I think it’s fair to say most of us take our gut for granted. ,That is to say we are able to get on with our day-to-day life without suffering any ill effects. But there’s a lot going on inside us!
Firstly, some facts…
From churning of food with digestive enzymes to absorption of nutrients through the fronds of our beautifully designed small intestine and disposal of waste products through our colon, we owe a lot to our gut. Did you know that the small intestine (where we absorb nutrients) measures six-metres in length, the colon measures further two-metres long and we have 100 trillion micro-organisms inside our guts – that is equivalent to up to six pounds of bacteria lining our guts. A total of 70% of our immune system lives inside our gut and nerves inside our guts play a part in communicating messages to the brain. There is truth in the saying, ‘gut feeling’!
My role at the Trust
My job is fascinating as I get to care for a wide range of people who have gut conditions, and I specialise in helping people manage their diet for Inflammatory Bowel Disease (IBD). IBD comprises of 2 conditions: Ulcerative Colitis and Crohn’s disease. Both cause inflammation and ulceration of the bowel and this can cause profound problems for people.
These conditions cause a lot of discomfort, especially when the disease is active – we often call this a ‘flare up’ – and I’ve been told it feels a lot like a severe case of sunburn inside the gut. IBD causes a lot of abdominal discomfort and often means people have to make frequent visits to the loo. So you can imagine that the last thing they want to do is eat at times.
Living with a gut condition can be really distressing and can have devastating effects on the body. A lot of people need special supplement drinks to take alongside bland food to help them absorb things better. Without these, people run low on vitamins and minerals and lose body weight very quickly which can have serious consequences.
Sometimes I advise the patients to “rest” the gut this way, to help their insides heal. I also advise people to try special elimination diets to test whether they react to food. This may involve cutting out gluten, milk or certain fruits and vegetables and fibre to see if they feel better. The science behind this is continually evolving and hopefully in the future we will be better able to know what diet is best to keep people symptom free. I am very fortunate to care for these patients alongside the specialist multidisciplinary team including Kathy Webb, Lead IBD nurse and the gastroenterology consultants. We meet every week to discuss the management of these patients and work out what medical or surgical and nutritional input these patients need.
Having these meetings helps to get to know the patients so that when I see them in clinic I am up-to-date with their own particular issues and needs. Working in this way is enormously beneficial to me and my patients. I get to know who needs help, and can arrange to see them in outpatient clinic and can work on keeping them out of hospital!
My other specialty – coeliac disease
Again, this is a condition which causes damage to the gut, this time the duodenum, the first part of the small intestine. It’s more common than most people think and affects 1 in 100 of the population.
It’s not an allergy or an intolerance but an auto-immune condition, in which the body launches an attack against gluten (a protein found in cereals) and damages itself. Coeliac disease, if left untreated, can cause malabsorption of vitamins and minerals, a change in bowel habits, thinning of the bones and even infertility and gut malignancy. A lot of medical conditions are treated by drugs, however coeliac disease is quite the opposite. The amazing thing about this condition is that the only treatment is one that eliminates gluten from the diet.
By the time most patients are referred to me for their first appointment, and have been formally diagnosed for coeliac through a blood test and biopsy of the small bowel, they have usually begun a gluten-free diet. It’s not an easy thing to do (gluten is found in bread, cereals and pasta) and it can be found in virtually everything that is processed – that’s everything in a wrapper! A lot of people struggle with gluten free bread. It’s come a long way since the 1950’s since it was first dispensed to people in tins…but it does take a bit of getting used to.
Everyone in clinic has their own style of eating, cooking and people’s lifestyle can vary a lot. I get to find out what people feel about their new diet and then provide them with the information they don’t know or want extra support with. Such as alternatives to bread, or what gravy is gluten free, how to achieve a balanced diet or how to eat out safely and not get ‘glutened’.
Alongside this, I have to work out whether people are short of vitamins and minerals (I can check bloods and read food diaries) and whether people need a scan of their bones (DEXA bone scans) or other investigations. It’s a really rewarding clinic because I get to see people who attend for follow up. In the majority of the time, people are quick to tell me how fantastic they feel now their symptoms have gone.
One patient, a mum in her forties said she felt like a new woman with lots of new energy and enthusiasm for hill walking, something she had not done since she was a teenager. It’s very humbling to be part to my patient’s journey to recovery. I’m really proud of all my patients and the amazing things they can achieve.
So finally, if you’ve been suffering with a change in bowel habits, either diarrhoea, constipation or wind, or have been feeling tired, make an appointment to see your GP and discuss having a blood test for coeliac disease. If you think you might have it, it’s important not to cut our gluten from your diet as it will affect your blood test.
Don’t suffer in silence, make an appointment and see your doctor!
Lucy is writing as part of the #WeCare2 campaign that will be running across our Trust communications. Look out for more from Dietetics, and their AHP and HCS colleagues, on our social media pages, Trust screensavers, Daily Email, Vital Signs and much more.