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DR MEGAN ROSSI: How to heal gut problems caused by Covid

With most infections, such as the common cold, we can feel quite miserable for a few days, but then we tend to recover slowly and return to normal within a week or so.

However, sometimes an infection can have a nasty sting in its tail, with longer-term effects that seem unrelated to the original symptoms. In particular, I am talking about irritable bowel syndrome (IBS) caused by a Covid infection.

I’ve noticed it a lot in my clinic, with clients who have never had bowel symptoms complaining of issues such as bloating, abdominal pain and altered bowel habits within weeks of recovering from Covid.

You may be wondering how a respiratory infection like Covid can leave you with persistent gut problems like IBS.

In fact, gut symptoms are a fairly common sign of a Covid infection itself. Although I managed to avoid them, many of my clients were not so lucky, and nearly 20 percent of the general population suffered from issues such as nausea, vomiting, diarrhea, and loss of appetite.

Most infections like the common cold can leave us feeling quite miserable for a few days but then we tend to clear up slowly and be back to normal within a week or so

Most infections like the common cold can leave us feeling quite miserable for a few days but then we tend to clear up slowly and be back to normal within a week or so

Studies have also shown that the virus is found in the stool of about 50 percent of people with Covid. In fact, during the height of the pandemic, it was considered a source of its spread.

This isn’t too surprising, since the virus that causes Covid (SARS-CoV-2) clings to ACE2 receptors in the body – and just like in your lungs, these receptors are found in the gut, allowing the virus to directly penetrate the gut wall. .

Interestingly, several studies have also shown that people with poor gut health are more likely to become unwell due to Covid.

Covid-induced IBS is something else – in fact something has disrupted the functioning of the gut: it looks good, but it just doesn’t perform as it should, which is what we call a functional disorder. And research shows that intestinal infections and stress in general (such as when you’re not feeling well) can increase your risk of IBS several times over.

So are changes in the balance of your gut microbes — the inflammation caused by a gut infection can upset this balance, raising your risk of IBS by as much as threefold. So if you are experiencing intestinal symptoms after Covid, it is possible that you have developed IBS. But before self-diagnosing, see your primary care physician for a check-up; there is also a Long Covid NHS service, visit yourcovidrecovery.nhs.uk.

If you are still leaning towards IBS, keep in mind that there are official diagnostic criteria.

What many people don’t realize is that IBS isn’t ‘just’ about diarrhea or constipation: the main symptom is recurrent abdominal pain – according to official criteria, to be diagnosed with IBS, this pain must average at least one day a week (with symptoms that started six months ago), and must be associated with two or more of the following:

  • The pain improves or worsens when defecating.
  • The pain is more common when your poo occurs more or less often than usual.
  • The pain coincides with your poo being softer or harder than usual.

If this describes your symptoms, the first-line treatment is to look at your diet. This means cutting back on alcohol and avoiding spicy foods, caffeine, fried foods and fatty meats, as these all stimulate bowel movement, which can make symptoms worse.

Artificial sweeteners are another thing to watch out for (especially ones that end in -ol, such as sorbitol and xylitol, as these can be poorly digested, causing gas and pain).

Drink plenty of water, but limit juices and smoothies – you should aim for two pieces of fruit; five servings of vegetables; three servings of whole grain and two servings of nuts/seeds/legumes per day.

Covid-induced IBS is something else - in fact something has disrupted the functioning of the gut: it looks good, but it just doesn't perform as it should, what we call a functional disorder

Covid-induced IBS is something else - in fact something has disrupted the functioning of the gut: it looks good, but it just doesn't perform as it should, what we call a functional disorder

Covid-induced IBS is something else – in fact something has disrupted the functioning of the gut: it looks good, but it just doesn’t perform as it should, what we call a functional disorder

Persistent intestinal complaints are not only related to a Covid infection. Gut bacteria may also have a longer-term effect that appears to have nothing to do with the bug itself; cause temporary lactose intolerance, for example.

Lactose is the sugar found in dairy and temporary lactose intolerance I see in the clinic all the time. After an intestinal infection, people often find that they simply cannot tolerate eating many of the dairy products they previously enjoyed, as it causes symptoms such as cramping pain, bloating and loose stools.

What happens is that the gut infection and inflammation it causes damages the cells in the gut that produce lactase, the enzyme that digests lactose. As a result, lactose is not broken down properly and ends up in the large intestine, where it is fermented by lactose-naive bacteria that live there, producing gas and causing digestive symptoms such as loose stools.

Fortunately, most other digestive enzymes are produced outside the small intestine, namely in the pancreas, which is why intestinal infections tend not to impair their ability to digest other components of our food. Most people affected by this can still handle small amounts of lactose – 50 ml of milk (which you could have in a cup of tea) per sitting and up to 150 ml during the day – without any problems.

The trouble is, there’s a lot of lactose ‘hidden’ in our food – it’s used as a sweetener in food production, such as in cereals and biscuits, so you may not realize that your gut symptoms are actually caused by the lactose in that biscuit. and slice of cake and not, say, IBS.

But what may seem surprising is that while milk can cause problems, hard cheese is fine: That’s because a lot of the lactose has leaked out during the manufacturing process, so it contains very little lactose.

Similarly with live yogurt, the bacteria have eaten a significant amount of lactose during the fermentation step of yogurt production.

Many people with lactose intolerance think they should cut dairy for good, but that’s just not the case. It’s worth including small amounts you can manage in your diet, as fermented dairy, in particular, is associated with a range of health benefits, such as a lower risk of heart disease and a healthy body weight, as well as being an important source of calcium, important for bone strength and nerve function.

Within two to three months, your lactase production should return to normal as your gut heals from the infection — and you can enjoy lactose-containing dairy products again.

For those who have genetically induced lactose intolerance — which can affect as many as 95 percent of people of African American and Asian ethnicities — it’s worth including a small amount of lactose in your diet anyway. This, in turn, supports the growth of lactose-digesting bacteria in your gut, which over time improves your gut’s ability to process lactose, leading to greater tolerance and fewer symptoms.

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ask Megan

My daughter (8 years) often gets a bloated and hard stomach after eating – and has a lot of gas. How can we reduce this? Tests by the doctor have determined a mild lactose intolerance. We have significantly reduced her lactose intake and we eat healthy overall.

Name and address provided.

It’s important to get bowel symptoms under control while children are young, but it’s also important not to overemphasize them and make them feel self-conscious, which can worsen in adulthood and lead to bowel problems.

Talking openly with your daughter about her bowel movements will provide valuable information to help you and your GP determine whether diarrhea or constipation could be causing an upset stomach — both common causes of excessive gas and bloating. I would consider the frequency of bowel movements, as well as the consistency.

This information would also help fine-tune any dietary recommendations. Overall, your daughter’s diet sounds like it has a good amount of fiber. Fluid is also important, as it allows fiber to work its magic on laxatives, so I’d make sure she had plenty of fluids too (about 1,300ml per day for eight year olds).

If she doesn’t like water, add fresh mint and frozen berries to make it more appealing. Whole fruit is great for kids, but as with adults, too much at once can make you feel bloated, so consider spreading her fruit to no more than 80g at a time, with up to three times over the day.

Try this: Zucchini & Hazelnut Salad

When you and your microbes crave something light that doesn’t fall short on flavor, look no further. This light bite hits the spot, bringing you 7g of fiber and eight planting points closer to your weekly goal.

Serves 2

2 courgettesl 40g mixed salad leaves (e.g. spinach, arugula, watercress)l 60g feta, crumbled (switch to 30g Parmesan cheese if you are lactose intolerant)l 30g hazelnuts, toasted and choppedl 20g mixed seeds

Dressing

  • 1 tbsp extra virgin olive oil; l Juice of half an orange (approx. 40 ml); l 2 tsp cider vinegar; l 1 tsp honey

Toppers

  • 2 tsp mint leaves, finely chopped;
  • 40 g pomegranate seeds

Combine the dressing ingredients. Season and adjust the flavors to taste. In a small bowl, peel the courgettes into ribbons and pour over the dressing.

Let marinate for a few minutes before tossing in the lettuce leaves.

Divide the zucchini mix between two serving dishes and add the feta, hazelnuts and seeds in each dish.

Pour over the remaining dressing and sprinkle over the mint leaves and pomegranate seeds.

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