Ask the doctor - digestive health

Read expert medical advice with doctors' questions and answers from Prima, SHE and Good Housekeeping

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Coping with Crohn's the natural way

I have mild Crohn's disease. I don't need any medication at present and hope to avoid ever having to take steroids. Can natural supplements help?

Crohn's disease is a long-term inflammatory disease of the bowel that tends to have flare-ups, with periods of remission between. Some people find particular foods exacerbate their symptoms, so it may be helpful to keep a food diary to help you identify foods that might trigger a flare-up, so you can avoid them. A low-fibre, high-vitamin diet may also help, and it's worth cutting back on sugar. Probiotic supplements supplying friendly digestive bacteria (notably lactobacilli, found in products such as Yakult and Multibionta) are also beneficial, as is aloe vera juice. A recent study suggested that extracts of rosehip can reduce symptoms in people with inflammatory bowel disease. The National Association for Colitis and Crohn's disease has a helpline (0845 130 2233) or visit the website at www.nacc.org.uk.

Dr Sarah Brewer, Prima (May 09)

 

What sort of fibre should I be eating?

I've always tried to keep my fibre intake up because otherwise I tend to suffer from constipation. But now I'm confused because I've read there are two kinds of fibre. What's the difference?

There are indeed two kinds of fibre - but the good news is that if you eat a high fibre diet, you're probably getting enough of both. I wish more people were - about four out of five Brits, including 90% of women, don't eat the recommended minimum of 25g a day. Insoluble fibre is what we often call ‘roughage' - it's especially high in cereal grains (breakfast cereal and wholemeal bread and pasta) and fruit and vegetable skins. It's great not just for constipation and piles, but also for helping keep your weight down. Soluble fibre is high in foods like oats, peas, beans, lentils and lots of fruit and vegetables. This helps to keep your blood sugar stable, improve your concentration and lower your cholesterol. Between them, high fibre foods can cut your risk of bowel cancer (and possibly breast cancer) by up to 40%, reduce your risk of getting diabetes by a third and also cut your risk of heart disease.

Dr Sarah Jarvis, Good Housekeeping (Jan 09)

 

I've had IBS for 15 years and thought I had it under control. But when my mother died recently, the symptoms returned. Why was that?

 

IBS (irritable bowel syndrome) is the most common gastrointestinal disease with symptoms including tummy cramps, bloating, diarrhoea and/or constipation. The symptoms come and go but flare ups are associated with stress and it's believed that overactive nerves or muscles in the gut may trigger it. Anti-spasmodic drugs can relax the muscles in the gut wall, but as your IBS is clearly stress-related, you could try a psychological treatment. Cognitive behavioural therapy (CBT) has been found to be very helpful - ask your GP if you can be referred to a therapist, or visit babcp.com (the British Association for Behavioural and Cognitive Psychotherapies) for a list of qualified CBT practitioners. You could also try yoga, meditation or hypnotherapy - visit hypnotherapists.org.uk for qualified hypnotherapists.

Meanwhile, start taking Boots Probiotic & Prebiotic Food Supplement (£7.99 for 30) on an empty stomach, before breakfast, to ease the symptoms. It may also help to switch all your carbohydrates to wholegrains and avoid saturated fats, alcohol and processed foods. Some IBS sufferers believe that cutting out artificial sweeteners helps too. Up your fruit and veg intake and eat foods in their natural state if possible - it gives your body more to work with and reduces constipation and diarrhoea.

Dr Louise Selby, SHE

 

 

Treating IBS

I have been diagnosed with Irritable Bowel Syndrome (IBS) and was going to take probiotics, as I've read that they help to restore the bacterial balance in the gut. Is this true and, if so, which one should I take?

IBS is an extremely common problem but the exact cause is not known. Symptoms can vary from person to person but most sufferers experience stomach pain, bloating and bouts of diarrhoea or constipation. Studies show that taking probiotics - live ‘friendly bacteria' -which are found in a number of dairy products such as bio yoghurt - can help to ease the symptoms. Probiotics are thought to aid digestion and boost the absorption of nutrients in food. Look for products containing both Lactobacillus and Bifidobacteria - two strains that have been linked to improving IBS - and choose one containing the highest concentration of bacteria, such as Yakult or Actimel. Alternatively, try Multibionta's probiotic multivitamin supplement (60 tablets, £6.14 from Boots).

Keep yourself hydrated - drinking plenty of water helps prevent constipation and replaces lost fluid from diarrhoea. Add barley and aloe vera juice to your diet, as both have a soothing effect on the digestive system. Finally, stress is known to exacerbate IBS so relaxation techniques like yoga and meditation can help. Find out more from The Gut Trust on 0114 272 3253 or visit www.theguttrust.org
Dr Louise Selby, SHE

 

Steatorrhoea

I’ve been diagnosed with chronic inflammation of my pancreas, and the patient leaflet I’ve been given says I may develop steatorrhoea. What is it and should I be worried?

Steatorrhoea is the medical term for stools that are high in fat. If you have it, your stools tend to be bulky, smelly and hard to flush away. Steatorrhoea can be a feature of chronic pancreatitis (inflammation of the pancreas) and conditions such as coeliac disease, cystic fibrosis and malabsorption. Basically, getting steatorrhoea tells you that your body's digestive system isn't absorbing fats properly. Chronic pancreatitis can be caused by gallstones and other problems, as well as by excess alcohol. You have no need to worry as long as you have regular check-ups with your doctor and make sure you take the supplement you'll have been prescribed.
Dr Sarah Jarvis, Good Housekeeping

 

Crohn's disease

I'm a 35-year-old woman, and relatively fit. Recently however, I've been getting terrible stomach aches and diarrhoea, which occasionally is stained with blood. I also feel exhausted all the time. I am so busy at work that I haven't had time to go to my GP. Ten years ago I had a bout of Crohn's disease. Could it have returned?

Yes, Crohn's is a condition that can come back, and you are describing classic symptoms of the disease, which is caused by an inflammation of the gut. However, it's very important that you see your doctor so you can be diagnosed correctly as occasionally these symptoms can be a sign of bowel cancer.
Statistically about one in 1,500 people are affected by Crohn's disease. It can develop at any age but often starts between the years 15 to 40. It affects women more often than men, no-one is quite sure why.
I suspect you're feeling so exhausted because you are anaemic. There are two reasons for this: firstly, you may be losing a significant amount of blood in your motions, and secondly, Crohn's can affect the ileum – the part of the gut that absorbs the vitamins and iron essential for making red blood cells. While awaiting a diagnosis I would suggest you start taking a multivitamin that contains vitamin B12, folate and iron. These are the three essential building blocks needed to combat anaemia. If you're diagnosed with Crohn's your doctor will discuss the various treatments that are available. The common treatment to control symptoms when Crohn's first develops is either a steroid or a 5-aminosalicylate medicine. Both treatments reduce inflammation, but work in different ways. Medication is taken for a few weeks until symptoms clear and then are usually prescribed again each time symptoms flare up. If you are a smoker, giving up cigarettes can reduce the number of flare-ups. Stress is also a trigger for Crohn's so think about trying some relaxation exercises. Also, try taking a probiotic such as Yakult yoghurt or Multibionta. Recent research suggests that probiotics may compete for space in the gut with harmful bacteria, helping to dampen down inflammatory responses.

For further information contact the National Association for Colitis and Crohn's Disease (NACC) on 0845 130 2233; www.nacc.org.uk
Dr Louise Selby, SHE

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The answers to specific problems may not apply to everyone and are not substitutes for professional medical advice. If you're worried, see your GP. For more information, visit www.netdoctor.co.uk