Digestive Wellness - Q4 - Dec 2018

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Digestive Wellness

DECEMBER D ECEMBER 2018 2018 HEALTHAWARENESS.CO.UK

The importance of bowel screening Deborah Alsina MBE Chief Executive, Bowel Cancer UK P4 7 steps for better gut health Dr Megan Rossi PhD RD The Gut Health Doctor P6

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IN THIS ISSUE

BSGAR A new, lessinvasive test can help diagnose colon cancer

Exclusive recipe from Dr Joan Ransley using ingredients that look after your gut

Chloe Cunningham and Ali Neilan, nutritionists and founders of Health is Wealth Group Stress affects every part of your digestive system

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Digestive health: making the invisible visible Digestive disorders can make people's lives a misery through shame and stigma, says Andy McGuiness, Campaigns Manager at Crohn's & Colitis UK. It's time all of us understood these conditions more.

By their nature, digestive disorders are generally invisible. But just because you can't see them doesn't mean they're not very real, lifechanging issues for hundreds of thousands of people.

Indeed, their impact can be devastating. You just might not realise.

T

ake Crohn's disease and colitis, for example. There are over 300,000 people in the UK alone living with these two long-term, incurable, inflammatory bowel conditions. One of their main presenting symptoms is chronic diarrhoea which, during a flare-up, Follow us

may result in 20 or 30 visits to the toilet a day. Three in four patients have said that they have had an accident in public because they couldn’t reach a toilet in time.

Digestive disorders can impact mental wellbeing

Unfortunately, in British culture, we don't tend to deal with issues about our poo very well. In fact, it's become a source of humour: something to ridicule. If a bowel condition affects you personally, however, it's no laughing matter. It's made worse if you feel shame and stigma, rather than sympathy and support.

In fact, shockingly, we know that 52% of people with Crohn's and colitis have experienced MediaplanetUK

Three in four patients have said they had an accident in public because they couldn’t reach a toilet in time discrimination because of their condition; while over 50% have received negative comments while using accessible toilets. This is the real shame. And it's unacceptable. If people don't have the confidence to access the facilities they need when they need them, it can make them

Andy McGuiness ness nager, Campaigns Manager, is UK Crohn’s & Colitis

feel isolated and have a huge impact on their mental wellbeing.

Over the last 30 years, we have significantly progressed disability awareness and rights in workplaces and the physical environment. Yet we still have a long way to go to remove the stigma associated with digestive health disorders.

That's why our organisation started a campaign to challenge public perception of such conditions and emphasise that: ‘Not Every Disability is Visible’, by changing accessible toilet signage across the UK. This is having a positive effect: 80% of people with Crohn's and colitis said that they felt more comfortable visiting a site with the signage installed.

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More awareness of these conditions is needed

Stigma isn't the only issue surrounding digestive disorders.

Diagnosis can be frustratingly slow.

Naturally, much more needs to be done. Thankfully, research for new breakthroughs goes on, although — of course — this requires funding.

All of us are able to help people with digestive disorders, however.

We can do it by talking about these conditions, understanding them, and stopping the stigma associated with them.

Tony Greenway Read more at

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ARCH members are qualified to help support you with your digestive health challenges · Colon hydrotherapy is indicated for IBS, bloating, constipation and digestive disturbances · ARCH members are qualified in many other naturopathic & complementary disciplines · ARCH members meet national occupational standards for colon hydrotherapy · ARCH members are independently regulated and referenced on the NHS questions page · ARCH members will be happy to answer your queries and discuss your needs

Contact a therapist in your area for a personal consultation

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Stressed? Your digestive system will switch off Stress. The word is everywhere. Stress is the health epidemic of the 21st century. But what is stress? And, perhaps more importantly, what does it meant to be stressed?

S

tress in the short term is great; we experience a spike in adrenaline and cortisol leading to an increase in focus, alertness and overall performance. If you have ever been in an accident you will know that it can decrease your perception of pain, for example.

Consistent stress, however, very quickly becomes detrimental to health. Long-term stress can lead to a wide array of health issues, some more obvious such as exhaustion and burnout, while others seem to have less of a direct correllation, such as IBS and recurrent colds.

Flora Montgomery Gutsy UK

It is safe to say that stress will exacerbate any existing illness whilst having the capability to trigger more.

The issue that we face is that we are bombarded with an incessant string of stressors every single day, both physical and psychological, from the moment your alarm clock triggers the first stress response of the day to the email that you read at 11pm.

Our stress reaction hasn’t adapted to our modern day comforts Evolution has not yet caught up with our relative safety in the modern world, and physiologically, the release of stress hormones remains the same, regardless of the cause.

The cause could be the stress of a presentation, too much coffee or an argument with a loved one/ colleague; and the response is aptly named ‘fight or flight’.

Physiologically, this means we have an increase in heart rate, an increase in blood pressure, an increase in alertness an increase in metabolic rate and an increase in temperature.

When you are stressed, your gut switches off So how does stress affect the gut? Well, fundamentally, it’s important to know that when you are stressed your digestive system is effectively switched off.

Stress puts your body into fight or flight mode, prioritising oxygen to your brain and your muscles. In a life or death scenario, your digestion is not considered essential and so food is passed through the GI tract as quickly as possible with little-to-no absorption (and thus assimilation) of its contents.

When you consider the number of individuals within the corporate world who eat at their desk / in a lunch meeting / while reading emails, it

CHLOE CUNNINGHAM (LEFT) AND ALI NEILAN (RIGHT), NUTRITIONISTS AND FOUNDERS OF HEALTH IS WEALTH GROUP

becomes increasingly apparent how problems appear.

It doesn’t end ther, though. Stress can affect every part of the digestive system.

It is detrimental to the gut flora, which leads to dysbiosis, and it is proinflammatory, which can aggravate the gut lining, leading to a wide array of disruptive issues from food intolerances to autoimmune disease.

Emotional stress can reduce the vitamins in our bodies Both emotional stress and physical stress deplete the body of certain nutrients- for example magnesium and B vitamins. As such, it’s vital to have a steady flow of nutrients into the body in order to support and nourish our adrenals as well as to metabolise stress hormones.

Stress is unavoidable and, as we have seen, has the potential to be detrimental to our health. What we as individuals

can do is build our resilience to stress, and we can do that with both our diet and lifestyle choices.

When we first created Health is Wealth Group, we had lots of individual corporate clients who were suffering with digestive complaints. They were predominantly stress-related, and we realised that, with a few simple adjustments, ailments could be easily resolved.

We educate and empower individuals within the corporate environment to take their health into their own hands.

Once individuals realise that diet is key, they begin to use it not only to restore health but to achieve optimum performance; and this is how we empower businesses to succeed through the health and wellbeing of their people.

Start getting to know your gut in 2019 Gut health is so important. Here’s what you can do each day to better it. Thanks to an increasing awareness to all things gut-healthrelated in the media today, gut health is enjoying a renaissance that is here to stay.

O

ur microbial diversity is declining every decade and the latest science is suggesting that the disorder of microbial ecology may well be a major contributor to the modern epidemics of allergy, auto-immune disease, obesity and diabetes.

A multitude of factors have

been suggested to contribute to the decrease of diversity of species of gut microbiota.

Hygiene hysteria, excessive antibiotic pillpopping, and supermarkets stocked up with increasingly processed and fibre-poor foods has possibly had its toll.

Sadly, with our modern climate, this means, for some of us, our guts are struggling. By being more aware and searching for answers to these problems, we can improve our gut microbiome with diet and lifestyle, and ultimately our health as a whole with some very achievable lifestyle choices.

Our guts are unique to us; our lifestyle should mirror that

Our guts are totally unique to us, and our diets and lifestyle choices should mirror that. Gut health is all about the individual and, in time, we will discover what our bespoke microbial blueprint is and how we can influence it.

You are a cloud of microbiome, being affected all the time.

Start getting to know yours and pay attention – it has a wonderful way of

communicating with us every day!

Your gut could impact your mental health

We are also beginning to understand that gut health affects multiple other factors; hormone health, immunity, age, environment and another very trending subject – mental health!

Research is slowly revealing how much our gut health affects so many other systems in our bodies. The most widely discussed connection of 2017 being IBS and stress; a classic gut health conundrum, which will hopefully be recognised much more in medical circles in 2018.

One of the most encouraging discoveries of 2017 is the complexity of the microbiome.

The gut is more than just one mechanism within us; it is striving to perform for you on a daily basis. If we treat our gut well, we are giving our bodies a helping hand to let your body start healing itself.

Read more at

gutsy-uk.com

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CT colonography – a less-invasive test for bowel cancer

Dr James Stephenson Consultant Radiologist, University Hospitals of Leicester Executive Committee Member, British Society of Gastrointestinal and Abdominal Radiology

Mr Baljit Singh Consultant Colorectal Surgeon, University Hospitals of Leicester

Early diagnosis saves lives Deborah Alsina MBE Chief Executive, Bowel Cancer UK

A new, non-invasive test can help diagnose colon cancer.

Called the FIT test (faecal immunochemical test), it can be done at home and is more accurate at detecting blood in stools.

U

ntil the FIT test becomes mainstream, asymptomatic patients over 60 years of age, who are invited to take part in the NHS Bowel Cancer Screening Programme, are sent a guaiac faecal occult blood test (gFOBT), where a stool sample is tested for the presence of blood.

The new FIT test is more sensitive, which means health professionals can be more certain you do not have a bowel cancer if the test is negative.

I have had a positive FIT test, does this mean I have a bowel cancer?

While a negative FIT test can exclude a bowel cancer, a positive FIT test does not mean you have a bowel cancer. There are a number of reasons a FIT test can be positive, but it does mean you need a formal examination of the bowel.

Colonoscopy is considered the gold-standard test to exclude or diagnose bowel cancer. It uses a long, thin, flexible tube that contains a camera, which is inserted into the rectum and passed around the bowel to look for a cancer or polyp. It is a safe test that most people tolerate.

Are there any tests that do not involve colonoscopy to detect bowel cancer?

Another test, called a CT colonography, has been shown to be equal to a colonoscopy to detect bowel cancers and large polyps in many clinical trials.

CT colonography is often better tolerated than a colonoscopy, is considered less-invasive and the preparation is less demanding as the laxatives used are not as strong. It also takes less time, and sedation – which is sometimes needed for colonoscopy – is not required.

It involves having a computerised tomography (CT) scan of the tummy after taking a drink preparation called gastrograffin. During the scan, gas is used to inflate the bowel using a small tube passed into the rectum.

The scan produces a ‘virtual colonoscopy’ that a radiologist can then assess on a computer work-station and report back to your doctor.

CT colonography can be used to assess the bowel in patients with symptoms of bowel cancer and/or a positive FIT test and is used in the screening programme when colonoscopy fails or is not possible.

Another advantage of CT colonography is that it will also look at your other abdominal organs such as the liver, pancreas and kidneys.

I have rectal bleeding, is a CT colonography a good test?

If you have rectal bleeding a CT colonography can be used, however a flexible sigmoidoscopy would be the first examination recommended after an examination of the bottom known as a digital rectal examination (DRE).

Bowel cancer is the fourth most common cancer in the UK with almost 42,000 people diagnosed every year. Sadly, around 16,000 people die from the disease each year, making it the second biggest cancer killer.

H

owever, this shouldn’t be the case as bowel cancer is treatable and curable, especially if diagnosed early. In fact, early diagnosis is crucial to survival rates, as nearly everyone will survive if they are diagnosed at the earliest stage.

The importance of bowel screening

Taking part in bowel cancer screening is the best way to diagnose the disease early. Screening can detect the disease at an early stage when treatment has the best chance of working.

Screening can also prevent bowel cancer through the removal of polyps (non-cancerous growths), which may develop into cancer in the future.

The Bowel Cancer Screening Programme in England, Wales and Northern Ireland currently sends all men and women aged 60 to 74 (50 – 74 in Scotland) a home test kit every two years. However, in August, the government announced that the age at which people become eligible for bowel cancer screening will be lowered to 50, in line with Scotland and international best practice.

With around 4,500 people in the UK being diagnosed with bowel cancer aged 50-59 and just over 1,200 dying from the disease in this age group every year, the introduction of screening from 50 will save many lives.

In addition, a more accurate, simple test, the faecal immunochemical test (FIT), is being rolled out from December this year. This test detects hidden traces of blood in poo that could indicate bowel cancer or polyps. It is easy to complete, with people required to collect one small poo sample in a test kit at home. If blood is detected, people will be referred for a colonoscopy to either confirm a diagnosis of bowel cancer or, hopefully, receive the all clear.

Nearly a million more tests are needed each year in England, with demand for colonoscopies doubling in the last decade The NHS is under pressure

However, improvements to the screening programme, an ageing population and changes to GP referral guidelines has meant more people are being referred for a colonoscopy – a key diagnostic test for bowel cancer - and this is putting NHS hospitals under unprecedented pressure.

At the very least, nearly a million more tests are needed year on year in England, with demand for colonoscopies doubling in the last decade. But this has not been matched with additional trained workforce by the government and is having a significant impact on both colonoscopy and pathology services.

Staff shortages are the biggest barrier to improving bowel cancer survival rates

In fact, staff shortages in bowel cancer diagnostic services are the single biggest barrier to meeting commitments to improve survival rates for the disease. Already, thousands of patients are waiting longer for life-saving tests that diagnose bowel cancer, and nearly half of hospitals are breaching waiting time targets for these tests.

In response, services are relying on short-term fixes, which are both costly and unsustainable for the NHS. For example, the National Endoscopy Survey, published in 2017, found that bowel cancer services have introduced extended working hours over the weekend and many hospitals reported paying extra for bowel cancer diagnostic workload to be outsourced to external private providers to cope with demand.

A plan is needed to tackle staff shortages

Bowel Cancer UK’s recent Capacity Crisis campaign highlighted these workforce capacity issues. With the support of over 7,000 people, the charity wrote an open letter calling for a fully funded action plan to tackle NHS staff shortages in diagnostic services for bowel cancer.

This includes ensuring funding is made available to Health Education England so staff can be recruited and trained. With the NHS looking forward to the next decade with their upcoming long-term plan, workforce shortages must be addressed so in the future bowel cancer is no longer the UK’s second biggest cancer killer.

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New liver failure treatment could be here by 2020 170,000 people in Europe die from liver failure every year. The cirrhosis death toll could be cut from 2020, thanks to advanced dialysis technology being trialled in the UK and Europe now.

Many people with liver disease do not see it coming until it's too late

Millions of people around the world are unaware they have liver disease, which may be nonalcoholic steatohepatitis (NASH), nonalcoholic fatty liver disease (NAFLD) or even cirrhosis.

“In the UK, 0.5% of the population have cirrhosis, the scarring of the liver that is the end-stage of liver disease, but 75% of them do not know,” says Rajiv Jalan, Professor of Hepatology at the Institute for Liver and Digestive Health, Division of Medicine, at University College London and Honorary Consultant at the Royal Free Hospital.

100,000 people go to hospital because of accidents, infections, overdrinking or for surgery, and discover that that they have cirrhosis,” says Jalan. “About 20-30% of them develop acute-on-chronic liver failure (ACLF) and multi-organ failure, which may affect the brain, the heart or the immune system. This carries a 30% risk of death within four weeks.

“You can go from walking around with no idea that you are at risk to your deathbed in just four weeks.”

At present, treatment centres on supportive care for the failing organs including dialysis. The only potential cure is a liver transplant - and there is currently a shortage of donated livers.

Every year, 170,000 people in Europe die from liver failure.

Many people find they have cirrhosis when they enter hospital for something else

New dialysis machine uses liver’s regeneration properties

“Every year in the UK, 50,000 to

However, the liver can regenerate

itself - and a new dialysis technology, now being trialled, takes advantage of that.

Jalan says: “If we can get over the two- to four-week period when the patient is at high risk of death, and prevent more damage to the liver, it will start to repair itself.”

Jalan is the project coordinator of the ALIVER project, which is trialling a new dialysis machine, called DIALIVE. An advance on existing dialysis technology, it uses two specialised filters to remove blood-borne products of liver failure such as products of cell death, toxins from bacteria and metabolic toxins, which traditional dialysis machines do not. It also replaces the albumin that is depleted or destroyed when the liver fails.

Jalan says: “This could keep the patient alive long enough for the liver to regrow or for a transplant

Rajiv Jalan Professor of Hepatology, Institute for Liver and Digestive Health, Division of Medicine, University College London Honorary Consultant, Royal Free Hospital

donor to be found.”

The DIALIVE technology was invented at UCL and is being developed by spin-off company, Yaqrit. The €7.8 million ALIVER project, funded by the EU Horizon 2020 research programme, runs until 2020.

obesity, over-drinking and liver diseases such as viral hepatitis, and says: “Ask your GP for a liver function check.”

Linda Whitney

SPONSORED

Current trials for liver disease will see results next year

DIALIVE is being trialled in several hospitals across Europe, and its benefits are being compared to the standard of care. “Initial results are due in 2019 and if they are positive, a larger study will go ahead later in the year,” says Daniel Green, CEO of Yaqrit. “This technology has the potential to save the lives of liver patients who are at a high risk of short-term mortality.”

Meanwhile, Jalan points out that risk factors for liver diseases include

This project has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No 733057.

Read more at

aliver.info

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Getting creative in the kitchen – gut-friendly recipes This vegan fry up is tasty and filling and contains a wealth of gut-friendly ingredients. Black beans are a great source of dietary fibre which that to keep the gastrointestinal tract moving and also contain galactooligosaccharides, which act like a fertiliser in the gut and provide material for beneficial gut microorganisms to feast on. Ginger is a soothing spice that’s gentle on the gut.

Ingredients 200g mixed small peppers

Avocado and black bean mash

3 tbsp olive oil for drizzling

1 large ripe avocado, mashed

Tomato and tamarind ketchup

200g black beans, crushed slightly

1 banana shallot, finely chopped

Squeeze of lemon

40g fresh ginger, peeled and finely grated

½ clove garlic, crushed

CREDIT: GETTYIMAGES

CREDIT: DR JOAN RANSLEY FOR LOVE YOUR GUT

Gut health; fad or cure-all?

Gut health is one of the latest trends to hit the health and wellness world. But, unlike many other trends, the science stacks up, suggesting this is one development that might actually be worth jumping on board.

Dr Megan Rossi PhD RD The Gut Health Doctor

1 tsp cumin, ground 2 tbsp tamarind paste (available from large supermarkets)

200g wild mushrooms, brushed clean and roughly chopped

400g tin chopped tomatoes 1 tsp of palm sugar

200g spinach, washed and roughly chopped

Method Preheat the oven to 200ºC/Gas mark 6. Place the peppers on a roasting tray and drizzle over a little of the olive oil. Roast for 20 minutes or until the skins begin to blister and turn brown. Remove from the oven.

To make the ketchup Drizzle a little more of the olive oil in a pan, add the chopped shallot and sweat until soft. Add the grated ginger and tamarind paste to the pan and cook gently for 2 minutes before adding the chopped tomatoes and palm sugar. Simmer for 20 minutes until the sauce is thick. Season to taste with salt and pepper.

While the ketchup cooks make the avocado mash. Simply mix the mashed avocado with the black beans, lemon, garlic and cumin to form a rough paste.

Place the mushrooms in another pan with a drizzle of olive oil. Cook over a moderate heat for 5 minutes or until the mushrooms are soft. Move the mushrooms to one side of the pan, add the spinach and cook until it wilts.

Serve the mushrooms, spinach, avocado and black bean mash with the tomato and tamarind ketchup. This would be lovely served with fresh toast.

Love Your Gut Love Your Gut is an initiative of Yakult UK Limited, in association with Guts UK charity (formerly Core), Bowel & Cancer Research, St Mark’s Hospital Foundation, The IBS Network, Bowel Disease Research Foundation and the Primary Care Society for Gastroenterology.

A national campaign, Love Your Gut is a national campaign that raises awareness about the importance of gut health through expert tips, recipes, case studies, digestive health news and more.

Exclusive Recipe by Dr Joan Ransley for Love your Gut –

www.loveyourgut.com

Gut health relates to the functioning of your entire gastrointestinal (GI) tract (the tube that delivers food from entry to exit). This involves the digestion and absorption of nutrients, the “leakiness” of your gut, 70% of your immune cells, and many other functions that happen without you knowing.

H

owever, it’s only been in the past decade - since we’ve discovered the significance of the trillions of bacteria that live within everyone’s GI tract - that gut health has started to turn heads.

And there’s good reason to; this community of bacteria, known as your gut microbiota, is considered central to our overall health and happiness.

Why is gut health important?

Anyone who has suffered symptoms of gut distress such as diarrhoea, constipation and stomach pain, knows just how debilitating it can be. One study highlighted that people with irritable bowel syndrome (IBS) would give up 25% of their remaining life to get relief from their gut symptoms!1 In fact, the importance of gut health extends beyond the gastrointestinal tract impacting other vital organs like the brain, heart, kidney and liver. Your gut microbiota have been linked with many conditions including mental health, diabetes and autoimmune conditions. And it doesn’t stop there - gut health is not just about

preventing and treating disease but may even affect your general wellbeing by impacting your mood, thoughts and perhaps even your food preferences.

important part.

Tip: Aim to chew your food between 10-20 times, until the food is broken down.

7 steps for better gut health

Take time to breathe, destress and sleep well

1 Eat a varied diet rich in fibre

High-fibre food include vegetables, fruit, wholegrains, legumes and pulses.

Tip: gradually increase fibre over several weeks to give your gut time to adapt.

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5 There’s a direct link between your brain and gut. Being stressed and tired can profoundly affect your gut health.

6 Exercise regularly

Exercise helps to regulate bowel habit, particularly those prone to constipation. It’s also associated with greater diversity within your gut microbiota, which is a good thing.

Experiment with fermented foods containing good bacteria e.g. kefir, kimchi, sauerkraut

Foods naturally containing live bacteria come at no extra cost and taste great.

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7 Know when to seek medical advice

Gut symptoms can mask underlying disease, alarm features include: • Unexplained weight loss

Avoid unnecessary medications, particularly overuse of antibiotics and painkillers.

These can aggravate gut problems and disrupt your gut microbiota.

4 Take your time to eat, chew your food well

• Low iron levels • Rectal bleeding • Family history of coeliac disease, bowel cancer or ovarian cancer • Being over 60 years of age with changes in bowel habit lasting more than six weeks

Digestion starts in the mouth and chewing your food well is an

1: INTERNATIONAL SURVEY OF PATIENTS WITH IBS SYMPTOM FEATURES AND THEIR SEVERITY, HEALTH STATUS, TREATMENTS, AND RISK TAKING TO ACHIEVE CLINICAL BENEFIT HTTPS://WWW.NCBI.NLM.NIH.GOV/PMC/ARTICLES/PMC2700202/

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