1. MAY 2016
AN INDEPENDENT SUPPLEMENT DISTRIBUTED IN THE GUARDIAN ON BEHALF OF MEDIAPLANET WHO TAKE SOLE RESPONSIBILITY FOR ITS CONTENTS
DigestivehealthHEALTHAWARENESS.CO.UK
JamesHaskell
Therugbystaronthe
importanceofbeing
healthyinsideandout
READ MORE ONLINE
Gastrointestinalcancer:
whyearlydiagnosismust
beapriorityforGPs.
THE GOOD, THE BAD
AND THE UGLY
DrAntonEmmanuelon
thebasicsofgutillnessP5
PHOTO:BOWELCANCERUK
2. 2 HEALTHAWARENESS.CO.UK MEDIAPLANETAN INDEPENDENT SUPPLEMENT BY MEDIAPLANET
READ MORE ON HEALTHAWARENESS.CO.UK
Do you have
Coeliac disease?
How to check for
the disease and
how to tackle it,
from Coeliac UK
P4
Back to basics
DrBarneyHawthorne
explains the nine
things you need
to know about
Inflammatory Bowel
Disease
Allergies in children
Four top health
experts give advice to
parents and provide
insight on the rise of
asthma and allergies
in recent years
IN THIS ISSUE
The new medical knowledge that
can boost your digestive health
Medical advances mean that digestive health is better understood and easier to achieve,
says Dr Ian Forgacs, President of the British Society of Gastroenterology
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Good digestive health
is partly in your own
hands, but progress
in diagnosis, treatment and
dietaryknowledgemeanthat
gastroenterologists can help
more than ever before.
Endoscopy means tissue
for research is readily avail-
able so with advances in ge-
netics, immunology and re-
lated sciences our under-
standing of gastro-intestinal
disorders is developing fast.
In particular, new re-
search is uncovering the po-
tential importance of the
microbiome in gastrointes-
tinal health. The microbi-
ome, the collective name for
the largely uncharted sea of
bacteria in the bowel, is like-
ly to play a significant role in
causing irritable bowel syn-
drome (IBS) and inflamma-
tory bowel disease (IBD).
Advanced imaging equip-
ment used in screening cam-
paignsisloweringyourchance
ofdyingfromcolorectalcancer
- but only if you choose to un-
dergothescreening.
Dietary studies are also ad-
vancing treatment. People
Dr Ian Forgacs
President, British Society
of Gastroenterology
“Awareness of
gut health is the
way forward”
with IBS who experience al-
teredbowelhabitandbloating
may be helped by a diet low in
FODMAPS (food chemicals
that promote watery stools
and flatulence). Gastro-oe-
sophageal reflux (heartburn
and regurgitation) can be
helped by avoiding fatty foods
andexcessalcohol.
Diet is also used to treat
coeliac disease. This condi-
tion is under-recognised but
is readily detected by a blood
test. Campaigns to increase
awareness and lead to earlier
diagnosis are underway.
If you respect your gut and
liver the healthier they will
be. Maintaining a healthy
weight and observing the
lower alcohol consumption
guidelines introduced in Jan-
uary 2016 should help com-
bat the growth in hepatic
conditions that can lead to
cirrhosis and liver cancer.
Awareness of gut health,
coupledwithearlyactionand
early diagnosis in response
to ongoing stomach, bowel
and intestinal problems, is
the way forward for patients
and professionals.
@MediaplanetUK
3. COMMERCIAL FEATURE
The life-time risk of
developing bowel
cancer in the UK is
1/14 for men and 1/19
for women. The new Spee-
dboat RS2 technology could be
an improved method of treat-
ment for potentially cancerous
bowel polyps.
“This could reduce risk, save
repeated hospital admissions
for patients, make procedures
more effective for endosco-
pists and save the NHS money,”
says Professor Brian Saunders,
Consultant Gastroenterologist
and Adjunct Professor of Endos-
copy at St Mark’s Hospital in
North West London.
Colorectal polyps are common
and often undetected but about
one in ten can develop into
bowel cancer. Where screening
reveals large, flat potentially
cancerous polyps, patients are
often sent for surgery or the
polyp is removed in multiple
pieces, leading to a higher risk
of complications or recurrence.
A newer, minimally-invasive
endoscopic approach may be
a significant advance in thera-
peutic endoscopy. It involves
injecting fluid under the polyp
to separate it from underlying
muscle and the use of an
electrosurgical instrument
to remove the entire lesion in
one piece, potentially enabling
improved diagnosis and cura-
tive outcomes without the need
for surgery.
Saunders says: “This proce-
dure can be quite difficult and
time consuming with current
technology, but the new mul-
timodality device I have been
developing with UK electrosur-
gery specialists Creo Medical
is designed to be user friendly
and to overcome some of the
difficulties associated with the
use of multiple instruments.
This new technology could also
potentially reduce the overall
procedure time for patients.”
“Many patients with large
polyps are currently sent for sur-
gery, but this new endoscopic
tool has the potential to make
the procedure less invasive, qui-
cker, safer and lower cost.”
The Creo Medical Speedboat
RS2 technology incorporates
an injection needle, a rota-
table speedboat-shaped hull to
protect the underlying mus-
cle and a cutting edge used for
excising the tissue with bi-po-
lar electrosurgical energy as
well as the capacity for
controlled cauterisation using
microwave technology.
“Research and testing have
shown good early results and it
should be available for clinical
use soon,” says Saunders.
New technology designed to help removal of
large polyps and potential early bowel cancer
The new Speedboat RS2 technology could make it easier and safer to remove polyps that
could develop into cancer, potentially saving lives and NHS money
Professor Brian Saunders
Consultant gastroenterologist and
adjunct professor of endoscopy,
St Mark’s Hospital, London
WE
TURN
INTEREST
INTO
ACTION
Readmoreexpertinsightondigestivehealth
fromtophealthcareprofessionalsonlineat
healthawareness.co.uk
5. MEDIAPLANET 5AN INDEPENDENT SUPPLEMENT BY MEDIAPLANET
InHealth Endoscopy carries out more than 20,000 procedures a year
from over 25 community and hospital sites across the UK, providing
excellent and pioneering Endoscopy services to the NHS for over 10 years.
ARE YOU SUFFERING
FROM HEARTBURN FOR
MORE THAN 3 WEEKS?
Heartburn
DOES FOOD GET STUCK
IN YOUR THROAT ON A
REGULAR BASIS,WITH
NO EXPLANATION
Swallowing
DO YOU EVER
REGURGITATE FOOD
WITH BLOOD IN IT?
Regurgitate
• Transnasal endoscopy offered whenever possible
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For any queries contact us on: 0333 202 3187
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Prime Endoscopy Bristol are part of the InHealth Group offering services from Westbury on Trym Primary Care Centre, BS9 3AA – telephone number 0117 962 3406
Visit your GP and ask for an InHealth referral.
I
t is probably fairly self-ev-
ident that what goes in to
the digestive system must
have a key role in deter-
mininghowitworks,inthe
same was as our lungs are affect-
ed by the quality of air we breathe.
Proving this however is often dif-
ficult for scientists – diet is so de-
pendent on personal tastes, social
influences, mood, availability and
much else, that proving something
is unequivocally helpful is difficult.
We present a summary of what in-
formation –whether beneficial,un-
helpful or not proven – is available
to help us make choices.
The good
Thediseasewiththestrongest
evidence base to support die-
tary change is Coeliac disease. In
fact, dietary avoidance of gluten
(wheat)isthecureofthisotherwise
potentially severe condition associ-
ated with diarrhoea, malnutrition
and fatigue. It is important to re-
memberthatglutencanbefoundin
the most surprising foods - stock
cubes, soy sauce and hot chocolate
for example.
Another recent positive dietary
therapy is the use of the low FOD-
MAPs diet for patientswith the irri-
table bowel syndrome (IBS). “FOD-
MAPs” is a medical acronym for dif-
ferent food chemicals that promote
watery stools and flatulence. As
such, IBS patients with diarrhoea
andbloatingcanexperiencesignifi-
cant helpwith such a diet.
The bad
If you suffer with gastro-oe-
sophageal reflux (symptoms
of heartburn and regurgitation)
then fatty foods and excess alcohol
can make things a lot worse. It is
easy to see how that late-night ke-
bab after a few drinks results in ter-
rible heartburn in the small hours.
Skipping meals and eating “on the
go” disrupts gut function and predis-
posestoconstipationandindigestion.
Excessive amounts of coffee and
alcohol can irritate the bowels. They
encourage bowel movements which
may lead to incontinence if consumed
inlargequantities.
Beyondwhatyoueat,howyoueatisal-
soimportant.Skippingmealsandeating
“onthego”disruptsgutfunctionandpre-
disposestoconstipationandindigestion.
The ugly
For as many facts as there are,
as many myths abound about
the role of diet in gut function. For
example,constipationisnotalways
caused by low fibre intake.In a very
common type of constipation,
calledslowtransit(characterisedby
hard stools and infrequent urge to
empty the bowel),reducing fibre of-
ten improves symptoms.
Whilst as many as 20% of peo-
ple believe they are lactose intoler-
ant, only 5% of the UK population is
trulyso.Andavoidingmilkdeprives
you of a key source of calcium to
fight osteoporosis.
Finally, eating a late night meal
is not more fattening: calories can-
not tell the time.It has been shown
that weight gain is not related to
eating a heavy late night meal –
weight gain is related to the total
number of calories we eat, not
when we eat them.
Dietsandgutillness:
The good, the bad
and the ugly
Dr Anton Emmanuel
British Society of Gastroenterology
“Diet is dependent
on personal
tastes, social
influences, mood,
availability and
much else”
Read more on
healthawareness.co.uk
6. 6 HEALTHAWARENESS.CO.UK AN INDEPENDENT SUPPLEMENT BY MEDIAPLANET
COLUMN
Dr Nick Read
Chair and Medical Adviser,
The IBS Network
Irritable
Bowel
Syndrome
I
rritable Bowel Syndrome (IBS)
is an unexplained gut illness
that comprises abdominal
pain, bloating, diarrhoea and
constipation, for which there is
no clear cause. It also includes
a variety of other symptoms
that affect other organs and regions of
the body and it overlaps with other unex-
plained illnesses, notably Chronic Fatigue
Syndrome, Fibromyalgia and Functional
Dyspepsia. Anxiety and depression are al-
so very common, suggesting that IBS is the
visceral expression of an illness that affects
both mind and gut.
IBS may start with an attack of gastroen-
teritis and/or a traumatic experience. Both
may lead to depletion of colonic bacteria,
increases in gut permeability, excitation of
the gut immune system and changes in the
emotional centres of the brain and their
connections with the gut, resetting the gut
control systems to be more sensitive to diet
and stress (food and mood). Reducing in-
take of fat and fermentable sugars (FOD-
MAPs) in the diet may calm IBS symptoms
as can a more balanced, measured and re-
laxed life style. Medications,which in-
clude antispasmodics and bowel regulators
offer relief for specific symptoms.
IBS often fluctuates according to what is
happening in a person’s life. Thus it is im-
portant to help people understand the con-
text of their illness and help them deal
with it. Self-help involves diet, stress re-
duction and over the counter medication
for relief of symptoms,while changing life
situation and perception and adopting a
positive focus may give rise to longer
term remission.
IBD – a hidden disease
1 IBD is made up of Crohn’s
disease and Ulcerative Co-
litis (UC) and causes ill-health
through repeated episodes (or
persistent) inflammation of
the bowel which can go on for
years. Because talking about
bowels is embarrassing, the
condition is not as well recog-
nised as other ‘chronic’ disor-
ders like Parkinson’s disease,
rheumatoid arthritis or multi-
plesclerosis.
IBD is not Irritable
Bowel Syndrome
2 Unlike IBS, IBD can cause
progressive damage to the
bowel,with ongoing disability,
often resulting in the need for
surgerytoremove thecolon,or
parts of the small intestine. It
alsocancauseanaemia,weight
loss, and problems with other
areas of the body (skin, eyes,
and joints) – which can be in-
flamed just like the gut is in-
flamed.
IBD is partly related to
genes
3 IBDrunsinfamilies,more
soforCrohn’sthanforUC.
Itisknownthatthereareovera
hundred genes that are linked
with the risk of getting IBD.
Theriskofhavingfamilymem-
bers affected is higher in chil-
dren getting IBD. You need
more than just genes inherited
from your parents to get IBD
though(seeno.4).
IBD affects youngsters
4 IBD starts most com-
monly in people in their
20’s, but a quarter of patients
get it in childhood (ie under
the age of 16). Children get-
ting it have more areas of the
gut involved, and are often
sicker for longer, so it has a
huge impact on their educa-
tion,work and family life that
can have big consequences
for their later life.
IBD is occurring more
frequently and is to do
with the environment
5 Four out of every 1000
people have IBD. It is
gradually becoming more fre-
quent especially in urbanised
or industrialised societies.
Children who move from ru-
ral societies to industrialised
areas have the increased risk
ofdevelopingIBDjustlikethe
population they are joining.
IBD is to do with bugs
in the gut
6 Perhaps the risk of get-
ting IBD is influenced by
thingsintheworldaroundus,
and by what we eat, by alter-
ing the millions of bacteria in
the gut. It is known that pat-
terns differ in IBD patients,
andthisisanewandcomplex
area of research.
Is it my diet doctor?
7 Itslogicaltothinkthatdi-
et is a key factor in caus-
ing IBD, particularly Crohn’s
disease, but there is no strong
evidence that any particular
dietaryhabitcausesCrohn’sor
UC. Diets high in refined car-
bohydrates (sugars) or low in
fruit andvegetables have been
implicated,butevidenceisnot
thatstrong.
Smoking and IBD
8 Patients with Crohn’s dis-
ease are more likely to
smoke, but UC patients often
gettheirillnesswhentheygive
up cigarettes! If they start
smoking again the inflamma-
tionoftenimproves(butitsnot
arecommendedtreatment!).It
isnotknownwhysmokinghas
this opposite effect in Crohn’s
andUC,buttheeffectisrelated
tonicotineincigarettesmoke.
Treatment for IBD
9 There is no curative drug
treatment for IBD, but
there are a number of drugs
that can control the inflam-
mation. Because the tradi-
tional drugs (like ‘steroids’)
have side-effects, and don’t
workonallpatients,therehas
been a huge amount of re-
search to find new drugs.
Nine things
you should
know about
Inflammatory
Bowel Disease
NEWS
Dr Barney Hawthorne
Chair IBD Section, British Society
of Gastroenterology; clinical
director for Gastroenterology,
Cardiff and Vale UHB
Read more on
healthawareness.co.uk
7. MEDIAPLANET 7AN INDEPENDENT SUPPLEMENT BY MEDIAPLANET
The importance of good
nutrition for a healthy lifestyle
BeinganEnglandandWaspsrugbyplayer,JamesHaskellisno
strangertohealthyeatingandnutrition:it’sbecomeavitalpartofhis
trainingregime.HeisinterestedintheworkofBowelCancerUK,the
UK’sleadingbowelcancerresearchcharity,andtheworktheydoto
promotehealthfromtheinsideout
J
ames said, “I was very shocked when I heard that
bowel cancer is the second biggest cancer killer in
the UK. Like so many families,we have sadly lost a
much-loved, close family member to cancer.There-
fore through my mission to help educate people about
the importance of good nutrition and regular exercise, I want to
help prevent people dying from the disease.That’s why I’m sup-
porting this charity, to raise awareness, support vital research
and lifesaving work, to stop bowel cancer.”
“I understand that there are several factors that can increase
the risk of bowel cancer and two of the most important are your
genes and your lifestyle.We can’t do much about the genes we
inherit but we can lower our risk through healthy living.”
James has just published a new book, on lean gains and body-
building, and while it is primarily about men and women devel-
oping and honing their physique to get fit and in great shape,
the book has, at its very core, the message that the right diet
and proper nutrition is needed to fuel the body correctly.
James continued, “I’d be the first to admit that understand-
ing the basics of nutrition and then putting them into practice
is not the easiest of first steps. However it is a vital cog, so we
have worked to create partnerships with specialist nutrition
companies to help provide practical solutions.”
James has been supporting Bowel Cancer UK through partici-
pation in Decembeard, the annual fundraising, beard-growing
challenge in December, as well as ongoing support to raise
awareness of the disease.
James Haskell
International rugby
star and supporter of
Bowel Cancer UK
You can find more information at
www.bowelcanceruk.org.uk
By Leanne Thorndyke, Bowel Cancer UK
FOTO:THINKSTOCK
