Ask the doctor - fatty liver
Read expert medical advice on digestive health with doctors' questions and answers from Prima and Good Housekeeping
I’m told I have a fatty liver. I’m a healthy weight and hardly ever drink alcohol, so what has caused it?
Some experts estimate that non-alcoholic fatty liver disease (NAFLD) affects as many as one in five people, although many cases are mild and remain undiagnosed. It is most common in people who are obese, have type 2 diabetes mellitus or raised triglyceride levels, but in some people, such as yourself, there is no obvious underlying cause. NAFLD has been linked with free radicals, so try taking an antioxidant supplement. Milk thistle and globe artichoke extracts both have bene cial actions on liver function and are widely available at health-food stores. Milk thistle inhibits liver cell damage, maintains levels of the antioxidant glutathione, and reduces liver brosis. Artichoke increases bile secretion and has a beneficial effect on glucose balance and insulin production. It may also be wise to request a referral to a liver specialist.
Dr Sarah Brewer, Prima (Apr 12)
My husband recently noticed some blood when he opened his bowels. He assumed it was caused by piles, but I’ve noticed he’s visiting the bathroom more often than usual. Should I insist he sees the doctor?
Absolutely. Anyone who experiences rectal bleeding with a change in bowel habits will be referred to a hospital specialist team for investigations to find out the cause. Although in many cases, nothing serious is found, this can be a sign of a bowel cancer which is easier to treat and cure if diagnosed early. If you are concerned, contact the Bowel Cancer UK nurse for advice. Visit www.bowelcanceruk.org.uk, or call 0800 840 3540.
Dr Sarah Brewer, Prima (Mar 12)
My GP recently told me I have irritable bowel syndrome – I’ve had bloating and tummy pain on and off for months. Do I need any tests to confirm the diagnosis, and what lifestyle changes can I make to avoid the symptoms?
When it comes to irritable bowel syndrome, or IBS, there isn’t a test to prove you have it. Instead, other causes need to be excluded – for
example, you may have blood tests to rule out conditions such as coeliac disease and anaemia. Importantly, though, IBS very rarely starts for the first time over the age of 40 and, in women over this age, cancer of the ovary needs to be considered as a possible cause of IBS-like symptoms. Somewhat bizarrely, IBS can cause diarrhoea, constipation, or a combination of the two in turn. Other symptoms often include: abdominal pain that is eased by opening your bowels or passing wind; a feeling of not completely opening your bowels; passing mucus with a motion; bloating and feeling full after eating only a small amount. Advice for the treatment of IBS has changed over the years, and doctors now recognise that while dietary fibre may relieve constipation, it can worsen IBS-associated diarrhoea. It also seems that the kind of fibre you eat makes a major difference. Foods we traditionally think of as high fibre, such as wholemeal foods and bran contain insoluble fi bre or ‘roughage’ that can make symptoms of IBS worse. By contrast, foods high in soluble fibre – oats, okra, aubergines, prunes, strawberries, beans, peas and nuts – may help. Lifestyle changes, including trying to avoid stress, eating regular meals and cutting down on fizzy drinks, are all worth trying. Probiotics are products rich in bacteria that help our guts to function properly. While some foods such as yogurts and sauerkraut are naturally high in probiotics, it’s not clear if enough of the ‘good’ bacteria survive their journey through the rest of the digestive system to help, so it may be worth trying a fortified product such as Danone’s Activia. The National Institute of Clinical Excellence suggests at least a four-week trial before deciding whether they are helping you.
Dr Sarah Jarvis, Good Housekeeping (Nov 11)
My 12-year-old has bad bouts of constipation despite taking laxatives prescribed by our GP. Can you suggest anything to help?
A good fluid intake is important, so encourage drinks such as freshly squeezed fruit juice and water. Probiotic drinks and bio yoghurt will help to ensure a healthy balance of bacteria. Fibre-rich dried fruit such as raisins and apricots are usually acceptable to kids or Ortis Fruit and Fibre Cubes (£6.45 from Boots, www.boots.com) work gently to encourage results. Molasses is also an effective laxative – take one teaspoon daily.
Dr Sarah Brewer, Prima (Nov 11)
I’ve always suffered from bloating and keep a careful eye on my diet, as I know some foods make it worse. I’ve heard that taking pre-biotics or pro-biotics might help but I’ve no idea what the difference is – or which ones work best.
Bloating is often caused by an imbalance of the natural bacteria in your gut. These are essential to help break down what you eat, but some produce gas as they ferment your food. Increasing the proportion of ‘good’ bacteria, such as bifidobacteria and lactobacilli, can keep gas-producing bacteria at bay. Pro-biotic food (including some yogurt and sauerkraut) contains these good bacteria, but they only help symptoms if the bacteria survive the digestive process and make it to the large bowel. Pre-biotics feed the good bacteria that are already in your gut, encouraging them to colonise and grow at a faster rate. Some food, such as fruit and veg, contain natural pre-biotics. I don’t usually mention products but there’s also clinical evidence that Bimuno pre-biotic supplements (£8.99 for 30 sachets from Boots) increase good bacteria and reduce symptoms such as bloating and wind.
Dr Sarah Jarvis, Good Housekeeping (Mar 11)
I suffer from indigestion most days. Is it safe to keep taking an antacid?
Although excellent indigestion remedies are available from pharmacies, these should only be used for a short time – no more than two weeks. This is because recurrent symptoms of indigestion can mean you have a problem that needs medical tests and treatment. Persistent indigestion can mean you have a stomach infection (with the bacterium helicobacter pylori), a peptic ulcer, or even a tumour. Discomfort behind the breastbone can also be due to angina or even a heart attack, in which case it will be worse when you exert yourself, and may be associated with a cold sweat, palpitations, vomiting, shortness of breath or general weakness.
Dr Sarah Brewer, Prima (Sept 10)
I suffer from gastroparesis, which makes it difficult to eat normal full meals, fruit or veg without experiencing terrible stomach pains. Can you offer any advice?
Gastroparesis (delayed emptying of the stomach) can occur when the nerves and muscles in the stomach don't churn food and move it on through the digestive tract properly. As well as discomfort, this can cause nausea, vomiting, bloating and poor appetite, as well as weight loss and swinging blood-glucose levels. Treatment with drugs that stimulate gut mobility, such as metoclopramide or domperidone, may help and are available on prescription. A drug called mirtazipine, also on prescription, has been shown to reduce nausea and vomiting, as well as having an antidepressant action. As you will know, eating little and often is helpful. Nutritional supplements such as Fortijuice, Fortisip or Ensure, which supply protein, energy, vitamins and minerals, are also important. These are available on prescription or from pharmacies. For excellent information on how to improve nutrition when you need extra calories, visit http://tinyurl.com/yzwktgn.
Dr Sarah Brewer, Prima (Jul 10)
I've just been diagnosed with Crohn's disease - can any particular diet help? The only advice from my consultant is to avoid foods that seem to upset me.
Crohn's disease is an inflammatory disease of the bowel. Particular foods often make symptoms worse, but it's not always easy to identify
the culprits. In research, the foods found most likely to cause problems were corn, wheat, milk, yeast, egg, potato, rye, tea, coffee, apples, mushrooms, oats and chocolate. In one study, over half of people who followed the low-fibre, fat-limited exclusion (LOFFLEX) diet were still free from symptoms after two years. It involves avoiding pork, fish prepared in batter, oil or tomato (plain fish is fine), milk and dairy products, wheat, rye, barley, millet, buckwheat, corn, oats, yeast, beans, onions, tomatoes, sweetcorn, citrus fruit, apples, bananas, dried fruits, certain oils (vegetable, corn and nut oils), nuts, seeds, tea, coffee, alcohol, squashes and cola. This diet is best followed under medical supervision.
Dr Sarah Brewer, Prima (Jun 10)
My husband's GP gave him a medicine for indigestion called Losec, which he swears by. I also had indigestion recently, and our local pharmacist offered to sell me the same thing. But if it's a prescription drug, is it safe to take it without seeing my GP?
Like many other medicines, Losec has been moved from a category called Prescription Only Medicine (POM) to Pharmacist Advice (P). Many prescription medicines that have been around for years have an excellent safety profile, and in the past 20 years dozens of them have been moved to P status. Unlike over-the-counter medicines, which you can pop in your shopping basket at the supermarket, P medicines can be sold by pharmacists only after they go through a checklist to confirm it's safe to do so. They will sell you only short or intermittent courses, and the dose is often lower than your GP can issue on prescription. While pharmacists may not have medical training, they are highly trained in the safe use of medicines, and will always advise you to see your doctor if their checklist raises any concerns of a serious underlying problem that needs medical expertise.
Dr Sarah Jarvis, Good Housekeeping (May 10)
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 netdoctor.co.uk
