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British Dietetic Association - Probiotics

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British Dietetic Association - Probiotics

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What are probiotics?

Although people tend to think that bacteria are harmful germs that spoil food or make you ill, there are many bacteria that are good for our health. The gut is the organ of the body where food is digested and absorbed and it naturally contains trillions of bacteria that are important for helping us stay healthy. Probiotics are ‘good’ bacteria found in food products or supplements that can beneficially affect our health by improving the balance and function of the gut bacteria. They are found in many different forms such as yoghurts, tablets, capsules and sachets.

Probiotics are generally considered safe for healthy people of all ages. However, people whose immune system does not function properly may be at risk when taking a probiotic and should seek specific advice from a doctor or dietitian.

How do probiotics work?

Many probiotics have been shown to restore the balance of the gut bacteria which can help our body work at its best.

When we eat or drink probiotics they compete for space and for food with potentially harmful bacteria – evicting them from our gut. Probiotics also stimulate our own immune system to help it to fight infections better. For example, some studies have shown that they can make colds last for shorter lengths of time and improve your response to vaccines!

Probiotics can also help us to digest fibre from our diet. When they do this, probiotics produce acid compounds that keep the lining of our gut healthy.

Did you know?

The number of bacteria in your gut is almost ten times more than the number of your own body cells. If you gathered all of your gut bacteria together, they would weigh approximately 1kg (over 2lb).

The bacteria in the gut can be knocked out of balance for many different reasons, including: getting older, taking antibiotics, illnesses such as irritable bowel syndrome or inflammatory bowel disease or following an episode of food poisoning (gastroenteritis) or gut surgery.

What can probiotics be used for?

A lot of research has been done to find out if taking probiotics is good for healthy people and people with specific disorders. The scientific evidence for their use keeps growing, but here are a few areas where probiotics may be beneficial:

Taking a course of antibiotics

Antibiotics are really useful at fighting off bacterial infections, however, they also cause major changes to the balance of our gut bacteria, which sometimes results in us getting diarrhoea. Lots of research shows that many probiotics will help protect people from getting diarrhoea when they take antibiotics. Probiotics must be taken as soon as you start the antibiotics and continue for at least one week after the end of the course.

Preventing the Clostridium difficile superbug

Some people, particularly those taking antibiotics, are at risk of catching the gut superbug Clostridium difficile (sometimes called “C-diff”). This bug causes very bad diarrhoea, and although it can be treated with antibiotics, up to four in ten people will get C-diff again. Dietitians and other clinical researchers have found that a probiotic milk drink containing Lactobacillus casei and Lactobacillus bulgaricus may prevent older people who are taking antibiotics in hospital from getting C-diff in the first place.

Travelling overseas

Travellers’ diarrhoea can occur due to a bacterial or viral infection during or following a trip to specific countries. The symptoms are passing watery stools three or more times a day, either during or shortly after travelling. It usually lasts for around three to five days and is a common but usually mild illness that is spread through poor hygiene. A review of 12 different studies has shown that overall probiotics can reduce the chance of you getting travellers’ diarrhoea. If you are going to a part of the world where travellers’ diarrhoea is common then you might consider taking the probiotic Saccharomyces boulardii or a mixture of probiotics called Lactobacillus acidophilus and Bifidobacterium bifidum for the entire holiday.

Constipation

Constipation is common in the UK and its symptoms include infrequent bowel movements, hard stools, a bloated stomach and straining. Recent studies have shown that probiotics may help to ease the symptoms of constipation. If you suffer from constipation, try products that contain Bifidobacterium lactis for a trial period of four weeks. If they don’t work, try another brand or stop taking them.

Irritable bowel syndrome (IBS)

Approximately one in ten adults in the UK have IBS and symptoms include severe diarrhoea or constipation, together with abdominal pain. Some patients with IBS have been shown to have changes in the balance and function of their gut bacteria. Although many of the studies so far have been small and inconclusive, in general researchers have shown that certain probiotics may help to reduce symptoms of IBS, particularly bloating. Dietitians recommend that patients with IBS take probiotics for a trial period of four weeks and if they don’t work to try another brand or stop them – they won’t work for everybody.

Inflammatory bowel disease

Ulcerative colitis and Crohn’s disease are both inflammatory bowel diseases that result in severe diarrhoea and major changes to the balance of the gut bacteria. Some probiotics have been shown to be very useful for patients with ulcerative colitis, particularly for helping them to stay well for longer. However, their use for patients with Crohn’s disease is not as conclusive.

Prebiotics

Some probiotics find it difficult to reach the gut because they are killed by acid in the stomach. One way of boosting your own natural good gut bacteria is through eating prebiotics. Prebiotics are types of carbohydrate that only our gut bacteria can feed upon. Eating prebiotics therefore causes more good gut bacteria to grow in your gut.

You can get prebiotics by eating onions, garlic, asparagus, artichoke, chicory and banana. However, in the UK we don’t eat large quantities of these foods and so some people choose to take a prebiotic supplement such as fructo-oligosaccharide. Although some research studies have been done on the use of prebiotics in the areas covered above, in general, more studies have been done on probiotics. More research is required in these areas for the use of prebiotics.

Did you know?

Not all probiotics work the same way! Research has shown that different probiotic bacteria have different effects in health and disease, which means not all probiotics will help with all symptoms or conditions.

Ask your doctor or dietitian for information on the best probiotic to use for your symptoms.

Summary

There are lots of natural bacteria in our gut which help us stay healthy but these can sometimes be knocked out of balance.

Probiotics are good bacteria which can improve the balance of our gut bacteria and can be found in food products such as fermented milk drinks, some yoghurts and supplements.

Probiotics are generally safe for healthy people to take. However people whose immune systems do not work properly may be at risk so they should seek professional advice beforehand.

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This Food Fact Sheet explains what probiotics are, what they do to you, and their effect on certain diseases.

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Can you treat IBS by changing your diet?

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Can you treat IBS by changing your diet?

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Overview

This factsheet is about Irritable Bowel Syndrome (IBS)

Irritable bowel syndrome (IBS) consists of a number of symptoms. The most common symptoms of IBS are abdominal pain and abnormal bowel habits. IBS is the most common disorder of the digestive system and up to one third of the population experience symptoms. Women are slightly more affected than men and the usual age for patients to seek advice is between 20 and 40 years.

How does irritable bowel syndrome occur?

During digestion, the bowel squeezes its contents along our insides towards the anus. This process (peristalsis) is usually painless and we do not realise that it is happening unless there is an abnormal squeeze within the bowel or, for some reason, the intestine becomes more sensitive. In addition, patients with IBS seem to have greater sensitivity to the way that their intestines are moving, meaning they feel pain more easily. These changes can be quite painful.

How food (food bolus) moves along the gut

Causes

Causes of irritable bowel syndrome

We do not think that IBS has a single cause. There is a wide variety of reasons why patients develop the condition. However, the single most common trigger to the start of symptoms is following a bout of food poisoning or gastroenteritis. There does not seem to be a genetic cause and there appears to be many factors that can provoke symptoms. Some people find that stress makes their symptoms worse. In some people, eating irregularly or eating an abnormal diet may be responsible. Some drugs, particularly when taken long term for chronic conditions, can cause IBS type symptoms such as diarrhoea. Overall, there seems to be some interaction between the nervous system in the gut and brain, emotional state, the gut microbes and the immune system of the gut.

Diagnosis

How is irritable bowel syndrome diagnosed?

The GP will want to rule out other diseases but will probably be able to make a diagnosis based on the described symptoms. Sometimes IBS symptoms can be caused by drugs you are taking for other conditions. It may be worth discussing this with your doctor to see if a drug switch can be made.

Further tests may include blood tests, which will be used to assess the following:

Symptoms

How can IBS affect you?

IBS is one of the most common reasons for a visit to the GP. As many as 1 in 8 people have symptoms of IBS at any one time. Once diagnosed, and given help most people can find effective ways of living with their IBS.

The most common symptoms of IBS are:

Many patients with IBS get crampy abdominal discomfort or pain, which comes and goes, and fluctuates with bowel function (typically easing after a bowel movement). Other common symptoms are wind, bloating and distension (a widening of the girth of the abdomen) and pooing mucus. Sometimes other symptoms might also occur, such as feeling tired, feeling sick, backache and bladder symptoms. Approximately one third of IBS patients suffer from bouts of constipation, one third suffer from bouts of diarrhoea and most other patients don't fall into a single pattern. The form of IBS that seems to follow gastroenteritis often leads to the diarrhoea type. This is called post infectious IBS. Identifying these different types of IBS is important because treatments often work quite differently depending upon whether diarrhoea or constipation is the main problem. However we do know that the pattern of bowel movements can alter over time and this means that your treatment might need to change should your symptoms vary.

Symptoms that may be of concern

These symptoms are not usually associated with IBS but may be associated with other diseases. If you experience any of these, even if you have had IBS for some time, you should see your doctor as soon as possible:

The need to see a doctor is especially important if there is a family history of bowel disease (such as cancer, colitis or Crohn's disease).

Treatment

What treatment is available for Irritable Bowel Syndrome (IBS)?

Dietary management

If a dietary cause is suspected your GP can give advice on simple first line dietary changes to try or may refer you to a dietitian. The dietitian will try to identify any foods that cause your IBS symptoms (trigger food). This may involve leaving out particular sorts of foods from the diet, to see whether these symptoms improve. The dietitian may suggest an 'exclusion diet', which will exclude a number of common 'trigger' foods from your diet. A particular form of this is the low FODMAP diet. If symptoms improve, individual items can then be added back into the diet until the specific trigger food or foods are identified. If you have a diagnosis of an eating disorder, or you have had one in the past, exclusion diets may not be the best treatment option for you. There are other non diet treatments than can be tried, instead.

If constipation is a symptom, then bulking agents such as natural oat or rice bran, bran containing cereals such as oats, wholegrain rice or isphagula husk (a natural laxative) are helpful. But some laxatives containing fibre or senna, whilst helping with constipation, may make pain a little worse in some people. Avoid adding additional wheat bran in your diet as this can make symptoms worse.

Drug therapy

Drugs to reduce bowel spasm have been used for many years. They are generally very safe and often worth trying. Most are available without a prescription and the pharmacist can advise. Unfortunately, they only benefit a relatively small number of patients. Laxatives can be prescribed for constipation by your GP or from the pharmacist whilst some patients benefit from treatment with peppermint oil or other over-the-counter medicines. Some patients find probiotics very helpful, but there is no specific prescribed preparation. It is rather a question of trial and error. Sometimes when pain is a major problem, small doses of drugs, which are used as antidepressants, such as amitriptyline, can be helpful. These can be useful in patients who have no signs of depression. There are also new classes of drugs that may be used if simpler treatments do not succeed.

New drugs are being developed, some of which may help patients whose main symptom is diarrhoea and others who tend to be constipated. Some of these newer agents are not yet available to doctors to prescribe but it does seem likely that a wider range of treatments will be available to patients with IBS in the near future.

Other treatments

Hypnotherapy and relaxation therapy: These have both been shown to be effective for some people but it is unclear whether they improve bowel symptoms. Hypnotherapy can be obtained through approved therapists who should be members of the British Medical Hypnotherapy Association. Ask about a type of therapy called gut directed hypnotherapy. Your GP can advise on counselling, and some specialists believe that a psychological treatment called Cognitive Behavioural Therapy (CBT) can be useful.

How can I self-manage my irritable bowel syndrome?

Irritable bowel syndrome (IBS) is a condition where good self-management can make a huge difference to the symptoms experienced.

Identifying trigger foods

This may be done with a dietitian. Keeping a food diary together with a record of bowel symptoms. This may show which foods cause the most problems or whether there is some other pattern. Foods which commonly cause abdominal upset include wheat products, dairy products, onions, nuts and caffeine-containing drinks such as coffee, tea and cola. Some patients cannot digest lactose (the sugar in milk) and so develop wind and diarrhoea after taking large amounts of milk or dairy products, which can include cream, cheese, yoghurt and chocolate.

Healthy eating habits

Following healthy eating habits, avoiding trigger foods and eating regularly can bring about a significant improvement in symptoms.

Patient support

The IBS Network provides a unique self-care programme to support people living with irritable bowel syndrome. The programme is available to members, to work through at home, or in IBS support groups. To become a member go to the website.

Support

What to ask your doctor?

These are some useful questions you can ask your doctor:

NICE Guidelines for IBS:

Research

The National Institute for Health and Care Excellence (NICE), the government agency tasked with developing guidelines on how best to manage conditions, published guidelines for IBS, which were subsequently updated in 2017. As part of those guidelines, NICE published a set of research recommendations for areas and questions where more information was needed and hence more studies were encouraged.

These questions included:

What is the clinical and cost effectiveness of low-dose antidepressants for treating IBS in primary care?

What is the clinical and cost effectiveness of computerised CBT (cognitive behavioural therapy) and mindfulness therapy for the management of IBS in adults?

What is the clinical and cost effectiveness of a low FODMAP diet (as well as issues around research for culturally specific foods)?

Research centres such as King ́s College London (KCL) and Monash University have carried out research on the Low FODMAP Diet. The team at KCL have gathered evidence that the Low FODMAP Diet is effective in the short and long-term, broadly acceptable to patients and enables a nutritionally balanced diet. They have also provided evidence and practice guidance to assist health professionals in the delivery of the low FODMAP diet.

In the area of CBT, a large study from the University of Southampton has found that CBT delivered over the phone or via a website was more effective than usual treatment for refractory IBS (IBS where symptoms continue after 12 months despite receiving appropriate medication and lifestyle advice). Face-to-face CBT had been shown before to be effective in IBS but patients often found adherence difficult and its availability in the NHS was poor. These telephone or web-based alternative ways to deliver CBT are a promising addition to the treatment for IBS.

Research on IBS is carried out globally. A new registry called ContactME-IBS allows users to find out about IBS research and will also give users the opportunity to be matched to relevant IBS studies when they become available.

Register here for further information.

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Irritable Bowel Syndrome | Causes, Symptoms & Treatment | Guts UK

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Overview Irritable bowel syndrome (IBS) consists of a number of symptoms. The most common symptoms of IBS are abdominal pain and abnormal bowel habits. IBS is the most common disorder of the digestive system and up to one third of the population experience symptoms. Women are slightly more affected than men and the usual age for patients to seek advice is between 20 and 40 years.

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Irritable bowel syndrome (IBS) is a medical term used to describe a collection of gut symptoms. Food can have an impact on symptoms.
Symptoms vary from one individual to another and can be worse for some than others. It is a very common condition affecting around one in five adults. An assessment for IBS should be considered if you have had any of the following symptoms for at least six months: abdominal pain or discomfort, bloating, or change in bowel habit.

A diagnosis of IBS should be considered only if there is abdominal pain or discomfort that is either relieved by defaecation or associated with a change in bowel habit. This should be accompanied by at least two of the following four symptoms:

altered stool passage (straining, urgency, incomplete evacuation)

abdominal bloating (more common in women than men), distension, tension or hardness

symptoms made worse by eating

passage of mucus

Other features such as lethargy, nausea, backache, and bladder symptoms are common in people with IBS and may be used to support the diagnosis. It is important to have a diagnosis of IBS confirmed and other conditions such as coeliac disease and inflammatory bowel disease ruled out. If you think you may be suffering with IBS, but also have any of the following symptoms, see your doctor to discuss whether a referral to a specialist may be required:

unintentional and unexplained weight loss

rectal bleeding

a family history of bowel or ovarian cancer

a change in bowel habit to looser and/or more frequent stools persisting for more than six weeks in a person aged over 60 years

What steps can I take if I have IBS?

Try to:

eat three regular meals a day

try not to skip any meals or eat late at night

smaller meal sizes may ease symptoms

limit alcohol intake to no more than two units per day and have at least two alcohol free days a week

reduce intake of caffeine-containing drinks e.g. no more than two mugs (three cups) a day

reduce intake of fizzy drinks

drink at least eight cups of fluid per day, especially water or other non-caffeinated drinks, for example herbal teas, diluted cordial/squash

cut down on rich or fatty/fried foods including chips, fast foods, ready meals and sauces, pies, samosas, batter, cheese, pizza, spring rolls, creamy sauces, snacks such as crisps, chocolate, cake and biscuits, spreads and cooking oils, and fatty meats such as burgers and sausages

limit fresh fruit to three portions per day (one portion is 80g)

Helpful hints

Take time to relax - mindfulness/meditation, yoga, aromatherapy or massage may help

Take regular exercise such as walking, cycling, swimming

Take time to relax while eating meals and chew your food well

Keep a food and symptom diary whilst you are making changes so you can see what has helped

Make one change at a time so that you can see what has helped

Symptoms

Dietary changes can often help IBS symptoms and sometimes simple changes are all that are needed.

If symptoms include bloating and wind

Limit intake of gas-producing foods e.g. beans and pulses, Brussels sprouts, cauliflower, and also sugar-free mints/chewing gum

You may find it helpful to eat oats (such as oat-based breakfast cereal or porridge) and linseeds (up to one tablespoon per day taken with at least 150ml of uncaffeinated fluid)

If symptoms include constipation

Ensure that you drink six to eight glasses of uncaffeinated fluid per day to improve stool frequency and decrease the need for laxatives

Try to gradually increase your fibre intake - any sudden increase may make symptoms worse. Rich sources include wholegrains, oats, vegetables, fruit, and linseeds. They help to soften stools and make it easier to pass

Try adding one tablespoon per day of brown or golden linseeds (whole or ground) to breakfast cereal, yoghurt, soup or on salad. Have around a small glass/teacup (150ml) of fluid with each tablespoon of linseeds taken

Avoid eating extra wheat bran

If symptoms include diarrhoea

Replace lost fluids by drinking plenty of uncaffeinated fluid

Limit caffeine intake from tea, coffee, and soft drinks to three drinks per day

Try reducing intake of high-fibre food (such as whole-wheat breakfast cereals and wholemeal bread)

Avoid sugar-free sweets, mints, gum and drinks containing sorbitol, mannitol, and xylitol

Fermented dairy and probiotics

You may wish to try yoghurt, a fermented milk drink such as kefir, or a ' probiotic ' supplement.

If using a probiotic supplement, try one at a time and take it daily for at least four weeks to see if your symptoms improve. If it does not appear to help then you could try an alternative brand.

Further advice

Give your bowels time to adjust to any changes. If your symptoms persist after following general lifestyle and dietary advice, re-introduce the foods you have cut out and ask your doctor to refer you to a healthcare professional with expertise in dietary management, who can ensure your diet is nutritionally adequate whilst following a dietary intervention e.g. a dietitian. They may suggest that you trial a diet restricted in fermentable carbohydrates (also known as a low FODMAP diet). You could ask your doctor, health visitor or other medical staff to refer you to an NHS dietitian for support with this diet.

Alternatively, you can watch IBS webinars produced by specialist NHS dietitians on the NHS Patient Webinars website or search the BDA's directory to find a private dietitian for you.

If dietary changes and medication have not helped your symptoms, you may find it useful to trial hypnotherapy or cognitive behavioural therapy (CBT).

IBS is not caused by food allergy. If you feel that you may be suffering with a food allergy, please refer to Allergy UK or Anaphylaxis Campaign for further information.

Top tips

1. It is important to have a diagnosis of IBS confirmed and other conditions such as coeliac disease and inflammatory bowel disease ruled out

2. Try simple dietary changes first - you may find that major changes are not needed

3. Aim for regular, healthy, balanced meals

4. Limit alcohol, caffeine, and fizzy drinks

5. Take time to eat in a calm environment, chewing food well

6. Take time to relax

7. Keeping a food and symptom diary can help you to monitor the effect of any changes

8. Make changes according to your symptoms

9. If you try probiotics, probiotic yogurt or fermented milk drink, try one product at a time for at least four weeks

10. Seek specialist advice if you are struggling or dietary intake becomes limited

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Irritable Bowel Syndrome Food Fact Sheet

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Dietary changes can often help irritable bowel syndrome symptoms and sometimes simple changes are all that are needed. This Food Fact Sheet explains that dietary changes can help these symptoms.

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British Dietetic Association - What is a portion?

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British Dietetic Association - What is a portion?

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What is a portion of food?

A portion is the amount of a food that you eat at one time, for example how much food you put on your plate at a meal or how much is in a packet.

Why are portion sizes important?

The key to eating a balanced diet is to eat a wide variety of foods in appropriate amounts. Making healthier choices and choosing to eat some foods more often, and in larger amounts, than others.

It is important to be aware of portion sizes, as eating too much or not enough of any type of food can increase your risk of health problems. This is because your body may be getting too much or too little of what it needs to stay healthy.

As every person is different, the recommended number of portions for each food will vary according to age, sex, size, health and other factors, but this sheet provides a good place to get you started.

Carbohydrates - what is a portion?

Top tip: Choose wholegrains or higher fibre versions with less added fat, salt and sugar. For more information, see the BDA Food Factsheet on Wholegrains. Be mindful that the carbohydrate portions provided contain different amounts of carbohydrate and calories.

Dairy and alternatives - what is a portion?

Top tip: Try to choose lower fat and lower sugar options where possible.

Protein - what is a portion?

Top tip: Eat more beans and pulses such as lentils and peas, and two portions (140g) of sustainably sourced fish per week, one of which is oily such as mackerel, salmon, trout, sardines, herring. Eat less red and processed meat. Choose lean meat.

Fruit and vegetables - what is a portion?

Top tip: Eat at least five portions (400g) of a variety of fruit and vegetables every day. Choose from fresh, frozen, canned (in juice) or dried. Eat a rainbow!

Oils and spreads - what is a portion?

Top tip: Use small amounts of oils and spreads and measure out. Choose unsaturated vegetable oils such as olive oil, rapeseed oil, sunflower oil.

Drinks - what is a portion?

Drink plenty of fluids - generally six to eight cups or glasses daily but this will depend on age, gender, the weather, how much physical activity you do and health. Water, lower fat milks, lower sugar or sugar-free drinks including tea and coffee all count. Younger children need relatively smaller servings (150ml-200ml) whereas older children and adults need larger servings (250ml-300ml).

Fruit juice and smoothies should be limited to one small glass (150ml) per day at a mealtime to protect your teeth.

Mixing food types and portions

People will often have more than one portion of one food type at each meal.

Based on the portion sizes above:

A sandwich with two slices of bread with two teaspoons of spread (one on each slice) would be two portions of carbohydrates and two portions of fats

A meal including meat or fish plus beans or pulses would be two portions of protein

A meal containing broccoli and carrots would be two portions of vegetables

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A portion is the amount of a food that you eat at one time, for example how much food you put on your plate at a meal or how much is in a packet. This Food Fact Sheet provides an overview of recommended food portion sizes of typical foods.

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Learn about irritable bowel syndrome (IBS) symptoms, how it’s diagnosed, and when to see your doctor

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British Dietetic Association - Fibre information

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British Dietetic Association - Fibre information

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Fibre is essential for your gut to work normally. It increases good bacteria which supports your immunity against inflammatory disorders and allergies.

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Constipation: Tips for those suffering with constipation

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Can stress and anxiety affect my IBS symptoms?

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Can stress and anxiety affect my IBS symptoms?

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A brief thought about paying the electricity bill could spiral into worries about money or work and take your mind off the meditation.

Remember: having a totally blank mind is not the goal of meditation. It's OK if a thought intrudes - just gently try to shift your focus back to your breath.

If your mind wanders off 10 times during a meditation, bring it back to the breath 10 times.

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How to meditate for beginners - Mental wellbeing tips - Every Mind Matters

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A brief thought about paying the electricity bill could spiral into worries about money or work and take your mind off the meditation. Remember: having a totally blank mind is not the goal of meditation. It's OK if a thought intrudes - just gently try to shift your focus back to your breath.

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Breathing and relaxation exercises | NHS inform

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Guidance on doing breathing exercises to help with stress, anxiety and tension. Learn how to do these and how they can help.

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Meditation for IBS. A guided meditation (2019).

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A simple guide to stressing less and enjoying life more.

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Get advice from other people who have found ways to improve their mood.

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Unlock hundreds of mood-boosting meditations, relaxing sleep exercises, focus music, and more with our biggest offer of the year.

It's the healthiest, happiest deal you'll find this Black Friday, and it won't last long.

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Meditation and Sleep Made Simple - Headspace

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Live a healthier, happier, more well-rested life in just a few minutes a day with the Headspace app.

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Calm is the #1 app for sleep and meditation. Join the millions experiencing better sleep, lower stress, and less anxiety.

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Nerva | Fix the miscommunication between your gut and brain

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Stop IBS from restricting your life. Nerva combines cutting-edge neuroscience and gut-directed hypnotherapy to help you manage IBS symptoms and get back to enjoying food and daily activities without worry.

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