Constipation

How do you fix your diet to take adequate fibre?

/ Subash Rau / Leave a comment

Fibre or roughage refers to anything that that can be taken by mouth and is not digested, bulks up the contents of the intestine and helps smooth evacuation of stools.

Having a diet that has plenty of fibre is good for health. Apart from preventing constipation, dietary fibre has a beneficial effect in lowering the risk for heart attacks and strokes, reducing the risk of diabetes, improving diabetic control in those already with diabetes and in preventing obesity. Modern dietary habits, based on the consumption of large amounts of refined cereals (grains) has very little fibre and therefore increases the risk of developing common lifestyle diseases such as obesity, dyslipidaemia, hypertension, diabetes and their complications.

What are the types of dietary fibre?

Dietary fibre comes predominantly in three forms namely, soluble fibre, insoluble, fibre and fermentable fibre.

Soluble fibre, dissolves in in water and puffs up, fills the tummy, promotes satiety (a feeling of being full, and therefore reduces hunger). It therefore helpful in those with diabetes and dyslipidaemia.

Insoluble fibre doesn’t swell up in water but tends to bulk up the intestinal contents, reduce intestinal transit times and helps quicker elimination from the body. Insoluble fibre is very important in maintaining intestinal health and preventing constipation.

Fermentable fibre can come from both the above groups and maintain a population of good bacteria in the gut. These are often referred to as pre-biotics (food for the good bacteria). Their digestion by intestinal bacteria (flora) results in short chain fatty acids (which can be used by the human host as an energy source) and is also converted to gas (methane, ammonia, hydrogen and carbondioxide.

So how much fibre do we need in our diets daily?

Most dietary institutes recommend 30 g of fibre for adults and reduced amount of fibre in children based on their ages.

While there is no upper limit to the amount of Phiber that can be consumed every day, it is recommended that any increase in dietary fibre is done gradually in order to prevent gas, bloating, constipation, diarrhoea and abdominal pain.

How do you fix your meals in order to have enough fibre daily?

This can be simply done by incorporating more green vegetables, taking more of whole fruit with skin, whole grains (instead of polished grains), plenty of lentils, and legumes(beans), a generous helping of nuts and also drinking plenty of water (upto 3 to 4 L per day).

By knowing how much fibre different foods and vegetables have, you can design your healthy meals with adequate fibre. Make sure that every meal has a fibre containing food in it just as you have proteins in every meal.

So what then is constipation?

Constipation refers to defecation that is unsatisfactory because of passing stools infrequently, needing to strain stools or with a feeling of incomplete bowel evacuation. Constipation could refer to for example, passing motions to 3 times a week only (not daily) or passing hard stools that are difficult to expel.

Why are people constipated?

People may be constipated because their diet does not contain adequate fibre or because of not taking enough fluids by mouth or because they dont exercise daily (and more so if they are elderly, bedridden or sick). Constipation can also occur due to the presence of medical conditions such as diabetes, hypothyroidism, kidney failure, high calcium levels, intestinal tumours especially cancers of the large bowel (causing partial or total obstruction), diverticular disease, neurological conditions such as Parkinson’s disease/Multiple Sclerosis etc. A variety of medications such as painkillers, antidepressants, iron tablets, antihistamines, certain antihypertensives, psychiatric medications and anti-seizure medications commonly cause constipation.

So how is constipation treated?

Before medication is tried, it is important to correct dietary deficiencies of fibre, inadequate water intake and being physically inactive. Medical conditions often stop patients from being able to do the above (patients with heart or kidney failure who can’t drink much water, patients with intestinal obstruction or inflammatory bowel diseases who cannot take fibre or those who can’t walk or exercise) may need laxatives to help them pass motions every day. Laxatives work by loosening the stools or relaxing the intestines thereby helping defecation.

So the most important thing to do would be to prevent constipation by fixing your diet by taking adequate fibre.

Do you have IBS?

/ Subash Rau / Leave a comment

Irritable Bowel Syndrome is one of the common functional bowel diseases that affect us. Intestinal diseases may be classified broadly into Organic and Functional, where Organic refers to structural intestinal disease as compared to Functional disease where an identifiable structural bowel problem like an ulcer or narrowing (stricture) or bulge (diverticula of the intestine) is absent. IBS is characterised by abdominal pain and altered bowel habits (constipation or diarrhoea).

People with IBS tend to have visceral hypersensitivity i.e., increased perception of pain on intestinal distension. Studies done on IBS patients have shown increased inflammatory/ immune cells in the intestines (on biopsy) such as lymphocytes, mast cells which secrete inflammatory cytokines, histamine, serotonin and other substances that stimulate the nerves inside the bowel wall (Myenteric plexus) and cause increased cellular permeability, pain and increased contractions of the intestinal muscle leading to diarrhoea. This could be the cause for the so called post infectious IBS that is associated with bacterial, viral, protozoal and helminthic infections. There is also a theory that composition of fecal microbiota could be associated with the development of IBS. Small intestinal bacterial overgrowth (SIBO) also has an association with IBS. Studies done have shown that people with IBS have abnormal breath tests indicating bacterial overgrowth and gets better with antibiotc treatment which can reduce the bacterial population. Food allergies, carbohydrate indigestion and gluten sensitivty are also attributed as causes for IBS. Genetic causes, psychological causes such as anxiety depression phobias and somatization have also been shown to be risk factors for IBS development.

IBS is usally suspected when symptoms of abdominal pain and altered bowel habits persist for more than 3 months. The following are typical features of IBS: The symptoms could be either intermittent or continuous.

1. Abdominal pain for atleast 1 day a week. It is usually lower abdominal.

2. Changes in stool frequency – Constipation or diarrhoea

3. Changes in stool form – lumpy hard, pellet like or tooth paste like or loose and watery!

4. Change in stool passage – urgency, need to strain or having a feeling of incomplete evacuation

5. Bloating of abdomen.

6. Association with depression, anxiety, chronic stress or somatization.

What features would suggest that IBS is UNLIKELY!

1. Alarm symptoms such as alternating constipation with diarrhoea, blood in stools, nocturnal diarrhoea, weight loss and fever might indicate a more sinister pathology such as cancer or Inflammatory Bowel disease.

2. An Acute onset might suggest an infective cause for the symptoms.

Such people with the above features and those with a family history of cancer, Inflammatory Bowel disease or Coeliac disease would need other investigations such as Colonoscopy and biopsy.

IBS is classified into 4 types. IBS with diarrhoea (bowel movement > 3 /day), IBS with constipation (bowel movement < 3/week) , IBS with both diarrhoea and constipation and IBS that is not subtyped.

A complete blood count, ESR, CRP, stool complete and occult blood test, Stool calprotectin and and a sigmoidoscopy and colonoscopy may be done (for those with alarm features only) are some of the tests that may need to be done for someone suspected to have IBS.

IBS is a chronic disorder and therefore education and reassurance go a long way in helping the patient cope with the disorder. IBS is prone to recur with periodic exacerbations and remissions. Moderate exercise is believed to be helpful. Avoidance of gas causing food may also help. A diet low in FODMAPS (fermentable oligo, di, mono sacharides and polyols may be helpful. Restriction for 2-4 weeks may improve symptoms. The FODMAPs include 6 food groups:

1. Fructose – corn syrup, apple, pear, watermelon and raisins.

2. Fructans – garlic, onions, leeks, asparagus and antichokes.

3. Wheat based foods – breads, pasta, cereals, cakes.

4. Sorbitol – stone fruits

5. Raffinose – legumes, lentils, brussel sprouts, soybean and cabbage.

Many pharmacologic agents (medicines) are being used to treat IBS.

Antispasmodics such as hyoscyamine, dicyclomine and mebeverine and Probiotics are used for abdominal pain.

Loperamide can be used for diarrhoea.

Polyethylene glycol 3350 is used for constipation predominent IBS. Newer medicines such as Lubiprostone, Linaclotide, Plecanatide and Tegaserod are also used for the same condition. Antidepressants such as Tricyclics and SSRI are also useful. Rifaxamin, a non-absorbable antibiotic is used with good effect for bloating.

Cognitive behaviour therapy, yoga, relaxation and hypnotherapy is also believed to be helpful.