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A digested guide to perfect digestion: Experts reveal how to relieve common symptoms – with some very surprising advice
We are a nation obsessed with our guts. From bloating to bowel issues, an estimated nine million of us have problems with our digestive systems.
‘The number of people being diagnosed with digestive disorders is on the rise, as people are taking their symptoms more seriously and are getting diagnosed earlier,’ says Dr Anton Emmanuel of the gut health charity CORE.
One in five of us suffers with Irritable Bowel Syndrome (IBS), a disorder of the gastrointestinal tract characterised by diarrhoea, stomach cramps and bloating.
Many of us resort to all kinds of measures for a healthy gut, chomping through bowls of high-fibre cereals and guzzling water. But could we be unwittingly making our symptoms worse?
Here, some of the country’s leading digestive experts dispel the most common myths and advise how to have a happy gut.
DITCH THE FIBRE
IBS patients are often told to eat more fibre. ‘But this is the worst thing for a significant number of patients, particularly when it comes to bran,’ says Peter Whorwell, professor of medicine at Wythenshawe Hospital in Manchester and a leading authority on IBS.
‘While eating more fibre undoubtedly helps to sort out mild constipation, it’s rarely helpful for severe IBS symptoms and it won’t help diarrhoea. Fibre is a bulking agent which gives the bowel even more work to do, so it’s likely to worsen symptoms in people with severe constipation.’
Instead, he advises white bread, white pasta, biscuits and cream crackers — anything made from refined white flour, as these don’t contain as much ‘rough’ fibre.
This means giving up not just wholemeal or granary bread, but brown pasta, most cereals and cereal bars, as well as digestive biscuits, which many people don’t realise are wholemeal. ‘It sounds daunting, but patients really do find their health improves,’ he says.
White bread is good for you: While eating more fibre undoubtedly helps to sort out mild constipation, it’s rarely helpful for severe IBS symptoms
IT’S OK TO USE LAXATIVES
Many people who suffer from chronic constipation say they feel tired and lethargic, but much better once they’ve been to the loo, says Professor Whorwell. ‘A good guide is that going to the loo any more than three times a day is classed as diarrhoea, and any less than three times a week is constipated.’
And rather than suffer, he advises taking a daily laxative. ‘It’s a fallacy that laxatives damage the bowel. The fact is some people are always going to have a sluggish bowel whatever they do. In this case, you’re better off emptying your bowels regularly rather than worrying.’
The best bet for most people is a laxative containing polyethylene glycol (macrogol), which is found in products such as Movicol and Dulcobalance. These draw water into the bowel and are safe to take once a day.
‘Andrews Salts (available from pharmacies) is a magnesium form of laxative which works in the same way,’ says Dr Peter Fairclough, a consultant gastroenterologist at the London Clinic. ‘These are a more gentle version of Epsom salts; not only do they taste better, but the results aren’t so violent.’
Start with 2tsp in a glass of water at night and gradually increase the dose until you get the desired effect.
Andrews Salts is a magnesium form of laxative which draws water into the bowel and is safe to take once a day
TAKE A HAPPY PILL
We know the brain is full of nerves, but many people don’t realise the gut is driven by nerves, too, says Dr Deepak Suri, consultant gastroenterologist at the Whittington and St John and Elizabeth Hospitals in London. ‘The gut has its own nerve system; that’s why you get “butterflies” in your stomach if you’re nervous or have a “funny” tummy before an important event,’ he explains.
Stress is to blame for a large proportion of digestive problems, adds Dr Nick Read, chairman of the IBS Network (formerly the Gut Trust). ‘It takes blood away from the digestive system, drying up the secretions that help us digest food and also sending the muscles into spasm, hence that stomach ache.’
Because of this, one of the best treatments prescribed for people with chronic IBS symptoms is a low-dose antidepressant, usually Amitriptyline. ‘It basically desensitises the gut and is quite often used when a patient still has problems after trying the usual treatments such as anti-spasmodic medication and laxatives.’
Two-thirds of patients with IBS find psychological treatments can help ease symptoms when medicine hasn’t helped, says Dr Julian Stern, a consultant psychiatrist at St Mark’s Hospital in Harrow, which has a specialist unit investigating the relationship between emotional trauma and the gut. We are not saying their problems are in their head, just that stress and other unresolved psychological issues may be a contributory factor.’
A range of treatments is available, including counselling to look at any underlying issues (such as a bereavement or trauma) to gut-directed hypnotherapy, which can help two-thirds of patients, and cognitive behavioural therapy. Availability of these treatments on the NHS varies, but all can be done privately.
Don’t glug water: Drinking a lot will not necessarily help you feel less constipated
Some people may find eating the recommended five portions of fruit and vegetables upsets their gut, either because it has a laxative effect or because the fibre from the skin is too harsh, says Dr Emmanuel of CORE. ‘If this is the case then don’t torture yourself trying to achieve it.’
DON’T GLUG WATER
‘There seems to be a craze that we’ve got to drink three litres of water a day, but it’s a complete scam,’ says Dr Fairclough. ‘I see many patients who say they drink this amount, yet they are still constipated.’
Water is absorbed into the blood stream before it reaches the large intestine, he explains — and it’s the large intestine that determines the consistency of stools.
‘Some people just have a sluggish bowel,’ says Dr Peter Fairclough. ‘This often seems to run in families. Drinking a glass of prune juice could also help ease constipation.’
Common painkillers such as codeine and morphine are notorious for causing constipation, says Dr Emmanuel. ‘They stop pain signals, but also block the messages that tell the gut to keep things moving along.’ Blood pressure tablets and iron supplements are other known culprits.
Many people with IBS complain of stomach cramps, caused by spasm in the circular muscle around the bowel. ‘You can help prevent this by avoiding irritant foods such as coffee, fat and chocolate,’ says Professor Whorwell.
‘If they still occur then an anti-spasmodic drug such as Buscopan Cramps can really help.
‘Avoid ibuprofen wherever possible, as this can irritate the gut. If you can’t get hold of an anti-spasmodic then paracetamol is a much better bet.’ Another natural anti-spasmodic is peppermint oil, which is available in capsules, or you could swap your coffee for peppermint tea, adds Dr Suri.
PROBIOTICS CAN HELP
Anyone interested in their gut health should consider taking a probiotic, or ‘good’ bacteria, says Glenn Gibson, professor of microbiology at the University of Reading and a leading authority on probiotics.
‘Probiotics have been shown to fight “bad” bugs in the gut and improve intestinal health, easing symptoms such as bloating and constipation. Look for products containing lactobacillus and bifidobacterium and in quantities of more than 10 million.
‘I particularly like Morrisons Active yoghurt drinks which have probiotics and prebiotics. [The latter help the former to survive.]
‘With tablets, I would recommend Multibionta, as the capsule has a protective coating around it which protects the probiotics from stomach acid until they reach the large intestine.’
A controlled trial published in the journal Ailmentary Pharmacology and Therapeutics found that women who ate two plain Activia yoghurts a day improved the rate at which waste passed through the gut by up to 75 per cent.
LAUNCH A PRE-EMPTIVE STRIKE
If you know you get stomach cramps after a big meal or before an important event, don’t be afraid to take an anti-spasmodic drug beforehand, says Professor Whorwell.
The same goes for taking Immodium if you tend to suffer from diarrhoea at times.
‘There’s no need to wait until the problem starts to treat it — in fact, it’s better to prevent it in the first place.’ (But never start taking medication without a diagnosis, as this may mask symptoms of more serious disease.)
Keep fit and trim: Being obese puts you at a high risk of not being able to control bowel movements and becoming incontinent
A GOOD REASON NOT TO GET FAT
Being obese puts you at a high risk of not being able to control bowel movements and becoming incontinent, says Dr Emmanuel. ‘The extra weight puts enormous pressure on the pelvic floor, which plays a role in continence, and the natural “S” shape of the intestine can no longer be retained. This rapidly speeds up the digestive process, causing diarrhoea and incontinence.’
RULE OUT COELIAC DISEASE
An increasing number of people with gut problems are being diagnosed with Coeliac disease, where the body is intolerant to gluten, says Dr Emmanuel. ‘Crucially, many people are being diagnosed between the ages of 40 and 60, so if you have any number of symptoms such as bloating or diarrhoea then get yourself checked out — it usually just involves a blood test.’
‘Inflammatory bowel disease [such as Crohn’s and ulcerative colitis] is also on the rise and strike at any age,’ says Dr Mike Stroud, consultant gastroenterologist at the Spire Southampton Hospital.
Never self-diagnose a food allergy or intolerance, says Dr Read — see your GP for a proper test.
DON’T IGNORE YOUR PROBLEMS
Many people worry about how often they go to the loo, but it’s a change in habits which should ring alarm bells, says Professor Mayberry. If you suddenly get constipated or diarrhoea and it lasts for more than a few days, see your GP who will refer you for a colonoscopy, an internal examination, usually under sedation.
Bowel cancer is the second-biggest killer in the UK, says Dr Suri. ‘But before it develops there tends to be a ten-year window before non-malignant changes such as abnormal cells and polyps become cancerous. These changes produce the tell-tale bowel cancer symptoms such as bleeding and a change of bowel habit.
‘That’s why it’s important not to ignore symptoms. At an early stage, these things can be removed in a straightforward, half-hour procedure at the time of colonoscopy. If you let the cancer develop there’s the possibility of chemotherapy, surgery, a colostomy bag and poor survival.’
For more information: ibs-care.org, thegutrust.org, corecharity.org.uk