Friend's Bowel Health

Question 1

A friend has approached you with some embarrassment, explaining that he has been suffering for some time now from very unpredictable bowel conditions, sometimes constipated, sometimes suffering acute diarrhea, sometimes painful and sometimes unbearably flatulent (!).

Take your friend through his symptoms, outlining questions you will need to ask him and his answers, which will include a brief discussion of his average daily diet. Explain to him the things that may be going wrong then suggest ways to alleviate his problems in the short term and set up conditions that will prevent a recurrence in the long term. Be sure to cover all possible causes of his bowel condition in your answer, including leaky gut and small intestinal bacterial overgrowth (SIBO).

Conversation with friend

I will name my friend Peter in this section.

Me: Hello Peter, How are you doing?

Peter: I am not very well. I have been experiencing unpredictable bowel conditions for some time now.

Me: How has the experience been like?

Peter: I have experienced constipation, acute diarrhoea, sometimes pain and unbearably flatulent.

Me: I am sorry for that Peter. Tell me more about your diet.

Peter: I eat a variety of meals since I am only allergic to meat. My diet includes fruits, vegetables, and I do some snacks too.

Me: How about drinks?

Peter: Well. I like coffee so much. But I also take sodas and some alcohol, especially on weekends.

Me: I see. And have any of your family members experienced similar conditions to what you go through?

Peter: No. that’s why I feel so embarrassed to even talk to them.

Me: That’s right then. And by the way, have you experienced any form of stress before the onset or during the conditions you have been experiencing?

Peter: Well. I must say that before I started experiencing this way, I didn’t have any issues and my life was just normal. However, when I started experiencing constipation, diarrhoea, and stuff, I became anxious and concerned and I just can avoid thinking about the whole thing at the moment.

Me: Alright Peter. I think we can work out something helpful.

Peter, from your description in our conversation, it is clear that there a problem with the gastrointestinal tract and digestive system. You may be suffering from the condition known as irritable bowel syndrome which is a gastrointestinal disorder associated with abdominal cramping, bloating and changes in the bowel habits. Diarrhoea and constipation, as well as flatulence, are common manifestations of the condition.

Irritable bowel disorder is closely associated with leaky gut and small intestines bacterial overgrowth in terms of the manifestation. Leaky gut is a condition where the linings of intestine or digestive tracts are exposed to openings permitting the bacteria to move to and from the tract. Alcohol is thought to weaken the linings of the gastrointestinal tract causing leakages. On the other hand, small intestines bacterial overgrowth is a condition where there is an excessive amount of bacteria within the small intestines. Thus, leaky gut and small intestines bacterial overgrowth are possible causes of irritable bowel syndrome.

There are other common causes of irritable bowel syndrome, some of which you have highlighted in our conversation. Diet is one of the main causes of IBS and as you have rightly mentioned, I believe you have been consuming most or all of the foods that can cause IBS. Foods that cause flatulence are top of the list and they include onions, beans, celery, carrots, sprouts, raisins, and bagels. Dairy products such as milk, yogurts, and chocolate, sugar-free gum products, and products with caffeine such as coffee are other foods that cause IBS. As you mentioned in the conversation, I tend to believe that your diet includes most of the listed products and your love for coffee is undoubted.

Diet is however not the only cause of irritable bowel syndrome. Environmental factors such as anxiety and stress can result in upsets in the proper digestive functioning and cause irritable bowel syndrome. The inability of the central nervous system to control digestion, Sensitivity of digestive organs to pain and malfunction in the food movement muscles which could as well be associated with leaky gut or small intestines bacterial overgrowth are other causes of IBS.

Irritable Bowel Syndrome is manifested with some peculiar symptoms. First, abdominal pain is common and is associated with changes in bowel movement and this can be accompanied by constipation and/or diarrhoea. Other symptoms are bloating, and the feeling that you haven’t finished your bowel movement. Other patients experience frequent urination.

Managing the irritable bowel syndrome can be achieved through the short- term and long term measures. Short term measures are mostly targeted on the diet aspect and include measures that can be implemented to reduce the intake of foods that may trigger bowel reactions. Among the actions include avoiding sorbitol found in some chewing gums, diet foods and sugar-free sweets.

The other measures include increasing the consumption of oat-based foods, eating slowly to avoid accumulation of gas in the bowel and not skipping meals since this will prevent unparalleled stimulation of food consumption of bacteria that will end up destroying the intestinal tract linings. Limiting alcohol consumption, tea, and coffee or all caffeine products and avoiding carbonated sugary beverages are measures that can be helpful in managing the irritable bowel syndrome. Finally, you should drink enough fluids such as water to aid in digestion.

Stress and anxiety management is one of the long term measures for managing IBS. The central nervous system plays a role in regulating digestion and thus stress and anxiety affect the brain and nervous system normal functioning and may result bad feeding habits like binge eating. Thus, as an intervention, stress management will enhance the central nervous system’s ability to control digestion. Stress management can be achieved through relaxation techniques such as meditation that directs the mind to think of more positive issues, regular physical exercise which leaves the body refreshed, rejuvenated and relaxed and cognitive behaviour therapy. Cognitive behaviour therapy seeks to train the brain and mind to function properly and every brain part and central nervous system to perform their usual functions optimally. As a last resort, however, medication can be sought to manage various symptoms of irritable bowel syndrome.

References

• Bures, J. (2010). Small intestinal bacterial overgrowth syndrome. World Journal of Gastroenterology, 16(24), 2978. doi:10.3748/wjg.v16.i24.2978
• Dysphagia. (2018, August 20). Eating, Diet, & Nutrition for Irritable Bowel Syndrome. (2017, November 9). Retrieved from https://www.niddk.nih.gov/health-information/digestive-diseases/irritable-bowel-syndrome/eating-diet-nutrition
• Hoveyda N, Heneghan C, Mahtani KR. A systematic review and meta-analysis: probiotics in the treatment of irritable bowel syndrome. BMC Gastroenterol 2009; 9:15. https://www.nidcd.nih.gov/health/voice/pages/dysph.aspx

Question 2

Imagine you are a Nutritional Therapist and a client has told you that they want to try a three day fast. Make a list of relevant questions that you will need to ask, and record your client’s responses (if it helps you can imagine that you are also the client, so the answers will be based on your own health and lifestyle)

Give preparatory advice for a three day fast, explaining its benefits, assessing your client suitability and advising on juices and how and when to prepare them. Also advice on possible short-term discomfort in the course of the fast and what, if anything, should be done about it.

The client assumes the name, Ann

Ann: Good afternoon, Sir?

Me: Good afternoon, welcome. Have a seat, please.

Ann: (sitting) Thank you.

Me: How may I help you?

Ann: I need your help with fasting. I have been planning for some time now and I want to fast.

Me: How do you want to fast and why?

Ann: I would like to do a 3-day fast. I checked it online and thought it would be helpful to make me lose weight and have a healthy lifestyle.

Me: Well, that’s impressive. Have you been diagnosed with any chronic medical conditions and are you currently under any medication?

Ann: No. I believe I am perfectly fine.

Me: Do you drink alcohol or smoke? And if yes, how frequently?

Ann: I take a glass or two of alcohol like once a week.

Me: I’ll then have to conduct some tests on you and then guide you on how to implement your plan.

Ann: No problem. Go ahead. You are the expert after all. (Both laughing)

After testing: (Blood pressure, blood glucose level, and BMI results fall within normal range)

Me: The test results show that you are healthy. Tell me more about your exercising routine, if any.

Ann: Well, I rarely exercise but once in a while, I take a walk for around 20 minutes. But it’s not premised on a regular pattern.

Me: I am impressed with your efforts. I believe you can make it through a 3-day fast. It’s achievable with patience and perseverance.

Ann: I am ready for it and to follow your directions.

Fasting as a form of losing weight and gaining a healthy lifestyle comes with benefits as well as hurdles and thus before undertaking the fast, there are steps that can be followed. Ann already made the initial step by visiting a nutritionist to get more advice. This is the starting point for fasting and is followed by practically cutting down habitual lifestyle behaviours such as drinking alcohol. In this case, Ann will have to avoid consuming alcohol for at least 2 weeks before starting the fast and gradually reduce consumption of food as the fast approaches. Since the results of the tests were positive, Ann can suitable manage the 3-day fast routine.

Healthy living is an aspiration of many people and there are a number of measures for weight loss and maintaining a healthy lifestyle. A 3-day fast, commonly known as intermittent fasting involves limiting the intake of energy for 1-3 days a week and eating freely the remaining days.

Limiting the intake of calories during the 3-day fast over a period of time can result in a number of health benefits like losing weight, and reduced risk of cardiac disorders. If Ann commits to the 3-day fast plan, then she would likely achieve her desired objective of weight loss as pointed out in the conversation. Another benefit of this type of fasting is decreased cholesterol levels in the body. To effectively achieve these benefits, it is important for the 3-day fast to be repeated for some weeks.

While intermittent fasting has some benefits, there are a couple of side effects that Ann should be aware of. Top of the list is the probability of over-feeding during the non-restricted days and this can result in the accumulation of more weight.

With the 3-day fast, the restrictions in the energy intake result in significant reduction of glucose in the body and since glucose is crucial for body functioning, the body will resort to burning fats to get the energy. The reduction in glucose levels might cause headaches, dizziness, nausea, heartburn and bad breath. However, as a mitigating measure, drinking plenty water can help reduce the headaches and taking enough rests to manage the dizziness. It is important to schedule the fast in the days that you are not so active such as during the weekends in order to avoid draining the body with intense activity on reduced energy levels. This will further reduce your productivity and this is not the intention of the 3-day fast.

Juices can also be used to complement water during the 3-day fast. However, there are some considerations that should be followed in preparing the juices and the ideal type of fruit juices that can be helpful during the fast. First, fruits that are acidic such as oranges, pineapple, passion fruits, and lemon should not be used to make the fruit juices because acidic fruit juices cause heartburn in the body. The ideal fruits for making juices include mangoes, watermelon, bananas, and avocado. When making fruit juices, all the fibre should be sieved from the juice and no sugar added. This helps to prevent activation of the digestive system from fibres and increase in insulin level from sugar. The ideal time for preparing juices during the 3-day fast is at noon in order to get energy during the day.

Intermittent fasting is one of the effective short-term measures that can result in weight loss and living a healthier lifestyle. The choice of Ann can be more effective if physical exercise is integrated into the plan. However, it is crucial that the individual is committed to the plan. Fluids such as water and juices are crucial during the fast as they keep the body rejuvenated and active during the period. As pointed in the above discussion, there are benefits as well as probable side effects of the intermittent fast though they can be mitigated during the entire period of fasting.

References

• Barnosky A.R., Hoddy K.K., Unterman T.G., Varady K.A (2014): Intermittent fasting vs. daily calorie restriction for type 2 diabetes prevention: A review of human findings Translational Research, 164 (4), pp. 302-311.
• El-Hawary A, Salem N, Elsharkawy A, Metwali A, Wafa A, Chalaby N (2016): Safety and metabolic impact of Ramadan fasting in children and adolescents with type 1 diabetes. J Pediatr Endocrinol Metab.; 29(5):533-41.
• Heilbronn LK, de Jonge L, Frisard MI, DeLany JP, Larson-Meyer DE, Rood J, (2006): Effect of 6-month calorie restriction on biomarkers of longevity, metabolic adaptation, and oxidative stress in overweight individuals: a randomized controlled trial. JAMA; 295:1539–48.
• Mattson MP (2014): Challenging oneself intermittently to improve health. Dose-Response. 12:600–18. https://doi.org/10.2203/doseresponse.14-028.Mattson. eCollection 2014
• Mercken EM, Crosby SD, Lamming DW, JeBailey L, KrzysikWalker S, Villareal DT (2013): Calorie restriction in humans inhibits the PI3K/AKT pathway and induces a younger transcription profile. Aging Cell; 12:645–51. https://doi.org/10.1111/acel. 12088.
• Vakili R, Niazi Z, Rezaie P (2016). Type 1 diabetes and Ramadan fasting: a narrative review. J Fasting Health; 4(1):22-4.
• Zahra M, Reza R, Amirali A, Kamran G, and Kiarash G (2014): Impact of Short term, Repeated Water Fasting on the Weight of Mice.