Transcript DIET AND GUT WDHD 2016

ALL diseases begin in gut
hippocrates
• Gut health is critical to overall health
• Unhealthy gut --- diabetes, obesity, RA,depression, CFS
autoimmune disease , skin disease ( eczema and
psoriasis)
• Integrity of gut barrier - imp goal
• Gut flora & gut barrier determine the gut health
• Our gut is home to 100 trillions organism
• Gut has 10 times more bacteria than any entire human
cells in body WE are more bacterial than human
• Role of gut flora
• Relationship between what we eat & development of
GI symptoms
• Example is coeliac disease, affects 1% of the
population
result of eating gluten (protein )
• a new entity : non-coeliac gluten sensitivity, affect
>10% of the population.
• Food intolerances : common affecting up to 40% of
individuals who have IBS type symptoms.
• Dietary interventions studies benefit patients with IBS
when trying a FODMAP diet, gluten free diet or
probiotics.
• Area of confusion for both clinicians and the public
alike are the entities of Food Allergy and Food
Intolerance.....
• Leaky gut syndrome : increased intestinal permeability.
• Lining of our intestines : important job : tight junction.
• Tight junctions compromised, increase in intestinal
permeability, "leaky gut“: unhealthy substances get through:
immune system reactivity : chronic health problems
• Like a chicken and egg problem, it is unknown if certain
health conditions can cause or are caused by an increase in
permeability
• What Causes Leaky Gut Syndrome?
– Bacterial or viral infections
– Certain medications
– Poor diet and diet toxins like wheat
– Excessive alcohol intake chronic stress
– hormone imbalance
• Role in autoimmune disorder and autoimmunity
• Affect all systems of body
• What is zonulin : increase in leaky gut but also found in DM, MS,
thyroid disiorders, IBD coeliac disease
• Wheat has gliadin and has similarity to zonulin
• An unhealthy balance of gut flora, known as dysbiosis
• Modern life style and unhealthy gut flora :
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antibiotics,
diets in high in refined CHO/sugar/processed foods
diet low in fermentable fibres
diet toxins like wheat and industrial seed oil that cause leaky gut
chronic stress , chronic infections
non breast fed new borns
• Health Problems Associated with Intestinal
Permeability
• this is only a hypothesis, not a firm conclusion.
• Acne
Allergies Arthritis Asthma
• Cardiovascular disease
Celiac disease
• Chronic hepatic inflammatory disorders
Diabetes
• Food allergies Inflammatory bowel disease (IBD)
• Irritable bowel syndrome (IBS) Metabolic
disease
• How to maintain and restore healthy gut
– Avoid all the things listed above
– Not always possible
– Remove all food toxins
– Eat plenty of fermentable fibres (sweet potato)
– Eat fermented foods
– Treat any intestinal pathogens
– Manage stress
• What to do
– Split food, increase frequency & decrease quantity, avoid bed time
snacks
– Limit intake of difficult to digest CHO like beans pulses, cabbage
cauliflower broccoli, ?potato,?rice, prefer lettuce, banana, grapes
YOGHURT
– Avoid alcohol, soft drinks, caffeine containing drinks milk, fatty/fried
foods
– Consume fermented dairy products
– Introduce fibre gradually over wks
– Limit polyol containg foods like artificial sweetners
– Avoid overeating, do not rush to eat, chew food slowly
– Favor diet based on protein/dairy products, low FODMAP diet
– Lifestyle modifications exercise, posture healthy BMI, avoid central
obesity OTC drugs
– ROLE OF SPECIALIST role of SIBO
• Fermentable fiber foods: role in health of the lower gut/overall
wellness. .
• What Is Fermentable Fiber?
• Fermentation is important because it’s the gases and acids produced
during the process that result in significant health benefits.
• The benefits of soluble and insoluble fermentable fibers include:
– good bacteria production in the colon
– stabilization of blood glucose,
– suppression of “bad” LDL cholesterol and triglycerides,
– increase of lower gut acid levels: absorb essential minerals such as
iron, calcium and magnesium
– improving the protective layer in the lower gut
– stimulation of the immune system by boosting production of helper
cells
– reduction in the number of dangerous conditions associated with an
unhealthy diet, including obesity and a diverse array of
gastrointestinal disorders such as inflammatory bowel disease,
diverticulitis
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Cereals
Fibre in g/100g edible portion
Rice
0.2
Wheat1.2
Bajra
1.2
Maize 2.7
Jowar
1.6
Ragi 3.6
Bengal gram, whole 3.9
Green gram, whole 4.1
Carrot
4.4
Cauliflower 1.2
Lotus stem, dry 25.0
Guava 5.2
Dates fresh
3.7
Identify packaged foods that are sources of fibre check
the per serve column of the nutrition information panel
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• FODMAP Diet (FODMAP=Fermentable Oligo-Di-Monosaccharides and
Polyols) FODMAPs are carbohydrates (sugars) that are found in foods.
• Not all carbohydrates are considered FODMAPs.
• The FODMAPs in the diet are:
– Fructose (fruits, honey, high fructose corn syrup (HFCS), etc)
– Lactose (dairy)
– Fructans (wheat, garlic, onion, inulin etc)
– Galactans (legumes such as beans, lentils, soybeans, etc)
– Polyols (sweeteners containing isomalt, mannitol, sorbitol, xylitol,
stone fruits such as avocado, apricots, cherries, nectarines, peaches,
plums, etc)
– FODMAPs are osmotic (means they pull water into the intestinal tract),
may not be digested or absorbed well and could be fermented upon
by bacteria in the intestinal tract when eaten in excess Symptoms of
diarrhea, constipation, gas, bloating and/or cramping may occur in
those who could be sensitive to the effects of FODMAPs.
• HIGH FODMAP DIET
• VEGTABLE AND LEGUMES – Garlic, onions, wheat, cauliflower, Beans,
Mushrooms, peas, spring onions
• Fruits- Apples, cherries,dates, guava, lychee, mango, peaches, pears,
pomegranate, water melon plums
• Meat- Sausages, processed meat
• Cereal, grains, bread- Wheat containing products, bread, cashews, pasta,
pastries, muesli, muffins
• Sweet- High fructose corn syrup, honey, jam , pickle, sugar free sweets,
sweeteners
• Prebiotics food - Fos /inulin/oligofructose
• Drinks –Bear, coconut water, soy milk, tea(strong), wine, rum, fruit
juices ( apple, mango pear large amount) sugar soft drinks (lemonade, cola
,soda)
• Dairy foods- Butter, cheese, gelato, icecream, milk, butter milk
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LOW FODMAP DIET
Vegetables and legumes- Cabbage, carrot, corn, cucumber , ginger , peeper,
lentils, lettuce, potato pumpkin, raddish, spinach, sweet potato, tomato,
water chestnuts
Fruit –Grapes, guava, ripe, kiwi, lemon, orange, papaya, pine apple, tamarind
Meats – Beef, chicken, pork , tuna fish, fresh fish, seafood
Cereal, grains, breads, biscuits- Wheat free breads, oat bread, wheat free pasta,
almonds, buck wheat, brown/whole grain rice, chips, corn flour, coconut
mixed nuts, oats, millets , walnuts, sourdough, rice noodles
Condiments- Chocolate, maple syrup, mustard sugar(sucrose), vinegers (apple
cider)
Drinks- Alcohol (bear ,vodka, gin whisky. Wine ) Coffee ( black/lactose free milk )
Sugar free soft drinks (diet coke) , Tea ( black /green/ herbal)
Dairy foods and eggs- Butter, cheese, eggs, tofu, lactose free whipped cream
Cooking ingredients , herbs and spices – Oil, Sunflower, vegetable coconut,
olive oil, ghee, salt
• OBESITY based on BMI
• PLAN diet and lifestyle modification, drugs
and bariatric surgery
• Requires long term care and multidisciplinary
approach and education
• Developing world : a challenge ,childhood
obesity, effect of globalisation and FDI
• Predictive factors for maintaning wt loss
• Nutrition diet and obesity
– Energy intake less than expenditure wt loss of .5
to 1 kg per week requires calorie deficit of 500 to
1000 cals per day with no changes in physical
activity diet <800 cals not recommended
– Low fat vs low CHO diet long term results ?
– Low glycemic load diets/high protein diets/high
fibre diets
– Potential adjuncts dietitians/eating
breakfast/adding dietary fibres
GLYCEMIC INDEX OF INDIAN FOODS
• Lifestyle changes and obesity
– Physical activity
– Behavioural modification and counselling
– MAINTENANCE OF WEIGHT REDUCTION
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Eating low fat fibre and protein rich diet
Self monitoring
Physical activity
Wt loss of more than 2 kg in 4 wks
Expending up to 2500 cals per wk
Patients belief and behavioural modification
• FEW FACTS FOR OBESITY
• Will nuts cause wt gain 10 almonds(75 clavs one
samosa(165 cal), 8cashew(85)vs idli(150),20
peanuts(90)vs4 glucose biscuits(140),16 pista(88)vs 4
marie bis(100)
• Role of soybean/omega3fatty acids
foods/nuts/fruits/green vegetables
• Role of calcium/iron/B complex/Vitamin amin A,C,
E/phosphorus
• Role of weighing machine in obesity
• Keep ur waist below 37 inches in male and 31.5 inches
in female
• WDHD theme four key GI symptoms--heartburn, abdominal pain/discomfort,
bloating and constipation
• Common troubling but not disabling
symptoms
• Cultural differences effect the prevalance
• Causes, type of treatment and response
effected by dietary, lifestyle, cognitive,
emotional /behavioural/psyhcosocial factors
• PATIENT FACTORS
– Age/gender
– Lifestyle- smoking/alcohol/diet pattern, exercise,
sleep, stress, travels
– Culture related to food/diet
– Health literacy- self care capacity
– Health status
– Psychosocial factors/family history
– Prescription/non prescription medications
– Dietary supplements
– Efforts to relieve symptoms
• HEART BURN
GERD / Functional
– Definition- site/type/timing /description
– Atypical features- cardiac/pulmonary
– Alarm features – new onset age>50 to 55 yrs, GI
bleeding, dysphagia, unintentional wt loss….
– Other features which exclude self care –
symptoms >3 mo, continuing after 2 wks of
therapy, symptoms suggestive of cardiac pain,
continuous N/V/diarrohea
• Management of heart burn
– Occasional symptoms by antacids
– Avoid chocolate coffee, alcohol, smoking, carbonated
drinks, mint, fried/fatty foods, citrus fruits/juices,
tomato products, garlic/onions, spicy foods
– Elevating head of the bed
– Small frequent meals, avoiding food or liquids three
hours before lying down
– Avoid medications like OCP, NASID’s ,TCA etc
– ROLE OF PHYSCIAN/SPECIALIST
• ABOMINAL PAIN/DISCOMFORT
– Definition—chronic/recurrent , assoc. symptoms
– IBS like features
– Food intolerance--- FODMAPS’s, lactose, fructose
– Alarm features– wt loss, gi bleeding, lab abn., new
onset, asso. with inability to pass stool/gas
– Management -- dietary and lifestyle
modifications, symptom based OTC medications
– role of SPECIALIST
• BLOATING
– Definition – vague, includes flatulence, frequent
burping, abdominal rumbling,
– Has a diurnal pattern -- worse in evenings
– Causes are complex, in Upper GI– aerophagy, in LGI it
is fermentation
– Usually benign causes difficulty in relation too
work/recreational/social activity, increase in sick days,
physicians visit
– Alarm features – bleeding, anemia, wt loss free fluid
• CONSTIPATION
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Definition
Alarm features
D/D from IBS abdominal pain
Self care strategies
• Not miss Bfast
gastrocolic reflex max
• Include fibre rich food fruits/legumes veg. whole grain and
seeds gradually increase fibre in diet
• Fruits rich in pectin apples strawberries lychees and pear
• Drink water ,avoid fried foods and alcohol and caffeinated,
sugar rich beverages, decrease intake of refined sugar
• Exercise avoid stress improve sleeping patterns
• Do not ignore urge to pass stool and optimal toilet sitting
position
• Minimise use of medications use simple bulking agents