Irritable Bowel Syndrome(IBS) is one of many bowel disorders that can cause anything from mild discomfort to extreme bowel issues. IBS belongs to a group of bowel disorders classified as non inflammatory bowel disorders as opposed to Inflammatory Bowel Disease which is characterized by inflammation of the intestines. So read further to understand what is IBS and how to manage the condition.

What Is Irritable Bowel Syndrome(IBS)?
IBS is classified as a functional gastrointestinal disorder where there are issues as to how the gut and brain work together. IBS is characterised by multiple symptoms such as stomach cramping, abdominal pain, bloating and changes in bowel movement. It is a chronic condition that tends to occur in people aged 20-45 and is seen more commonly in women.
What are the Symptoms of IBS?
IBS displays a varied range of symptoms. Some of the common symptoms are:

• • pain in your abdomen (often related to your bowel movements)
  • changes in your bowel movements (diarrhea, constipation, or in some cases, both)

A few of the other symptoms are:

• • feeling bloated/gassy
  • feeling very full
  • mucous discharge in your stool

The symptoms of IBS tend to occur in episodes of symptom free periods followed by periods of severe burst of symptoms. Certain trigger foods might cause the onset of symptoms.
What are the causes of IBS?
The muscles lining the intestine play a vital role in pushing the food mass through the intestinal canal. As the food gets digested and water gets absorbed through the intestinal walls, undigested material forms the hard stool. In the case of IBS, the muscles tend to push the food through the canal too fast or too slow causing diarrhea or constipation respectively.
Although we are unable to pin-point what could cause this malfunction at this point of time, many theories have been put forth such as, oversensitive nerves in the intestine, intestinal muscle disorders,inflammations of the intestinal wall and genetics. Psychological stress and food intolerances are thought to be triggers as well.
What are the risk factors of IBS?
A few of the risk factors associated with IBS are as follows:

• • Age – IBS tends to occur in people of the 25-50 age groups
  • Gender – IBS seems to be more common in Women than Men. It is thought that the female hormones play a role in this
  • Family History – Genes or a shared environment or both in combination may play a role in risk of IBS
  • Mental Health Problems – Anxiety, depression and other mental health issues are associated with IBS

What are the types of IBS?
Based on the type of symptoms, IBS can be divided into 3 types namely:

• • IBS-C – IBS with constipation characterised by Infrequent stools and constipation
  • IBS-D – IBS with diarrhea characterised by frequent stools and diarrhea
  • IBS-A – IBS with alternating constipation and diarrhea

Are IBS and IBD the same?
Although IBS and IBD share a lot of symptoms, they are completely different disorders. While IBS is characterised by multiple symptoms, it is not a disease in itself and is not considered to be as dangerous as IBD. IBD on the other hand causes inflammatory reactions and causes damage to the intestine leading to intestinal bleeding, rectal bleeding, ulcers, etc.,
A simple non-invasive test to differentiate between the two is to take a fecal calprotectin test which measures the presence of certain antibody proteins in the stool. A positive result indicates the presence of IBD while the negative test could mean that the symptoms may be caused due to IBS and needs further testing for confirmation.
How is IBS diagnosed?
After a review of your symptoms and their frequency, a doctor would recommend certain tests to diagnose IBS. This includes physical examination for bloating, tenderness or pain. IBS is mainly diagnosed by ruling out the presence of other disorders such as IBD and food intolerances(Gluten, Lactose, etc.,). The doctor might also recommend a routine blood and stool test and in some cases an upper GI endoscopy or a colonoscopy.
What is the low FODMAP diet?
FODMAP stands for fermentable oligo-, di-, and monosaccharides and polyols. It is a class of carbohydrates that are not well absorbed in the intestine for some people. This leads to food items getting accumulation in the intestine and fermented by the gut bacteria leading to release of gas.
These conditions tend to trigger IBS in individuals. The list of foods that are classified as FODMAPs is extensive and is maintained by the International Foundation for Functional Gastrointestinal Disorders and it is recommended to go on a low FODMAP diet and introduce one food at a time to identify the trigger food.
How does IBS affect quality of life?
Although there are very few complications associated with IBS, mental health and quality of life are the biggest complications individuals with IBS tend to face. Some people may feel they’ve lost control over their body as they can never be sure when they would have to go to the toilet.
Another issue is that it could be embarrassing to talk about issues with their bowel movements or passing a lot of wind often. 
Can IBS be treated?
IBS is a chronic condition that does not have a complete treatment as of now. But the condition can be managed by changes in diet, lifestyle, certain medications and in some cases, mental health therapies. The process of finding what treatment works best is a trial and error process in order to identify certain trigger foods or conditions.
Based on the type of IBS, individuals may be prescribed with fiber supplements or laxatives to treat their condition.

References

1. Irritable bowel syndrome: Overview
2. Definition & Facts for Irritable Bowel Syndrome, NIDDK

PCOD/PCOS.
This term is commonly heard of nowadays. We see several women diagnosed with this condition. But what is it? Do we really know?
This article aims to cover the basics of Polycystic Ovarian Syndrome (PCOS) or Polycystic Ovarian Disease (PCOD). We believe it is imperative to have basic knowledge about the conditions that are seen today and make ourselves more aware.
What is PCOS?
Polycystic Ovarian Syndrome, commonly known as PCOS is a metabolic, endocrine and reproductive disorder seen in women of reproductive age (1,2). It is characterised by a myriad of signs and symptoms associated with ovarian dysfunction and androgen excess (1,2). The signs and symptoms associated with PCOS varies from person to person, and will be discussed in the coming section.

Why does it occur?
The exact cause for PCOS remains mostly unknown. It is said to be a multifaceted disease (1) in which a variety of factors play a role in the development. These include environmental and/or genetic influence, diet, lifestyle, ovarian steroidogenesis, abnormal insulin signalling and excess oxidative stress. (1,2).
What are the signs and symptoms?
As mentioned earlier, PCOS is characterized by a variety of signs and symptoms. Any combination of these symptoms could indicate the possibility of PCOS. Menstrual irregularities, obesity or excess androgen could be a sign of this disease. However, in order to standardise the signs and symptoms, the Rotterdam Criteria is used as a rule of thumb (3). The presence of any two of the three symptoms listed in Table 1 are used to diagnose the presence of PCOS. (3,1) To confirm the presence of polycystic ovaries, an ultrasound is performed by the gynaecologist.
However, it is to note that although widely used, the Rotterdam criteria for diagnosing PCOS has been questioned due to a paucity in data (4).
In addition a fasting lipid panel, BMI, waist circumference a 2-h glucose challenge test must be done (4,5). Also, screening for thyroid disorders is important as thyroid disorders are a common cause of menstrual irregularity (5).

Table 1: Signs and symptoms associated with PCOS.

Presence of 2 out of 3 of these symptoms are used to diagnose the presence of PCOS.

Are there different types of PCOS?
While most people assume that excess adiposity and irregular or absence of menstrual cycle is only associated with PCOS, it is imperative to know that it is not the case. As seen above, 2 out of 3 of the symptoms presented could indicate the manifestation of PCOS. Hence, it is a spectrum. Once again, the Rotterdam criteria (3) divides these into 4 phenotypes, as seen in Table 2:

What are the risks?
Insulin resistance (IR) is considered as an important manifestation in PCOS (6). Increased insulin and Luteinising Hormone levels could lead to anovulation (7). As a result of IR, PCOS is said to increase the risk for Type II Diabetes and gestational diabetes for the individual (8). Impaired glucose tolerance (8) and obesity are additional contributing factors to this.
Obesity is also an important feature of PCOS. However, it isn’t inherently caused by PCOS, but rather could also be due to lifestyle and environmental influences (1). Women with PCOS have more visceral fat and subcutaneous fat distribution (9). Whether obesity leads to PCOS or whether PCOS leads to obesity is still debatable (5).
Due to the nature of the symptoms women with PCOS could have a higher chance of being infertile. Infertility is more commonly associated with the existence of PCOS than healthy women (10). However, there still remains a gap in the literature on the influence of the different phenotypes on female fertility. More controlled studies are needed looking at the degree of infertility in each phenotype and the outcomes on pregnancy (1).
What is the treatment like?
Due to PCOS presenting itself as a spectrum, there is no single universal treatment. Most treatments are symptom based, targeting the issues pertaining to androgen excess,insulin resistance, hirsutism, acne and oligoovulation (1,2). In addition, lifestyle counselling should be provided in all cases in order to prevent or treat obesity (2).
Women with Classic PCOS symptoms are likely to resume their cycles on dietary and lifestyle interventions. Dietary interventions such as consuming high fibre and protein rich foods can help with weight loss in those with PCOS. Infact, a recent review addressing nutritional management of PCOS (11) concluded that the diet composition of those with PCOS should be low in saturated fat and contain sufficient fibre from whole grains, legumes, fruits and vegetables. In addition, consumption of carbohydrates with a low glycaemic index was recommended. Soy protein has also been to have favourable effects on BMI, glycaemic control and triglycerides in those with PCOS (12)
Oral Contraceptive Pills (OCPs) are commonly used to address menstrual irregularities and hyperandrogenism (2). This helps in reducing the secretion of luteinizing hormone and decrease free testosterone levels (Costello 2007). Metformin, is another anti-diabetic drug that is used to target insulin sensitivity. Though studies using Metformin show mixed results, it is used in pregnancy complications in women with PCOS (2). However, using OCPs does have certain side effects such as mood swings, weight gain, nausea and bloating among others (13). This also varies with the dosage and type of hormone in the OCP.
Inositol is a recent development in PCOS treatment. It is marketed as Myo-inositol (MYO) and D-chiroinositol (DCI). MYO has shown to improve insulin resistance in those with PCOS. Infact, a recent meta-analysis concluded that MYO supplementation may be beneficial in improving the metabolic profile of women with PCOS (14).
While the exact cause for PCOS is unknown, it has affected a number of women globally. It is crucial to not let this go undiagnosed. Moreover, it is also important to seek treatment from professionals. It is clear that PCOS is a multifaceted disease,that needs both medical and lifestyle interventions. There are a wide variety of treatment options available. Thus,it is not something to be feared, rather something that needs your attention.

References:

1) El Hayek S, Bitar L, Hamdar L, Mirza F, Daoud G. Polycystic Ovarian Syndrome: An Updated Overview. Frontiers in Physiology. 2016;7(124).
2) Escobar-Morreale H. Polycystic ovary syndrome: definition, aetiology, diagnosis and treatment. Nature Reviews Endocrinology. 2018;14(5):270-284.
3)Rotterdam, E. A.-S. P. C. W. G. (2004) Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertility and Sterility. 2004;81(1):19-25.
4) Azziz R. Diagnosis of Polycystic Ovarian Syndrome: The Rotterdam Criteria Are Premature. The Journal of Clinical Endocrinology & Metabolism. 2006;91(3):781-785.
5) Kamangar F, Okhovat J, Schmidt T, Beshay A, Pasch L, Cedars M et al. Polycystic Ovary Syndrome: Special Diagnostic and Therapeutic Considerations for Children. Pediatric Dermatology. 2015;32(5):571-578.
6) Sıklar Z, Berberoğlu M, Çamtosun E, Kocaay P. Diagnostic Characteristics and Metabolic Risk Factors of Cases with Polycystic Ovary Syndrome during Adolescence. Journal of Pediatric and Adolescent Gynecology. 2015;28(2):78-83.
7) Dunaif A. Hyperandrogenic anovulation (PCOS): A unique disorder of insulin action associated with an increased risk of non-insulin-dependent diabetes mellitus. The American Journal of Medicine. 1995;98(1):S33-S39.
8)Randeva H, Tan B, Weickert M, Lois K, Nestler J, Sattar N et al. Cardiometabolic Aspects of the Polycystic Ovary Syndrome. Endocrine Reviews. 2012;33(5):812-841.
9) KIRSCHNER M, SAMOJLIK E, DREJKA M, SZMAL E, SCHNEIDER G, ERTEL N. Androgen-Estrogen Metabolism in Women with Upper BodyVersusLower Body Obesity*. The Journal of Clinical Endocrinology & Metabolism. 1990;70(2):473-479.
10) Hart R, Doherty D. The Potential Implications of a PCOS Diagnosis on a Woman’s Long-Term Health Using Data Linkage. The Journal of Clinical Endocrinology & Metabolism. 2015;100(3):911-919.
11) Faghfoori Z, Fazelian S, Shadnoush M, Goodarzi R. Nutritional management in women with polycystic ovary syndrome: A review study. Diabetes & Metabolic Syndrome: Clinical Research & Reviews. 2017;11:S429-S432.
12) Karamali M, Kashanian M, Alaeinasab S, Asemi Z. The effect of dietary soy intake on weight loss, glycaemic control, lipid profiles and biomarkers of inflammation and oxidative stress in women with polycystic ovary syndrome: a randomised clinical trial. Journal of Human Nutrition and Dietetics. 2018;31(4):533-543.
13) Consensus statement on the use of oral contraceptive pills in polycystic ovarian syndrome women in India. Journal of Human Reproductive Sciences. 2018;11(2):96.
14) Unfer V, Facchinetti F, Orrù B, Giordani B, Nestler J. Myo-inositol effects in women with PCOS: a meta-analysis of randomized controlled trials. Endocrine Connections. 2017;6(8):647-658.

Gut health is currently the new buzzword in the health and fitness industry. Products claiming to improve your gut and its function are slowly increasing. This might make you wonder what the fuss is all about! Gut microbes, microbiota, microbiome… What do these terms mean? Why is the gut so important? Read on to find out!

What is the gut and gut microbiota?
The gastrointestinal tract or in simple terms, the digestive system which starts from the mouth and ends at the rectum, are collectively termed as the gut. However, what people usually refer to when they use the term ‘gut’ is the intestines.
The gut, all the way from the mouth to the rectum contain a number of microorganisms (also called microbes) that are tiny microscopic organisms which are not visible to the naked eye. Microbiota refers to all the microorganisms living in the same environment, while microbiome refers to all genes of these microbes. So, the gut microbiota refers to the large community of microbes that reside in the gut.
What is the function of the gut microbiome?
The gut microbiota plays an important role in digestion, absorption and metabolism of food (1). Beyond this, the gut bacteria are also thought to play an important role in obesity (1), immune function (2) and also influencing mood (3) . In fact, our gut bacteria is said to have an impact on most of our physiological functions, directly or indirectly (2). While the research around the gut microbiota is ongoing, it is clear that it is a key factor in several aspects of the body’s optimal functioning.
What are the common gut related disorders and why does it occur?
In certain situations (for example, a disease condition) the microbes that reside in your gut can be disrupted. This will be different from the microbe community that was present when your body was healthy. This is termed as dysbiosis (2). Dysbiosis can be caused by change in eating habits, bowel movements and even medications taken when one is ill. (2). However it is to note that what changes in the microbiota are helpful or not is still being looked into.
Some of the most common gut related disorders you would have come across are constipation, indigestion and diarrhoea. However, conditions like Irritable Bowel Syndrome (IBS), Crohn’s disease, Celiac disease, lactose intolerance and colitis are also gut related.
What can I do for a healthy gut?
The following simple tips can be incorporated in order to ensure your gut microbes are functioning well in order to support your body’s optimal functioning;
Diverse diet: As mentioned before, a large and diverse community of microbes reside in our gut. To support these microbes, our diet needs to be equally diverse. Our food serves as substrates for these microbes to thrive. It is clear that the diversity of our diet determines the diversity and richness of the gut microbiota (4). The increasing number of fad diets is also an issue of concern as it encourages elimination of food groups, which in turn affect the diversity of the gut microbiota (5). Fibre intake and polyphenols also play key role in shaping the microbiome. Low intake of fibre paired with high fat and sugar intake may reduce certain microbe groups in the gut (6). Polyphenols are found in foods like tea, chocolate, spice, seasonings,herbs and even fruits and vegetables. Interactions between polyphenols and the gut microbes can also impact health (7).
What can you do? Ensure your diet is diverse by varying the foods you eat on a daily basis. Consume fibre rich food such as whole grains, lentils/legumes, fruits and vegetables. Aim for at least 25-30g of fibre a day. Fruits and vegetables, also ering rich in polyphenols provide an additional benefit.
Fermented foods: Fermentation is a natural process by which bacteria break down substances into simpler forms. Examples of fermented food are kimchi, yoghurt, kefir among several others. These are commonly termed as ‘probiotics’ since they contain live cultures of microorganisms in them! While the research on probiotics is still ongoing, they do seem to show promising effects on enriching the existing gut flora (8). Why not give this a go?
Stress: This is something that affects each one of us on a day to day basis. While everyone knows that extreme stress is unhealthy, little do we know that stress also affects the diversity of microbes in the gut (9). Yes, you heard that right! While we do know how stress negatively affects several aspects of health, it also has an impact of the tiny bugs living in your gut.
In conclusion, gut health is a growing area of research. While there are a number of questions unanswered, the field seems vast and promising. It is clear that the gut plays an important role in several aspects of human health. Hence, it is necessary for us to understand this and nourish the gut by living a healthy lifestyle.

REFERENCES:

1) Ursell L, Metcalf J, Parfrey L, Knight R. Defining the human microbiome. Nutrition Reviews. 2012;70(Suppl 1):S38-S44.
2) Shreiner AB, Kao, JY, Young, VB. The gut microbiome in health and disease. Current Opinion Gastroentology. 2015;31(1):69-75
3) Dash S, Clarke G, Berk M, Jacka F. The gut microbiome and diet in psychiatry: Focus on depression. Current Opinion in Psychiatry. 2015;28(1):1-6.
4) Makki K, Deehan E, Walter J, Bäckhed F. The Impact of Dietary Fiber on Gut Microbiota in Host Health and Disease. Cell Host & Microbe. 2018;23(6):705-715. 
5) Heiman M, Greenway F. A healthy gastrointestinal microbiome is dependent on dietary diversity. Molecular Metabolism. 2016;5(5):317-320.
6) Sonnenburg E, Sonnenburg J. Starving our Microbial Self: The Deleterious Consequences of a Diet Deficient in Microbiota-Accessible Carbohydrates. Cell Metabolism. 2014;20(5):779-786.
7) Ozdal T, Sela D, Xiao J, Boyacioglu D, Chen F, Capanoglu E. The Reciprocal Interactions between Polyphenols and Gut Microbiota and Effects on Bioaccessibility. Nutrients. 2016;8(2):78.
8) Bell V, Ferrão J, Pimentel L, Pintado M, Fernandes T. One Health, Fermented Foods, and Gut Microbiota. Foods. 2018;7(12):195.
9) Konturek PC,Brzozowski T, Konturek SJ. Stress and the gut: pathophysiology, clinical consequences, diagnostic approach and treatment options. Journal of Physiology and Pharmacology. 2011;62(6):591-599.