Page 90 - Retail Pharmacy Magazine October 2020

88 HEALTH ANTIFUNGALS FROM PAGE 87 “Probiotics also re-inoculate the bowel with friendly digestive bacteria and suppress the gas-forming bacteria that have been associated with some cases of irritable bowel syndrome,” she said. Helpful nutritional supplements Dr Brewer suggests include vitamin C, vitamin D, biotin, iron, magnesium, selenium, zinc, artichoke, caprylic acid, co-enzyme Q10, cranberry, curcumin, echinacea, garlic, grapefruit seed, olive leaf, peppermint oil and Siberian ginseng. Associations between Candida bacteria and IBS tricky Geraldine Georgeou, an accredited practising dietitian for 20 years, former board member of the Gut Foundation and co-author of The Gut Foundation Cookbook, warns against making facile links between Candida and IBS and tackling the condition from this association. She says an antifungal diet could work for IBS patients, keeping in mind that they could have many other conditions, such as celiac disease or a condition that has to be diagnosed via their GP or gastroenterologist. “I’ve had patients in their 30s who present with something that doesn’t appear to be sinister, such as constipation, who in fact have colorectal cancer, or patients who think they may have overflow diarrhoea but are constipated,” Ms Georgeou said. “This makes it clear the extent to which healthcare professionals have to be mindful as to how long the person has been struggling with the condition and what is actually going on with their health to bring them to the point where they enter a pharmacy and ask for assistance. “I can’t emphasise enough how much caution should be taken in avoiding the ease of oversimplifying medical conditions.” Ms Georgeou highlights that a quick means of gaining clarity is to refer patients to their GP for a stool test or to make use of the Microba insight test, which comes in the form of a microbiome test kit that provides detailed insights into the microorganisms inhabiting a patient’s gut and how they function. “It’s a powerful, evidence-based tool that enables patients to learn about their unique microbial community in as-yet- unknown detail and identify dietary suggestions that could improve overall health and wellbeing,” she said. “Overall, though, I don’t see Candida as a presenting issue for IBS.” She points out that IBS could follow a patient undertaking a “crazy diet” with little to no fibre, which results in an imbalanced gut microbiome, adding that the patient could even have a parasitic or bacterial infection in the gut that needs to be medically addressed. In this scenario, Ms Georgeou says she would work out what fibres the patient needs to consume in their diet and whether they need a prebiotic or probiotic to reset their gut and encourage good gut health. Prebiotics – non-digestible food ingredients – are types of dietary fibre that feed the friendly bacteria in the gut to assist gut bacteria to produce nutrients for colon cells and hence a healthier digestive system. Prebiotic foods include substances known as fructo-oligosaccharides and inulin. They are found in foods such as chicory root, broccoli, cauliflower, cabbage, onion, garlic, tomatoes, aubergine, asparagus, fennel, beets, oats, wheat lentils, barley, almonds, pistachios, honey, unripe bananas and apples, among others. Probiotics are live microorganisms that are intended to have health benefits when consumed or applied to the body. They can be found in yoghurt and other fermented foods, or some dietary supplements. Probiotic bacteria are found in yoghurt and fermented foods such as miso and tempeh, as well as probiotic supplements. Ms Georgeou highlights that the main issue here is whether someone is getting enough fibre, with the average person needing, and often not getting, 20g to 30g a day. “Lack of adequate fibre could be the result of following the keto diet, as an example,” she said. “So here pharmacists could help patients determine whether they’re getting enough of what they need from insoluble to soluble fibre, cereals (low sugar), natural yoghurt and fermented food. “I advise patients that fruit, and dry fruit, have to be consumed with care, as they’re high in sugar and don’t always provide as much fibre as people imagine, as well as homemade kombucha and fermented food, not to mention ensuring they get the probiotic that’s right for them.” She says some people might need more Lactobacillus GG types of probiotics in reference to antifungal conditions, with oil of oregano and other recommended antifungal foods being questionable as they can precipitate exacerbation of reflux for those predisposed to the condition. She adds that potatoes are “interesting” because although they’re often “frowned” upon as a higher GI carbohydrate, they’re a great source of resistant starch that feeds the gut microbiome. Pharmacist input on the ground When it comes to the link between Candida and IBS, Mr Webster says that, in his experience, a disruption in gut health “likely leads to overgrowths”. “These matters are challenging for standard pharmacy environments, with people making links between Candida and tinnitus, too, and then there’s the issue of Candida biofilms, which can be difficult to treat with most of the OTC remedies and supplements,” he said. A biofilm is a polysaccharide matrix that can be found inside or outside the body and which acts as a protective structure for the microorganism. The biofilm is problematic because it enables the pathogen to seek sanctuary in it and protect itself from all the treatments GPs and the immune system can “throw” at it, he says. TO PAGE 90 “Lack of adequate fibre could be the result of following the keto diet, as an example.” RETAIL PHARMACY • OCT 2020