Do you suffer from digestive health complaints? Have you ever eaten anything and felt bloated or sick? If so you may be intolerant to certain types of food. Thankfully such complaints can be tackled by making simple changes to your diet, so you may not need to spend time sitting in the waiting room at the doctors or put up with unnecessary discomfort.

To give you some helpful advice on food intolerances we’ve got Dr Sarah Jarvis coming into the studio for a 30-minute digestion clinic. She will be talking about the difference between allergies and intolerances and answering all of your questions on digestive health. She’ll also be talking about the Lactofree Elimination Challenge Diet, which is a great starting point for testing your tolerance to lactose.

Digestive complaints are actually quite common in the UK, for example up to 1 in 7 people suffer from Lactose Intolerance alone. Common symptoms include bloating, stomach cramps, nausea and abdominal pains, which can prove difficult to live with. Sarah will be offering professional advice on how to rid yourself of these symptoms and will also explain how you can enjoy your food without fear of further digestive issues. So if you’ve been suffering on the food front, why not come along and submit a question?

Dr Sarah Jarvis joins us live online on Friday 18th January at 2pm to discuss digestive health.

H: Hello and welcome to the Healthcare Show, I’m Lis Speight. Now, do you ever suffer from indigestion? Have you ever eaten something and then felt really bloated and sick afterwards? Well if so it could be that you’re suffering from an intolerance to a certain type of food. Now thankfully these sort of symptoms can usually be remedied by eliminating things from your diet, and I’m pleased to say that to talk to us about the whole subject of digestive health, we’re joined in the studio today by GP Dr Sarah Jarvis, welcome along Sarah, it’s really nice to see you again. Now Sarah’s going to be talking all about digestive health, answering questions and also explain the difference between intolerances and allergies, and that’s quite an important point. We’ve got lots of food here in the studio and we’re going to be talking through some of this and how some of it may cause you some problems with your tummy. So Sarah, tell us a little bit about digestive health problems – how common are they these days?

S: Remarkably common but possibly under-diagnosed

H: Ah that’s interesting

S: We know in a recent survey that about one in six people know they’ve got a digestive health problem

H: That’s a lot actually isn’t it?

S: Well it is except that as a GP of course I’m aware that it’s probably a lot more than that, because the number of people who come in and they’ll complain of tiredness and then when you actually get drilled down to it, it’s you know I’m not sleeping very well because I always feel bloated at night

H: Right

S: It is incredibly common. At least a third of people know that they or someone in their family has got a digestive health problem, and the vast majority of them of course are not seeking help because very often they’re not – you know it’s not going to kill them

H: Right

S: It’s not terribly serious but it’s a bore

H: It’s just unpleasant

S: It’s there day in, day out and until they work out what might be causing it it can be very very difficult to put their finger on it, and they assume that they’ve got this – kind of got to live with it. It may be of course that they’ve been to see a GP and because they haven’t got what we would be worrying about, which is any signs of cancer, any signs of a serious underlying condition, it may well be that they’ll have been told to go away and live with it or relax or whatever else

H: So it gets pushed under the carpet a little bit then sometimes?

S: Absolutely

H: And what sort of things can cause allergies or intolerances, digestive health problems?

S: You’re absolutely right and I’m really glad you mentioned that it was so important to make – point out the difference between allergy and intolerance, because the number of people who’ll come in and say they’re allergic to something when actually they’re intolerant of it and the reason it’s important is because allergies are potentially life-threatening, they are hugely important but they are much, much rarer than intolerances

H: Right

S: If you are allergic to something then your body’s defence mechanism, which is what helps us fight off infection, which is what you know helps us to keep alive actually, has recognised something as an enemy, and that means that once it’s been exposed to it more than once, it starts to recognise even the tiniest quantity the moment it’s exposed to it, the whole body system will take over. Now in extreme cases you can get something called anaphylaxis which is where you completely collapse, but you’ll very often get symptoms which aren’t anything to do with your gut

H: Right

S: You can get gut symptoms, you can get diarrhoea you can get bloating if you swallowed something you’re allergic to, but an allergy you’re much more likely to get an overall reaction, so you can get swelling round your mouth, swelling round your lips, problems with wheezing, problems with breathing and so on.

H: So that’s more likely to be sort of peanuts and shellfish –

S: Absolutely

H: And you’ll get an instant shock

S: Strawberries – we have had a huge rise actually –

H: Strawberries?

S: In the number of people who have had real allergies, but as I say there is a genuine difference, now one of the big difficulties is that there are quite a lot of people who have got say wheat intolerance that means that they get gut symptoms if they take a lot of it, and it’s a local thing, so with an intolerance you can have sometimes a sort of mild intolerance which means that you’re fine if you have – as with milk – if you have a teaspoon of milk in your tea –

H: Right

S: You’re absolutely fine but you drink a glass of the stuff, you get bloating, you get wind, you get cramps in your tummy and very often you get diarrhoea. If we think about all those symptoms, what they have in common, they are all related to the gut-

H: Right

S: Which is where your body is reacting badly to it. Not that many people are actually allergic to milk, but some people are allergic to wheat, and they’ve got a condition called celiac disease, they’re allergic to gluten in wheat. Now that’s very much more serious and they have to avoid absolutely everything containing wheat, containing gluten, because the tiniest amount can cause severe diarrhoea, can cause severe symptoms and can actually change the structure, the internal structure of the gut

H: So thankfully most people don’t have that –

S: Vast majority of people

H: But a lot of people do have these intolerances

S: Absolutely

H: So explain to me what it is in milk and wheat that actually our bodies don’t like

S: Well interestingly with milk – which is remarkably common – we all think of us being able to take milk because of course we all have it when we’re babies –

H: That’s right

S: In one form or another, but amazingly a lot of people stop being tolerant to milk when they grow up because they stop producing an enzyme called lactase which – surprise surprise – is what breaks down lactose

H: And that is the sugar in the milk?

S: Yes, that’s the sugar in the milk and basically it’s one of the major ingredients, not just the milk, and this is the issue, we’ll come onto this later – it’s why we’ve got things a great deal more varied than just glasses of milk on the table –

H: Right

S: Because it’s amazing how many things do contain lactose

H: Is that quite problematic for people then because they might stop drinking milk but then they’re still getting the symptoms. How difficult is it to actually spot that you’ve got an intolerance?

S: Well the answer is that you have to be aware of hidden sources of lactose

H: Right

S: And I think that’s the real issue. We know that probably about maybe 50% of Mediterranean people, maybe about 10% of northern European people, a whopping 95% of Asian people and about 70% of people of Afro-Caribbean people, by the time they become adults are actually intolerant of lactose

H: That’s incredible

S: Now that’s not an allergy – it is remarkable isn’t it?

H: And is that to do with the diet or is it just in their make-up, the way that their races are made up?

S: We think it’s probably to do with a combination of the two, their genetic make-up

H: Right

S: We do know that things that happen outside, so with children for instance if they get an infection, a gastroenteritis, a tummy bug, whether it’s winter vomiting virus or anything else –

H: Oh dear

S: Then they’ll often be lactose-intolerant for a little while afterwards

H: Right

S: But that tends to go away, whereas with adults once it’s gone you tend not to produce this enzyme lactase which breaks down the sugar in milk as you say for the rest of your life, and therefore you’re probably going to be lactose intolerant for life. Now we think that a lot of people don’t realise they’re lactose-intolerant because their intolerance is quite mild and therefore they may well have avoid – have learnt to avoid certain foods because interestingly at least a third of people who’ve got a lactose intolerance and about half of people who have a food intolerance have worked out that they need to avoid certain foods

H: Right

S: So they’re kind of doing the job themselves you know

H: Yes – self-medicating as it were

S: Absolutely, if you have a heavy curry or whatever late at night and you lie down and you’re up half the night, you’re going to realise, the chances are it’s something to do with that

H: Right

S: Whereas if you haven’t had an obvious source of lactose, so for instance really surprisingly, some bread contains lactose

H: Really?

S: Some crisps contain lactose

H: Oh my goodness

S: Cheese – you’d think that kind of hard cheese, you think of it as being very solid and yet actually it’s only got a third as much lactose as the soft cheese, so that’s actually got a lot more. Milk, condensed milk, all those sorts of things contain a lot of lactose

H: So you’ve got to learn to read the labels then on things

S: Absolutely

H: And try and work it out – but you should obviously go and see your doctor –

S: Well not necessarily, what we can do – I mean there are certain symptoms that obviously we are going to be very very worried about, so for instance if you’ve had a change in your bowel habit and it’s been very recent, especially if you’ve started getting diarrhoea, especially if there’s blood in there

H: Right

S: If you’re off your food, if you’ve lost weight without intending to, if you vomit and there’s any blood in it, if you poo and either there’s blood in it or if it’s black and tarry, now those things mean there could be something serious underlying it

H: Right, so don’t ignore it then

S: No, absolutely not, but in the short term, frankly the chances are your GP isn’t going to do anything except tell you to go away and take a lactose-elimination challenge where basically you take out all sources of lactose in your diet for two weeks, you see if your symptoms get better, and then after two weeks you introduce it in stages.

H: Right

S: that can be quite difficult to work out how to introduce one gram of lactose

H: Yes – one crisp

S: Absolutely! But there’s a fabulous website lactofree.co.uk and they’ve got the elimination challenge which has been supervised by a dietician and so on. What they recommend is that if you go on there you can work out very easily – I’m a completely technophobic and even I was able to get –

H: You can work it out

S: If I can do it anybody can believe me! Anybody who can watch a webchat can certainly do it. You get on there and you can print it off for about 2-4 weeks you take out all lactose from your diet, so that means a lot of pretty obsessional label reading I’m afraid

H: Yes, yes

S: It’s a bore

H: But it’s worth it if it sorts you out isn’t it?

S: Absolutely because you’re probably – the vast majority who are lactose-intolerant can have a bit, so they may well find that once they’ve worked out what their limit is, that actually they can be fairly laid-back as long as they avoid the obvious sources

H: right

S: Then after a couple of weeks, on the first day – and it will tell you again exactly how to do this – you have one gram of lactose so for instance an ounce of hard cheese provides you with exactly one gram of lactose – you see what happens. Do your symptoms come back again, do you get nausea, do you get bloating, do you get stomach cramps, do you get diarrhoea. So then if you’re alright with that then you start to increase the dose. Now if you find that your symptoms don’t get better when you stop the lactose and if you find that they don’t come on again when you start it, the chances are it is something else and it may well be worth going to see a doctor, in fact I would recommend that you do or at least that you have a chat with your GP. But if that’s the case, you know you stop the foods that maybe causing it and your symptoms go away, well it’s not rocket science is it?

H: No exactly and it’s just changing your lifestyle I suppose isn’t it to fit in

S: Absolutely

H: Now we’ve got questions coming in actually but we’ll try and crack on and answer a few of those – the first one is, Tracy wants to know “do intolerances get worse with stress?”

S: Almost certainly. Almost certainly, not least because digestive problems tend to get worse with stress. Huge issue in general practice and obviously for the people who are suffering from it, but I see a lot of people coming in with irritable bowel syndrome

H: Right

S: And of course anyone whose got irritable bowel syndrome will know a) that it’s miserable and b) that it tends to cause bloating, wind, diarrhoea and so on. Now it may well be in fact that some people think they’ve got irritable bowel have actually got lactose intolerance

H: Right

S: but we do know that your gut is very, very sensitive to stress, so yes you can possibly start being intolerant when you’ve had smaller amounts of lactose, or even if the symptoms actually physically haven’t changed you’ll be more aware of them because your body just can’t cope, it’s got so much going on

H: So how do you cope with stress in your stomach, how do you deal with that?

S: Well obviously if it’s due to lactose intolerance

H: Yes

S: Then it may be that having previously just, you know say substituted – not drunk glasses of milk and we must get on to how to keep calcium in your diet –

H: Yes well exactly

S: Really really important

H: That’s important isn’t it with osteoporosis

S: It maybe that for instance you’d substitute something like lacto-free which is milk but with the lactose taken out which is perfect –

H: All the calcium still in there

S: Because you’ve got all the calcium

H: Because we don’t want bones to deteriorate do we

S: very much not

H: Causing another problem by curing one

S: No, absolutely and of course the problem is that’s kind of a silent problem that you may not know about until it’s too late so really important. But it may be that for instance if you’re not under stress you can cope with small amounts so you can eat an ounce of soft – hard cheese, but when you are under stress you have to cut out all sources of lactose in the diet

H: Now we’ve got an interesting question come in here, I don’t know whether you can answer this, it’s Sean from Wembley says – “Sarah what is your typical daily food intake?” I guess he’s wondering whether you might be intolerant to anything or whether you avoid things

S: I have to say I’m not intolerant to things apart from people who refuse to eat their diets and continue to eat burgers and chips every day, I’m very intolerant of them

H: Intolerant of naughty patients

S: I can tell you for a fact that I had a wholemeal sandwich with artichoke hearts, pesto and peppers in it for lunch today

H: That’s very exotic

S: It was utterly delicious. I tend to eat lots and lots of fruit. I have to say I’m – it’s fairly obvious to see I’m not Afro-Caribbean and I’m not Asian

H: But you’re very slim though aren’t you?

S: I am but that’s because of lots of running around, I do lots of regular exercise

H: Yes

S: Basically what I do is to have lots of the good things, the things that are good for me, lots of fruit and vegetables, lots of unrefined – so I never have white when I can have dark, so things that are much harder to digest. If you have a really heavy unrefined food like some of these breads, they’re a lot harder to get down, you know you’ve eaten them

H: Yes and it’ll fill you up for longer

S: It will fill you up, it gets absorbed less quickly, so that means your blood sugar doesn’t tend to go woohooo and then drop down again, a lot of people will say “oh I suffer from hypoglycaemia so I eat a lot of sugar” – it gets absorbed very quickly into your system so it brings your sugar up, but then of course then your sugar plummets straight down again and you may well find that you’re actually making the problem worse. So I try not to have refined carbohydrates and I also very much try and avoid dairy fats

H: Oh right

S: But I am extremely conscious about calcium in my diet because I’m afraid I’m female which means I’m very high risk of osteoporosis later on compared to men, and I’m also white which means I’m at very high risk compared to most other races

H: So extra calcium then obviously drinking your milk or your lacto-free if you’re lactose-intolerant. Green leafy vegetables –

S: Dark green leafy vegetables, lots of nuts, almonds, Brazil nuts, hazelnuts, that sort of thing are great sources. Fortified breakfast cereals, obviously quite difficult if you can’t have any milk so again you’d have to have them with the lacto-free, certain fortified breads, figs, lots of nuts, seeds, pulses, all the sort of you know really, really healthy stuff and you know what? It’s terribly easy to make them taste good, it’s not you know it’s not –

H: Once you get into it

S: Exactly

H: And your body, I mean if I sort of eat really unhealthily you can really feel that your body’s sort of poisoned, I don’t know – but anyway there we are, that’s just what my doctor ordered, Sarah’s diet – lots of fruit and vegetables and that’ll see you right. Now Steve’s written in and he wants to know “a friend of mine claimed for a few years to have a yeast allergy, but all of a sudden started eating bread and drinking beer again with no obviously effect. Are there some sorts of allergies that just go away over time?” so can you –

S: That would be no, he probably got bored of pretending he had an allergy. It is astonishing how many people, you know almost everybody, I have to say who goes to see certain nutritionists, I do have a real problem with some nutritionists who are constantly sending my patients back to me saying “oh I’m wheat intolerant, I’m dairy intolerant, I’ve got systemic candida, I’ve got a yeast infection throughout” – or occasionally just to ring the changes they’ll have a combination of all three

H: They’ve got to earn their money these people I suppose don’t they?

S: Well the problem is of course usually that sort of people – there are loads of fantastic nutritionists out there, especially the ones who are qualified as dieticians because they have got to have all the training beforehand, but the problem is that a lot of the others they’ll be trying to flog supplements, now my view is very much that you should be getting everything you need from your diet and not taking supplements unless – and there a few exceptions so for instance if you are at risk of osteoporosis, particularly and you really do find it very difficult if you can’t stand the taste of milk for instance, you might want to take a calcium supplement, if you’re trying to get pregnant, folic acid, that sort of thing and Omega-3’s from fish oils if you really can’t stand your oily fish, but I’d much rather you were having your one portion a week

H: So you should be trying to get a healthy diet but I suppose if you take a multi-vitamin it doesn’t hurt does it?

S: I’m not –

H: She says –

S: The problem with taking a multi-vitamin is it kind of gives you an excuse,

H: Not to eat healthily, right

S: Shall I eat a chocolate bar or shall I walk down the road and get myself a salad? Oh I’ll have a chocolate bar and take a multi-vitamin, you have no idea, but no going back to allergies, no they don’t go away.

H: Right

S: Intolerances you can learn to live with, I suspect the chances are that his mate was – somebody was having him on and he finally worked out that maybe there wasn’t an issue

H: And he liked his beer and his bread too much – maybe. Maybe. It’s only a hypothesis isn’t it?

S: Allegedly

H: Allegedly yes I don’t want to get into trouble. Now Clare wants to know “I eat normally, have cereal or porridge for breakfast as it’s healthier than having toast –

S: Yes

H: Good

S: Can be, yes

H: “Sometimes I feel really sick when I’m on the train to work. I don’t know if it’s the walk to the station too soon after eating or what I’ve eaten not agreeing with me. Should I try cutting it out, but I wouldn’t know what else to eat for breakfast then that would fill me up the same as porridge does. Any tips?”

S: Ah well you see the chances are she may well be lactose-intolerant because of course both what porridge and cereal have in common you put milk on them. So for instance it may well be worth her trying a couple of weeks of the elimination challenge, substituting lacto-free for her normal milk and avoiding all the other dietary sources and that is important, so it is worth logging on and finding out about these elimination challenges because it may be other things. Now it’s possible that it’s the walk to work, it’s possible that you eat in a great rush and actually the sickness if because you know you’re stressed about getting to work, are you running late, have you bolted your food down, anything like that, but I suspect it’s certainly worth her while trying a little elimination challenge. There are lots of ways of cutting out things like that. I mean fibre is so important so porridge is great. A lot of wholemeal breakfast cereals have high fibre breakfast cereals are great and really virtually nobody is allergic to them, some people are intolerant of what but I would suggest that it’s much more likely that – given that both of them contain milk or contain lactose

H: It may be that. And Clare maybe try and just see what you feel like on the days that you don’t go to work, if you still feel the same then maybe it’s nothing to do with the walk to work. But it’s interesting that isn’t it? But it’s good that people actually recognise that they have these symptoms and wanting to do something about it. Now Emily Rosen has written in and she wants to know “I often get stomach cramps after meals which seem safe like pasta or fish, any suggestions?”

S: Ah it’s amazing how many people think they’re safe because the basic ingredient is there

H: Yes

S: And likewise you know it’s amazing how many people will be tempted onto these low carbohydrate diets because they say – ah carbohydrates don’t agree with me, I put on loads of weight. Well of course it’s probably not the carbohydrates, in fact it’s not the carbohydrates, it’s what you’re adding to it. It’s the half inch of butter you put on top. Exactly the same thing often happens with fish and pasta, if you think about it both prime candidates for creamy sauces. Now fish on its own, grilled fish, should be fine. Fish in breadcrumbs, fish in batter will often contain lactose, and it may well contain, there may well be lactose in the bits that you make with it, or the sauces you put on top of it. Likewise some pasta has got lactose in it so have a look in the ingredients

H: Right

S: But if that’s not the case then you might want to start looking at other foods in your diet, possibly in that case you know if it’s always when you have fish with your pasta, maybe it is a wheat intolerance rather than an allergy

H: Yes, ok well that’s – good luck with that anyway Emily. It’s rotten isn’t it getting stomach cramps after you’ve eaten –

S: Especially since she’s doing all the right things, it does seem particularly unfair Emily

H: Yes that’s right. And going out to restaurants as well is quite difficult isn’t it for people with intolerances

S: It can be difficult going out to restaurants, but I think again if you’ve got an intolerance the likelihood is you can probably tolerate a small amount

H: Right

S: So if you’re a little bit careful with the ingredients, so for instance take lactose intolerance – if for instance when you go out you order pasta with a tomato sauce then the chances are that it’s not going to have any lactose in it. If you have it in any other kind of sauce it’s going to have cream and it’s going to have all sorts of other things

H: Yes, just learn to recognise –

S: Don’t forget the parmesan, it may not have as much, it’s delicious but it does have lactose in it. Not as much as soft cheese, but a gram of parmesan, like other hard cheese has got about a gram – sorry an ounce of parmesan has got a gram of lactose

H: Right, ok. Just before we go, top tips on intolerances and allergies if you think you’re suffering what should you do?

S: Well if you think you’[re suffering and this has been something that has been going on for a long time, then there is absolutely nothing to be lost by trying the elimination challenge

H: Right

S: Don’t forget my top tip would be first try the elimination challenge, secondly if you think you’ve done it already, have a look at the elimination challenge, you’ll be amazed at how many foods contain hidden sources. If things don’t settle when you take out lactose from your diet, or if they get better, they don’t get worse when you put lactose back into your diet, it may be something else and it is worth going to see your GP. Secondly if you are then, if you do discover that you’re lactose intolerant whatever you do look out for your long term health. Do not take all dairy products out of your diet without substituting something else. Now dark green leafy vegetables, fabulous, pulses and grains, fabulous, but don’t forget that you need to eat a pretty large pile of purple sprouting broccoli in order to get enough calcium in. It may well be that rather than using a supplement you might want to use something like lacto-free which of course contains the protein, it doesn’t have to be high fat because there’s semi-skimmed versions etc etc, so do just be aware that you need to substitute other sources of calcium. Thirdly enjoy, relax as we heard from our very first question – stress can make all these things worse

H: Yes. Ok well on that note, thanks very much for coming in and talking to us about food intolerances and digestive health

S:My pleasure

H: Dr Sarah Jarvis it’s lovely to see you again, and thanks to all of you at home or in the office or wherever you are for sending in your questions to us, we hope we’ve been of some help to you. And for all the information you need on that elimination challenge you can go to the website which is www.lactofree.co.uk. That’s lactofree.co.uk and you can go on there, there’s plenty of information, you can also send off for leaflets as well that can be sent off to you so – there we are, good luck with your elimination diet and we’ll see you next time. Bye bye

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