28 May 2019 Gut Problems with an Irritable Bowel?

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(Part 2 – From a Psychologist’s and Dietitian’s Perspectives)

A panel of health experts share facts on Digestive Health in conjunction with World Digestive Health Day on May 29.

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Digestive health disorders and diseases affect millions of individuals worldwide and its impact is reflected in decreased quality of life for the patient, healthcare costs and work absenteeism. In putting digestive diseases in perspective, most disorders can be compartmentalised into two disease categories ie; Organic and Functional Digestive Disorders.

Organic diseases are serious illnesses marked by anatomical, structural (tumours or masses) or biochemical abnormalities, as seen in Helicobacter pylori infection, colorectal cancer (CRC) and gastroesophageal reflux disease (GERD). Functional Digestive Disorders like dyspepsia, functional abdominal pain, functional constipation and functional diarrhoea, on the other hand, do not exhibit such disease characteristics.

Psychological well-being and IBS

IMUH’s clinical psychologist, Puvessha Jegathisan says, “Being a stress-sensitive disorder, IBS is triggered when the body undergoes stress which in turn causes a fight-or-flight response. Enzymes and hormones are released, affecting the gut environment.”

“There is a strong correlation between the severity of IBS and its co-morbid psychiatric disorders, depression and anxiety. Major life traumas were frequently reported 38 weeks prior to onset of IBS symptoms in patient studies. Co-morbidity of IBS and psychiatric disorder is approximately 40% to 60%.”

“Social stigma continues to be the biggest hurdle that is preventing patients from seeking the psychological help they need. Most shy away from seeing a therapist for fear of being labelled crazy, feeble-minded or weak. There are yet others who do not know where to seek help.”

Puvessha shares that treatment for IBS is often viewed and approached from a holistic biopsychosocial perspective. This essentially means that counselling and psychotherapy may be applied to work in tandem with pharmacotherapy.

“The role of the clinical psychologist is to identify stress triggers so that solutions and direction can be offered to the patient to manage and prevent future episodes.”

Among the measures recommended to manage symptoms of stress include deep breathing, imagery and progressive muscle relaxation exercises and cognitive-behavioural therapy (CBT) or mindfulness-based CBT.

In CBT, patients build insight into the relationship between situations, thoughts, behaviours, physical reactions, and emotions; and learn ways to catch and change unhelpful thinking patterns and behaviours that may contribute to physical or psychological distress and to some extent, intervene on their own physiologic responses.

Many people have the misconception that being in therapy involves costly, long-drawn gut-spilling sessions at the psychologists’ office. However, if indeed there is a mental issue and the underlying issue of psychological health is not properly addressed, patients may find that they are just treating symptoms as and when they appear.

“The aim of psychotherapy is to ultimately wean the patient from being dependent on medication and therapy so he can function normally in society.”

Influence of gut microbiota on overall health

Recent advances in research have described the importance of gut microbiota in influencing interactions and biochemical signalling between the gastrointestinal tract and central nervous system.

Dietitian at IMUH’s medical clinic, Kanimolli Arasu explains that host factors like genetic background, gender, age, specific disease or birth route; and environmental factors like diet and lifestyle, hygiene, medication and geography affect microbiota.

“Early life exposure like vaginal delivery where the infant is exposed to maternal microbes; subsequent infant diet; antibiotics which results in selective killing of microbes; probiotics which results in selective enrichment; and the physical environment where an individual is exposed to environmental microbes as well as subsequent adult lifestyle choices have been known to impact upon gut microbiota.”

“In the case of symbiosis, where a good balance of microbiota is achieved, an individual benefit from healthy metabolism, immune tolerance and intestinal homeostasis. When microbial imbalance occurs, a person may become pre-disposed to non-communicable diseases (NCDs) of the immune system like asthma and multiple sclerosis and intestinal disorders like necrotising enterocolitis and IBD. “

Kanimolli says prebiotics like FOS, GOS, Inulin, isomaltulose and Soluble corn fibre found in foods such as leek, onions, garlic, Jerusalem artichoke, wheat bran, oats, legumes, soy beans, asparagus, corn and raw banana support optimum gut function in favour of the proliferation of normal bacterial flora and inhibit the growth of pathogenic organisms. The changes in microbiota induces softer stools, increases stool frequency and reduces incidences of travellers’ diarrhoea.

Probiotics, which are present in foods like yogurt, cheese, kefir, miso, kimchi, sauerkraut, tempeh and kombucha is useful adjunct to rehydration therapy in treating acute, infectious diarrhoea in adults and children and improves chronic constipation in children. In IBS, probiotics appear to be beneficial in terms of improved clinical symptoms.

Although there have been multitude of studies and tests done on prebiotic and probiotic strains more than 200 strains and combination of strains to date) in different dosage formats (5-20g) on various health conditions, there is no specific indication as documented benefits are strain and dose dependent. There is evidence however that changes in microbiota after supplementation with prebiotics and probiotics is rapid but microbiota changes when supplementation is stopped.

Kanimolli advises that for optimal gut health, it is best to combine prebiotic and probiotic-rich foods for symbiotic effect. “You could have yogurt with banana slices, stir-fried asparagus with tempeh and miso soup with cubes of tofu.”

“Consuming a variety of plant-based foods will confer the benefit of different fibres and nutrients for a more diverse microbiota.”

Part 1 – From Medical Practitioners’ Perspective: Gut Problems with an Irritable Bowel?

This article is brought to you by IMU Healthcare.

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