Irritable bowel syndrome (IBS), is one of the most common functional gastrointestinal disorders (FGID) affecting 10-20% of the adult population worldwide, yet most challenging when it comes to treatment. The condition is most commonly found amongst Western populations, particularly affecting females and younger age groups.

Its symptoms are chronic, recurrent and heterogeneous, manifesting as lower abdominal pain or discomfort, excessive gas production/ borborygmi, abdominal bloating and distension, altered bowel motility (constipation and/or diarrhoea) and nausea. Some patients may also suffer extra-intestinal symptoms, such as urinary frequency, headache, dyspareunia, heartburn, back pain, sleep problems, fibromyalgia and chronic fatigue. In addition to physical symptoms, IBS sufferers are affected mentally, with mood swings, hopelessness, anxiety and depression being the most common emotional symptoms. IBS is not known to cause bowel cancer or excess mortality, however, it can seriously reduce quality of life, interfering with daily activities, social and occupational life, and often leads to excessive healthcare costs.

What causes your IBS?

The disorder is proposed to be due to a complex interaction between biological and psychosocial factors:

-acute gastroenteritis

-small intestine bacterial overgrowth (SIBO)

-increased visceral sensitivity (where nerves and muscles in the bowel are extra sensitive resulting in pain, discomfort and spasms)

-abnormal gut motor function

-disturbed gas metabolism

-altered gut permeability

-impaired viscerosomatic reflexes and abdominal-wall dystony

-food intolerances

-sex hormones and genetic predisposition

are all plausible mechanisms leading to altered gut flora and microscopic inflammation, which in turn may trigger IBS onset.

Additional factors that your doctor may underestimate:

-Emotional factors – feelings of anxiety, resentment and guilt, psychologically many patients are obsessive-compulsive personalities, trauma, divorce, -accident, bereavement

-Prescription drugs, laxative abuse

-Smoking – nicotine affects motility of the colon

-Lack of dietary fibre

-Yeast overgrowth (candida)

-Caesarian pregnancy and lack of breastfeeding – as antecedents to imbalanced gut flora and hence IBS

-Spinal maladjustment (trapped spinal nerve)

-Insufficient chewing – amylase and lipase in saliva start breaking down carbohydrates and fats, hence less fermentation lower down in the digestive tract, and also send signal to the other parts of the digestive system to prepare for food digestion

-Chronic use of antibiotics, OCP, HRT and steroids, iron, anxiolytics – detrimental effect on gut flora

Food Intolerances and IBS

Food intolerances are among the most common IBS mediators :

1. Lack of enzymes e.g. lactase enzyme to break down lactose from dairy into galactose and glucose. Lactose ferments in the gut causing gas, pain and bloating due to hydrogen production. There may also be lack of pancreatic digestive enzymes, insufficient hydrochloric acid from the stomach and/or insufficient bile to break down fats, all of which lead to insufficient nutrient absorption, creating a vicious cycle

2. Reaction to chemicals, all of which can cause different IBS symptoms, depending on the individual, but mainly bloating, pain and diarrhoea: natural e.g. amines (citrus fruit, cheese, red wine, chocolate, coffee), or additives: MSG, sodium benzoate, nitrates, sulphites, sweeteners (aspartame, sorbitol) and colours (sunset yellow and tartrazine).

3. Raised IgG antibodies – associated with inflammation, which damages the wall of the intestines and can cause leaky gut. Inflammation can also trigger IBS symptoms like pain and spasms associated with particular foods. Gluten intolerance: IBS-like symptoms, as well as fatigue, headaches and joint pains; gluten is a sticky protein that “glues” on the wall of the intestine impairing sufficient digestion and absorption of nutrients. Dairy intolerance – can be due to lactose, casein or whey, fat).

Other dietary factors that can trigger IBS

- Added and refined sugars – not only disturb the balance of the gut flora, but also decrease blood sugar levels. Stress hormones are produced in response, triggering IBS symptoms

- Resistant starch (e.g. amylose in legumes, potatoes, green bananas, rice) – It resists digestion and ferments in the large intestine causing IBS symptoms

- High saturated fat (dairy, meat) – can result in quicker or slower stomach emptying and muscle spasms. Fat malabsorption means Omega 3 is harder to absorb what can increase inflammation, aggravating pain and bloating.

References

Clearing up myths about fat

“Eating too much fat is bad for us.” This is logical. Fatty food intake causes a build-up of fat in our arteries, which clog up and gives us heart attacks; and the same fat also builds up in our body and makes us fat. Cholesterol is traditionally seen as one of the worst fats and has been accused of cardiovascular disease.

This is what doctors have been telling their patients since the 1980s – and some still are. However, this is just a story: cholesterol has wrongly become synonymous with heart disease. Some fats in our diet are not only good for us but essential. Cholesterol and other fats are found in every single cell, meaning we can’t survive without fat. The type of fat, of course, that we choose to consume will dictate whether we support health and vitality or not.

The cholesterol myth

Today we know that thinking was oversimplified and wrong. Heart disease is a complex condition that involves not only cholesterol but inflammation, blood sugar, triglycerides, and a host of other factors. The impact of saturated fat on cholesterol is not so simple either. Some forms of saturated fat raise LDL cholesterol, the so-called bad kind. But at the same time, saturated fat raises HDL cholesterol, the protective kind. Saturated fat also has a beneficial impact on the size and density of LDL. It creates large and puffy particles, which are less atherogenic. Sugar, on the other hand, leads to small and dense LDL particles, which create inflammation and plaque in the arteries.

Cholesterol as a marker of disease is not always useful. A total high cholesterol level is usually bad, but keep in mind that cholesterol is made up of both good and bad lipids. In men, it is more useful as a marker than in women, but in the elderly, a slightly high level is protective (against cardiovascular disease and brain deterioration). A much better marker for measuring the number of high-risk lipids is ApoB, which deposits cholesterol in the wrong places and opens channels in the vessels allowing the lipid to form the plaque that causes the damage. It is the place where cholesterol localises, rather than the total amount that matters more, in contrast to what was previously believed.

High cholesterol foods, like eggs, are often wrongly avoided. Keep in mind that 80% of cholesterol is synthesised inside us and only 20% comes from food. Besides cholesterol is essential in making vitamins (vitamin D) and essential hormones.

Other common fat myths

We are all taught that eating dietary fat leads to accumulation of body fat – that fat that passes through the lips ends up in your hips. Also that dietary fat is to be blamed for the accumulation of plaques in arteries and hence heart attacks. This is far from true. Eating fat doesn’t make you fat and doesn’t cause heart attacks.

The idea of fat being our enemy is based on three main erroneous beliefs:

1. Body fat and dietary fat are the same, so dietary fat becomes deposited as fat in the body once ingested.

2. All calories are created the same. Since a gram of carbs or proteins contains 4kcal, while a gram of fat contains 9kcal, carbohydrates will keep us leaner than fats. However, a Harvard study showed that fat can speed up metabolism and hence help lose weight, what carbs do not do.

3. Cholesterol leads to blocked arteries and further lead up to heart disease.

The anti-fat campaign that started around the 1950’s in the US but mainly in the last few decades, has deprived us of many nutrients and reduced the diversity of food we are eating. So before you routinely reach for the zero-fat labelled items on the shelf, it would be a good idea to find out more about them. Finally, many decades after spreading misinformation about fats, health authorities are confessing that these ideas were wrong. Fat can be very healthy for our bodies when consumed in moderation and in good form.

Fat VS sugar

A higher fat diet is definitely better for us than a high sugar diet, however the type of fat matters.

Fats, unlike carbs, do not contain glucose hence do not spike our blood sugar levels and trigger the release of insulin, which signals the deposition of fat in our fat cells. Fats do the opposite. They increase our metabolism, which means that more calories are burned. In addition, blood sugar, insulin, triglycerides, and HDL cholesterol (cardiovascular markers) all seem to be better following a high-fat diet as compared to a high-carb diet/low-fat diet. Subjects in such studies also show improved muscle mass following a high-fat diet.

In order to replace the fat content, the food industry has steadily increased sugar levels in processed foods. This has led to dire warnings of sugar being the biggest killer of our times.

Studies have repeatedly shown that fats in our blood that cause heart attacks are the ones that come from eating sugar and carbs, not fat. This occurs because our body literally turns carbohydrates to fat in a process known as de novo lipogenesis, which is most active when one consumes lots of sugar and starch.

Eating the right kind of fats and oils can protect you against weight gain. In fact, randomised controlled trials have shown that a high-fat diet beats out a low-fat diet for weight loss. Eating the right fats burns body fat, boosts your metabolism, improves HDL, lowers triglycerides and is associated with significantly lower risk of heart disease, diabetes, and obesity.

To sum up, a high-fat diet is preferred to a high sugar diet, however, meals need to be balanced and everything should be consumed in moderation. The kind of the fat also plays a big role. Besides, trans and hydrogenated fats, which are the “bad” fats come with high carbohydrates.

Low-fat VS high-fat products

It is common sense that anything that is processed, is not the best option. Not only because chemicals are often added to low-fat products, but also sugar is most commonly added to counterbalance for the loss of taste, e.g. dessert yogurts. Also, as mentioned above, full-fat products allow for the absorption of fat-soluble nutrients like vitamins A, D, E, K and hence calcium. The importance of saturated fat is highlighted above.

References

Hyman, M. (2018). Food.

While millions of people have been self-isolating in an effort to reduce the spread of COVID-19 and the curve has flattened in many countries, it is still very important that we aim for optimal health in order to protect ourselves against the coronavirus disease.

Am I at risk?

Scientific data confirms that both pre-existing health conditions and age are independently associated with COVID-19 severity. Data suggests that people under 65 with a pre-existing condition have about the same risk of being hospitalized as people over 65 without a pre-existing condition. Having a pre-existing condition at any age doubles or triples your risk of being hospitalized.

What qualifies as a pre-existing condition or risk factor?

• chronic lung disease

• diabetes, Pre-diabetes and Insulin Resistance

• cardiovascular Disease

• metabolic Syndrome

• obesity

• chronic liver disease

• chronic renal disease

• being immunocompromised

• neurological disorder

• neurodevelopmental or intellectual disability

• smoking

• pregnancy

WHAT DOES AN IMMUNE-BOOSTING DIET LOOK LIKE?

1. Aim for whole foods, and avoid anything processed, packaged, ready-made. Avoid sugar and white flour – I can’t emphasize this enough.

2. Tons of vegetables. You should aim for 7-9 portions of fruit and vegetables every day (fruit should be no more than 2 portions). Aim for colourful fruit and vegetables (eat your rainbow) to gain as many antioxidants as possible. Fruit juices (even fresh) are a bad idea.

3. Specific immune-boosting vegetables: dark green leafy vegetables, like kale, rocket, spinach, mustard greens, beet greens, chard. Cruciferous vegetables, like cabbage, broccoli, cauliflower, kale, mustard greens, Broccoli sprouts, turnips. Make sure you have at least 1-2 cups of each category daily. When it comes to fruit, frozen berries and strawberries, as well as citrus fruit contain the most immune-boosting properties. To the surprise of some, some of the richest foods in vitamin C are broccoli, strawberries, peppers, greens. Fermented unpasteurized vegetables, like sauerkraut, pickles and kimchi improve your gut flora and boost immunity. Have 1-2 tbsp daily.

4. Water, water, water: You should drink at least 2-3 litres of water depending on your weight and level of activity. You should aim for about 1 litre for every 22kg – especially if exercising.

5. Sulphur-rich foods are great for liver detoxification and for boosting the immune system: garlic, onion, asparagus. Anti-inflammatory foods like turmeric, ginger, nuts and seeds, garlic, EVOO, avocado are also very important.

6. You should not forget about your omega fatty acids, found mainly in wild-caught oily fish (like sardines, mackerel, anchovies, wild salmon, herring), dark green leafy veg, EVOO, olives, coconut oil, grass-fed meats, pasture-raised eggs, nuts and seeds and their butters, tahini, avocado.

7. Probably the most important of all is to keep your insulin levels as stable and low as possible. You should seek help from a professional to specify your personal daily carb needs. Keeping carbohydrates to a minimum is very important.

8. Avoid takeaways and deliveries. Make sure that you eat from scratch, so that you know what exactly goes through your body. Don’t forget: your fork is the most powerful medicine.

9. Aim for organic when possible. If, due to the situation, you cannot find everything organic check the ‘Dirty Dozen’ and ‘Clean Fifteen’ lists.

10. An adequate amount of protein, either animal or plant-based. Aim for about a palm-size with every meal. Again, this should be specified by a professional.

WHAT SUPPLEMENTS SHOULD I FOCUS ON?

1. At least 4000IU of vitamin D. Higher doses should be taken if you have a chronic or autoimmune disease.

2. 2 grams of vitamin C in a bioavailable form, in divided doses.

3. A strong, quality multi-vitamin.

4. High-strength probiotics.

5. An antioxidant formula (containing zinc, NAC or glutamine etc) or an antioxidant or immune-boosting powder.

*Note that not all supplements are created equal, so it is very important that you avoid high-street supplements and seek the help of a professional for a personalized plan.

WHAT ABOUT PANICKING?

Panic has repeatedly shown that it weakens the immune system. It is very important that at this stage you try to remain calm. Quarantine has been hard for all of us, but you should try to make something good out of this. Some great ideas are:

- A new exercise routine, like brisk walking in nature or connecting with your friends or even people you don’t know, for live online yoga sessions. Connection can help bring those stress levels down.

- Begin your day with deep breathing/meditating and have your breakfast out in the sun – when possible.

- New hobbies, such as creative healthy cooking with the family.

- Mini trampoline with music! This will boost your lymphatic drainage and improve your immunity.

- Read your favourite books (feel free to get in touch if you need any suggestions for health/nutrition/mindfulness and self-help related books). Watch your favourite movies.

- Don’t forget to protect against the UV blue light in the evening.

- Get at least 7-8 hours of sleep each night. Nap if needed.

- Self-care and self-love are the most important things to be practised daily, whether in quarantine or not.

- Should you have any worries about you or your loved ones being at risk or need a little help with your diet or your supplement regimen or you simply need help to bring those stress levels down, contact me.

Stay calm & safe!

References

Antoni, M. and Dhabhar, F., 2020. The Impact Of Psychosocial Stress And Stress Management On Immune Responses In Patients With Cancer.

Bell, V., Ferrão, J., Pimentel, L., Pintado, M. and Fernandes, T., 2018. One Health, Fermented Foods, and Gut Microbiota. Foods, 7(12), p.195.

Black, D. and Slavich, G., 2020. Mindfulness Meditation And The Immune System: A Systematic Review Of Randomized Controlled Trials.

Cai, Y., Li, Y., Tang, L., Tsoi, B., Chen, M., Chen, H., Chen, X., Tan, R., Kurihara, H. and He, R., 2020. A New Mechanism Of Vitamin C Effects On A/FM/1/47(H1N1) Virus-Induced Pneumonia In Restraint-Stressed Mice.