What’s up with your gut? Find the answers to bloating and diarrhoea in my new book

Gut problems are incredibly common and plague millions of people on a daily basis.Sadly, many people never find a satisfactory explanation or diagnosis for their painful and embarrassing symptoms.

Whether you bloat after eating bread or pasta, suffer cramping pains in your abdomen or experience bouts of watery diarrhoea or suffer  unexplained constipation despite eating lots of fibre – it can be a battle to get to the bottom of  what’s really up with your gut.

With coeliac disease for instance, where the body’s immune system mistakes gluten, a protein found in wheat, barley or rye for a pathogen and mounts an inflammatory response, it can take an average of 13 years to get a diagnosis and in the UK it’s been estimated that 75 per cent of cases go undiagnosed.

It’s the same with a whole host of other gut conditions -including bile acid diarrhoea and non coeliac gluten sensitivity to name just a few.With this in mind, I’ve co-authored a new book with gastroenterologist Professor Julian Walters from  Imperial  Healthcare in London called ‘What’s Up with Your Gut?’ (Hammersmith Press £14.99 on Amazon).

The book discusses possible causes for gut problems and helps you spot key symptoms for different diseases.  These include familiar ones you will heard of including IBS ,coeliac disease and Crohn’s disease but also some lesser known but surprisingly common conditions you might not have come across before, including bile acid diarrhoea, non coeliac gluten sensitivity, small intestinal bacterial overgrowth (SIBO) and microscopic colitis. There are also useful sections on spotting the signs of cancer, indigestion  GORD, globus sensation and pretty much every other gut complaint you can think of!

There’s also lots of information about FODMAPs (short chain carbohydrates or sugars) and the foods you should try and cut down on; tips on how to get tested  for lactose intolerance and other food intolerances.

Seven mystery gut problems you probably haven’t heard of

Here’s a taster of seven mystery gut complaints that you can read all about in the book.

  • Bile acid diarrhoea: Up to one million people in the UK could have bile acid diarrhoea (BAD) also known as bile acid malabsorption – according to some estimates. It’s a particularly nasty type of diarrhoea which can produce up to 10 watery bowel movements a day. The good news is that there’s a test and a treatment available for it.
  • Non coeliac gluten sensitivity (NCGS): It’s estimated between four and seven million people could have NCGS in the UK. Despite NCGS producing symptoms similar to coeliac disease including bloating, diarrhoea, and weight loss and it responding to a gluten-free diet – blood tests and biopsies are negative for coeliac disease.
  • SIBO (small intestinal bacterial overgrowth):SIBO is another common cause of watery diarrhoea. It’s caused by too much bacteria growing in the small intestine  and results in fatty stools, weight loss, bloating or even anaemia. Some experts have proposed it is a possible cause of Irritable Bowel syndrome.
  • Microscopic colitis: This can be a cause of severe, watery,persistent diarrhoea, bloating and pain and is caused by inflammation of the colon and estimated to affect one in 1,000 people. The inflammation is only visible under a microscope and can be missed in standard  biopsies.
  • Globus sensation: This is the medical name for feeling that you have a lump in your throat (when no physical lump exists) and accounts for one in 20 referrals to ENT specialists.
  • Pelvic Radiation Disease: PRD can cause 21 different bowel symptoms including bloating and diarrhoea with loose and fatty stools and is caused by radiation treatment for cancer in the pelvic area. Symptoms can develop long after treatment so patients may not realise they are connected to their radiotherapy.
  • Slow transit constipation: Between 15 and 30 per cent of patients with chronic constipation have slow transit where their gut doesn’t move food and waste at the normal rate. Eating more fibre will make it worse – leading to years of discomfort unless the right diagnosis is made.

I’ll be blogging about some of these conditions in more depth shortly but just thought I’d give you the heads up that the book is now available to buy (there’s a Kindle  version too). I really hope the book  helps you find out what is up with your gut – the inspiration for  it came from the very encouraging feedback I’ve had on the blog so thanks to everyone who has commented and read WUWYH. Big thanks go to Professor Julian Walters for his help and guidance with the research  and writing of the book too.

Here’s a link  to an article in the Daily Mail about the book which will tell you more (the fact that it has been shared online 1.5K times means there are clearly a lot of people out there affected by these issues). http://www.dailymail.co.uk/health/article-3820080/The-7-mystery-gut-problems-doctor-not-spot-Millions-patients-left-undiagnosed.html

Continue reading What’s up with your gut? Find the answers to bloating and diarrhoea in my new book

You’ve been told you have IBS but could you have BAD ?

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CAPTION: Always on the loo?

Until a few weeks ago I’d never heard of bile acid diarrhoea (let’s call it BAD). Despite writing about all manner of tummy upsets for quite a while now – including Irritable Bowel Syndrome (IBS), Crohn’s disease and ulcerative colitis to name but a few – I’d never come across this particular gut nasty.
But then I spoke to Professor Julian Walters, professor of gastroenterology at Imperial College, London, and learned that up to 500,000 people in the UK who have been diagnosed with Irritable Bowel Syndrome – may actually have BAD instead.
Why does it matter? Well, according to Professor Walters, BAD is comparatively easy to treat and there’s a diagnostic test and effective medicine you can take for it – where as the diagnosis and treatment for IBS is far more complicated and seems (to a layman like me at least) to be a more let’s suck-it-and-see-if-it-works approach.

Why don’t more people know about BAD?

I can’t be the only one who is wondering why BAD is not on the radar of more doctors(and patients). By contrast, coeliac disease has become fairly well-known now as has Crohn’s disease. But BAD affects potentially far more people, so why is there is no information about it?
‘Most patients – and doctors – are unaware that bile acid diarrhoea even exists and that there is a diagnostic test and effective drug treatment available,’ explains Professor Walters.
‘IBS is estimated to affect four million adults in the UK; of those 1.3 million have diarrhoea as the predominant symptom. However, its cause is often difficult to diagnose and patients may undergo several investigations, including those for inflammatory bowel disease, colonic cancer, coeliac disease and chronic infections, without a definitive cause being identified or effective treatment.’

Freedom after 48 years

Judith Fulton who I interviewed for the Daily Mail Good Health section http://www.dailymail.co.uk/health/article-2255492/Bile-acid-diarrhoea-For-40-years-doctors-said-I-IBS-In-fact-hormone-problem-cured-simple-pill.html suffered from unexplained daily bouts of watery diarrhoea for over 40 years. She had countless tests including the invasive kind most of us would rather avoid if it isn’t absolutely necessary – doctors just said it was IBS though -and they offered her no treatment.
When Judith read about Professor Walters’ research though it was a light bulb moment and she tracked down his email on the internet and asked him for a consultation. She was later diagnosed with BAD and after treatment with the drug cholestyramine (Questran) her symptoms disappeared within a few weeks. After forty-eight years of suffering she is now free to leave the house without researching where the nearest toilet is. That’s what I call a result and partly why Judith was willing to be interviewed about such an embarrassing health problem – she wants more of us to know about it.
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CAPTION: FREEDOM TO GO OUT WITHOUT RESEARCHING THE NEAREST LOO

A bit about bile acid (before we go on)

I won’t bore you with a full blown biology lesson, but in a nutshell: bile acids are essential for digestion and absorption of fats and fat-soluble vitamins in the small intestine. The liver produces large amounts of bile acids which flow into the intestine every day, but only relatively small quantities are lost from the body. This is because approximately 95 per cent of the bile acids are recycled back to the liver from the ileum (part of the small intestine). But in bile acid diarrhoea – bile acid is overproduced and the excess bile passes into the colon causing watery diarrhoea.
Bile acid diarrhoea is also associated with Crohn’s disease, a chronic severe condition characterised by inflammation, ulcers and bleeding that may affect any part of the gastrointestinal tract, including the terminal ileum (the end of the small intestine). This is because Crohn’s causes inflammation and reduces absorption of bile in the intestine and this sometimes necessitates removal of the ileum. This is referred to as bile acid malabsorption as bile is not as absorbed as well in the intestine.
‘In idiopathic bile acid diarrhoea though – patients don’t have a problem with absorbing the normal amounts of bile produced, explains Professor Walters.’Their diarrhoea is triggered by a hormone disorder which causes overproduction of bile and it is this excess bile which causes the diarrhoea – this is an important distinction,’ explains Professor Walters.

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CAPTION: Bile acid is produced in the liver

Hormone deficiency is the cause

Professor Walters conducted research which found that the trigger for idiopathic BAD (from an unknown cause not related to Crohn’s disease) is a deficiency in a hormone called FGF19, which normally switches off bile acid production when bile acid is reabsorbed.
‘At the moment we don’t know why this happens – it doesn’t appear to be genetic although some patients report their symptoms started after a gastrointestinal infection.’

Symptoms
Unfortunately the symptoms of BAD can be hard to distinguish from diarrhoea caused by IBS.These include up to ten watery bowel movements every day, usually with an urgent need to go and frequently resulting in accidents or faecal incontinence. There is also some bloating and abdominal discomfort.

Diagnosis and treatment

Unlike IBS though, there is a diagnostic test available for BAD. It’s called the SeHCAT test(which stands for selenium-labelled synthetic bile salt) and involves two full body scans seven days apart. In a person with normal bile acid production more than 15 per cent of bile is detectable in the body after seven days, but in people with BAD this figure can be as low as one to five per cent.
Once diagnosed with BAD patients can be prescribed cholestyramine and around two-thirds of patients are reported to respond – although this admittedly may take some time until the correct dosage to control symptoms is found.
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CAPTION: What’s really causing your upset tummy?

Hang on a minute though…..
As with many things in medicine though, not everyone agrees. The National Institute for Clinical Excellence, for instance, recently decided although it was’promising’ there was insufficient evidence to recommend the SeHCAT test. Professor Carole Longson, NICE health technology director, said there was also little evidence of the clinical effectiveness of the drugs used to treat the condition and also whether bile acid diarrhoea is a primary or secondary condition.

Professor Nick Read,a gastroenterologist and adviser to the IBS Network is somewhere in between the two camps. He doesn’t believe BAD is a medical condition in its own right – just a symptom of IBS diarrhoea, but on the other hand he says he prescribes cholestyramine frequently to people with IBS where diarrhoea is their predominant symptom and it works really well. He told me:’I find that cholestyramine is an effective drug which mops up bile acid in the intestine. I’ve seen patients who have had diarrhoea for years dramatically improve using this treatment.’

Whatever the mechanism – the upshot is if you’ve had diarrhoea for years and been given an IBS diagnosis and told to live with it, you might want to ask about getting a SeHCAT test. Just like Judith the test (and the treatment) might give you your life back.

Watch Professor Walters here: http://www.youtube.com/watch?v=-O3uR0iDObw

ALL IMAGES:SHUTTERSTOCK

Here’s some more of my articles about gut health you may want to read.
http://www.dailymail.co.uk/health/article-2194464/My-doctors-orders-Crisps-doughnuts-strictly-veg.html
http://www.dailymail.co.uk/health/article-1350238/Feel-bloated-Cramps-The-problem-BRAIN.html
http://www.dailymail.co.uk/health/article-1313821/For-TEN-YEARS-Lucy-told-worry-stomach-cramps-In-fact-chronic-disease-eating-away-gut.html