On Thursday 21.03.19, an event that has been in the works for a while came to life! As requested by so many, I’ve managed to team up with Zurich’s top gastroenterologists for an evening that was all about gut health.
We covered 4 main topics that evening, which were irritable bowel syndrome (IBS), small intestinal bacterial overgrowth (SIBO), the gut microbiome and food intolerances. I decided to highlight the most interesting take away messages from that night in hope to shed some light on how complex this whole area is and how important it is to consult specialists given that things are not so black and white. Here goes…
On Irritable Bowel Syndrome (IBS):
- It is a chronic condition that is more prevalent than we think, where the exact cause is still unknown.
- Prevalence is around 10-15% of the world’s population.
- Diagnosis starts by “process of elimination” as conditions such as IBD and Coeliac disease need to be ruled out. However, the Rome criteria is a tool used to approach a diagnosis of IBS. A typical IBS workup looks as follows:
- Blood, serum chemistry, TSH basal
- Coeliac disease?
- Gastroscopy/colonoscopy if indicated
- Stool bacteriology / parasites
- H2 breath test
- Calprotectin
- Haemoccult
- Abdominal sonography
- Once a diagnosis has been made, then a number of approaches are considered to manage symptoms.
- Dietary triggers of IBS include FODMAPS, fatty food, alcohol, caffeine, highly spiced foods. Non-dietary triggers include stress, anxiety and poor sleep to name a few. Management is a multifaceted approach.
- The low FODMAP diet is a clinically supported approach to managing IBS symptoms, however is not a cure. It is also only a temporary diet and should not be followed long-term. For more information on the low FODMAP diet, you can sign up to our Beat the Bloat program.
On Small Intestinal Bacterial Overgrowth (SIBO):
- SIBO is very much a “real” condition that many GPs don’t necessarily look into.
- It is a condition where there is excess bacteria in the small intestine, which is not normally the case. This could be largely due to a potential motility issue (i.e. ?lack of movement in the small intestine).
- Diagnosis can be made via a breath test (i.e. lactulose breath test) or via small intestinal fluid sample that is analysed by a specific lab.
- If a person tests positive for SIBO then management would entail using a “localised” antibiotic e.g. rifaximin including a low FODMAP approach.
On the Gut Microbiome:
- An immense amount of research is emerging linking the gut microbiome to obesity, cancer, autoimmune disease and mental health. As exciting as the research may sound, it is too early to establish exact connections. We are all watching this space though!
- Companies that are offering to analyse your microbiome offer great insight but we still don’t know what to do with such information in clinical situations. Importantly, what is a “normal” or “ideal” microbiome one should work towards?! That we don’t know.
- Probiotic supplements are another health trend where a lot of misinformation exists. Firstly, not everyone needs a probiotic supplement and most important of all, you need to determine the type of probiotic strain required to treat or aid your condition!
- In order to help your own gut probiotics to strive:
- The bulk of your diet should be plant-based with a variety of fibres
- Include more food sources of probiotics (fermented foods: yoghurt, sauerkraut, kimchi..) and prebiotics (leek, oats, legumes…)
- Stress-management due to the negative impact stress has on the diversity of your gut microbiome
On Food Intolerances:
- The two food intolerances that a gastroenterologist is able to test for are lactose intolerance and fructose malabsorption.
- The only method to diagnose an intolerance is via an elimination diet. As a specialist dietitian, it’s my role to play detective using extensive medical and nutritional history where we could investigate the possibility of a food chemical intolerance vs FODMAP sensitivity.
- Despite popular practice, there is absolutely no blood test that can accurately diagnose a food intolerance. IgG testing is unreliable, inaccurate and not a clinically approved diagnostic tool. Below are excerpts of position statements re: IgG intolerance tests made by a number of international societies and academies of clinical immunology and allergy:
From the Australasian Society of Clinical Immunology and Allergy: “IgG antibodies to food are commonly detectable in healthy adult patients and children, independent of the presence or absence of food-related symptoms. There is no credible evidence that measuring IgG antibodies is useful for diagnosing food allergy or intolerance, nor that IgG antibodies cause symptoms. In fact, IgG antibodies reflect exposure to allergen but not the presence of disease.”From the European Academy of Allergy and Clinical Immunology: “Food-specific IgG4 does not indicate (imminent) food allergy or intolerance, but rather a physiological response of the immune system after exposition to food components. Therefore, testing of IgG4 to foods is considered as irrelevant for the laboratory work-up of food allergy or intolerance and should not be performed in case of food-related complaints.”From the Canadian Society of Allergy and Clinical Immunology:“The test is also being marketed to concerned parents, and may lead to exclusion diets which carry risks of poor growth and malnutrition for their children: for example, the elimination of dairy products, wheat, eggs, and/or other foods found in healthy balanced diets.”From the American Academy of Allergy Asthma and Immunology: “Additionally, and perhaps of greater potential concern, a person with a true immunoglobulin E (IgE)-mediated food allergy, who is at significant risk for life-threatening anaphylaxis, may very well not have elevated levels of specific IgG to their particular allergen, and may be inappropriately advised to reintroduce this potentially deadly item into their diet.”
And what a night it was! Couldn’t thank these two doctors more for being a part of this and for our lovely audience who were extremely engaging and voiced their concerns and questions. For more on how to reach our doctors, you can click on the following links below:
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