It’s a difficult time for everyone, with the Covid-19 outbreak bringing severe and unexpected changes to our lives, along with new concepts like ‘social distancing’ and ‘cocooning’.
Here at TheJournal.ie, we are running a weekly Voices column, ‘Wellness Wednesday’, in which we feature advice and information from mental health professionals, yoga teachers, mindfulness practitioners and many more. We hope this weekly section will help you, our readers, navigate this unprecedented shift in how we live.
April is irritable bowel syndrome awareness month and so today we hear from Dr Deirdre G. O’Donovan, Consultant Gastroenterologist at the Blackrock Clinic about IBS. She offers advice on how to manage it in a difficult time:
THERE ARE THOUSANDS of symptoms of IBS that people can experience from bloating, cramps and unpredictable bowel movement. Stress is also known to be a factor for sufferers.
In Ireland, IBS affects 20,000 people and the figure is much higher, of course in the UK. Females are twice as likely to be affected as males, with younger females even more affected.
IBS is a complex and debilitating condition for which there is no known cause. However, many doctors now agree that symptoms can be triggered by psychological as well as physical factors. People suffering from IBS have been known to carry spare toilet tissue and research the location of toilets before going out. IBS can take a toll emotionally also with people feeling depressed, anxious and having low self-confidence and social isolation can make things worse.
The syndrome significantly affects the quality of life of patients and they can end up being isolated from friends, family, colleagues and even their partners as a result of IBS flare-ups. Symptoms such as unpredictable bowel movements mean they constantly need to be “within reach of a toilet.”
Microbiome is the key
In addition to this, there is growing evidence suggesting that the gut microbiome can influence sleep quality. In some cases, our energy levels are profoundly affected by our gut health.
This can be through a number of mechanisms – we are all familiar with that desire to have a nap after dinner and that is because a high-calorie meal requires an increase in blood flow to the gut as part of the digestive process with an associated drop in blood pressure systemically and particularly to our brains, hence that sleepy feeling.
Meal composition, therefore, is important if we want a nice balance of macronutrients to allow an easier digestive process. Some people will drop their blood pressure significantly after a carbohydrate-rich meal. This applies particularly to people with diabetes and older patients so again they may feel tired after a meal. They may even run the risk of fainting and that’s caused by a problem of the autonomic nervous system. In many cases, conditions like coeliac disease, when untreated, cause fatigue because patients are not absorbing necessary nutrients, especially iron from their diet.
Anaemia and brain fog
Other gut-related diseases which cause bleeding from the bowel can also result in anaemia and the lack of energy that brings may be the only sign to alert to someone that something is wrong.
For others, dysbiosis, or alterations in the natural gut flora can contribute to what many refer to as ‘brain fog’ and profound mental ‘weariness’ and this can be helped by introducing a good probiotic. Alflorex is one I generally recommend. Fermented foods, such as kefir have been found to make a major difference, with University College Cork leading the way in research into the microbiome.
It’s clear with IBS, the causes can be varied so if simple interventions such as looking at meal composition and trying a probiotic don’t work then people are advised to see their GP.
I think there is a growing awareness in the public that what they eat and the gut health has a direct bearing on their energy levels. What I would be more worried about is people not making the connection that if it’s not improving it may be a sign of a more significant process going on that needs medical input.
What is happening in our gut when we’re feeling run down and tired? A lot, potentially! Depending on the cause feeling run down can reflect underlying anaemia i.e. low iron, or a vitamin B12 deficiency.
In those cases, your gut ‘villi’, the finger-like projections that absorb iron may be faltered as in the case of coeliac disease or there may be antibodies floating around in the blood preventing the absorption of B12 as in the case of Pernicious anaemia.
What is very interesting is that a large proportion of our immune system is based in our gut and our resident gut flora likely interacts with this on a daily basis, potentially switching on and off certain immune responses.
This is an area where a lot of research is happening currently, so we await the outcome of those investigations. This research might be helpful in telling us what’s happening to our gut flora during periods of stress in our lives and how our immune systems respond to the changes. What is key here will be finding ways we might influence this process positively.
People often ask if there is anything they can do to help their gut in relation to IBS. I would say these simple changes will make a big difference:
Listen to your gut
We are not designed to cope with stress 24/7 so make sure to keep up your ‘self-care’, whether it’s getting up and going for a walk, learning to say ‘no’, mindfulness, yoga whatever works for you. Complementary therapies such as acupuncture can also play a role.
There is also the ongoing debate ‘nature vs nurture’ but we can’t blame genetics for everything. Genetics can play a role in some conditions affecting the bowel, such as inflammatory bowel disease, but often the timing of the disease presenting itself is influenced by a stressful period in one’s life, which affects immune responses. It sounds corny but we all need to listen to our bodies. Try and respect them as outlined above. Most people have a sense that something is not right so act on that ‘gut feeling’.
Dr Deirdre O’Donovan’s 12 facts about good gut health and managing IBS
1. Fibre
Add more fibre to your diet. Become familiar with the labels on your food. If a product has more than six grams of fibre per 100-gram portion, then that’s considered a high fibre product. Foods like porridge and wholegrain cereals are top of the tree, but simple changes like swapping wholegrain bread for white bread can make a real difference.
2. Plant-based foods
Help your gut to help itself by taking in a wider variety of plant-based foods. Our guts are filled with good bacteria, that make up what’s called our gut flora. By eating more fruit, vegetables and pulses we are not only eating healthily for ourselves, but we’re also ensuring our gut flora are eating healthily. To help further, avoid processed foods and choose a better alternative.
3. Limit red meat
Try to limit red meat, and increase your intake of fish. Red meat is fine in moderation, but eat too much and you increase the likelihood of consuming too many nitrates. This can adversely affect long term gut health.
4. Eat regularly
Don’t allow too long between meals, and when you eat, make sure you chew your food well before swallowing. Give your gut every chance to absorb the best nutrients it can from what you eat as the food passes through.
5. Stay hydrated
We all need at least six cups of water per day to stay healthy. While cups of tea and coffee are fine in moderation, try and drink peppermint tea and camomile where possible.
6. Prebiotics and probiotics
Explore the use of prebiotics and probiotics. Prebiotics are foods that can encourage the growth of good bacteria in the gut, such as asparagus, leek, artichoke, onions and garlic. Probiotics are products that can directly add good bacteria to the gut to help it stay healthy and are available in chemists and health food shops.
7. Vitamin D
As well as probiotics and prebiotics, consider adding some vitamin D to your diet. Known as the sunshine vitamin, it interacts well with your gut flora.
8. Be active
Exercise helps the whole body, and has been shown to improve the transit time for food through your gut. If you exercise regularly, while implementing the social distancing guidelines, the odds are higher that your bowel will be regular.
9. Alcohol reduction
Drinkaware, the national charity working to prevent and reduce alcohol misuse in
Ireland is encouraging the public to manage the time spent at home or in self-isolation
without alcohol, given that 50% of Irish adults cite ‘coping’ as motivation for their
drinking habits.
This one might not be popular, but you need to reduce your alcohol intake. As well as
taking on empty calories that add weight, alcohol consumption can affect your bowel,
impact your liver function and increase the risk of serious illness, such as cancer.
Equally, avoid smoking for obvious reasons.
10. Destress – reduce your stress
Studies have shown that there is a link between the brain and the gut, called the gut-brain axis that runs along what’s called the vagus nerve. Emotional stress can result in bowel disturbance, as the brain releases certain endorphins that can lead to what your mother would have called “butterflies in the tummy”.
11. Sleep – try to get a good night’s sleep
Those with irregular sleep patterns, such as shift workers, can experience a disturbance in their gut flora as their circadian rhythm is disturbed. Taking a product like Alflorex can sometimes help.
12. Don’t ignore
Most importantly, don’t ignore red flag symptoms that your gut is in distress. These include unexplained weight loss, persistent heartburn, a change in bowel habit or any bleeding from the back passage. Should you experience any of these, seek urgent medical help from your GP.
Dr Deirdre G. O’Donovan is Consultant Gastroenterologist at the Blackrock Clinic in Dublin.
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