harm than good.

To help you make every mouthful count, I’ve outlined some of the most essential pre-conception nutrients and the best foods to find them in:

  • Folic Acid

Folic acid is the most essential pregnancy nutrient. It works together with vitamin B12 to ensure that the baby’s genetic materials are fully developed. Low levels of folic acid increases the risk of brain and spinal cord defects, so it is essential that you have sufficient intake both before and during pregnancy (Scholl & Johnson, 2000).

ASo-1100lthough folic acid can be found in many foods (such as beans, peanuts, avocado and green leafy vegetables), it is hard to get sufficient quantities from food alone. Folic acid is therefore the only supplement that all women must take before conception (Glenville, 2010). 400mcg per day is recommended from 3 months prior to conception until the end of the first trimester of pregnancy, plus a further 200mcg from food.

  • Zinc

Zinc is the most widely studied nutrient in terms of fertility. It is an essential component of genetic material and deficiency can lead to chromosomal changes in both men and women, leading to difficulty conceiving (Carlson et al., 1992). It is also involved in the body’s use of reproductive hormones and in the development of the brain and immune system. Zinc is also found in high concentrations in sperm and reducing zinc in a man’s diet may therefore reduce his sperm count (Glenville, 2010).

Good sources of zinc include oysters, meat, beans, yogurt and brown rice.

  • Vitamin A

Retinol (the animal form of vitamin A found in many supplements) should be avoided during pregnancy, as it can cause developmental and birth defects in excess (Azaïs-Braesco & Pascal, 2000). It is therefore important to be cautious when taking multi vitamin supplements or Cod Liver Oil which can contain high levels of Vitamin A in retinol form.

Healthy levels of vitamin A can be obtained from the diet in fortified foods, dairy products, eggs, chicken and fish and will help keep the fallopian tubes healthy. Beta-carotene, a precursor to vitamin A found in brightly coloured vegetables, may be supplemented as it does not carry the same risks as retinol.

  • Iron

spinach-dd-02When you fall pregnant, the volume of circulating blood in the body increases by a third. This leads to an increased demand for iron, which is essential for the formation of the baby’s blood, brain, eyes and bones (Glenville, 2010). Pregnant women can easily become deficient in iron and must ensure that they regularly consume plenty of iron rich foods before pregnancy in order to build up iron stores, along with Vitamin C to aid iron absorption.

Iron-rich foods include red meat, beans, nuts, dried fruit, whole grains (such as brown bread and rice), fortified breakfast cereals and dark green leafy vegetables.

  • Calcium

Well known for strengthening bones and teeth, calcium is also needed to produce the fertile mucus that helps sperm to reach the waiting egg. Demand for calcium increases in pregnancy and breastfeeding (Glenville, 2010).

Dairy products such as yogurt, milk and cheese are good sources of calcium, along with canned salmon or sardines (with bones), nuts and tofu.

  • Essential Fatty Acids (EFAs)

Essential fats are crucial for healthy hormone functioning and the ovulation process. Consumption is particularly crucial for men as the semen is rich in prostaglandins, produced from these fats. Men with poor sperm quality or low count tend to have inadequate levels of these beneficial prostaglandins (Carlson et al., 1992). The omega 3 fatty acids found in EFAs are also essential in foetal brain development.

imagesGood sources of essential fatty acids are oily fish (such as sardines, mackerel, anchovies, salmon or herring), cold-pressed oils such as flaxseed and pumpkin-seed, eggs, soy products, nuts and seeds and green leafy vegetables.

NOTE: Elevated levels of mercury found in many deep-sea fish can be dangerous and may affect a baby’s developing nervous system. Avoid eating shark, swordfish or marlin before and during pregnancy and try to limit tuna consumption to a couple of times a week.

  • Vitamin E

Vitamin E is a powerful antioxidant and has been found to increase fertility when given to both men and women during IVF treatment (Geva et al., 1996). It has been suggested that the antioxidant activity of vitamin E might regulate oestrogen levels and make the sperm more fertile (Glenville, 2010). Wheat germ oil is the best source, but other vegetable oils, nuts and whole grains are good sources too.

What to avoid

Certain foods and drinks can be detrimental when trying to conceive:

  • Caffeine

tea+vintage+image+graphicsfairy008cResearch has indicated that drinking as little as one cup of coffee a day may reduce your chances of conceiving (Bolumer et al., 1996) and may also decrease sperm count in men. More research is required to substantiate these claims but in the meantime it is advisable to reduce consumption of caffeine-containing food and drinks. This includes cola drinks, chocolate, teas (including green tea, although to a lesser extent than black tea) and coffee. Tea and coffee also contain a substance that can bind with iron making it harder for the body to absorb it (Glenville, 2010). Cutting down on tea and coffee may therefore also help to improve iron levels.

NOTE: Caffeine is also found in some cold and flu remedies, so always check with your GP before taking any of these during pregnancy.

  • Alcohol

The Department of Health (DH) recommends that women should not drink alcohol while they are trying to conceive. Drinking alcohol causes a decrease in sperm count and an increase in abnormal sperm; it can also inhibit the body’s absorption of B vitamins and zinc. Birth defects associated with prenatal alcohol exposure can occur in the first 3-8 weeks of pregnancy, before you even know if you are pregnant (Maier et al., 2001). You should therefore eliminate alcohol from your diet for at least three months in order to give yourself the best possible chance of conceiving and having a healthy pregnancy. If you do drink during this time, try to limit yourself to 1-2 units per week.

Water should be your number one beverage before and during pregnancy. The human body is mostly composed of water, so consider it a vital nutrient.

  • Smoking

Smoking has been linked with infertility in women (Hakim, 1997) and may bring on an early menopause, a particularly important consideration for older women hoping to fall pregnant. Nicotine ages the ovaries and can make the eggs resistant to fertilisation. It can also decrease sperm count and quality in men (Carlson et al., 1992).

  • Aspirin and other NSAIDS

If at all possible, avoid unnecessary medications and drugs including over-the-counter preparations. Even non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin and ibuprofen may inhibit ovulation.

Conclusion

Every mother wants her baby to be as healthy and strong as possible and the best way to free-vintage-baby-boy-clipart-fptfy-1do that is to start at the very beginning: before conception. Establishing a varied and healthy diet early on can help your chances of conceiving, set the stage for a healthy pregnancy and give your baby the best possible start in life.

It is possible to get all the nutrients you need naturally*, from the food you eat, in order to prepare your body for pregnancy and build the best possible environment for your baby to grow in. Making wise, informed decisions about your food and drink now will benefit both you and your baby for the long term.

* With the exception of folic acid.

© Sarah West Nutrition

References

Azaïs-Braesco, V & Pascal, G (2000). Vitamin A in pregnancy: requirements and safety limits. American Journal of Clinical Nutrition, 71, 5, 1325S-1333

Bolúmar et al., (1997). Caffeine Intake and Delayed Conception: A European Multicenter Study on Infertility and Subfecundity. Am. J. Epidemiol.145 (4): 324-334.

Carlson, E, et al., (1992) Evidence for decreasing quality of semen during the past 50 years. British Medical Journal; 305: 609-13.

Dickerson, J  & Lee, H(1988).  Nutrition in the Clinical Management of Disease. (2nd ed.) London: Edward Arnold.

Fertility Journey (2010).  Preconception diet for women. Retrieved from: http://www.fertilityjourney.com/thinking-about-getting-pregnant/peconception-health-for-women/diet/index.asp?C=11836404596506018518

Food Standards Agency (2006) Trying for a Baby. Retrieved from: http://www.eatwell.gov.uk/

Food Standards Agency (2006) When You Are Pregnant. Retrieved from:  http://www.eatwell.gov.uk/

Geva et al., (1996). The effect of antioxidant treatment on human spermatozoa and fertilization rate in an in vitro fertilization program. Fertility and sterility 66, 3, 430-434.

Glenville, M (2010). Solutions to infertility. Retrieved from: http://www.marilynglenville.com/infertility.htm

Hakim (1997). Alcohol and caffeine consumption and decreased fertility. Fertility and Sterility 70, 4 , 632-637

Maier, S et al., (2001). Drinking Patterns and Alcohol-Related Birth Defects. Alcohol Research & Health, 25.

Marieb E (2004) Human Anatomy & Physiology. United States of America: Pearson Education, Inc.

Pelton, R (1999). Drug-Induced Nutrient Depletion Handbook. Lexi-Comp: US.

Scholl, T & Johnson, W (2000). Folic acid: influence on the outcome of pregnancy.

American Journal of Clinical Nutrition, 71, 5, 1295S-1303.

Warren, K & Foudin, L (2001). Alcohol-Related Birth Defects-The Past, Present and Future. Alcohol Research & Health, 25.

West et al., (2005). Dietary Oestrogens and Male Fertility Potential. Human Fertility 8, 197-207.

The dangers of ‘detox diets’

Thinking of embarking on a detox diet to boost your health or lose a few pounds? Before you do, it’s time to cleanse yourself of the intriguing concept that we need to be periodically detoxified through our diet.

What is dLiver-detox-smoothie-copy.pngetoxification?

Strict diets might claim to rid your system of toxins, but in actual fact your body does that job for you; working to break down what goes in, absorb the good and excrete the not so good.

Real detoxification of foreign substances takes place in your liver, which works to modifies their chemical structure and enable them to be excreted by the kidneys (which filter them from the blood into the urine). This is a constant process, meaning you’re actually detoxing all day long. If you’re not detoxing- you’re dead!

Why detox diets are counterproductive

Many detox diets suggest fasting or existing on ftumblr_mfks50fRHX1ryp4qio1_1280ruit and vegetables alone to help aid good health. Whilst it’s true that you are likely to see rapid weight loss from this approach, any weight loss will be from water, glycogen (the body’s carbohydrate stores) and muscle loss, rather than fat.

Restricting your food consumption to this extent also limits your intake of energy and important nutrients needed for good health. When you starve your body of calories in this way, you will ultimately start to build up chemicals called ketones. These chemicals can result in nausea, dehydration, weakness, light-headedness and irritability.

Furthermore, a prolonged lack of protein can cause your body to break down its own muscle stores which will eventually compromise your immune system. Proof that whilst fruit and vegetables provide vital vitamins, minerals and dietary fibre, they are not so good for you in isolation!

And finally, if you are depriving your body of nutrients in this way, you won’t have adequate fuel available to help you carry out sustained exercise and activity – an important aspect of any health and wellbeing plan.

What is a healthy alternative?

So now you know that traditional detox diets are marketing myths rather than nutritional reality, what can you try instead?bodybuilder  velvettangerine 3084405810

It is quite simple; if you want to maintain optimal health then the best approach is a balanced diet containing a variety of brightly coloured fruit and vegetables, plenty of wholegrain cereals, protein in the form of lean meat and fish (or vegetarian alternatives such as beans and pules) plus low-fat dairy products.

And why not add in some exercise while you’re at it? The skin is the body’s largest organ and plays a large part in helping the body stay healthy through perspiration. Working up a sweat helps your internal organs stay cool by lowering your overall body temperature and aids with the removal of toxins from the body through the skin. So if you want a quick ‘detox’ fix, try eating a balanced meal and sweating it out at the gym instead.

Nutritious, anti-detox meal suggestions:

Breakfast:

  • Homemade oat and nut granola served with fresh fruit and live yogurt
  • Scrambled or poached eggs on wholemeal toast
  • No added sugar muesli with nuts and seeds

Lunch:

  • Lentil and vegetable soup with wholegrain rye bread
  • Mixed salad with avocado, beetroot, pepper, tomato plus chicken pieces/ mozzarella pearls and a reduced fat Caesar dressing
  • Vegetable omelette served with salad

Dinner:

  • Lentil ragu served with wholemeal spaghetti and reduced fat cheese
  • Smoked salmon in a reduced fat crème fraiche sauce, served with steamed green beans and broccoli
  • Homemade prawn and cauliflower curry with wild or brown rice

© Sarah West Nutrition

 

The facts about Irritable Bowel Syndrome

Irritable Bowel Syndrome (IBS) is a term used to describe re-occurring disruption to the function of the stomach, digestion or colon in the absence of any specific, detectable cause.

It is a common disorder with an estimated 10-20% of people in England suffering from some form of IBS (NICE, 2010).

Diagnosis

IBS is considered a ‘functional’ disorder (referring broadly to an impairment in normal function), as diagnostic testing does not reveal any visible disease process. Doctors sos cropped(1)therefore make a diagnosis of IBS based purely on a patient’s symptoms, which can include a combination of any of the following:

  • Abdominal pain/ cramping (often worsened by eating and relieved by passing a stool)
  • Changes in bowel habits (such as frequent diarrhoea and/ or constipation)
  • Flatulence (including wind and gastrointestinal reflux) and bloating
  • Abdominal spasms / stomach rumbling

Symptoms may be intermittent and will often vary in severity from day to day. Several conditions may present with symptoms similar to IBS, including coeliac disease, inflammatory bowel disorders (such as Crohn’s Disease or Ulcerative Colitis) and parasitic infections. It is therefore important to see your doctor for tests to rule out these conditions. If you have any signs of blood in stools or experience significant, unexplained weight loss then it is particularly important that you seek advice from your GP.

Causes

The exact cause of the impaired digestive functioning seen in IBS is unclear, but possible triggers include:

  • Food Intolerance – lactose (milk sugar), fructose (fruit sugar) and sorbitol (an artificial sweetener) are common triggers in IBS patients. In addition wheat, dairy, coffee, eggs, corn, potatoes, onions and yeast can often cause problems.
  • Psychological factors – It is thought that IBS is a disorder of the interaction between the brain and the gut, with sufferers experiencing increased sensitivity within the gut to external stimuli such as stress. The frequency of depression, stress, anxiety and other psychiatric disorders in IBS patients is high (DeNoon, 2010).
  • Use of certain medications – article-newantibiotics, non-steroidal anti-inflammatory drugs such as ibuprofen (e.g. Nurofen) and diclofenac (e.g. Voltarol) plus stomach acid suppressing drugs/ antacids may worsen symptoms.
  • Gender – women tend to be more susceptible. Many women with IBS find their symptoms are particularly bad around the time of their period, suggesting that female hormones may play a part.

Management

There is no cure for IBS, but symptoms can often be eased by changes to diet and lifestyle. No treatment is guaranteed to eliminate symptoms completely; instead the goal is to relieve them sufficiently to prevent them from interfering with daily activities. The following suggestions may be helpful:

Dietary modification

Treatment plans for IBS are highly individual, but symptoms are generally improved by alterations in food intake. It may firstly be helpful to complete a 2 week food and symptom diary in order to establish links between food consumption and IBS attacks. This can be a tedious process, but a simple record of what you eat and how you feel may help to identify one or more foods that are problematic. These triggers can then be reduced or eliminated.

A nutritionist or dietician can provide further advice on specialised exclusion or rotation diets that may help to identify triggers and ease symptoms.

Current national guidelines (NICE, 2010) regarding IBS include the following general suggestions which may also help to minimise symptoms:

  • Have small, regular meals and take time to chew each mouthful well. Avoid large meals which can place stress on the digestive system and trigger spasms in the gut.
  • Avoid missing meals or leaving long gaps between eating.
  • Drink at least eight cups of fluid per day, especially water or other non-caffeinated drinks such as herbal teas. This helps to keep stools soft and easy to pass along the gut.
  • Restrict tea, coffee and alcohol consumption (caffeine and alcohol are gastric irritants and act as a triggers in some individuals)
  • Restrict carbonated drink consumption, which may contribute to bloating or cramping.
  • Be mindful of fibre consumption. Fibre can often help to regulate IBS symptoms, but large amounts of insoluble fibre (found in whole grains, bran and fruit and vegetable skins) may worsen symptoms in some individuals. Try introducing gradually and monitoring symptoms until the desired effect is achieved. Soluble fibre (found in rice, pasta, oats, potatoes, beans and barley) may be easier to tolerate.
  • Avoid artificial sweeteners such as sorbitol (found in sugar free sweets, chewing gum and slimming products), particularly if you have diarrhoea.
  • FODMAP dietFODMAP is the acronym for a group of osmotically active, rapidly fermentable, short-chain carbohydrates, thought to be a common IBS trigger. The FODMAP diet is a plan that temporarily eliminate FODMAPs from the diet, and is thought to be very effective.

Supplementation

  • Peppermint oil – has antispasmodic properties and relaxes intestinal muscles (Hadley & Gaarder, 2005). Choose capsules with enteric coating to prevent gastroesophageal reflux.
  • Psyllium (soluble fibre) – soothes and regulates the digestive tract, symprove-132-pstabilises intestinal contractions and normalises bowel function (in cases of both predominant diarrhoea AND constipation) (Ford et al., 2008)
  • Probiotics – may help restore normal bowel flora in the colon and reduce instances of diarrhoea. Faecal samples of IBS patients have showed a reduction in Lactobacili and Bifidobacteria and higher concentration of pathogenic bacteria (Moayyedi et al., 2010). Try Symprove – this clinically proven probiotic contains 4 strains from the Lactobacilli family and works without triggering digestion, ensuring they reach the right area of the gut (unlike other popular dairy-based or freeze dried probiotics) 
  • Digestive Enzymes such as papaya extract, lactase, ox-bile extract, pancreatic enzymes may aid digestion and reduce bloating. 

Behavioural strategies

The relationship between the mind and over activity of the gut is complex. The entire length of the bowel is controlled by a nervous system which carries signals back and forth to the brain, via hormones and neurotransmitters. These signals control the action of the smooth muscle surrounding the intestines and regulate the process of digestion. It is therefore no surprise that emotional issues trigger symptoms of IBS and that people with anxious personalities may find symptoms particularly difficult to control. Intestinal upset is often simply a physical manifestation of stress or anxiety (Kearney & Brown-Chang, 2008., Whitehead et al., 2002).

It is important for IBS sufferers to try to reduce the amount of stress in their lives. Some people find relaxation techniques, stress counselling, cognitive behavioural therapy, psychotherapy or hypnotherapy useful in controlling their symptoms. Regular exercise also helps to helps keep bowel movements regular and reduces stress. Including additional information regarding your mood within a food diary may help to identify emotional factors that are contributing to your symptoms.

Medication

There are a variety of drugs that can help relieve specific symptoms of IBS, such as anti spasmodics for abdominal cramps, laxatives to relieve constipation and antidiarrhoeals to prevent diarrhoea. Low doses of tricyclic antidepressants are sometimes prescribed to relieve pain in patients who do not respond to other treatments. Talk to your doctor or pharmacist for more information.

Outlook for patients with IBS

For most people with IBS, the condition will persist periodically throughout their life. IBS does not pose a serious threat to a person’s health, nor does it cause serious damage or disease of the digestive system. However, it can have a considerable impact on a person’s quality of life for those who are severely affected, often leading to work absenteeism (Maxion-Bergemann et al., 2006, Paré et al., 2006). It is therefore important to learn to recognise and avoid individual triggers in order to manage symptoms as effectively as possible.

© Sarah West Nutrition

References:

DeNoon, D (2010). Irritable bowel syndrome in the brain. Web MD. Retrieved from: http://www.webmd.boots.com/ibs/news/20100725/irritable-bowel-syndrome-in-the-brain

Ford, A., Talley, N., Spiegel, B., et al (2008). Effect of fibre, antispasmodics, and peppermint oil in the treatment of irritable bowel syndrome: systematic review and meta-analysis. British Medical Journal. Retrieved from: http://www.ncbi.nlm.nih.gov/pubmed/19008265?dopt=Abstract

Hadley, S., Gaarder S., (2005). Treatment of irritable bowel syndrome Am Fam Physician 72 (12): 2501–6. Retrieved from: http://www.aafp.org/afp/20051215/2501.html

Hammerle & Surawicz (2008). Updates on treatment of irritable bowel syndrome.World Journal of Gastroenterology. 14, 2639-2649.

Kearney & Brown-Chang (2008). Complementary and alternative medicine for IBS in adults: mind-body interventions.

Paré, P., Gray, J., Lam, S, et al. (2006). Health-related quality of life, work productivity, and health care resource utilization of subjects with irritable bowel syndrome: baseline results from LOGIC (Longitudinal Outcomes Study of Gastrointestinal Symptoms in Canada), a naturalistic study. Clinical therapeutics28 (10): 1726–35.

Maxion-Bergemann, S., Thielecke, F., Abel, F., Bergemann, R., (2006). “Costs of irritable bowel syndrome in the UK and US”. PharmacoEconomics 24 (1): 21–37.

Moayyedi, P., Ford, A., Talley, N., et al (2010). The efficacy of probiotics in the treatment of irritable bowel syndrome. Gut59 (3) 325-32. Retrieved from: http://www.ncbi.nlm.nih.gov/pubmed/19091823?dopt=Abstract

NICE Clinical Guideline (2010); Irritable bowel syndrome in adults: diagnosis and management of irritable bowel syndrome in primary care. http://www.nice.org.uk/guidance/index.jsp?action=byID&o=11927 

Whitehead, W., Palsson, O., Jones, K. (2002). Systematic review of the comorbidity of irritable bowel syndrome with other disorders: what are the causes and implications?. Gastroenterology 122 (4).

What is vitamin D?

Vitamin D is a steroid hormone. It differs from other vitamins as it is produced within the body as well as being obtained from dietary sources.

Where do I get vitamin D from?

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It can be found in fish liver oils (such as cod liver oil), fatty wild fish such as salmon, mackerel, tuna, sardines and herring, fortified foods (such as cereals) and egg yolks. However, only about 10% of our vitamin D intake comes from food sources, so it is nearly impossible to get adequate amounts of vitamin D from diet alone.

Exposure to sunlight is the most reliable way to generate vitamin D in your body; it is produced by the skin in response to exposure to ultraviolet (UV) radiation. It is possible to generate 20,000 units of vitamin D following only 20 minutes of sun exposure without suntan lotion. It is also found in some food sources.

What does vitamin D do?

Like all hormones, vitamin D is involved in the production of enzymes and proteins within the body, which are crucial for preserving health and preventing disease. It improves muscle strength and strengthens bone. It also has anti-inflammatory effects, aids the action of insulin within the body and has anti-cancer properties.

Because of its vast assortment of benefits, maintaining optimal levels of vitamin D is crucial for good health. Vitamin D deficiency has been linked with many of the diseases of modern society.

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Vitamin D deficiency is rarely considered to be a problem in the modern world. However, it remains a common deficiency in many children and adults. Worldwide, it

is estimated that the epidemic of vitamin D deficiency affects one billion people.

Before birth and during childhood, vitamin D deficiency can cause slowed growth and skeletal deformities and may increase the risk of fractures later in life. Vitamin D helps your bones absorb calcium, which keeps them healthy and strong. In adults, vitamin D deficiency has been linked to muscle weakness and play a role in many major diseases, including osteoporosis and osteopenia, many types of cancer, depression, heart disease and heart failure, obesity, diabetes, multiple sclerosis, rheumatoid arthritis, sexual health and infertility, Parkinson’s, depression, Alzheimer’s and chronic fatigue syndrome.

Gwyneth Paltrow hit the headlines after revealing that she has been diagnosed with the early stages of Osteopenia, a bone-weakening disease that is most commonly diagnosed in elderly women. If left untreated, bones may become more brittle, leading to osteoporosis. Paltrow was confused by her doctors’ advice to get more sun in order to increase her vitamin D levels, which was counterintuitive to warnings about protecting the skin from harmful UV radiation.

So how much sunshine do you need?

il_570xn-317727000All living things need sun; the important factor is getting the right balance. In the last few years, numerous studies have shown that modest sunlight exposure may actually be beneficial; helping the body to manufacture the adequate levels of vitamin D it needs to keep bones healthy and protect against a range of health problems, including skin cancer. However, excessive sun exposure can cause melanoma and skin ageing.

As a general rule, if you are not vitamin D deficient, about 20 minutes of sun exposure a day (without sun cream) is sufficient. It doesn’t matter which part of the body you expose to the sun. All you need is a common sense when heading outdoors; make sure you do it gradually and always avoid sunburn.

Are you getting enough vitamin D?
Current UK guidance is clear on who should be taking vitamin D supplements and in what quantity. It indicates that for most adults they are completely unnecessary.

Pregnant and breastfeeding women need extra vitamin D to make sure they have enough to protect their bones and ensure that their baby grows properly. They should take 10 micrograms a day – about twice the dose found in the average multivitamin pill. Other at-risk groups, which include the elderly, the housebound and those who cover their skin for religious or cultural reasons, should also take 10 micrograms.

Signs of a vitamin D deficiency include muscle pain/weakness and bone pain; don’t let these warning signals go unanswered.

The only way to accurately ascertain whether you are vitamin D deficient is to see your GP for a blood test. It is then perfectly possible to reverse a diagnosis of vitamin D deficiency with prescribed vitamin D supplementation and controlled, moderate sun exposure. Don’t rely on food alone for your Vitamin D needs. Although irresponsible sunbathing is unquestionably harmful and precautions need to be taken, regular, moderate sun exposure is essential for good health.

A diet rich in vitamin D and calcium, regular weight-bearing exercise like jogging, walking and avoiding smoking are also key to help prevent osteopenia, osteoporosis and other associated conditions.

© Sarah West Nutrition

Re-train your brain

HEALTH:

In order for any weight loss regime to succeed, you need to start looking at healthy food in a different way.

Instead of resenting the changes to your lifestyle, try thinking of the food you eat as high quality fuel that will help you to look and feel better with every mouthful. The positive association could make all the difference.

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Instead of fixating on the negative aspects of exercise, try making a list of all the benefits; such as  looking leaner, having more energy, receiving compliments on your appearance and being able to wear clothes you don’t currently feel comfortable in.

Imagine being your goal weight and how it would make you look and feel. Surely that’s worth going to the gym for?

NUTRITION:

A common dieting pitfall is the belief that you can eat as much as you like as long as you exercise. However, the truth is that your portion sizes are an important part of the plan.

However long you spend in the gym, you won’t see results if you consistently consume more additional calories than you burn off. You can’t out run your fork!

© Sarah West Nutrition

Boost your immunity

HEALTH:

There is no avoiding exposure to germs and viruses, but some people seem more susceptible to them than others. A strong, well-functioning immune system is the cornerstone of good health, fighting off disease and infections and allowing you to recover more quickly if you do get sick.

EXERCISE:

Research supports a link between regular, moderate exercise and a healthy immune system due to its effect on the production of white blood cells.

under-the-weather1Physical activity sends these immune cells through the body at a faster rate, enabling them to detect and fight bacteria and viruses more effectively. It can also slow down the release of stress-related hormones, which increase the chance of illness.

NUTRITION:

One of the best ways to boost your immunity is through the consumption of a healthy diet including plenty of whole grains, nuts, seeds and brightly coloured fruit and vegetables.

Fresh, unprocessed foods contain numerous immune-boosting antioxidants which help protect and repair our cells from damage on a daily basis.

© Sarah West Nutrition

In the genes

HEALTH:

Ageing is a complex biological process, driven by the build up of damage in our cells, tissues and organs. This damage is accumulated by a mixture of how we live our lives and the genetic mechanisms that repair that damage, making nutrition and lifestyle an irrefutable factor in the ageing and disease process.

EXERCISE:

detoxification-camtreatments.jpgNew research has discovered that just 20 minutes of activity can alter the DNA in your muscle cells, making them work better for further exercise. It has also been found that certain genes are boosted in their ability to metabolise sugar and fat, as well as regulate glucose (blood sugar) levels. These positive DNA effects increase as the intensity of the exercise does.

NUTRITION:

You can greatly improve your health outlook by simply changing certain environmental factors to which you expose your body – specifically, by avoiding harmful compounds (such as harmful trans fats and large amounts of sugar and salt) and including more protective polyphenols (powerful antioxidants found in colourful fruits and vegetables). Every little helps!

© Sarah West Nutrition

Eat like an athlete

HEALTH:

Training for sport requires a combination of endurance, strength, speed and agility. High energy requirements coupled with high fluid loss and the potential for sports injury make a well-established nutrition strategy a must in order to get the best results possible.

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To stay hydrated, you must drink plenty of fluids before, during and after a training session.

Water is all that is needed if you’re exercising for less than an hour, but sports drinks or diluted fruit juice are a better choice for longer workouts. These contain sugars which provide fuel for the exercising muscles and help speed up the absorption of water into your bloodstream.

NUTRITION: 

A diet rich in carbohydrates will provide energy to maintain performance and assist recovery. A high carb, low fat meal should be eaten 2-3 hours before you begin training, with yet more carb-rich foods consumed soon afterwards to help replenish glycogen stores.

It is also important to include protein-packed foods post-workout to aid muscle repair and growth.

© Sarah West Nutrition