Category: Chronic health problems

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A gentle introduction to IBS for IBS Awareness Month

Irritable Bowel Syndrome

Irritable bowel syndrome (IBS) is an invisible, fluctuating disease and as such it is often difficult for family members, friends, colleagues, health service professionals, welfare insurance administrators and others who encounter people with the disease to understand the suffering of the individual.

People with IBS are often faced with troublesome and sometimes severe physical symptoms that in different ways obstruct or challenge their everyday life. The disease is by its nature potentially shameful. In our modern western society some of our most fundamental bodily functions, like flatulence and defecation, are considered to be private and nothing you would want others to know about. Hence, for many persons with IBS, sharing their illness experience does not come easily.

Among healthcare professionals, knowledge about IBS is quite often insufficient and it is regarded as a low-priority disease. Sometimes IBS patients find that their troubles are dismissed or belittled, for example, in healthcare encounters or by family members. Not being taken seriously – at home or by healthcare professionals – can be a devastating experience which affects self-image. For some people getting the diagnosis is affirming, providing a legitimate passport to the healthcare system. For others, however, being diagnosed means nothing but being a ‘closed-case’, and they feel left with insufficient information, advice and support. They find they have more questions than answers. In the jungle of potential self-management suggestions (available through various websites, blogs and chat forums) about what to eat, when to sleep or how to behave if you get urgent bowel movements and start to panic on the bus, it is easy to get confused. Being on your own, having to figure out how to live the rest of your life with an illness that won’t go away, and a disease for which there is no treatment or clear and certain ‘rules’ to follow but learning to know one’s own body and what works best, is not an easy task.

Literature about IBS has until now tended to be either too medically orientated, complex and difficult for lay people to understand, or to be like a pamphlet, too brief to be useful. Irritable Bowel Syndrome is therefore a very much welcomed contribution for all laypersons – people with IBS, family members, colleagues, neighbours and others who for some reason need to learn more about the disease, what life with IBS is about and what help is out there. The book offers a thorough explanation of the mechanisms and (as far as there is scientific evidence) likely causes of IBS, and of available pharmacological and non-pharmacological treatment options. It also portrays life with the illness from the perspective of those who live with the disease, and linked to this, a variety of self-care strategies are described. The book can of course be read as a whole, but it also forms a very useful reference book for certain aspects or topics of particular interest to the reader. I am certain that anyone who is interested in knowing more, or has specific questions, about IBS will find useful information and answers to their questions.

Cecilia Håkanson RN, PhD is a researcher and senior lecturer at the Palliative Research Centre and the Department of Health Care Sciences at Ersta Sköndal Bräcke University College, Stockholm, Sweden. She is also an affiliated researcher at Karolinska Institutet, Department of Neurobiology, Care Science and Society, in Stockholm, Sweden.

This extract is taken from Irritable Bowel Syndrome: Navigating your way to recovery By Dr Megan Arroll and Professor Christine Dancey

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Eat to beat depression

Eat to beat depression for World Health Day

Tackling depression naturally for World Health Day

Nutrition-related health issues seem to take an age to become part of accepted medical practice. The medical establishment requires comprehensive scientific evaluation, randomised trials and peer review before a new drug can be licensed, for instance. The pharmaceutical company has to weigh up the costs of research and development versus the potential profit to be made from launching a successful product that can earn a good return on their investment. (When you add in the factor that 80 per cent of their budget goes on marketing, it is clear the stakes are high indeed.) As real food is simply real food and can’t be licensed, branded or patented, there is little impetus for the medical community to fund costly research.

Medical research over the last couple of decades has, nevertheless, highlighted how an unhealthy gut can contribute to many physical diseases and these findings are becoming more accepted in mainstream medicine. Clinicians increasingly agree that the gut-brain axis also plays a crucial part in emotional wellbeing, including the development of conditions as diverse as chronic fatigue syndrome, depression and autism.

The Gut-Brain Axis

The gut-brain axis is a way of describing the interrelationship between gut health and brain health. The various aspects of digestion are controlled via the vagus nerves by a complex set of neurons embedded in the oesophagus, stomach, intestines, colon and rectum. The brain sends messages to all the nerves in your body, including the neurons that control digestion. All work efficiently enough until a person is anxious or stressed on an ongoing basis. You perhaps know for yourself that if you are feeling nervous your stomach can feel upset and queasy. The reason for this is that strong negative emotions, stress and anxiety increase cortisol and adrenaline, which then stimulate the sympathetic nervous system and shut down the parasympathetic system, which includes control of the gut. This causes a physical chain reaction:

* Reduction in pancreatic enzyme production

* Reduction in gall bladder function

* Reduction in the production of stomach acid

* Slowing down of peristalsis – the involuntary muscle movements essential for moving food efficiently through intestines for the absorption of nutrients

* Reduction in blood flow to the intestines

* Suppression of the intestinal immune system

In the short term, this allows the body to focus its resources on ‘fight or flight’ – a good survival mechanism. However, with ongoing stress and anxiety, this cumulative slowing down and suppression of the digestive process can, over a prolonged period, lead to a condition called ‘small intestinal bacterial overgrowth’ (SIBO). As the digestive process is compromised by stress and anxiety, the lack of stomach acid allows the stomach and small intestine – which should both be pretty much microbe free – to be colonised by unhealthy bacteria, and yeasts, causing foods to be fermented rather than digested. In addition to gas and bloating, compromised digestion leads to declining absorption of nutrients, which contributes to the loss of the co-factors needed for good digestion, and consequently further gut problems.

Now consider this situation lasting for extended periods of time. The integrity of the gut lining may be compromised, contributing to gut permeability (‘leaky gut’) that may be sufficient to produce chronic low-grade inflammation.

Chronic Inflammation

The inflammatory process includes the production of cytokines, chemical signals of inflammation that are carried by the blood to the brain. The cytokines can activate cells – so that the inflammation originating in the gut thereby causes widespread inflammation in the rest of the body, including the brain.

The impact of brain inflammation is that the brain has reduced nerve conductance which – guess what – shows up as depression, anxiety and stress.

This vicious circle can self-perpetuate and requires long-term changes to heal the gut, which in turn will help to heal the brain. This is done through changes in behaviour and improving levels of nutrition through changes to food choices. To improve your natural resilience to stress it is important to increase the amount of healthy polyunsaturated omega-3 oils in your diet, so look for oily fish, grass-fed meats and butter made from the milk of grass-fed dairy herds. Good plant sources include hemp seeds, linseeds, chia and some nuts and nut oils (macadamia, almond).

If you consider yourself to be depressed it will be helpful for your recovery to manage your stress levels, improve your sleep patterns and add nutritious and gut-healing foods into your regular eating plan.

Do bear in mind, however, that you may also need professional help if you have been suffering from this debilitating psychological disorder for some time. Please make sure you are accessing all the medical and psychological support you need. Try hard not to add isolation to an already challenging situation.

This blog has been taken from How to Feel Differently About Food by Sally Baker & Liz Hogon.

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Invisible Illness: recognising the symptoms of Pernicious Anaemia

Invisible Illness: recognising the symptoms of Pernicious Anaemia

Pernicious Anaemia (PA) is an invisible illness caused by deficiency in vitamin B12 owing to problems absorbing it from food.

Everyone is different and sufferers of pernicious anaemia will experience the symptoms of the condition to varying degrees. Some patients will have all of the symptoms listed below while others will recognise only a few. This list has been compiled over a number of years and shows what a wide range of symptoms there can be. There are two problems with this wide range. First, many of the symptoms listed below are associated with other medical conditions, which often leads to confusion with other invisible illness and misdiagnosis. Secondly, because there are so many symptoms associated with pernicious anaemia, it makes it difficult for doctors to identify the symptoms specific to the disease – thus making an early diagnosis even less certain.

Common general symptoms of Pernicious Anaemia

  • Shortness of breath – ‘the sighs’
  • Extreme fatigue
  • Brain fog
  • Poor concentration
  • Short-term memory loss
  • Confusion (‘handbag in the fridge syndrome’)
  • Nominal aphasia (forgetting the names of objects)
  • Unaccountable and sudden bouts of diarrhoea, often following a spell of constipation
  • Clumsiness/lack of coordination
  • Brittle, flaky nails; dry skin anywhere on body
  • Mood swings, ‘tear jags’, heightened emotions
  • Sleep disturbance
  • Even though patient is exhausted, is unable to sleep
  • Waking up still tired, even after many hours’ sleep

Neurological symptoms of Pernicious Anaemia

  • Balance problems
  • Dizzy/faint
  • ‘Shoulder bumps’ – frequently bumping into or falling against walls
  • General unsteadiness, especially when showering and dressing
  • Inability to stand up with eyes closed or in the dark
  • Vertigo – inability to cope with heights, linked to the need for a visual reference as compensation for damage to the brain’s balance mechanism
  • Numbness/tingling – especially in hands, arms, legs, feet
  • Burning sensation in legs and feet – Grierson-Gopalan syndrome
  • Tinnitus – ringing/screeching/howling in the ear or ear
  • Neuropathic pain/fibromyalgia – often on only one side of the body
  • Irritability/frustration/impatience; desire for isolation, quiet and peace; aversion to bright lights and crowded spaces

Skin problems associated with Pernicious Anaemia

  • Hair loss – can range from moderate to sever; premature greying of hair
  • Psoriasis/eczema/acne
  • Rosacea – reddening of the skin around the nose and cheeks
  • Vitiligo – white patches that develop on the skin

Other medical problems associated with Pernicious Anaemia

  • Poor digestion
  • Arrhythmia – irregular, fast or slow heartbeat

Autoimmune conditions associated with Pernicious Anaemia

  • Rheumatoid arthritis
  • Hypo- or hyper-thyroidism – almost exclusively among females
  • Coeliac disease – sensitivity to wheat and/or wheat products
  • Myasthenia gravis – weak muscles leading to problems swallowing, chewing and opening eye(s)
  • Psoriatic arthritis

Vitamin B12 deficiency can be detected with a blood test, and if this deficiency is then determined not to be caused by diet it may be a clue that Pernicious Anaemia is the underlying invisible illness.

To learn more about Pernicious Anaemia diagnosis and treatment read What you need to know about Pernicious Anaemia and Vitamin B12 Deficiency by Martyn Hooper, founder of The Pernicious Anaemia Society.

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Is it ‘just’ indigestion?

Indigestion is that uncomfortable feeling most of us have experienced at some point in the upper abdomen or lower part of the chest – usually after eating or drinking (but not always). The official medical definition is upper abdominal discomfort or pain that may be described as a burning sensation, heaviness or an ache. It is often related to eating and may be accompanied by other symptoms, such as nausea, fullness in the upper abdomen or belching. It’s usually worse if you lie down directly after eating a heavy meal.

Other names for indigestion include dyspepsia and acid reflux or heartburn. It is basically an inflammation of the gullet (oesophagus) – the long pipe that runs from the mouth to the stomach. Indigestion is so common most people will have experienced it at some time and it’s usually more of a fleeting inconvenience than a major health problem. Most people don’t see their doctor about it and either grin and bear it or simply treat it themselves with remedies they can buy over the counter from a chemist. Only a quarter of people who suffer indigestion see their GP about their symptoms and about 10 per cent of these consultations will be referred for further investigations.

Indigestion is rarely a symptom of a serious underlying medical condition (but if you are worried check out our list of reasons for an urgent referral, below). In people who have an endoscopy to investigate their indigestion, 30 per cent will have no abnormal findings and 10 to 17 per cent will have oesophagitis (inflammation of the oesophagus) and the rest will have gastric or duodenal ulcers, gastritis, duodenitis (inflammation of the duodenum) or hiatus hernias, according to the British Society of Gastroenterology.

But, having said that, we’re not saying indigestion can’t still affect your quality of life and be a pain to deal with. If you’re one of the unfortunate ones who suffer from recurrent severe bouts of indigestion, Chapter 8 in What’s Up With Your Gut may help you get to the root of what’s causing your symptoms, help you find some long term relief and enable you to enjoy your food again.

Symptom Checker

If you have one or more of the following symptoms, you may have one of the conditions discussed in this blog.

  • Burning sensation, fullness, heaviness or ache in upper abdomen or lower chest
  • Burning, griping pain in the abdomen, lower gut and back
  • Sharp, persistent pain at the top of the stomach or above ribs on right
  • Bitter taste in the mouth
  • Nausea, vomiting
  • Bloating
  • Belching and burping
  • Lump in your throat
  • Tickly cough

What causes indigestion?

Diet

Most people associate indigestion with overdoing it, with a big meal, sometimes with a high fat or spice content – creamy curry sauces and dishes containing chilli for instance. You might also notice that particular foods can trigger your symptoms, including curries, fatty foods, citrus fruits, bananas and cucumbers – it’s very individual though. Sometimes however, it can be down to something simple such as eating too fast or too close to bedtime. Drinking too much alcohol, or caffeine in coffee, tea and chocolate may have a similar effect.

Drug side effects

There are many other causes of indigestion and sometimes the cause isn’t so obvious. These other causes include the side effects of drugs, including non-steroidal anti-inflammatory drugs (NSAIDs) taken to relieve the pain of arthritis (such as ibuprofen and aspirin) and nitrates prescribed for angina for instance.

Acid reflux or GORD

A major cause of recurring indigestion is acid reflux, or gastro-oesophageal reflux disease (GORD), which is caused by the sphincter in the oesophagus failing to close and prevent

large amounts of stomach contents, including acid, moving back up from the stomach and causing irritation and inflammation in the oesophagus. The inside of the oesophagus has a protective lining but it can become irritated and inflamed by stomach acid. If the lining becomes ulcerated by the stomach acid, it causes a condition called oesophagitis. Sometimes stomach acid can escape back up from the stomach to the oesophagus due to gastric and duodenal ulcers (known collectively as peptic ulcers), which are sores which develop in the lining of the stomach or duodenum. Peptic ulcers can be caused by a bacterial infection called Helicobacter pylori.

Another cause of GORD is hiatus hernia – where part of the stomach pushes up through the diaphragm (the sheet of muscle between the abdomen and the chest, needed for breathing), partially blocking refluxed stomach acid in the oesophagus. Being overweight or obese (including weight gain due to pregnancy) will make it more likely you’ll suffer from acid reflux – obesity causes more pressure in the abdomen which forces acid back up into the gullet. This is also true if you are constipated or wearing clothes with a tight waistband. Chemicals in cigarette smoke can also relax the ring of muscle that divides the stomach from the oesophagus and make it easier for stomach acid to escape back into the gullet, causing acid reflux/heartburn symptoms. Stress and anxiety are also believed to play a part in indigestion, as is increasing age.

If you have some of the ‘alarm bell’ symptoms described below you should be considered for urgent endoscopy referral rather than taking any prolonged treatments which may mask the symptoms of a more serious illness.

Reasons for an urgent referral

NICE advises that:

  • people with an upper abdominal mass require urgent referral for endoscopic investigation (an appointment within two weeks) [National Collaborating Centre for Cancer, 2015].
  • urgent direct access upper gastrointestinal endoscopy should be performed within two weeks to assess for stomach cancer in people with dysphagia (swallowing problems) or aged 55 and over with weight loss and any of the following: upper abdominal pain, reflux, dyspepsia.
  • referral for non-urgent direct access upper gastrointestinal endoscopy should be considered to assess for stomach cancer in people with haematemesis (vomiting blood) and in people aged 55 or over with treatment-resistant dyspepsia, upper abdominal pain with low haemoglobin levels, or raised platelet count with any of the following: nausea, vomiting, weight loss, reflux, dyspepsia, upper abdominal pain; or nausea or vomiting with any of the following: weight loss, reflux, dyspepsia, upper abdominal pain [National Collaborating Centre for Cancer, 2015].

If you’re struggling with indigestion don’t panic, but don’t let it ruin your life. If you have any doubts at all about whether your indigestion might be something more serious, visit your doctor and tell them ALL the symptoms.

What’s Up With Your Gut is available now as paperback and ebook.

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CFS/ME – Vicious circles and multitasking

As co-admin of Dr Myhill’s Facebook groups, I often see members asking what the single most important intervention in a person’s recovery from CFS/ME has been. I totally understand the reasoning behind this question – having limited funds where should attention be directed first to achieve the best results? Where does one find the most bang for one’s buck!

Dr Myhill instinctively takes this approach too, preferring her patients to do the ‘easy’ cheaper things first because these interventions are often enough on their own to elicit recovery. So, correcting sleep, doing the right diet and taking nutritional supplements are right at the top of the list. This is laid out in her CFS/ME checklist.

However, for some this is not enough and it is then that we must face the complexity of our intricate biological system with its many feedback loops and synergistic effects.

I am a mathematician and so the assumption is that I like linear arguments progressing from one irrefutable logic step to another, and so on, until we arrive at the ‘answer’! In my case, nothing could be further from the truth. For example, when first introduced to James Watt’s centrifugal governor, I was fascinated. This governor is essentially a continuous feedback system that controls the rate of a steam engine so as to maintain a near-constant speed, irrespective of the load or fuel-supply conditions. The constant speed of the engine achieved in this way is the mechanical equivalent of a well-functioning biological system. I enjoyed learning about these feedback systems but never had a chance to study the many biological examples because aged 12, I chose Latin and Ancient Greek over Biology for my school options.

However, life, and more specifically CFS, has forced me to become more acquainted with these biological systems because I am one of those for whom the ‘easy’ cheaper things have not fully worked.

As laid out in much more detail in Dr Myhill’s upcoming and fully revised book, Diagnosing and Treating CFS/ME – It’s mitochondria, not hypochondria and in Sustainable Medicine, there are many vicious circles in CFS/ME and these make the recovery process so much harder.

For example, if mitochondria go slow then the heart, being a muscle and so dependent on good mitochondrial function, will also go slow. The heart delivers fuel and oxygen to all cells in the body and so, if fuel and oxygen delivery is impaired then this too further impairs mitochondrial function. This can be seen below:

cfs-myhill-mitonchondria-vicious-circle

As further illustration, magnesium is of central importance for mitochondria. Having low levels of magnesium inside cells and mitochondria is a symptom of CFS but also a cause of it. This is because 40 per cent of resting energy simply powers the ion pumps for sodium/ potassium (Na/K) and calcium/magnesium (Ca/Mg) across cell membranes. When energy supply is diminished, as in mitochondrial dysfunction, there is insufficient energy to fire these pumps, and so magnesium cannot be drawn into the cells for oxidative phosphorylation to work. If there is insufficient energy to drag magnesium into cells, then there is a further diminishing of energy delivery, because of the lack of magnesium, and hence we have another vicious circle.

But all is not lost! We have at least two things in our favour – we now understand these vicious circles, and so can ‘break’ them, and many of the nutritional interventions we use can ‘multi-task’.

So, considering the two examples above, we can ‘break’ those vicious circles and so restore mitochondrial function by using Dr Myhill’s standard mitochondrial package of supplements, and by supplementing with magnesium we can further support the ion pump:

  • Coenzyme Q10 as ubiquinol – 200 milligrams
  • Vitamin B3 as niacinamide – 500-1500 milligrams – slow release
  • Acetyl-L-carnitine – 1-2 grams
  • D-ribose – up to15 grams
  • Vitamin B12 – 5 milligrams sublingually or ideally B12 by injection
  • Magnesium – ½ ml 50% magnesium sulphate, ideally, or 300mg orally

So, what of this multi-tasking then? Many interventions multi-task. High-dose vitamin B12 may be used to improve mitochondrial function, for detoxing via the methylation cycle, as an antioxidant and for its anti-inflammatory properties by damping down the pro-inflammatory fire of the NO/ON/OO cycle. This makes correcting multiple co-existent problems that much ‘easier’!

And then we have a ‘lovely’ example which I came to learn through both my own experience and also very many questions on Dr Myhill’s Facebook groups, essentially asking the same thing:

Why is it that when I have a sudden energy dip, I also feel weepy and emotionally fragile, weepy beyond what I would expect to feel?

Well, here is one way of looking at it – ATP is not only the energy molecule but also a neurotransmitter – to be precise, a co-transmitter. Other neurotransmitters, such as serotonin, dopamine, GABA and acetylcholine, will not work unless they are accompanied by a molecule of ATP. So, if ATP levels fall precipitously low, then one feels dreadfully fatigued [ATP as the energy molecule] and simultaneously one feels very low emotionally [ATP as co-transmitter]. To mitigate this ‘double whammy’ effect, I carry a bottle of water with D-Ribose dissolved in it and this works as a great ‘rescue remedy’ for when I experience these sudden ATP dips.

So, I suppose what I am saying is that CFS/ME sufferers should try the ‘easy’ things first but that if these don’t work out for you, then don’t despair. We know the circles that must be broken and we have some great helpers, like Vitamin B12 and D-Ribose, which can multi-task and solve more than one problem at once! Never ever give up!

Craig Robinson first met Sarah in 2001, as a patient for the treatment of his CFS, and since then they have developed a professional working relationship, where he helps with the maintenance of www.drmyhill.co.uk, the moderating of Dr Myhill’s Facebook groups and other ad hoc projects, as well as with the editing and writing of her books.

A fully revised and expanded 2nd Edition of Dr Myhill’s book Diagnosis and Treatment of Chronic Fatigue Syndrome: it’s mitochondria, not hypochondria will be published in January 2017.

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How to work out what’s wrong with your bowel

Apart from the red flag symptoms listed in the previous blog, where do you start when trying to work out what’s up with your gut?

You can help yourself and your doctor by:

Keeping a diary of your symptoms.

It helps your doctor make a diagnosis if you can be specific about how long you’ve had your symptoms, what they are, what seems to trigger them or whether they are present all the time, and how much weight you have lost. Keeping a diary of your gut symptoms will help you remember and give your doctor valuable information. One gastroenterologist has told how increasingly patients will photograph or video their bloated stomachs on their mobile phones to document their symptoms.

Not being embarrassed.

People literally die of embarrassment because they can’t get their heads round describing their stools/piles/diarrhoea to their doctors. Get over it. If you don’t like describing what your poo looks like ask your doctor if you can point it out on the Bristol Stool Chart.

Mentioning any family history of gut disease to your doctor.

Some complaints do have a genetic basis so it will be another piece in the jigsaw for your doctor if you can supply details of conditions such as bowel cancer or inflammatory bowel diseases in your immediate family. (Volunteer this if they don’t ask you first.)

Not cutting out food groups on a hunch.

If you do have an autoimmune condition, such as coeliac disease, where the body reacts to gluten and causes bowel symptoms, it’s important you don’t cut out any foods you suspect are to blame, such as bread or breakfast cereals, until your condition has been fully investigated. This is because you may need a gut biopsy to confirm your diagnosis (the villi – fingerlike projections in the gut which absorb nutrients – will be damaged and shrunken if you have coeliac disease) and if you have stopped eating gluten they may have returned to normal, giving a false negative diagnosis.

Being persistent.

If your doctor has told you to eat more bran to help with constipation and your symptoms are getting worse, go back and tell him or her. Whilst eating more fibre helps in a lot of cases of constipation, in up to 30 per cent of cases it doesn’t. (The cause could be slow transit in the gut, in which case too much fibre will make it worse!)

Not self-medicating for the long term.

Obviously it’s fine to buy over-the-counter remedies if your gut problems are short term, but if you are relying on laxatives, antacids or anti-diarrhoea medication in the long term it’s advisable to see a doctor and find out the underlying cause.

Finding reliable sources of information.

There are an awful lot of ‘snake oil’ salesmen out there on the internet, peddling dodgy cures or extreme diets with no good science to recommend them. Charities are good sources of accurate information about managing your condition and their online resources are written in a reader-friendly consumer style. Don’t forget organisations such as NICE (the National Institute for Health and Care Excellence) produce guideline summaries on the management of health conditions written especially for patients, setting out clearly what investigations and treatments are recommended.

For more information and advice on how to manage difficult bowel symptoms and improve gut health problems such as IBS and IBD, read What’s Up With Your Gut, out now.

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Recognising red flags when suffering from bowel problems

There are some gut symptoms associated with bowel problems you should never ignore and we thought it best to flag them up here – if you are think these symptoms may apply to you talk to your doctor. Chances are it’s nothing to worry about, but better safe than sorry.

New symptoms

A lot of people endure symptoms such as pain, alternating bowel habits and food intolerance. These may have gone on for a long time, fluctuating in intensity and are sometimes helped by one or two dietary changes, and sometimes not. But recent changes are likely to be more serious than something that has persisted for years. If you had similar problems in your 20s to those in your 50s  and in between), it is unfortunate that you may have had to wait so long to get any answers, but it is not likely to be a life-threatening condition. If the symptoms have just started, it is far more worrying.

Don’t be embarrassed. Help your GP assess what needs to be done. Be sure to describe how long you have had the symptoms and explain exactly what you mean. In particular, be sure to tell your GP about the following symptoms as they may indicate a serious condition:

  • abdominal pain and fever
  • anaemia
  • blood in your stools
  • change in bowel habits
  • jaundice and definite lumps you can feel
  • unexplained weight loss.

Abdominal pain and fever

Fever and sharp, stabbing abdominal pain can have several causes and you may need to go to A&E or even call an ambulance if these are severe and sudden in onset.

Anaemia

Anaemia, which will make you look pale and feel tired, may be due to hidden (‘occult’) blood loss, and your GP may organise for you to have an endoscopy and/or colonoscopy, together with blood tests for coeliac disease, iron, B12 and folate deficiency.

Blood in your stools

Blood in your stools must be investigated. If it occurs only on wiping the anus with toilet tissue, it may just be haemorrhoids (piles) or an anal fissure (tear), but this should be checked by an examination, and then perhaps by a limited flexible sigmoidoscopy. If there is blood mixed in with the stools, you should be referred to a gastroenterologist or colorectal surgeon and have further tests, such as colonoscopy (or possibly a CT scan), to be certain bowel cancer and ulcerative colitis have been excluded. These are major diseases which are much more successfully treated if caught early and are not difficult to diagnose with the proper tests, so get your GP to refer you to a gastroenterologist if you suspect one of these. Although bowel cancer increases in likelihood as you get older, it is common enough that people aged 40 to 50 or younger can get it. If you know that you have a family history of bowel cancer you are also more at risk. The good news is that, when you have had a colonoscopy, you can be sure for quite a long time (several years) that this has been excluded as the cause of your symptoms. The faecal calprotectin test is now also useful in predicting if you do need a colonoscopy. If you are older, be sure to get the routine screening tests that are now offered.

Change in bowel habits

If you have a recent change in your bowel habit, then tell your GP and be prepared to get more tests. Clearly, if everyone in your family has just got the same symptoms after eating the same food, or you have just come back from an area where gastroenteritis is common, and the symptoms are not too bad, you can wait a week or two to see whether things go back to normal. But if they do not, and particularly if there is blood in the stools, then you MUST get tests.

Jaundice and definite lumps you can feel

Jaundice symptoms (yellow eyes and skin) and definite lumps, particularly if they are tender, must not be ignored. The lumps may turn out to be only hard faeces but you want to be sure that a definite diagnosis is made in case it might be an inflamed gall bladder, an ovarian or another cyst, or possibly a stomach or bowel tumour. Hernias in the groin or in other places in the abdomen may also feel like painful lumps and can also cause problems until they are treated.

Unexplained weight loss

Unexplained weight loss is important and will lead to other blood tests and probably hospital referral. Sometimes there is a gut disease (coeliac disease or Crohn’s disease, for instance) or cancer, but in other cases can be due to an endocrine disorder, such as an over-active thyroid, or to a wide range of other disorders, including neurological or mental health problems (you cannot buy, cook or chew your food), or cannot easily eat (dental problems, for instance or Alzheimer’s). These should be fairly easy for your GP to diagnose.

It can be very hard to start figuring out what’s up with your gut, so listen to your body and be aware of any possible symptoms that you should tell a doctor or other health professional who may be able to help. For less serious conditions, just keeping track of how you feel can help you to improve your symptoms on your own.

For more advice on how to track your symptoms and get to the bottom of your bowel issues read our next blog: Working out what’s wrong with your bowel, and order your copy of What’s Up With Your Gut? by Jo Waters and Professor Julian Walters.

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IBS: a guide for family, friends and colleagues

Although IBS is invisible, it is a very real illness and it can be hard to know how to support people we care about when we can’t necessarily see the physical symptoms of what they are going through. Dr Megan Arroll and Professor Christine Dancey have combined their extensive knowledge to provide a helpful guide for supporting friends and family members with IBS.

There are many conditions where people look fine, even very well, but they are in fact in a great deal of discomfort and pain. It can be hard when you are suffering from the symptoms but look fine on the outside. Try to remember when you last had a headache. You probably looked fine on the outside, despite being in pain. Now imagine feeling like this constantly.

Not only does suffering an invisible illness make you feel physically awful, but people with IBS often face a lack of support from those close to them. Work and social situations can also be challenging; without outward signs of ill-health, someone with IBS can feel very isolated. People with IBS often find it very hard to acknowledge their condition and to discuss it with others due to the embarrassing nature of the symptoms.

Additionally, IBS can attract stigma as it is a complex condition and there are no scans, investigations, or blood tests which can show that a person has IBS. It is a multi-faceted condition and we are only just learning about the physiological processes underlying it.

So, someone with IBS may appear perfectly fine – in fact, almost anyone will say ‘good’ or ‘well’ if you ask them how they are – this does not mean that IBS is not a debilitating and intrusive illness. All it means is that your friend, sibling or workmate who has IBS is trying to put their brave face on.

What you can do to help a friend or family member with IBS

You don’t need to know everything about IBS; just by accepting what your friend says about what he or she is feeling is a great help and support. IBS can take a long time to diagnose and is often misdiagnosed. Both the struggle for a diagnosis and the feeling of frustration engendered by being misdiagnosed can be difficult, and this is on top of feeling unwell. While it can be tricky for friends and family members to offer the right help and support to someone with IBS, here are a few simple rules to help make living with IBS a little less irritable.

Never question the existence of IBS, even if your friend looks and seems well.

Be patient with the process of diagnosis and finding an effective treatment – it can take time.

Try not to be over protective or treat the person with IBS as if they are fragile.

Try to limit giving advice, even if well-intentioned.

Be willing to find IBS-friendly activities which are of interest to both of you.

Understand that plans may be cancelled at short notice.

Offer practical support, such as help with the children, shopping, housework, gardening, etc.

If IBS is affecting your sexual relationship or damaging your relationship overall, seek external and professional support.

Overall, simply being there and accepting that the person with IBS is trying their best to overcome this misunderstood condition will be an invaluable support. IBS is an embarrassing and stigmatised illness that can challenge someone’s relationship with their body. Support, whether emotional or practical, can limit the likelihood of depression and isolation, factors which we know are detrimental to us all.

For more detailed guidance on how best to support someone who is suffering from IBS buy your copy of Irritable Bowel Syndrome: Navigating Your Way to Recovery and follow Dr Arroll on twitter.

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10 Foods IBS Sufferers Should Avoid

It can be frustrating and take quite some time to discover if certain foods are affecting your Irritable Bowel Syndrome symptoms. Some dietary changes may work for one person but not another. Below we outline the safest foods for IBS sufferers, and the foods you should avoid – those that have the most chance of aggravating your IBS symptoms.

Information is taken from Irritable Bowel Syndrome: Navigating Your Way to Recovery by Professor Christine Dancey and Dr Megan Arroll. Dancey is Professor Emeritus of Chronic Illness Research at the University of East London (UEL). As a researcher into invisible long-term conditions and a mis-diagnosed sufferer, she has a unique insight into what people with IBS want and need to know.

Dr Megan Arroll is a Senior Lecturer in Health Psychology at BPP University and is a member of the Health and Illness Research Team (HIRT), a group that works to better understand IBS and other invisible long-term conditions.

The most commonly recommended way to find out if you have a food intolerance is an exclusion, or ‘elimination’ diet, where you cut out certain types of food from your diet for three to four weeks and slowly reintroduce them one by one to see if any of your symptoms come back or worsen.

Safe Foods for IBS

The foods which are considered the safest for sufferers of Irritable Bowel Syndrome include:

Rice and quinoa

Rice milk

Fish, lamb, venison and duck

Pine nuts, flax seeds

All vegetables except nightshade vegetables (see above)

Non-citrus fruits

Herbal tea

 

Foods to Avoid for IBS

The ten foods, or food groups, generally considered the worst for aggravating symptoms of Irritable Bowel Syndrome are:

Foods containing gluten, such as wheat, corn, barley and rye

Dairy products and eggs

Soy and soy products such as tofu

Meats such as pork, beef and chicken

Beans and lentils

Nightshade vegetables such as tomatoes, potatoes, aubergines and peppers

Citrus fruits

Caffeine

Alcohol

Refined sugars

Doing an exclusion diet isn’t easy, especially at first, so it is worth preparing foods you can eat in advance. After three to four weeks, you can add one type of food back into your diet. It is worth keeping a food diary as you reintroduce foods and seeing if your symptoms reoccur. It is essential to be methodical and keep a food diary, so for a full list of foods and a more detailed guide through the elimination diet for IBS order your copy of Irritable Bowel Syndrome: Navigating Your Way to Recovery.

Follow @HHealthBooks and @DrMegHealthPsy on twitter for the latest updates on IBS and chronic illness.

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Sustainable Medicine in The People’s Book Prize

Dr Sarah Myhill’s latest book, Sustainable Medicine, has reached the final of The People’s Book Prize Autumn 2015, in the non-fiction category.

The People’s Book Prize was set up to create an award for the books that readers loved as an alternative to the traditional book prizes awarded by panels of judges. The People’s Book Prize offers a level playing field for new and undiscovered authors, and it is the only award based entirely on a public vote.

We are very proud that Sustainable Medicine has been nominated in the non-fiction category, up against some stiff competition. Based on the essential premise that contemporary Western medicine is failing to address the root causes of disease processes, Dr Myhill’s book aims to empower readers to heal themselves through addressing the underlying reasons for ill health.

Sustainable Medicine author Dr Sarah Myhill

We believe in sharing information that empowers people to help themselves, and Sustainable Medicine is one of the most important and potentially game-changing books we’ve published. There is a crisis in modern medicine and we need to move forward with a sustainable and person-centred approach that maximises health without recourse to pharmaceuticals.

By voting for Sustainable Medicine in The People’s Book Prize you can help spread the word and lift the lid on some of the areas where change is most needed. Dr Myhill has already helped thousands of people struggling with chronic fatigue and other conditions so let’s get her latest book the recognition it deserves!

Click here to vote for Sustainable Medicine in The People’s Book Prize.

More about the author:

Dr Sarah Myhill qualified in medicine (with Honours) from Middlesex Hospital Medical School in 1981 and has since focused tirelessly on identifying and treating the underlying causes of health problems, especially the ‘diseases of civilisation’ with which we are beset in the West. She has worked in NHS and private practice and for 17 years was the Hon Secretary of the British Society for Ecological Medicine (renamed from the British Society for Allergy, Environmental and Nutritional Medicine), a medical society interested in looking at causes of disease and treating through diet, vitamins and minerals and through avoiding toxic stress. She helps to run and lectures at the Society’s training courses and also lectures regularly on organophosphate poisoning, the problems of silicone, and chronic fatigue syndrome. She has made many appearances on TV and radio. Visit her website at www.drmyhill.co.uk.

Sustainable Medicine is available as paperback and ebook from £4.50

Diagnosis and Treatment of Chronic Fatigue Syndrome is available in paperback and ebook from £4.50

Click here to vote for Sustainable Medicine in The People’s Book Prize.