What is it?

• Colonic diverticulosis is the condition whereby diverticula, or pockets, form from the lining of the colon. These protrusions of the colon lining occur at sites of weakness in the muscle wall possibly due to increased pressure from muscle contractions.
• Diverticulitis is an inflammatory process that causes acute symptoms and may be associated with serious complications.

What may cause it?

• Potential risk factors include increasing age; diets low in fibre, high in red meat and refined carbohydrates; obesity.
• There is no evidence that seeds or nuts cause diverticulitis.
• Changes in the biodiversity of the colonic bacteria

What are the symptoms?

• Diverticulosis is often asymptomatic and found on investigation by colonoscopy or CT scanning. It may be associated with low abdominal cramping, bloating or constipation.
• Diverticulitis, due to infection or inflammation of the diverticula, may cause localized lower left sided abdominal pain with either diarrhoea or constipation and fever. Bleeding may occur.

How common is it?

• Classically, this is a disease process that predominantly affects people over the age of 70 years and is more common in developed countries. It is however getting more common in younger people possibly related to obesity.

What tests are needed to diagnose it?

• A colonoscopy enables the gastroenterologist to examine the lining of the colon to confirm diverticulosis and to exclude colon cancer or inflammatory bowel disease.
• An abdominal CT scan is a radiological test used to diagnose diverticulitis and to look for complications.
• A blood test may be performed to look for any signs of infection or inflammation within the colon.

How do you treat it?

• Individuals with diverticulosis are advised to eat a healthy and balanced diet, avoid too much red meat and to lose weight if obese. Use of a prebiotic and/or a probiotic may be of benefit but at present this is an evidence-free zone.
• Mild diverticulitis is usually treated with oral antibiotics. A recent placebo-controlled trial however did not show, in the outpatient setting, that antibiotics were any better than placebo.
• Patients with complications of acute severe diverticulitis such as an abscess (collection of pus) or perforation (a hole in the colon) require emergency admission to hospital for intravenous antibiotics and sometimes urgent surgery.
• Long-standing severe diverticulosis or following recurrent attacks of diverticulitis the colon may get narrowed (stricture formation) and surgery may be required to avoid obstruction.

If you have any questions, please do not hesitate to contact Dr. Harris.

Studies conducted in recent years have explored the relationship between the gut microbiota, consisting of around 800 different bacteria species, and metabolism. It has been suggested that specific intestinal microbial compositions can either protect from, or contribute to, obesity and other metabolic diseases.

First, I would like to discuss short-chain fatty acids (SCFA) and the vital role they play in influencing gut health. SCFA are produced by bacteria from fermentation of dietary products, mostly fibre, within the colon. Their primary role is to serve as a source of energy for cells within the colon and to stimulate repair and replacement. Of potential interest, butyrate may influence how energy (including glucose) is metabolised in the body and so hold a possible protective effect against metabolic disease and obesity.

The potential relationship between gut microbiota and obesity was analysed in this excellent 2017 study when faecal microbiota from both lean and obese subjects was transferred into mice, which then changed their feeding behaviour and subsequently their body mass to reflect the human source. The researchers suggested that butyrate positively influences energy balance and thus protects from diet-induced obesity.

Subsequent research has shown a broad variety of possible effects of butyrate on metabolism including an increase in mitochondrial activity, preventing metabolic endotoxemia, improving insulin sensitivity, increasing intestinal barrier function and protecting against diet-induced obesity.

These fascinating findings suggest a relationship between the gut microbiota and human metabolism. Further research is needed in humans to extend the experimental findings in mice and to establish if the gut microbiome may be changed (by prebiotics, probiotics, antibiotics or even faecal transplantation) to help reduce obesity and even, diabetes.

If you have any questions about gut microbiota and its relationship to obesity, please do not hesitate to contact Dr. Harris

In the 19^th edition of the Gut Reaction series, I suggested that patients with Laryngo-Pharyngeal Reflux (LPR) may consider an alkaline water & plant-based Mediterranean style diet. As discussed in that blog, a paper published in JAMA Otolaryngology (October 2017) suggested that diet and consumption of alkaline water might be as effective as treatment with a PPI. The main outcome of the study was a change in Reflux Symptom Index (RSI) – the 1^st group were treated with PPI and standard anti-reflux precautions (PS) and the 2^nd group with alkaline water, a plant-based Mediterranean-style diet and standard anti-reflux precautions (AMS). Results from the study showed that the percentage of patients achieving a clinically meaningful reduction in RSI was 54% in PS-treated patients and 63% in AMS-treated patients.

How alkaline water and dietary change help the symptoms of LPR is unclear but it may change the biodiversity of the gut bacteria (microbiome) in the oro-pharynx, gullet (oesophagus) and stomach.

In this blog, I will provide some further information regarding alkaline water and what the Mediterranean-style diet involves.

First of all, the “alkaline” in alkaline water refers to its pH level. The pH level is a number that measures how acidic or alkaline a substance is on a scale of 0 to 14. Alkaline water has a higher pH level than regular drinking water. Because of this, some advocates of alkaline water believe it can help maintain balance by neutralising the acid in your body. Drinking water generally has a neutral pH of 7 while alkaline water typically has a pH 8-9.

It is relatively straightforward to make your own alkaline water at home. Here is a suggested recipe:

• Pour a half-gallon of the filtered water (preferable to tap water) into a gallon jug with a lid. If using tap water, a filtration system is recommended.
• Add one teaspoon each of baking soda, sea salt and coral calcium powder to the container.
• Wash a lemon and slice it in half. Squeeze the juice into a small bowl.
• Pour the juice into the water/baking soda/coral calcium mix.
• Secure the container lid and then shake it vigorously to thoroughly mix all the ingredients.
• Add the rest of the distilled water to the container, being sure to leave an inch of space at the top of the container for air.
• Close the container tightly and shake it to mix the water.
• Use pH strips to test the water to see the level, ideally around level 8 or 9. If that is not the case, add another ¼ teaspoon of baking soda and mix again until the proper pH level is reached.

Equally, many supermarkets stock alkaline water along with other specialty waters in the bottle water aisle. It can also be ordered online from a number of retailers.

Here is some basic information about the plant-based Mediterranean style diet:

• Eating primarily plant-based foods, such as fruits and vegetables, whole grains, legumes and nuts.
• Replace butter and other dairy with healthy fats such as olive oil and canola oil.
• Use herbs and spices instead of salt to flavour foods.
• Limit red meat to consume no more than a few times a month.
• Eat fish and poultry at least twice a week.

If you have any questions about alkaline water or a plant-based Mediterranean style diet, please do not hesitate to contact Dr. Harris.

Irritable Bowel Syndrome affects up to 20% of the UK population with women at least twice as likely to be affected as men. Common symptoms include bloating, constipation, diarrhoea and abdominal discomfort. While there is no clearly defined cause of IBS, many sufferers find that symptoms are exacerbated by high stress levels, an imbalance between good and bad bacteria in the gut and dietary factors such as wheat and dairy products, which are high in FODMAPS (Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols). To clarify, FODMAPS are a collection of poorly absorbed simple and complex sugars that are found in a variety of fruit and vegetables as well as in milk and wheat.

While many control their IBS with a strict diet, avoiding ingesting foods high in FODMAPS, this blog will examine the positive effects that probiotic supplements, and more specifically Symprove, appear to have on the illness, relieving symptoms by correcting the imbalance in gut bacteria. Probiotics are defined as “live microorganisms, which, when administered in adequate amounts, confer a health benefit on the host.” So, how may a probiotic supplement help to reduce IBS symptoms?

–    Probiotic bacteria may give a boost to the numbers of friendly bacteria in the gut, so less space is available along the gut lining for the colonisation of ‘bad’ microorganisms, which may cause both digestive discomfort and excess gas production.

–    The supplement’s ‘friendly bacteria’ may help to break down the FODMAPS foods that may exacerbate IBS.

–    The healthy bacteria may also play a role in modulating the gut’s nervous system, thus reducing the impact of stress on the gut.

Symprove, available without prescription from the internet and health food shops, is the first probiotic remedy proven in a clinical trial to work. A trial at London’s King’s College found that 57 per cent more patients with moderate-severe IBS achieved remission than those taking placebo (an identical looking and tasting supplement but one which didn’t contain any bacteria) while taking this supplement. Symprove is a water-based treatment that contains four live strains of the ‘friendly bacteria’ lactobacillus – the supplement’s makers claim that it helps to balance the gut and ‘reset’ the digestive system. There are two major advantages to Symprove compared to competitors, many of which contain bacteria that are freeze-dried or transported in food:

–    Symprove’s bacteria is live and ready to work immediately. The various strains work together to address the gut’s imbalance. This differs from freeze-dried products which are inactive when ingested and usually have very low survival rates when subjected to stomach acid. Those that do survive may also pass through the gut before having a chance to re-activate.

–    As it is water-based, Symprove doesn’t trigger digestion when ingested, meaning that it survives the stomach’s hostile environment. Food or dairy-based probiotics (such as yoghurts) usually trigger digestion, resulting in many of the bacteria being killed before it can have any effect.

Symprove is drunk at the start of the day at 1ml per kilogram per day. Symprove’s makers assert that it can take up to three months to notice positive effects – time is required for the friendly bacteria to build momentum to restore and maintain the gut’s balance, thus relieving the IBS sufferer of some of their worst symptoms.

For more information about this treatment option, please do not hesitate to contact Dr. Harris.

Most people with IBS find that making certain changes in diet and/or lifestyle can help reduce their symptoms. However, there is no single dietary modification that works for everyone, owing to the range of different symptoms experienced by any given individual.

Traditional dietary advice has been to maintain regular meal patterns, avoid large meals, reduce fat intake, avoid excessive insoluble fiber intake & reduce caffeine. More recently a low FODMAP (Fermentable Oligosaccharides Disaccharides Monosaccharides And Polyols) diet has also been shown to help symptoms of IBS. These types of carbohydrates aren’t easily broken down by the gut bacteria and the gases released during this slow process may lead to bloating and discomfort. A low FODMAP diet involves restricting the intake of various foods that are high in FODMAPs, such as some fruits and vegetables, animal milk, wheat products and beans.

However, a recent article in Gastroenterology (2015;149:1295-97) highlighted a study which compared two popular diets (i.e. traditional vs low FODMAP) in people with IBS. The main finding was that both diets were equally effective in improving symptoms. Although there is still a lack of basic science to explain how either diet works, we recommend spending time with an experienced dietician, who can help create the diet and lifestyle plan that works most effectively for you.