tag:theconversation.com,2011:/id/topics/ibd-18679/articlesIBD – The Conversation2024-03-08T16:20:12Ztag:theconversation.com,2011:article/2131962024-03-08T16:20:12Z2024-03-08T16:20:12ZGut microbiome: meet Ruminococcus gnavus – the bacteria with a sweet tooth<figure><img src="https://images.theconversation.com/files/580659/original/file-20240308-18-7k4a10.jpg?ixlib=rb-1.1.0&rect=12%2C0%2C4254%2C2847&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Some strains of _R gnavus_ have developed a sweet tooth for the sugars found in the gut's lining. </span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/white-sugar-on-pink-background-707968747">Thanatip S./ Shutterstock</a></span></figcaption></figure><p>Having a sweet tooth isn’t just a human characteristic. It turns out our gut microbes can have a preference for sweets, too – and one of these selfish, sugar-loving bacteria is <em>Ruminococcus gnavus</em>.</p>
<p><em>Ruminococcus gnavus</em> (<em>R gnavus</em> for short) is one of the many bacterial species <a href="https://pubmed.ncbi.nlm.nih.gov/37015876">normally found in the human gut</a>. While it doesn’t typically cause us harm, a growing body of evidence indicates that an overgrowth of <em>R gnavus</em> may be linked with certain intestinal diseases – including inflammatory bowel disease (IBD), irritable bowel syndrome (IBS) and colon cancer.</p>
<p>Not only that, but research has also found that people with health problems affecting <a href="https://pubmed.ncbi.nlm.nih.gov/37015876/">other parts of the body</a> – including skin allergies, heart disease, stroke, liver disease and brain disorders – have higher levels of these bacteria in their gut.</p>
<p>This association does not necessarily mean that <em>R gnavus</em> is a cause of these diseases. Rather, it may simply indicate that these diseases create favourable conditions for <em>R gnavus</em> to grow in the gut. Researchers are currently working to find the answer to this question, so that we better understand how <em>R gnavus</em> influences health and disease. This may also help us find new ways of diagnosing and treating certain diseases. </p>
<h2>Sweet tooth</h2>
<p>Not all <em>R gnavus</em> strains are equal. As with other bacteria, the name covers a multitude of strains with different characteristics, which may drive different health outcomes.</p>
<p>Some strains live in the <a href="https://pubmed.ncbi.nlm.nih.gov/36214382/">lining of our gut</a> and are therefore well positioned to sense changes in the gut environment and communicate them with the rest of the body. These play a role in our underlying immune system and can also have an effect on the function of other organs in the body. Other <em>R gnavus</em> strains live in the gut lumen (the inside of the large intestine) where they digest any food components that reached the large intestine undigested.</p>
<p>Almost all of the bacteria living in the gut use complex carbohydrates (which come from plant foods, such as fruits, vegetables and legumes) as their main source of food. These provide bacteria with the sugar they need to survive and grow.</p>
<p>But not all of the sugars found in the gut come from the food we eat. Our body can produce its own type of sugars (such as mucin glycans, which make up most of the gut lining). Sugars can also be found covering the surface of bacteria themselves.</p>
<figure class="align-center ">
<img alt="A woman with gut problems holds her stomach in pain." src="https://images.theconversation.com/files/580660/original/file-20240308-21-8pi1bo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/580660/original/file-20240308-21-8pi1bo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/580660/original/file-20240308-21-8pi1bo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/580660/original/file-20240308-21-8pi1bo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/580660/original/file-20240308-21-8pi1bo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/580660/original/file-20240308-21-8pi1bo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/580660/original/file-20240308-21-8pi1bo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">An overgrowth of <em>R gnavus</em> has been linked to conditions such as IBS and IBD.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/photo-large-intestine-on-womans-body-742620568">Emily frost/Shutterstock</a></span>
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<p>While <em>Ruminococcus gnavus</em> can use the sugars found in plant foods for sustenance, some strains have developed a sweet tooth for the sugars found in the gut’s lining. These strains have even <a href="https://pubmed.ncbi.nlm.nih.gov/31636419/">evolved selfish survival strategies</a> which ensure they can always access these sugars – regardless of our age, how our diet fluctuates or even when we’re suffering from health problems. </p>
<p>Also, when these sugars are used by <em>R gnavus</em>, the bacteria produce small molecules called metabolites which can then travel to different areas of the body and <a href="https://pubmed.ncbi.nlm.nih.gov/35579971/">influence how different organs</a> (such as the brain) function.</p>
<p>While other types of gut bacteria can produce metabolites too, <em>Ruminococcus gnavus</em> is shown to produce <a href="https://pubmed.ncbi.nlm.nih.gov/35951774/">certain metabolites</a> that are <a href="https://www.cell.com/cell-host-microbe/pdfExtended/S1931-3128(22)00562-5">unique to it</a>. For example, one of the metabolites <em>R gnavus</em> produces has been shown to affect digestion. This could explain why people with IBS experience symptoms such as stomach pain and discomfort.</p>
<p>Finally, sugars coating <em>R gnavus</em> can differ depending on the strain. On some occasions, these may <a href="https://pubmed.ncbi.nlm.nih.gov/33972416/">generate an inflammatory response</a> (which means the body’s immune system is primed to attack) as seen in the case of inflammatory bowel disease (IBD).</p>
<p>But some studies done in mice have shown some strains of <em>R gnavus</em> may actually have a <a href="https://pubmed.ncbi.nlm.nih.gov/37015876/">protective effect</a> against colitis or atopic eczema for example. </p>
<p>This illustrates the complex relationship <em>Ruminococcus gnavus</em> has when it comes to our health.</p>
<hr>
<p><em>This article is part of <a href="https://theconversation.com/uk/topics/meet-your-gut-microbes-150943?utm_source=InArticleTop&utm_medium=TCUK&utm_campaign=Health2024">Meet Your Gut Microbes</a>, a series about the rich constellation of bacteria, viruses, archaea and fungi that live in people’s digestive tracts. Scientists are increasingly realising their importance in shaping our health – both physical and mental. Each week we will look at a different microbe and bring you the most up-to-date research on them.</em></p>
<hr><img src="https://counter.theconversation.com/content/213196/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nathalie Juge receives funding from UKRI.</span></em></p>This bacterium has been linked to conditions such as IBS and colon cancer.Nathalie Juge, Deputy Chief Scientific Officer and Group Leader, Glycobiology of Host-Microbe Interactions in the Gut, Quadram InstituteLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1853372022-09-08T12:32:16Z2022-09-08T12:32:16ZYes, Black patients do want to help with medical research – here are ways to overcome the barriers that keep clinical trials from recruiting diverse populations<figure><img src="https://images.theconversation.com/files/483100/original/file-20220906-4642-3md5uc.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C2121%2C1412&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Creating a safe space for patients to ask questions and provide fully informed consent could help increase clinical trial recruitment.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/ethnic-woman-in-medical-consultation-with-female-royalty-free-image/1168998661">FatCamera/E+ via Getty Images</a></span></figcaption></figure><p>Clinical trial participants are <a href="https://doi.org/10.1001/jamanetworkopen.2021.11516">predominantly white</a>. Despite Black and Hispanic people respectively making up 12% and 16% of the U.S. population in 2011, together they made up <a href="https://www.fda.gov/science-research/womens-health-research/dialogues-diversifying-clinical-trials">only 6% of clinical trial participants</a> overall that year. </p>
<p><a href="https://www.nimhd.nih.gov/resources/understanding-health-disparities/diversity-and-inclusion-in-clinical-trials.html">Clinical trials that are representative</a> of all patients are essential to ensure that treatments are effective for everyone. Drugs work differently for each person <a href="https://theconversation.com/why-prescription-drugs-can-work-differently-for-different-people-168645">based on different factors</a>. Including diverse patient populations in clinical trials makes sure these factors are accounted for. But the <a href="https://doi.org/10.1016/j.cpcardiol.2018.11.002">perception that recruiting white patients</a> is easier, less time-consuming and more cost-efficient than recruiting underrepresented or underserved patients contributes to health disparities seen today.</p>
<p>We are <a href="https://www.researchgate.net/profile/Julia-Liu-9">gastroenterology researchers</a> at Morehouse School of Medicine who run clinical trials and study ways to improve participant diversity. Identifying and addressing the barriers to enrolling in research that patients face can not only increase participation, but can also lead to better patient care.</p>
<h2>The problem of access</h2>
<p>Barriers to clinical trial participation start with a <a href="https://doi.org/10.1177%2F107327481602300404">lack of access to trials</a>. </p>
<p>Clinical trials have specific eligibility criteria, and may require a number of study-related visits to the hospital where they’re conducted. But underserved and underrepresented populations often aren’t seen in practices that recruit patients for clinical trials. </p>
<p>Typically, clinical trials are designed by research-focused physicians working in <a href="https://www.cancertodaymag.org/summer2017/a-new-look-for-clinical-trials-diversity/">urban medical centers</a>. The majority of Black and Hispanic patients have <a href="https://doi.org/10.1377/hlthaff.2021.01409">limited access to the health care system</a> as a whole, and the centers that serve them often do not have the research infrastructure or resources to run clinical trials.</p>
<p>While researchers have made attempts to <a href="https://doi.org/10.1093/ibd/izac124">increase the diversity of clinical trial participants</a>, <a href="https://doi.org/10.1016/j.cpcardiol.2018.11.002">misconceptions and biases</a> within the medical community about underrepresented populations limit these outreach efforts. For example, <a href="https://doi.org/10.1353%2Fhpu.2006.0126">beliefs persist</a> that Black patients aren’t willing to participate in research studies and are noncompliant and mistrustful due to historical abuse from medical researchers, such as in the <a href="https://doi.org/10.1093%2Fqje%2Fqjx029">Tuskegee syphilis study</a>.</p>
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<iframe width="440" height="260" src="https://www.youtube.com/embed/7qAld9bGwlA?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Limited access to clinical trials is both a product of and driving factor behind health disparities.</span></figcaption>
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<h2>A colon cancer case study</h2>
<p>One example of how lack of diversity in clinical trial participation can lead to poor health for patients is outcomes for <a href="https://www.cdc.gov/ibd/what-is-IBD.htm">inflammatory bowel disease</a>. IBD is a chronic condition that comes in two forms, ulcerative colitis and Crohn’s disease. Patients with IBD have an <a href="https://doi.org/10.3748%2Fwjg.v20.i29.9872">increased risk of developing colorectal cancer</a>.</p>
<p>Black patients account for 75% of IBD cases at Morehouse School of Medicine. Many of our current patients were either previously misdiagnosed or only treated for their symptoms in the emergency room without further investigation. This has led to many of our patients getting diagnosed with IBD when the disease is already at an advanced stage, making it more difficult to treat.</p>
<p>Julia Liu started Morehouse’s <a href="https://clinicaltrials.gov/ct2/show/NCT04369053">first colorectal cancer clinical trial</a> in 2021. The Prevention of Colorectal Cancer Through Multiomics Blood Testing study evaluated whether a particular blood test could aid in early colorectal cancer screening. Due to misconceptions about Black patients’ interest in research, we anticipated few patients would participate in the trial because our patient base is 90% African American. The sponsor for the study expected an enrollment rate as low as one to three patients per week at our site. </p>
<p>However, when enrollment began, we saw high interest among our Black patients. After three months, we had enrolled <a href="https://eposters.ddw.org/ddw/2022/ddw-2022/353760/krystal.mills.fact.or.myth.black.patients.do.not.want.to.participate.in.html?f=listing%3D1%2Abrowseby%3D8%2Asortby%3D2%2Amedia%3D2%2Ace_id%3D2236%2Alabel%3D24500%2Aot_id%3D26916">100 patients, 85% of whom were Black</a>.</p>
<p>So how did we do it?</p>
<h2>Identifying barriers</h2>
<p>First, we identified the participation barriers our Black and Hispanic patients faced.</p>
<p>We conducted a pilot study to identify more broadly the main barriers to research participation in underserved and underrepresented populations in our area. We reviewed enrollment rates, failures to meet eligibility and data issues, among others, from our past studies to see where we could improve.</p>
<p>We evaluated the role of mistrust by <a href="https://doi.org/10.1093/ibd/izac124">surveying patients at an IBD education conference</a>. Although patients often cited mistrust of health care providers and systems as a major barrier to trial participation, 70% of patients with a college education trusted their gastroenterologists, and 100% of patients with less than a college education trusted their doctors. Moreover, while 83% of respondents knew about the Tuskegee syphilis study, only 23% indicated that their decision to not participate in research was influenced by that study.</p>
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<a href="https://images.theconversation.com/files/483278/original/file-20220907-12-uce7s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Clinician showing clipboard to patient in exam room" src="https://images.theconversation.com/files/483278/original/file-20220907-12-uce7s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/483278/original/file-20220907-12-uce7s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/483278/original/file-20220907-12-uce7s.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/483278/original/file-20220907-12-uce7s.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/483278/original/file-20220907-12-uce7s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/483278/original/file-20220907-12-uce7s.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/483278/original/file-20220907-12-uce7s.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">There often isn’t enough time to talk about the details of participating in a clinical trial during an office visit.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/doctor-with-a-tablet-computer-royalty-free-image/898328226">FatCamera/E+ via Getty Images</a></span>
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<p>We also identified other barriers based on our experience working with Black patients in other clinical trials. A significant one was low levels of <a href="https://medlineplus.gov/healthliteracy.html">health literacy</a>, or the ability to understand and make informed health care decisions. Another was limited access to specialty care, particularly when patients have been waiting for months for an appointment. Lack of transportation was another.</p>
<p>Time was another barrier. Because many of our patients have limited exposure to clinical studies, they have many questions and concerns that most clinicians <a href="https://doi.org/10.1016/j.cpcardiol.2018.11.002">do not have the time</a> to answer in the space of a standard appointment. Patients also could not afford the time commitment required for complex clinical trials. An informed consent process can take over an hour, and many trials require frequent and prolonged hospital visits, for which patients may not be able to take paid time off.</p>
<h2>Implementing solutions</h2>
<p>After identifying these barriers, we worked to create solutions to help our patients participate in research.</p>
<p>We pre-screened potential study participants by looking through their electronic medical records and provider referrals. This helped us identify qualifying patients and proactively reach out to them.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/483274/original/file-20220907-12-jyw7dk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Two researchers looking at test tube" src="https://images.theconversation.com/files/483274/original/file-20220907-12-jyw7dk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/483274/original/file-20220907-12-jyw7dk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/483274/original/file-20220907-12-jyw7dk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/483274/original/file-20220907-12-jyw7dk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/483274/original/file-20220907-12-jyw7dk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/483274/original/file-20220907-12-jyw7dk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/483274/original/file-20220907-12-jyw7dk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Training research and clinical staff on cultural competency could increase trial recruitment and improve care.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/detection-of-the-pathogen-coronavirus-infection-in-royalty-free-image/1207087144">valentinrussanov/E+ via Getty Images</a></span>
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<p>We also trained research staff as well as hospital administration, faculty, staff and students on the study, offering tips on how to interact with underserved and underrepresented patients.</p>
<p>Most importantly, we encouraged our clinicians and researchers to create a safe space for participants to be able to ask questions. This also provides an opportunity to work out ways to accommodate a patient’s schedule. </p>
<h2>Making an effort</h2>
<p>Working with diverse participants can be challenging, but so is every other aspect of clinical research. Our results showed that intentional recruitment, flexibility and creative solutions can help increase enrollment of underrepresented populations in clinical trials.</p>
<p>Partnering with an institution dedicated to serving underserved populations can also help. But above all, research participants are looking for a genuine interest in their well-being.</p><img src="https://counter.theconversation.com/content/185337/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Overcoming the access barriers and biases that underrepresented and underserved communities face could not only improve research participation but also improve care.Julia Liu, Professor of Medicine, Morehouse School of MedicineRaKetra Snipes, Physician Assistant in Gastroenterology, Morehouse School of MedicineLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1436392020-09-02T10:55:45Z2020-09-02T10:55:45Z‘I don’t want my friends to know’ – young people on growing up with Crohn’s or colitis<figure><img src="https://images.theconversation.com/files/355861/original/file-20200901-24-phdkyq.jpg?ixlib=rb-1.1.0&rect=59%2C51%2C5651%2C3750&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/depressed-pensive-bored-teen-hipster-girl-1736674304">insta_photos/shutterstock</a></span></figcaption></figure><p>Young people with chronic health conditions cope with all of the usual challenges of growing up – making friends, changing schools, adapting to new situations, developing a sense of self, and dealing with interpersonal conflict. But they also have to deal with the challenges of their illness.</p>
<p>Young people with <a href="https://www.youtube.com/watch?v=vuytsHjQvqc">inflammatory bowel disease</a> (IBD), a group of chronic conditions that includes Crohn’s disease and ulcerative colitis, have to deal with unpleasant symptoms, intrusive treatment and uncertainty. <a href="https://www.crohnsandcolitis.org.uk/about-crohns-and-colitis/what-are-the-symptoms">Typical symptoms</a> include diarrhoea, abdominal pain, weight loss, blood in their stools and fatigue. The disease can go into remission, but there is no cure and flare-ups can result in hospital stays and missing school or work. </p>
<p>Findings from <a href="https://www.crohnsandcolitis.org.uk/research/projects/being-me-with-ibd-young-people-and-social-interactions">our recent study</a> on mental health among young people with IBD show that when experiencing symptoms, some young people feel negatively about their friendships because they are embarrassed about their condition. And we found that this can lead to loneliness along with depression and anxiety. </p>
<h2>‘Hiding my condition’</h2>
<p>Many young people with IBD choose to conceal their diagnosis from friends and colleagues. <a href="https://www.hindawi.com/journals/ijcd/2020/1059025/">Our study</a> found this is often out of a desire to present themselves as “normal” along with wanting to keep health issues private for fear of being judged. </p>
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Read more:
<a href="https://theconversation.com/young-people-suffering-chronic-pain-battle-isolation-and-stigma-as-they-struggle-to-forge-their-identities-108134">Young people suffering chronic pain battle isolation and stigma as they struggle to forge their identities</a>
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<p>Being diagnosed with IBD can create an abrupt shift in a young person’s expected biography, derailing their plans and expectations of life. Challenges to our identity are difficult to manage at any age, but can be particularly hard for <a href="https://journals.sagepub.com/doi/pdf/10.1177/1359104518818868">young people</a> as they transition towards <a href="https://www.researchgate.net/publication/6576059_The_passage_to_adulthood_challenges_of_late_adolescence">adulthood</a>.</p>
<p>Some young people we talked to said they feared being stigmatised because of their condition – which has been shown to happen to <a href="https://link.springer.com/content/pdf/10.1007/s11739-019-02268-0.pdf">adults with IBD</a>. This can be a key concern for young people with IBD, particularly just after diagnosis and during major life transitions such as moving schools, going to university, or starting a job. </p>
<h2>To disclose or not</h2>
<p>In <a href="https://www.hindawi.com/journals/ijcd/2020/1059025/">our study</a>, all of the young people had told at least one friend something about their IBD. Mostly their decision to tell had been their choice. But, visible indicators of their condition, such as a <a href="https://www.crohnscolitisfoundation.org/diet-and-nutrition/nutritional-support-therapy">nasogastric tube</a>, meant several young people felt compelled to disclose. </p>
<p>For such long-term chronic conditions, disclosure is ongoing and young people must make decisions throughout their life about what to disclose (or not) as they meet new people and enter into new situations. And although the <a href="https://www.huffingtonpost.co.uk/entry/crohns-colitis_uk_5d6c3049e4b09bbc9ef0e9a6">social taboo</a> of talking about bowels is being challenged, there is still a strong sense that toilet habits are awkward to talk about. </p>
<figure class="align-center ">
<img alt="Group of girls posing for a selfie." src="https://images.theconversation.com/files/355863/original/file-20200901-24-1kb5vqq.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/355863/original/file-20200901-24-1kb5vqq.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/355863/original/file-20200901-24-1kb5vqq.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/355863/original/file-20200901-24-1kb5vqq.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/355863/original/file-20200901-24-1kb5vqq.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/355863/original/file-20200901-24-1kb5vqq.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/355863/original/file-20200901-24-1kb5vqq.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Many of the young people we spoke to said their friendships were important but they struggled with knowing how much to share.</span>
<span class="attribution"><a class="source" href="https://www.pexels.com/photo/four-women-in-front-of-green-bushes-1037989/">pexels</a></span>
</figcaption>
</figure>
<p>Starting a conversation about IBD was described as “tricky” and young people had to judge who they could trust – typically close friends – and how much to share. They generally avoided going into “too much detail”, or “making a big a thing about it” but also wanted friends to know it isn’t “just an upset stomach” as one young woman explained: </p>
<blockquote>
<p>It’s hard to explain colitis, it’s the hardest thing in the world, still now after so many years. It’s not just an upset tummy, it’s the whole body and lots more complications and medication. </p>
</blockquote>
<p>Some young people told stories of negative reactions from friends arising from misconceptions about IBD. Some friends worried they could catch IBD. Others were scared by the word “disease” or did not want to be friends with someone who was “different to them”. Some young people’s friendships were severed. Yet many found their friends to be supportive and their friendship ties strengthened.</p>
<h2>What helps?</h2>
<p><a href="https://www.ittakesguts.org.uk/">By talking</a> about their <a href="https://www.instagram.com/p/CDeT3N7HKVp/?utm_source=ig_web_copy_link">experiences</a> and sharing images of previously hidden aspects of treatment – such as <a href="https://www.instagram.com/p/CCY0suIluM2/?utm_source=ig_web_copy_link">their stoma bag</a> – young people are breaking down taboos and reducing the sense of isolation that can come with having a chronic health condition. </p>
<p>But while challenging social stigma is essential, our study also shows how important it is for young people with IBD to look after their <a href="https://www.ampersandhealth.co.uk/myibdcare/">mental wellbeing</a> – and friendships can be a key part of this. This is why we’ve worked with young people to come up with the “<a href="https://sites.edgehill.ac.uk/cc/">telling my friends</a>” resources, that will hopefully help other young people with Crohn’s or colitis talk to their friends about their condition. </p>
<p>It’s also important to highlight that our findings show that despite the struggles young people with IBD experience, none of them wanted to be or felt defined by their condition. They have the same concerns, aspirations and desires as other young people, and ultimately just want to be seen as normal – whatever that might look like.</p><img src="https://counter.theconversation.com/content/143639/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Bernie Carter received funding, along with Pamela Qualter, from Crohn's and Colitis UK to undertake the research underpinning this article.</span></em></p><p class="fine-print"><em><span>Alison Rouncefield-Swales was employed as Research Fellow for the study through the funding provided by Crohn's and Colitis UK.</span></em></p><p class="fine-print"><em><span>Pamela Qualter received funding, along with Bernie Carter, from Crohn's and Colitis UK to undertake the research underpinning this article.</span></em></p>Many young people with inflammatory bowel disease choose to conceal their diagnosis from friends and colleagues.Bernie Carter, Professor of Children's Nursing, Edge Hill UniversityAlison Rouncefield-Swales, Research fellow, Edge Hill UniversityPamela Qualter, Professor of Psychology for Education, University of ManchesterLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/960982018-06-11T22:15:34Z2018-06-11T22:15:34ZWhy we all need to be proactive about our bowels<figure><img src="https://images.theconversation.com/files/222281/original/file-20180607-121234-1k1m10h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Manipulating environmental exposures to optimize a healthy microbiome may hold the promise of preventing chronic inflammatory diseases, such as Crohn's disease and ulcerative colitis.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>Inflammatory bowel disease (IBD) is a mounting burden on health-care systems globally. </p>
<p>A 2012 study found that Crohn’s disease and ulcerative colitis (two types of IBD) are significantly on the rise. A follow-up study published last year in <em>The Lancet</em> demonstrated that these diseases <a href="http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)32448-0/abstract">affect over 0.3 per cent of the population in North America, Oceania and many countries in Europe</a>. </p>
<p>In Canada, the number of individuals affected by IBD is estimated to rise to around 0.7 per cent of the total population this year, and <a href="https://academic.oup.com/jcag/article/1/suppl_2/47/4916529">to almost a full percentage of the population (roughly 400,000 afflicted individuals) by 2030</a>. </p>
<p>IBD was conservatively estimated to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3495699">cost Canadians $2.8 billion per year in direct and indirect costs, as of 2012</a>.</p>
<p>Like the horse charging at a steaming locomotive in Alex Colville’s 1954 painting, <em>Horse and Train</em>, our health-care system is on track to crash with the unstoppable force of IBD. </p>
<p>Unless, that is, we turn our head and aim for an opening. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/222081/original/file-20180606-137315-1kg1po4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/222081/original/file-20180606-137315-1kg1po4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/222081/original/file-20180606-137315-1kg1po4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/222081/original/file-20180606-137315-1kg1po4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/222081/original/file-20180606-137315-1kg1po4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=565&fit=crop&dpr=1 754w, https://images.theconversation.com/files/222081/original/file-20180606-137315-1kg1po4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=565&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/222081/original/file-20180606-137315-1kg1po4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=565&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Alex Colville’s painting ‘Horse and Train’</span>
<span class="attribution"><span class="source">(Copyright A.C.Fine Art Inc. NO REUSE)</span></span>
</figcaption>
</figure>
<p>This opening is “proactive medicine” — preventing the disease from occurring in the first place. </p>
<p>One way of achieving this may be to manipulate environmental exposures and optimize <a href="https://www.bmj.com/content/360/bmj.j5145">a healthy gut microbiome</a>: The 100 trillion or so symbiotic microbes that live within our bodies that are necessary for our survival. </p>
<h2>A chronic and incurable disease</h2>
<p>Part of the reason for the dramatic increase in the number of individuals afflicted with IBD is because <a href="https://www.sciencedirect.com/science/article/pii/S0016508511013783?via%3Dihub">it is a disease of the young, most commonly diagnosed between the ages of 18 and 35</a>. </p>
<p>IBD is a chronic and incurable disease with low mortality. Those diagnosed with IBD are not likely to die from the disease; they can live long lives. This combination of young age at diagnosis and low mortality leads to <a href="http://www.nature.com/articles/nrgastro.2015.150">an epidemiologic concept called compounding prevalence</a>. </p>
<p>We all know about compounding interest: If we start saving money in our 20s, over time and with a steady interest rate, our savings will experience compound growth. In our 60s, we will be left with a large sum of money for retirement.</p>
<p>Compounding prevalence, in contrast, is when new individuals are being added to the affected population (diagnosed with the disease) but existing cases are not being removed — leading to a steady rise in the number afflicted with disease. </p>
<p>A recent study forecasted that <a href="https://academic.oup.com/jcag/article/1/suppl_2/47/4916529">the prevalence of IBD will rise an average of three per cent per year over the next decade</a>.</p>
<p>We are facing an impending disaster for our health-care systems, but one that may be averted by looking for solutions and altering our course now. </p>
<h2>Smoking, diet and cleanliness</h2>
<p>More often than not, clinicians are trained to practice reactive medicine: Treating a disease after it develops. For example, we treat Crohn’s disease with powerful, expensive, immune system suppressing medications; when these fail, we remove segments of the patients’ bowels. </p>
<p>Frequently, however, the disease returns, forcing us to continue this vicious cycle. The burgeoning number of patients with chronic inflammatory diseases who are being managed in a predominantly reactive health-care system has the potential to squeeze the system within an inch of its life — both in terms of fiscal and staffing resources. </p>
<p>We need to change the future of health care by starting to practice proactive medicine.</p>
<p>In order to prevent a disease, you have to understand the disease. In 2018, we have come to understand that chronic inflammatory diseases arise from <a href="https://www.sciencedirect.com/science/article/pii/S0016508516352672?via%3Dihub">interactions between susceptibility genes and environmental exposures linked to the Westernization of society</a>, such as <a href="https://www.nature.com/articles/nrgastro.2015.34">smoking, diet and even our intense focus on cleanliness</a>. </p>
<p>Mutations in <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3491803/">susceptibility genes</a> can affect the interaction of the immune system and the gut microbiome. And this microbiome is set in early childhood where decisions such as <a href="https://www.nature.com/articles/nrgastro.2015.34">bottle feeding or using antibiotics in infancy</a> may raise the risk of developing IBD later in life.</p>
<p>Manipulating environmental exposures to optimize a healthy microbiome may hold the promise of preventing chronic inflammatory diseases. Examples can include breastfeeding, avoiding unnecessary antibiotics early in life and avoiding cigarettes.</p>
<h2>We must prioritize proactive medicine</h2>
<p>This is the critical moment at which we need a major investment from government, industry and the public to fund clinical and laboratory research to explain the origin of chronic inflammatory diseases and foster strategies for disease prevention.</p>
<p>Diseases like IBD have significantly increased in diagnoses and are already affecting millions of people in North America, and many more around the world. </p>
<p>Health-care systems must account for the exponential rise in cases of chronic inflammatory diseases or face an unstable system, overwhelmed by a flood of complex patients. </p>
<p>Averting this disaster requires a collective shift from clinicians, government and the public — towards supporting proactive medicine. </p>
<p>Prioritizing proactive medicine will mean funding research to create the best available evidence to develop recommendations around healthy living — from infancy to adulthood — to ultimately lower the number of people afflicted with chronic inflammatory diseases. </p>
<p>By doing so, we may stand a chance at stemming the global rise of chronic diseases like IBD and avoid an ugly encounter with the proverbial train upon the tracks.</p><img src="https://counter.theconversation.com/content/96098/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Gilaad Kaplan has received speaking or consultancy honoraria from AbbVie, Janssen, Pfizer, and Shire. He has received a grant from Abbvie, Janssen, Merck, and Shire. Dr. Kaplan has received research funding from the Canadian Institutes of Health Research, Alberta Innovates, Health Canada, Crohn's and Colitis Canada, Broad Medical Research Program and the Canadian Foundation for Innovation. Dr. Kaplan is the Scientific Director of Alberta Health Services’ Digestive Health Strategic Clinical Network. He is a member of the Scientific and Medical Advisory Committee of Crohn’s and Colitis Canada. </span></em></p><p class="fine-print"><em><span>Stephanie Coward receives funding from an Izaak Walton Killam Doctoral Scholarship and an Eyes High Doctoral Recruitment Scholarship (from the University of Calgary). She is affiliated with the Canadian Gastrointestinal Epidemiology Consortium as a trainee member. </span></em></p><p class="fine-print"><em><span>Joseph W. Windsor does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Halting the rapid rise in inflammatory bowel disease will require a proactive approach to medicine, and a focus on the gut.Gilaad Kaplan, Associate Professor, Gastroenterology, University of CalgaryJoseph W. Windsor, Research Assistant, Cumming School of Medicine, University of CalgaryStephanie Coward, PhD Candidate in Epidemiology, University of CalgaryLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/602642016-06-08T10:41:36Z2016-06-08T10:41:36ZWhat you can do to reduce the risk of bowel cancer caused by E. coli bacteria<figure><img src="https://images.theconversation.com/files/125566/original/image-20160607-7438-13oxv00.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/cat.mhtml?lang=en&language=en&ref_site=photo&search_source=search_form&version=llv1&anyorall=all&safesearch=1&use_local_boost=1&autocomplete_id=&searchterm=E.%20Coli&show_color_wheel=1&orient=&commercial_ok=&media_type=images&search_cat=&searchtermx=&photographer_name=&people_gender=&people_age=&people_ethnicity=&people_number=&color=&page=1&inline=127627502">motorolka/Shutterstock.com</a></span></figcaption></figure><p>Several bacteria are already linked to human cancers, and new evidence points towards a link between <em>Escherichia coli</em> (<em>E</em>. <em>coli</em>) and an increased risk of bowel cancer. Luckily there are things we can do to limit the risk posed by bacteria.</p>
<p>The links between bacteria and cancer have been studied for a long time. The connection was first publicised in the 19th century when Rudolf Virchow suggested that cancer may result from <a href="http://www.sciencedirect.com/science/article/pii/S0140673600040460">inflammation triggered by infections</a>. Soon after, well known scientists Robert Koch and Louis Pasteur found <a href="http://www.nature.com/nrmicro/journal/v3/n4/full/nrmicro1130.html">bacteria in tumours</a>.</p>
<p>Bacterial infections nearly always cause inflammation, which occurs when our immune system recognises an infection. Immune responses often involve the release of molecules called cytokines that help to cause inflammation. Short-term stimulation of inflammatory cytokines is good and helps fight infections, but chronic stimulation can <a href="http://www.nature.com/nature/journal/v420/n6917/full/nature01322.html">contribute to cancer development</a>. Inflammation is a key feature that researchers are interested in, and new knowledge could help us to reduce our cancer risk.</p>
<p>Many bacteria have been linked to cancer via inflammation – <a href="http://www.nature.com/nrc/journal/v10/n6/full/nrc2857.html"><em>Helicobacter pylori</em> and stomach cancer</a>, <a href="http://onlinelibrary.wiley.com/doi/10.1002/jso.20530/abstract"><em>Salmonella typhi</em> and gallbladder cancer</a>, <a href="http://archsurg.jamanetwork.com/article.aspx?articleid=396990"><em>Streptococcus bovis</em> and bowel cancer</a>. Considering what we know now, this isn’t all that surprising.</p>
<p>Trillions of bacteria live in your digestive system, with hundreds of different species of bacteria living in your bowel alone. Bowel cancers are responsible for the <a href="http://onlinelibrary.wiley.com/doi/10.1002/ijc.25516/abstract">fourth highest</a> number of cancer-related deaths worldwide, and yet only a <a href="http://www.annualreviews.org/doi/abs/10.1146/annurev-pathol-011110-130235">small percentage</a> of bowel cancers are linked to genetic risk. The <a href="http://www.sciencedirect.com/science/article/pii/S109727651400272X">majority of new cases</a> occur somewhat randomly (sporadic cancers) or related to inflammatory bowel disease (<a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3376405/">IBD-associated cancers</a>).</p>
<p>This is where bacteria become important.</p>
<p>Most of the bacteria that live in your bowel are relatively harmless. In fact, they help with digestion, produce vital vitamins and help to repair damaged cells. But some bacteria are harmful. We are normally protected from harmful bacteria by our immune system and by other bacteria. Unfortunately, lifestyle factors <a href="https://theconversation.com/your-gut-bacteria-dont-like-junk-food-even-if-you-do-41564">such as high-fat diets</a>, smoking and stress can cause chronic inflammation. Under these conditions the good bacteria struggle to survive, while some harmful, or “pathogenic”, bacteria thrive and multiply. High numbers of pathogenic bacteria means higher risk of a dangerous infection.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/125568/original/image-20160607-15034-ny0uwk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/125568/original/image-20160607-15034-ny0uwk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=408&fit=crop&dpr=1 600w, https://images.theconversation.com/files/125568/original/image-20160607-15034-ny0uwk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=408&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/125568/original/image-20160607-15034-ny0uwk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=408&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/125568/original/image-20160607-15034-ny0uwk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=513&fit=crop&dpr=1 754w, https://images.theconversation.com/files/125568/original/image-20160607-15034-ny0uwk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=513&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/125568/original/image-20160607-15034-ny0uwk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=513&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">An <em>E. coli</em> bacterium.</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/cat.mhtml?lang=en&language=en&ref_site=photo&search_source=search_form&version=llv1&anyorall=all&safesearch=1&use_local_boost=1&autocomplete_id=&searchterm=E.%20Coli&show_color_wheel=1&orient=&commercial_ok=&media_type=images&search_cat=&searchtermx=&photographer_name=&people_gender=&people_age=&people_ethnicity=&people_number=&color=&page=1&inline=242816092">Everett Historical/Shutterstock</a></span>
</figcaption>
</figure>
<p><a href="http://www.nature.com/ajgsup/journal/v1/n1/full/ajgsup20124a.html#abs">High numbers of <em>E. coli</em></a> have been found under inflammatory conditions. Some types of <em>E. coli</em> can be beneficial and used to <a href="http://www.ncbi.nlm.nih.gov/pubmed/18240278">treat disease</a>; these can be found in most healthy people. However, inflammation increases the number of pathogenic <em>E. coli</em> and this can lead to disease. Patients with inflammatory bowel disease and bowel cancers have been found with huge numbers of pathogenic <em>E. coli</em> <a href="http://www.sciencedirect.com/science/article/pii/S001650850400513X">living inside tumours</a>. That’s because these <em>E. coli</em> can stick to and invade the cells lining our bowels and replicate inside them. To make things worse, these <em>E. coli</em> are capable of <a href="http://science.sciencemag.org/content/338/6103/120">producing a toxic substance</a> called colibactin that damages the DNA of bowel cells making them cancerous, and can help cancers to spread.</p>
<h2>Damage control</h2>
<p>Luckily, there are things we can do to limit the risk posed by pathogenic <em>E. coli</em> and other pathogens.</p>
<p><strong>Smoking</strong>, <strong>stress</strong> and <strong>high-fat diets</strong> are lifestyle factors that contribute to <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2796096/">increased risk</a>. Changing to a healthier, high-fibre diet can help to <a href="http://www.ncbi.nlm.nih.gov/pubmed/24114473">limit</a> your bowel cancer risk and the impact of pathogenic <a href="http://onlinelibrary.wiley.com/doi/10.1111/apt.13248/abstract">bacteria</a>. This is known as a “prebiotic” effect where dietary fibres produce a substance called <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2036.2007.03562.x/abstract">butyrate</a>. Butyrate has natural anti-inflammatory properties and can help replenish probiotic bacteria too.</p>
<p>Also, dietary fibres from <strong>plantains</strong>, <strong>bananas</strong> and <strong>broccoli</strong> can <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3520008/">block harmful bacteria</a> from sticking to your gut cells and promote their passage out of the gut. This is known as a “contrabiotic” effect and was recently shown to be effective against bacteria such as <em>E. coli</em> and <em>Salmonella</em>.</p>
<p><strong>Vitamin D</strong> has been shown to help kill pathogenic bacteria, <a href="http://www.ncbi.nlm.nih.gov/pubmed/25839777">particularly <em>E. coli</em></a>, even when they are already inside our cells. <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1470481/">Vitamin D deficiency</a> is now associated with colon cancer, so maintaining healthy levels of vitamin D could further reduce your risk.</p>
<p>Foods such as <strong>almonds</strong>, <strong>red onions</strong> and <strong>chives</strong> are high in molecules known as flavonoids that have <a href="http://www.sciencedirect.com/science/article/pii/S0924857911001300">antibacterial properties</a> and could help limit the effects of pathogenic bacteria.</p>
<p><strong>Regular exercise</strong> helps maintain a normal bacterial diversity in the gut and could reduce your risk of bowel cancer by <a href="http://link.springer.com/article/10.1023%2FA%3A1018458700185">up to 50%</a>. </p>
<p><strong>Anti-inflammatory drugs</strong> such as aspirin have been shown to <a href="http://jama.jamanetwork.com/article.aspx?articleid=2203800">reduce the risk</a> of bowel cancer. It is highly possible that future studies could find anti-inflammatory drugs reduce the inflammation caused by infections and hence your bowel cancer risk.</p>
<p>In the coming years we are likely to see both drug-based and natural treatments that specifically target <em>E. coli</em> and other bacteria associated with bowel cancer risk.</p>
<p>With researchers looking for more of these types of answers we are being enabled to fight bowel cancer in different ways. Therefore, it is becoming more necessary for us to be proactive and increase our awareness of the impact we can have before cancers can even develop.</p><img src="https://counter.theconversation.com/content/60264/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Bradley Meehan does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The bacteria in your gut aren’t always friendly. Luckily, there are a number of ways to beat the bugs associated with bowel cancer.Bradley Meehan, PhD Researcher in Molecular and Cellular Physiology, University of LiverpoolLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/391282015-08-20T04:48:09Z2015-08-20T04:48:09ZSo you think you have IBS, coeliac disease or Crohn’s? Here’s what it might mean for you<figure><img src="https://images.theconversation.com/files/79194/original/image-20150424-25527-15sca0i.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">See your doctor if you suffer from gastrointestinal symptoms, particularly if you've had them for weeks or months.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/hollylay/14406734266/">Holly Lay/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span></figcaption></figure><p>Conditions affecting the gastrointestinal tract are common in modern humans and many are on the <a href="http://www.nature.com/ajg/journal/v106/n4/abs/ajg201144a.html">rise</a>. The gastrointestinal tract extends from the mouth to the anus, via the stomach and the bowels, which include the small intestine and the large intestine (colon). </p>
<p>Around <a href="http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/irritable_bowel_syndrome">one in five Australians</a> suffers symptoms of irritable bowel syndrome (IBS) at some point in their life. Around <a href="http://www.coeliac.org.au/coeliac-disease/#Coeliac3">one in 70</a> have coeliac disease (though many don’t know they have it). Inflammatory bowel disease (IBD), which usually manifests as Crohn’s disease or ulcerative colitis, is <a href="http://www.ncbi.nlm.nih.gov/pubmed/20803698">less common</a>, affecting three in 10,000 Australians.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/92469/original/image-20150820-32467-1irauw3.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/92469/original/image-20150820-32467-1irauw3.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/92469/original/image-20150820-32467-1irauw3.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=715&fit=crop&dpr=1 600w, https://images.theconversation.com/files/92469/original/image-20150820-32467-1irauw3.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=715&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/92469/original/image-20150820-32467-1irauw3.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=715&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/92469/original/image-20150820-32467-1irauw3.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=899&fit=crop&dpr=1 754w, https://images.theconversation.com/files/92469/original/image-20150820-32467-1irauw3.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=899&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/92469/original/image-20150820-32467-1irauw3.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=899&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">The gastrointestinal tract.</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-25787644/stock-vector-human-digestive-system-labeled.html?src=nyJblS_KWL5jVuxPrk2PWw-1-41">Blamb/Shutterstock</a></span>
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<p><a href="http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/irritable_bowel_syndrome">Irritable bowel syndrome</a> is also called irritable colon. People with IBS have sensitive large intestines that are easily aggravated.</p>
<p><a href="http://www.coeliac.org.au/coeliac-disease/">Coeliac disease</a> is an autoimmune condition in which the body reacts abnormally to gluten, which is found in wheat, oats, rye and barley. (An easy way to remember this is the acronym WORB.) This abnormal reaction to gluten causes damage and inflammation to the small intestine. </p>
<p>Coeliac disease is_ not _a food allergy or intolerance. Some people can be sensitive to gluten, but not have coeliac disease. This is called <a href="http://www.coeliac.org.au/gluten-sensitivity/">non-coeliac gluten sensitivity</a>. </p>
<p>In inflammatory bowel disease, the gastrointestinal tract becomes <a href="https://www.crohnsandcolitis.com.au/">swollen and red</a> from inflammation. Abscesses and cracks can develop in any part of the tract in Crohn’s, while open sores called ulcers usually affect the large intestine in ulcerative colitis. </p>
<p>The causes of these gastrointestinal conditions are not well-understood, but may include a combination of genetic and environmental factors, such as infection, <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4202343/">psychological stress</a> and diet. Researchers have reported <a href="http://www.nature.com/ajg/journal/v106/n4/abs/ajg201144a.html">associations</a>, for instance, between higher intakes of total fat and meat and an increased risk of developing Crohn’s disease and ulcerative colitis. </p>
<h2>Symptoms</h2>
<p>Symptoms of these gastrointestinal tract conditions include bloating, cramps, abdominal pain, excessive wind, diarrhoea, constipation, nausea, fatigue, mucus or blood in stools, body aches, weight loss and nutrient deficiencies. </p>
<p>Suffering from a gastrointestinal condition can be very stressful. Imagine being in constant abdominal pain and your toilet habits alternating between diarrhoea and constipation. Or your gut becoming so inflamed you have to go to hospital. </p>
<p>See your doctor if you suffer from these symptoms, particularly if you’ve had them for weeks or months; don’t wait years. Due to similarities in the symptoms of these gastrointestinal conditions, diagnosis often takes some time. It may also be necessary to investigate bowel cancer as a possibility. </p>
<p>It’s best not to self-diagnose or self-treat. If you remove gluten from your diet and feel better, for instance, that doesn’t automatically mean that you have coeliac disease and need to carefully avoid gluten for life. </p>
<h2>Treatment</h2>
<p>Many gastrointestinal afflictions cannot be cured, but can be managed with combinations of medication, diet and psychological treatment. </p>
<p>Thankfully, irritable bowel syndrome can sometimes resolve over time and leave no long-term damage in the gastrointestinal tract. A <a href="http://www.ncbi.nlm.nih.gov/pubmed/25734736">2015 review</a> found that for the management of IBS symptoms, an individual’s diet, lifestyle and medical and behavioural factors must be taken into account. Because of a link between IBS and stress, <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4329838/">psychological therapy</a> has also been shown to reduce symptom severity and improve quality of life. </p>
<p>FODMAP stands for fermentable oligosaccharides, disaccharides, monosaccharides and polyols. These nutrients are poorly digested and absorbed in the small intestine, and therefore reach the large intestine, where they are fermented by bacteria. A <a href="http://www.med.monash.edu/cecs/gastro/fodmap/">low FODMAP diet</a> and certain <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2886445/">probiotics</a> may also help ease IBS symptoms, although the long-term benefits of a low FODMAP diet are <a href="http://www.ncbi.nlm.nih.gov/pubmed/25601299">unclear</a>. </p>
<p>In comparison, coeliac disease cannot be cured and <em>must</em> be managed with a strict, lifelong gluten-free diet to prevent small intestinal damage. And I mean strict. Even the gluten in a wheat bread <em>crumb</em> can cause bowel injury. </p>
<p>Conversely, symptoms associated with non-coeliac gluten sensitivity may indeed be due to gluten, or may be associated with other dietary components. Recent <a href="http://www.gastrojournal.org/article/S0016-5085%2813%2900702-6/abstract">research</a> has implicated FODMAP in non-coeliac gluten sensitivity. Like with the dietary management of IBS, a diet low or free from gluten and/or FODMAP may improve non-coeliac gluten sensitivity. </p>
<p>Inflammatory bowel disease cannot be cured and is often managed with <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2679125/">medications</a> such as steroids and immunomodulators that control the high levels of gut inflammation. There is currently <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2036.2009.04035.x/full">insufficient evidence</a> to suggest dietary changes can treat inflammatory bowel disease, but future directions may involve manipulation of gut bacteria using combinations of antibiotics, prebiotics, probiotics and diet.</p>
<h2>So, what can I eat?</h2>
<p>The first step is to find out if you actually have a clinical gastrointestinal problem, which you can only do by consulting with a medical professional and having appropriate tests. Any dietary advice will depend on this diagnosis, as well as your individual situation. </p>
<p>Avoiding <a href="http://www.med.monash.edu/cecs/gastro/fodmap/diet.html">FODMAP-containing foods</a> if you have non-coeliac gluten sensitivity or IBS may help ease symptoms and improve quality of life. This means cutting out otherwise healthy, fibre- and nutrient-rich foods, such as apples, onions and lentils.</p>
<p>The total removal of gluten from a coeliac’s diet means a rigid avoidance of not just bread and pasta but also <a href="http://qld.coeliac.org.au/uploads/60095/ufiles/QLD_docs/Gluten_free_catering_guide.pdf">many</a> processed foods, including sauces, stocks, processed meats, ice cream, mayonnaise, vinegar and other products. </p>
<p>It also means shunning foods that are supposedly “gluten-free” but may have been contaminated with gluten by the use of shared apparatus, such as tongs to serve both gluten-free and other cookies in a cafe. </p>
<p>Avoiding gluten if you have non-coeliac gluten sensitivity may not need to be so strict. </p>
<p>For inflammatory bowel disease, the evidence may not yet clear enough to prescribe nutrition therapy, but eating a <a href="http://www.nhmrc.gov.au/guidelines-publications/n55">healthy and balanced diet</a> can’t hurt.</p>
<p>People with gastrointestinal problems may benefit from personalised dietary advice from a health professional, such as a <a href="http://daa.asn.au/">dietitian</a>. There are also several national organisations that provide essential advice and support, such as <a href="http://www.coeliac.org.au/">Coeliac Australia</a>.</p><img src="https://counter.theconversation.com/content/39128/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dr Rebecca Reynolds is a registered nutritionist and the owner of The Real Bok Choy <a href="http://www.therealbokchoy">www.therealbokchoy</a> (formerly Wholesomely), a nutrition and lifestyle company that provides evidence-based information and advice</span></em></p>Conditions affecting the stomach and bowels are common in modern humans and many are on the rise.Rebecca Reynolds, Lecturer in Nutrition, UNSW SydneyLicensed as Creative Commons – attribution, no derivatives.