Don’t be shy TV doc ChristianJessen talks

Festive cheer Have a happy gut this Christmas

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No. 2 / December 2009

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Happy living: Learn what’s good for you, what’s not and how you can improve your gut health nowfeel better today

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in the know Food Doctor’s ian Marber on living with and treating coeliacs

Health miracles The woman who lost weight to save her husband’s life

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an independent supplement distributed within the sunday telegraph2 · december

Cleaning up in the battle against the bulge

The obesity crisis is likely to be with us for decades, yet those of us with weight problems can best help ourselves by addressing the quantity of food we eat – and perhaps looking towards vegetarianism for inspiration too.

“What should I eat?” is one of the most com-mon questions that I am asked as a gastro-

enterologist. There are a lot of views about the answer, but in most cases not much compelling evidence.

In Palaeolithic times, hunter gath-erers grazed on meat, fish, nuts and berries. About 20,000 years ago, hu-man communities settled down to a life of domestication, farming and family meals, which arguably per-sisted until the 21st century when grazing again became the norm in many parts of the world, although today’s savannahs are the aisles of Sainsbury’s, Asda and Tesco!

Understand the root causes

1 Domestication and farming ex-posed people to many new foods

(including beer 10000BC, popcorn 3600BC, chocolate 1500BC, and twiz-zlers AD1929) – some of which were only digestible because a settled life was associated with cooking.

Eating is sufficiently personal that what constitutes a healthy diet has

always engaged people. Many people look back to the various phases of the past to try to identify the universally healthy diet. The Palaeolithic (stone age) diet, vegetarianism, and rawism (no cooking) are partly promoted on the basis of such analysis. There is some evidence that vegetarians do live a little bit longer than carnivores, and vegetarianism probably does benefit the planet too. But the truth is that we are omnivores, well able to digest a wide range of different foods.

Evolution may explain some of the diet-related bowel problems that we experience. Many people are intoler-ant of wheat and some develop coeliac disease (see page 10), caused by wheat toxicity to the bowel. Wheat was on-ly developed 20,000 years ago and our bodies may not have fully adapted to it. Likewise, we drink more milk than in stone age times and our capacity to handle lactose (milk sugar) is limited.

The current issues

2 However, the principal threats to health today come from obes-

ity and from excessive hygiene. De-

pending on measurement – be it from official Government statistics or from surveys of people’s own perceptions – 35-50 per cent of the British popula-tion is now obese, and most people expect these figures to increase for at least another ten more years. Obesity is likely to reverse centuries of rising life expectancy in the country, killing people through cirrhosis, diabetes and many forms of cancer, including colon cancer and oesophageal (gul-let) cancer, not to mention the crum-bling joints that will become an epi-demic in the future. Despite the vari-ety of factors at play, for many, the an-swer to the question “What should I eat?” is, quite simply, “Less”.

As for hygiene, there are a number of diseases, including inflammato-ry bowel diseases (see page 8), where it appears that excessive hygiene in childhood, by limiting exposure to, and tolerance of, bacteria and foreign proteins, increases the disease risk later. So, perhaps the real answer to the question “What should I eat?” is “Less – with a bit of stone age dirt”... maybe!

“we often eat too much, and the quality of what we eat can leave a lot to be desired.”

Dr Christian Jessen the celeb tV doc on getting a healthier gut and beating the taboo.

We recommend

page 14

Christmas pud p. 041. sustain a healthy digestive system this festive period

Life-changing choices p. 062. the extraordinary story of the woman who shed weight to save her husband’s life

your healthy gut, 2nd edition, december 2009

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we make our readers succeed!

Professor Chris Hawkeypresident, british society of gastroenterology

Eat and drink in moderation.

1 Be careful about what you eat, although occasional treats

shouldn’t harm you.

Watch your hygiene levels.

2 We should not get too obsessed with hygiene as this could pre-

dispose you to illness, but washing hands before eating is important.

my beSt tipS

Challenges

The ugly truth Why depression has been linked to high mortality rates

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Moving forward: Work towards a better tomorrow.

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an independent supplement distributed within the sunday telegraph4 · december

Question: How can you ensure that the healthy functioning of your digestive system lasts a lifetime? Answer: Think ahead, says gastroenterologist Dr Anton Emmanuel, and seek help at once if serious symptoms appear.

Dr Anton Emmanuel is the medical direc-tor of gut and liver disease charity CORE. He is also a senior lecturer in neurogastro-enterology at UCL’s Division of Medicine.

The key goalWe are all affected with tummy problems from time to time, be it indigestion or a bout of diarrhoea. But while many don’t think twice about visiting a doctor with mild abdominal discomfort, those with alarming symptoms may be embarrassed or fearful.

“I think most gastroenterologists agree that our key challenge is to get people to think more about their gut health,” says Dr Anton Emmanuel.

“A quarter of GP consultations concern the gut, but these tend to be patients with recurrent symptoms such as dyspepsia and constipation. There’s a different group delaying before they see doctors, and then presenting with late-stage inflammation or tumours – really serious stuff.”

When you consider one in 20 of us will develop bowel cancer, it’s important to think ahead. While we know using sun-

screen can protect our skin’s future, like-wise we need to think about how we can best help our gut in years to come.

How to eatAs important as what we eat is how we eat. We have evolved the genes to store fat and calories in our bodies – fine when we were hunter-gatherers, but not so benefi-cial now, with widespread availability of high-calorie snacks.

“It’s not our portion control that’s the is-sue – we’re eating fewer calories at meal times than we did in the seventies – it’s the snacking calories which have increased,” says Emmanuel.

Snacking is not necessarily a bad thing when you have mild gastrointestinal is-sues – but the key is healthy snacking. For instance, one in ten of us experiences dai-ly heartburn, and trying to eat fewer meals while increasing grazing on fruit and veg-etables may be worthwhile. Large, high fi-bre meals should also be avoided if your IBS is flaring up.

Don’t binge at night. You’ll feel nauseat-ed the next day, skip breakfast and lunch, and then eat another late heavy meal, continuing the cycle.

The stress factorButterflies in your stomach before an exam? The link between stress and the gut is well known. But for some, stress causes gut problems lasting a few days not just hours.

“The chemicals in the gut which me-diate stress are the same as those in the brain which mediate stress,” says Em-manuel. “Both your brain and gut can ex-perience a ‘fight or flight’ response, but for some it’s more heightened. People tend to hide their extreme stress respons-es, but these aren’t signs of weakness. It’s a medical disorder.”

There are ways of tackling the problem:

Learn to recognise what your triggers ■■are

Learn to predict or avoid them – and ■■manage them if they are unavoidable

Use over-the-counter remedies to com-■■bat acute attacks of stress-induced diar-rhoea

A doctor can advise on all.

Eau, eau, eauHydration is vital. Emmanuel advises

drinking before exercise, rather than wait until you’re working out and you get thirsty, in a ‘pre-emptive’ strike to keep hydrated, and stave off the possibility of constipation.

“Remember we all lose a lot of fluid as we spend time in air-conditioned envi-ronments such as offices and warm forms of public transport,” says Emmanuel. “Two litres daily is helpful if you can manage it.”

All fluids count, not just water – so juices and teas contribute. Not alcohol, though!

Alarm bellsWhile minor niggles trouble us all from time to time, major symptoms should never be ignored.

Says Emmanuel: “Rectal bleeding, sud-den change in bowel habits, weight loss which is out of the blue and unintention-al, severe abdominal pain, difficulty swal-lowing… you must keep vigilant about these, as they’re all early-stage symptoms of potentially serious diseases which you should get checked at once.”

Act now – follow your gut feelings

ALEX GAZZOLA

info.uk@mediaplanet.com

change

“... Our biggest challenge is to get people to think more about their gut health.”Dr Anton Emmanuel Medical director of gut and liver disease charity CORE

inspirAtion

an independent supplement distributed within the sunday telegraph december · 5

inspiration

back to basicsby learning what to avoid- and what to look out for- you can take a more pro-active approach to your healthPhoto: Izabela habur

anton emmanuel’s best tips

4

avoid yo-yo dieting

1 Any drastic weight changes alters and weakens the mus-

culature which holds in your inter-nal organs, making bloating and gas-retention more likely. It also disrupts bowel function – alternat-ing diarrhoea and constipation are common side-effects.

keep alcohol intake to sensible levels

2 Alcohol limits nutrient in-take, and in the upper gut it

promotes acid production which can lead to gastritis (stomach in-flammation) and heartburn.

Give up smoking

3 Tobacco increases the risk of gullet and other cancers, and

predisposes you to ulcers and Crohn’s disease.

consult a doctor

4 Remember to get any symp-toms about which you’re un-

certain or concerned checked out immediately. And if you’re feeling embarrassed, remember doctors have seen it all before.read more on the web:

www.corecharity.org.uk

know what to look for

1step

6 · december an independent supplement distributed within the sunday telegraph

Find your motivation and enjoy the reward

Many women lose weight to slip into a little black dress. Samantha Lamb did it to save her husband’s life.

“I weighed 18 stone – but had no real health issues,” says the 37-year-old mother of three from Devon. “Andy thought the more there was of me to hold on to, the better! We were fine.”

That changed suddenly in early 2008 when Andy’s health declined. Already managing on just one donat-ed kidney following kidney failure in childhood and a transplant in his twenties, tests confirmed the cou-ple’s worst fears. Andy was one of the 45,000 people in the UK whose kid-ney was failing.

A turn for the worse“One night that July he became des-perately ill,” remembers Samantha. “He was hospitalised, and the kid-ney failed. From then on, it was dial-ysis three times a week, five hours at a time. He was told his chance of be-ing offered a new kidney was only fif-ty fifty.”

Samantha’s reaction was to swot up on kidney disease. It was in a medi-cal book she read about live donation: “Andy he told me he would never let me put myself in danger, but I quietly mulled it over, and became convinced I could – and would – do it.”

She put the idea to Andy’s consult-ant. “He said, ‘Yes, maybe – but you’ll have to lose some weight’,” she re-

calls. “I had tests to see whether I was a compatible donor – and they came back positive. Andy was still refus-ing to accept it. But by this stage, I could see the life draining away from him, and I was so stubborn I told him I would donate a kidney anyway – to someone else if he didn’t want it!”

Surgeons would operate if Saman-tha lost four stone. She consulted a

trainer, who devised an intensive three-month programme. “Physi-cally and mentally it was the hardest thing I’ve ever done. Boxing, aerobics, weights, running… plus the London Bridges Walk for Kidney Research UK. Andy boxed when he was young-er, so I had a trainer at the gym and one at home too!”

Healthy diet successCombined with a sensible eating re-gime, with lean protein and fresh fruit and vegetables, and sheer brav-ery and will, Samantha reached her target weight, and the operation went ahead –successfully – in Octo-ber. The couple are now convalescing at home.

“A lot of people say they’ll start los-ing weight tomorrow, or the next day, but you need a kick up the bum – and I was given a genuine wallop,” she laughs. “I lost weight for me as well as for Andy, but everyone finds their own reason to do it.”

Three million people live under the threat of kidney disease in the UK. “I want more people to know about live donation,” says Samantha, “and that you don’t have to be skinny to do something great.”

For more information visit www.kidneyresearchuk.org.

“i lost weight for me as well as for andy, but everyone finds their own reason to do it ”Andy and Samantha Lamblost weight to save her husband’s life

alex gazzola

info.uk@mediaplanet.com

Question:■■ struggling to find a good enough reason to lose some weight?

Answer:■■ if you can’t do it for yourself, then do it for someone you love, says samantha lamb.

HAppy FAmiLieSSam, Andy and daughter Beatrice after the operationPhoto: kidnEy rEsEarck uk

InspIratIon

Facts From the experts

Fiona hunter is a nutritionist with twenty years’ experience. she is the author of the Big GL+ Diet planner (£12.99, DBp). here are her tips to keep yourself in great shape.

Start the day right.■■ people who eat a healthy breakfast find it easier to main-tain a healthy weight. Breakfast offers an ideal way to get a head start on your ‘5 a day’. one orange, for instance, pro-vides all the vitamin c you need.

Get your fibre.■■ choose a whole-grain cereal for breakfast and eat beans and lentils at least twice a week. Fibre is key to healthy digestion, yet only one in nine adults gets enough.

Boost your defences.■■ poor eating and stress can deplete good bacteria in our gut that help keep our immune sys-tem healthy. Bananas, asparagus and Jerusalem artichokes contain prebiotic fibre that encourages their growth.

how i maDe it

Gordon Ramsay is a chef, restau-rateur and TV personality of Hell’s Kitchen, The F Word and Ramsay’s Kitchen Nightmares fame. He has 12 Michelin Stars to his name, and is the author of 16 books, the latest of which is Gordon Ramsay’s World Kitchen (£20, Quadrille). Here he shares his advice for healthy eat-ing and appetite.

Cook healthily

1 Choosing the right ingredi-ents is the core to healthy eat-

ing. Seasonality is important too. When assembling a healthy dish, balance and moderation are key. The healthiest ways of cooking are steaming, poaching, stir-fry, grid-dling, roasting, sautéing and brais-ing.

Choose a varied diet

2 Getting the right balance is down to choosing a varied di-

et, and making sure you eat sensi-ble amounts of starchy and com-plex carbohydrates, fruit and vege-tables, lean protein foods, good dairy foods, sugars and fats.

eat fresh fish

3 Oily fish are rich in omega 3 fatty acids which benefit you

in many ways. Fish should be bought and used as freshly as pos-sible. Omega 3 fatty acids tend to be lost in the canning process so tinned fish isn’t a good source of them.

Switch to healthy snacks

4 Snacking is fine, and healthy snacks include fresh fruit,

dried fruit and nuts, raw vegetables with dips such as guacamole, yo-ghurt and cucumber or hummous, low fat natural yoghurts, fresh smoothies and small amounts of good quality, dark chocolate.

The secret ingredient

5 My essential healthy store cupboard ingredient? Oats.

They are a terrific source of many vitamins and minerals, especially B vitamins, zinc, calcium, magne-sium and iron.

GorDon ramsay’s Best tips

6GeT moTivATed

2STep

7

an independent supplement distributed within the sunday telegraph8 · december

Question:■■ are heartburn and indigestion symptoms which everyone just has to learn to live with?

Answer:■■ absolutely not – tackling the root causes can ease discomfort and reduce the risk of complications.

When the adverts for indigestion-re-lief medication begin appearing on our small screens, you can be assured that the winter party season is truly upon us. It’s not surprising that, at this time of year especially, overin-dulgence of both food and drink can lead to uncomfortable symptoms in the upper part of the gut, leaving us with nausea and unpleasant feelings of fullness.

Dr David Sanders, consultant gas-troenterologist at Sheffield Teach-ing Hospital, says there are many usual culprits: “A long night out, eat-ing food late, alcohol and smoking... Some foods, such as spicy ones, can relax the valve between your stom-ach and gullet, increasing the chances of heartburn.”

Indigestion is usually related to heartburn, or acid reflux, when the acidic contents of the stomach es-

cape up into the gullet. To treat occa-sional symptoms, over-the-counter medication, such as alginates, which coat the lining of your stomach and gullet, can help – as can certain ant-acid medicines that neutralise stom-ach acid, reducing the burning.

Being overweight makes acid in-digestion more likely. Persistent symptoms can indicate a more seri-ous problem, though, and some are concerned that the non-prescrip-tion availability of some acid-reduc-ing treatments may mean some self-medicate when the underlying prob-lem is serious.

“Chronic reflux increases your risk of a stricture in the gullet, caused by inflammation due to the acid,” says Sanders. “One of the commonest as-sociated features of cancer of the gul-let is long-standing reflux, so get per-sistent symptoms seen to.”

Other problems include infection with the helicobacter pylori bacteri-

um, known to increase the likelihood of indigestion, but which is primarily implicated in cases of stomach ulcer, symptoms of which can be similar to those of indigestion, but usually with more severe pain. A breath, blood or stool test can diagnose it, and if pos-itive, eradication treatment will be advised, with antibiotics and pre-scription-only protein pump inhibi-tor (PPI) medication to limit acid pro-duction.

“You will need an endoscopy to confirm an ulcer,” says Sanders, “and you should make a rapid recovery af-ter treatment. After six weeks, a re-peat endoscopy can check that the ulcer has healed and there is no other underlying problem.”

Although it is wise to consult your GP if you have concerns, for most of us, experiencing mild or occasion-al symptoms associated with over-indulgence, such further investiga-tions or treatments won’t be needed. Just try to avoid going to bed on a full stomach, eat and drink sensi-bly at regular intervals, don’t smoke, and keep exercising. Your Christmas tummy will thank you for it.

Dr David Sandersconsultant gastroenterologist at sheffield teaching hospital

Have a Happiertummy in time for CHristmas

ALEX GAZZOLA

info.uk@mediaplanet.com

news

PrActice Self-control

3SteP

an independent supplement distributed within the sunday telegraph december · 9

news

QUestions & Answers

What are inflammatory bowel dis-■■

eases?– IBDs are chronic inflammatory dis-eases of the gut. In Crohn’s disease, the lining of the digestive system be-comes inflamed, often in the small in-testine or colon. This can cause com-plications, including obstructions and abscesses. Ulcerative colitis (UC) is inflammation of the colon, perhaps with ulceration or sores on its lining, which can bleed or leak pus.

What causes them?■■

– Genetic and environmental fac-tors are involved. With Crohn’s it’s a roughly even combination of the two, but with UC, environmental fac-tors are more dominant. Smoking is implicated in Crohn’s. It seems that both IBDs have something to do with altered responses towards bacteria in the gut. Stress can worsen IBDs too.

What are the symptoms?■■

– In UC, a sudden onset of rectal bleed-ing and bloody diarrhoea, which can be severe. In Crohn’s the symptoms are more varied. Abdominal pain and diarrhoea are common, but the diar-rhoea is usually non-bloody.

can they be misdiagnosed?■■

– UC is unlikely to be missed or mis-diagnosed. Crohn’s can be misdiag-nosed as irritable bowel syndrome (IBS), which affects one in four (Crohn’s affects only one in 800). If there is any weight loss, and diar-rhoea is persistent not intermittent, then it’s more than IBS. For both IBDs, an initial attack – or a relapse – can be precipitated by gastroenteri-tis. Normally, food poisoning settles after a few weeks, but if there’s diar-rhoea beyond three weeks, it should be investigated.

What help is there for sufferers? ■■

– Anti-inflammatory drugs, steroids, immunosuppressants and other therapies are available to help man-age IBDs. Eventually, surgery may well be required. The National Asso-ciation for Colitis and Crohn’s Dis-ease (NACC – www.nacc.org.uk) can offer patients an incredible amount of support and information too.

Prof Jon rhodesprofessor of medicine and honorary consultant gastroenterologist, royal liverpool university hospital

chriStmAS Stuffingthe best present for your gut this christmas is the gift of moderation and self-control.Photo: BoB thomas

Know the problems, be better prepared

ALEX GAZZOLA

info.uk@mediaplanet.com

4 best tips for ibs

4Irritable bowel syndrome (IBS) is a functional gut disorder character-ised by abdominal pain and abnor-mal or irregular bowel habit. Here are some tips from the British So-ciety of Gastroenterology and the charity Core:

Keep a food diary

1 You may find particular foods trigger an attack of pain.

Keeping a food diary together with a record of bowel symptoms may be helpful since you might be able to identify a pattern.

Be food aware

2 Foods commonly causing up-set include wheat products,

dairy products, onions, nuts and caffeinated drinks such as coffee, tea and cola.

Do you have trouble with lactose?

3 Some patients cannot digest lactose (milk sugar) and so de-

velop wind and diarrhoea after consuming milk or dairy products such as cream, cheese, yoghurt and chocolate.

use alternative therapies

4 Hypnotherapy and relaxation therapy have been shown to

be effective for IBS.

for more informAtion go to:

www.bsg.org.uk www.corecharity.org.uk

10 · december

“A kind of chronic indigestion” was how Samuel Gee, renowned lecturer in medicine at St Bart’s Hospital, Lon-don, described the illness he called the coeliac ‘affection’. Working in the late 19th century, he wrote of the ‘wasting, weakness and pallor’ of suf-ferers, and speculated that dietary control might be the only means of treatment.

Over a century on, we have a clearer picture of coeliac disease, and know it is the protein gluten which is toxic to sufferers. Found in wheat, barley and rye, gluten triggers an inflammato-ry reaction in the small intestine of a coeliac, which causes the body’s im-mune system to attack its own tis-sues. Because of this, it is classed as an auto-immune disease, like type 1 diabetes and rheumatoid arthritis.

Gut symptoms are typical, but oth-ers feature too: mouth ulcers, infer-tility and skin complaints are all pos-sible.

Where are all the coeliacs?The key challenge is it remains large-ly undiagnosed. “Only one in eight

coeliacs is diagnosed,” says Dr Char-lie Murray, gastroenterologist at Roy-al Free Hospital, London. “We know it affects one per cent of us, so we’re missing hundreds of thousands. Many children with coeliac disease

are missed because they have no symptoms, and many adults are di-agnosed with IBS.”

New changes to clinical guidelines state doctors should test for coeliac markers in patients with other au-

to-immune conditions. It is also rec-ommended that the disease be ruled out before an IBS diagnosis. With the help of charity Coeliac UK, more cas-es are being found.

But for the newly diagnosed, going gluten-free can be alarming. “They assume sandwiches, cakes and diges-tives are all banned,” says Michelle Berriedale-Johnson, editor of Foods Matter, and brains behind the Free From Food Awards, which rewards the best in specialist foods for those on restricted diets.

As recently as ten years ago, coeli-acs had few options. “But now there are breads you’d never know weren’t ‘normal’, biscuits made from rice, corn and potato flour – even accept-able scones and pastry,” she adds.

New promiseMeanwhile, cutting-edge treat-ments are being explored, including enzymes which dismantle the toxic elements in gluten, vaccines to in-duce gluten tolerance, and a promis-ing drug which blocks gluten absorp-tion.

“What is not clear is whether these will be as effective as gluten exclu-sion,” says Murray. The ‘dream’ sce-nario – ‘take a pill, eat what you like’ – is a long way off, he suspects.

“Nevertheless,” he adds, “these are exciting times.”

Beating the ‘affection’ and going against the grain

expert opiNioN. the future looks bright, says Samuel Gee Photo: s.gee

alex gazzola

info.uk@mediaplanet.com

Question:■■ Are we addressing coeliac disease’s underdiagnosis and the difficulties of living gluten-free?

Answer:■■ Yes, with new clinical guidelines, greater awareness, better foods – and promising new treatments.

news

Do your reSeArch

4Step

Facts

symptoms vary, but may include di-■■

arrhoea, constipation, nausea, malnutri-tion, weight loss, depression, headaches and others.

You are ten times as likely to have it if a ■■

first-degree family member has it. It can present at any age, and is twice ■■

as common in females.It can only be diagnosed through ■■

blood tests and a biopsy, and you must be consuming gluten throughout the process.

Gluten – coeliac disease’s trigger – is ■■

a protein found in wheat, rye, barley and spelt. sensitive coeliacs may react to oats too.

Naturally gluten-free foods include all ■■

unprocessed meats, fish, fruit, vegeta-bles, nuts, seeds, eggs and dairy prod-ucts. Rice, corn, millet, quinoa, buck-wheat and amaranth are gluten-free grains.

! More from the web:www.bsg.org.uk

www.coeliac.org.uk www.freefromfoodawards.co.uk

how did you feel when you ■■

were diagnosed?

! I’d suffered classic symptoms since childhood, but it had al-

ways been missed by doctors, who told me it wasn’t food-related. When I was eventually diagnosed it opened my mind to nutrition and inspired me to become a nutri-tional therapist.

how did you tackle the disease?■■

! I taught myself about it. My di-etitian just told me to avoid

gluten, but I wanted to know about healthy eating. I developed a keen sense of nutrition, and I took to mak-ing my own naturally gluten-free meals – meats, fish, vegetables, pota-toes, brown rice, quinoa and so on.

What advice would you give to ■■

someone newly diagnosed?

! I advise a lot of coeliacs to go for low GI, gluten-free grains,

while increasing lean protein. Choose nutrient-dense foods. A probiotic capsule in the early stag-es can help mineral and vitamin absorption. After a few years it’s easy to get tempted by gluten. But you could still be damaging your-self internally, even if you don’t get symptoms. So stick with it.

QuestIoN & aNsweRian MarberNutritional therapist Ian marber of The Food doctor was diagnosed with coeliac disease almost 20 years ago.

AN INdepeNdeNT supplemeNT dIsTrIbuTed wIThIN The suNdAY TelegrAph

Crohn’s in Childhood Research Association

Since 1978, CICRA ( Crohn’s in Childhood Research Association) has dedicated itself to creating a wider understanding of Crohn’s Disease and Ulcerative Colitis - collectively known as Inflammatory Bowel Disease, particularly in relation to how it affects the lives of children and young adults.

We provide support for sufferers and their families and also raise funds to support approved medical research aimed at finding more effective treatments and an eventual cure. To date over £3,000,000 has been spent on funding this research programme.

100% of all donations received now go to support services and funding our research.

We are the only UK Charity specifically providing support for children and

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I would like to make a donation - My cheque payable to CICRA is attached herewith / My credit card details are as follows: Card Type:................................ Card Number................................ Expiry Date: ................................ Amount donated: ................................

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an independent supplement distributed within the sunday telegraph12 · december

How to choose the right ‘biotics’ for a healthy gut

delicate balancethere are many options for those looking to improve their health, such as prebioticsPhoto: istock Photo

Of all the subjects to engage the public in health and nutrition, probiotics and prebiotics have been one of the most popular in recent years. But is contra-dictory reporting on the subject caus-ing the British public to lose interest?

“The information out there is too generic and – not surprisingly – peo-ple are confused,” says Dr Elisabeth Weichselbaum of the British Nutri-tion Foundation. “One day we hear probiotics work, and the next we hear they don’t. Saying probiotics do or don’t work is like saying a pill can or can’t make you healthy. We need to be specific. What we can say is that a par-ticular strain of probiotic can or can’t work for a particular health issue.”

bug researchEarlier this year, Weichselbaum re-viewed the evidence for probiotics in health, focusing on the gut and immune system. She found, for ex-ample, that the Lactobacillus casei imunitass bacterium helped reduce the severity and duration of colds, while the lactobacillus rhamnosus GG strain helped prevent antibiotic-

associated diarrhoea and relapsing ulcerative colitis.

Probiotics are bacteria which pro-mote health, but prebiotics are indi-gestible carbohydrates which feed those bacteria and encourage their proliferation. Dr Weichselbaum agrees that while it makes sense to look to consume both probiotics and

prebiotics, it’s key to bear in mind they should be taken in addition to a healthy diet, not instead of one: “Eve-rything you eat influences your gut bacteria. If you eat mainly meat and processed foods, you’ll have a differ-ent gut flora to someone who eats a lot of fruit and vegetables.”

Glenn Gibson, Professor of Food

Microbial Sciences at University of Reading, says although fruits and vegetables contain prebiotics, we may not be getting enough in our diets.

“For a beneficial shift in gut flora, you need to consume five to eight grammes a day,” he says. “A normal, healthy diet with five portions of fruit and vegetables may give you two grammes, so if you ate more than five portions, and focused on the foods high in prebiotics, you could manage it – but it would be difficult.”

think of the futureTo some extent, this difficulty may be an established problem for humans, contributing to a long history of gut disease and symptoms, which we are only now becoming better at iden-tifying, diagnosing, managing and treating.

“Many people think that because they’re healthy and that there is no history of, say, colitis, bowel cancer or IBS in their family, that they don’t need to think about prebiotics,” says Gibson. “But we need to get the mes-sage across to everyone that these in-terventions are preventative, rather than curative.”

He adds: “Improving your gut flo-ra can halt gastrointestinal problems before issues arise.”

“the information out there is too generic and – not surprisingly – people are confused”dr elisabeth Weichselbaum british nutrition Foundation

ALEX GAZZOLA

info.uk@mediaplanet.com

Question:■■ confused over probiotics, baffled about prebiot-ics – and tempted to switch off?

answer:■■ try not to. while much research is still needed – some key truths appear to be quietly emerging.

news

KnoW your options

5step

Facts

probiotics ■■ are bacteria which offer health benefits.

they are ■■ found naturally in cultured or fermented foods, such as yoghurts, sauerkraut, soy sauce and miso.

probiotic-fortified ■■ products include yoghurt drinks and juices.

prebiotics ■■ are complex carbohydrates which ‘feed’ probiotic bacteria in the gut, boosting their activity and population.

they are ■■ found generously in chicory and Jerusalem artichokes, and to a lesser

degree in garlic, onion, leek, asparagus, wheat, oats, beans and banana.

the known ■■ prebiotics are FOs (fruc-to-oligosaccharides), inulin and GOs (ga-lacto-oligosaccharides).

prebiotic-fortified ■■ foods are increa-singly popular, and include health drinks, confectionary, spreads, baked goods and cereals.

supplemental prebiotics■■ are now available, for instance as a pow-der to sprinkle on foods.

When might probiotics and ■■

prebiotics be worth taking?

! Before you travel abroad, cer-tainly, especially to tropical or

hotter countries, and in fact we’ve been doing a lot of work with sports people who travel the world and can’t afford to experience a bout of diarrhoea or gastroenteritis at cru-cial times – and this work may also prove useful for military person-nel, eventually. They’re also worth trying if you need to take antibiot-ics, as this can cause diarrhoea in many people, or if you’re going to hospital. But of course, most of us can benefit from extra probiotics and prebiotics in our diets.

can they help with winter in-■■

fections?

! There has been a good study from Germany which looked

at the effect of probiotics on the in-cidence and duration of colds and flu infections, and reductions were noticed. The gut is the biggest im-mune organ in the body, so if you take prebiotics and prebiotics you are likely to get some positive ef-fect on immunity.

can they help at christmas?■■

! Improved gut bacteria means improved digestion, and the

end products of carbohydrate me-tabolism in the lower bowel are pretty good for your health, while the end products of protein metab-olism are not. At Christmas, when you eat a lot of meat and other pro-tein-rich foods, there is the possi-bility that improving your carbo-hydrate digestion with beneficial bacteria and prebiotics could coun-teract those negative consequences of high-protein eating.

and what about the future?■■

! New possible prebiotics are currently being explored. And

we’re looking at how gut flora can affect health beyond the gut, which is an exciting development. It’s easy to see how gut bacteria and prebiotics may play a role in IBS, colitis and other gastrointestinal diseases, but I think they also have a huge potential systemic role too, with implications for weight, dia-betes, cognitive function and au-tism, for example.

QuestiOn & answerGlenn Gibson,professor of Food microbial scienc-es at the univer-sity of reading, is a leading authority on probiotics and prebiotics.

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An independent supplement distributed within the sundAy telegrAph14 · december

Come on, don’t be shy...

He’s led us fearlessly through ‘Embarrassing Illnesses’, compared the diets of members of the public both little and large on ‘Supersize vs Superskinny’, and won a BAFTA for ‘Em-barrassing Bodies’ – and what Dr Christian Jessen would like us all to do this Christmas is not be ashamed of our digestive system…

on the other hand, may point to a di-gestive problem of malabsorption, or pancreatic or liver problems. The symptom is be coming more com-mon since the fat absorption-block-ing drug Xenical – which aids weight loss – came on to the market. But, generally speaking, an occasional in-cidence is unlikely to be a worry.

Arguably, the most important sign to look out for is a change in bowel habit. “If you alternate between con-stipation and diarrhoea you must seek advice and assessment,” Jessen stresses.

“A useful tip that will help im-measurably is to keep a symptom and food diary for the few weeks be-fore you visit you GP. This will mean you are not relying on your memory and will cover enough meals and epi-sodes to make an accurate diagnosis more likely.”

The serious issuesBleeding, while it looks dramatic, is clearly alarming, and should never be ignored, usually turns out to be not se-rious as the causes are more often than not benign. That said, “Bowel cancer is on the increase and if detected early can be effectively treated and cured. If ig-nored, the results can be devastating.”

The message, then, is clear. You have nothing to fear, GPs have seen it all be-fore, and if you fear the dreaded gloved finger up the bottom, be assured that intimate examinations are unlikely for bowel disorders: palpation of the tum-my and talking about your symptoms is likely to be all that is required.

“Make sure you use your GP’s huge encyclopaedia of medical knowledge – it’s one of the more valuable resources that you will ever consult,” says Jessen. “You need to make a simple assess-ment: which is worse – the symptoms your bowel condition is giving you, or the embarrassment that you feel in talking about it? If embarrassment wins then you may need to ask what exactly it is that you are complaining about.”

A refusal to be embarrassed char-acterises the charming doctor’s easy-going bedside manner, but even he admits to have once been taken by surprise. “Bowel conditions don’t em-barrass me in the slightest,” he says, “but what did make me somewhat lost for words once was the discovery of a fully-clothed Action Man doll up one of my patient’s bottoms…”

“which is worse – the symptoms your bowel condition is giving you, or the embarrassment that you feel in talking about it?”

Dr Christian JessenA healther diet is one of the many ways to improve the health of your gut

attitude

professional insight

Easy on the calories

1 We tend to eat continually throughout Christmas and

the food is often high in fat, salt and sugar. Added to these are all the snacks, like chocolates and nuts, which are full of calories which you won’t burn off. Whilst you may not pile on many kilos over Christ-mas, studies have shown that what weight you do put on can be very hard to shift.

Choose more veg

2 Try not to eat the entire tur-key in one sitting but fill up

on vegetables too. This will help in-crease the amount of fibre to help your digestive system run more smoothly in the face of the on-slaught. Provided you are not smothering everything in butter then you can eat as many vegeta-bles as you like.

Keep up the activity

3 Don’t give up on the exercise. Remember the more that you

keep your workouts going then the more of those little naughty treats you can eat. Go for a long Christ-mas Day walk with the family to work up an appetite for dinner. If you are all out of the house, then you can’t all be eating and drinking can you?

Fish for health

4 Christmas can be meat-heavy so try to mix your diet up a bit

and include some fish. Oily fish is rich in omega 3 fatty acids, which are especially good for heart health. Salmon makes a special Boxing Day meal that can be eaten hot or cold

Give your liver a break

5 Christmas can be a bad time for your liver. We often start

drinking early and continue all day. Try to alternate alcoholic drinks with a glass of water, to help with how you will feel the next day. Hangover-wise remember that the browner the colour of your drink, the worse the hangover can be. Brown rum, brandy, port and whis-key can all be killers the next day! If you are worried about your weight then steer clear of the creamy cocktails – they are packed full of calories.

Dr Christian Jessenthe tV doc gives his best advice for having a healthier digestive system

ChanGE your pErCEpTions

6sTEp

Dr Christian Jessen, the charismatic and unembarrass-able medic of Em-barrassing Bodies

fame, wants us to abandon prudish-ness when it comes to our bowels.

“The idea of inspecting our faeces to check that our general health is okay seems abhorrent to most of us,” says the 32-year-old, “and yet think about the design of loos in many Eu-ropean countries. They often have a shelf on which your recently depos-ited evacuation sits, awaiting inspec-tion, before being sluiced away. This is seen as perfectly sane and sensible. Brits make jokes about those loos, but it’s to our detriment.”

Banish the tabooSexual health has always been an in-terest of Jessen – he has spent time working in east Africa researching HIV and malaria interactions – and he believes our reluctance to talk about our bowels echoes that of our difficulties with talking about sex, possibly a lingering legacy from a Victorian age where conversations about matters carnal were consid-ered forbidden. Appalling STI rates and increasing digestive illness may share an overlapping cause.

Clearly, his feeling is that our bowels, among the most hard-working of or-gans in the body, should be taken more

seriously, not only because of their mind-boggling sophistication, but al-so for the manner in which they deal with the modern, processed and calo-rific diets which get thrown at them.

“We live in a time when food is in abundance, and most of us constant-ly eat,” he says. “We often eat too much, and the quality of what we eat can leave a lot to be desired. Our bow-els efficiently get on with processing things, often without even a gurgle, and so deserve a little more respect and attention.”

He adds: “They have a highly de-veloped nervous system of their own, they have their own specialised im-mune surveillance system, and then there’s the complicated choreography of the smooth muscle walls which move our digesting food along their considerable length, all the while ex-tracting important nutrients.”

He says that our bowels can give us plenty of subtle signals that things may be going wrong, but our lack of attention means these signs are of-ten missed, leaving diagnoses to oc-cur too late, if at all.

a common problemFlatulence is a normal symptom, caused by swallowing air and nor-mal digestive processes, which, Jes-sen feels, we feel needlessly embar-

rassed about. But if you really want to reduce it, eat more slowly, re-duce gas-producing foods – such as beans, cabbage, broccoli, onion, corn, potatoes, apples and dairy products – and ditch the chew-ing gum and fizzy drinks. Foods like eggs, bananas, rice, and hard cheeses are more easily digest-

ed and produce less flatu-lence.

F l o a t i n g , smelly or greasy poos are also seen as embar-rassing and un-pleasant, but some people al-so worry about them. Some poos can be very airy, making

them less dense and more likely

to float, which can occur when you’re

suffering from a bout of diarrhoea. Fatty poos,

5tips

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