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Thursday, 3 January 2019

The scary polio-like illness

Leaky gut gets blamed for everything from everyday stomach issues to pain to anxiety, yet it is one of the most mysterious ailments to diagnose and treat.

Part of the reason for this medical mystery is because the gut is such a vast and complex system. “Science continues to find new ways that the gut can influence everything from heart health to keeping our brains young,” says Dr. Alessio Fasano, director of the Center for Celiac Research and Treatment with Harvard-affiliated Massachusetts General Hospital. “There is much we know about leaky gut in terms of how it affects people’s health, but there is still so much that is unknown.”
What is leaky gut?

You have to begin at the cellular level. The lining of your intestine is made of millions and millions of cells. These cells join together to create a tight barrier that acts like a security system and decides what gets absorbed into the bloodstream and what stays out.

However, in an unhealthy gut, the lining can weaken, so “holes” develop in the barrier. The result is that toxins and bacteria can leak into the body. This can trigger inflammation in the gut and throughout the body and cause a chain reaction of problems, such as bloating, gas, cramps, food sensitivities, fatigue, headaches, and joint pain, to name a few.

How do these “holes” form? The biggest culprits are genes and diet, according to Dr. Fasano. “Some people may have a weaker barrier because they were born with it, or they follow an unbalanced diet low in fiber and high in sugar and saturated fats, which may be the trigger that weakens the gut lining.” Age also plays a role because as you age, cells get damaged more easily and heal slowly, if at all, so the gut becomes more vulnerable.
The role of leaky gut in overall health remains unclear

“Leaky gut could be the cause of some health problems, or a sign of something larger,” says Dr. Fasano. “The science is still up in the air.” For example, digestive conditions like inflammatory bowel disease, celiac disease, and Crohn’s disease share many of the same symptoms as leaky gut, and all are linked with chronic inflammation, but it’s not known how, or if, they are connected.

“The challenge is that it’s difficult to measure the strength of a person’s gut barrier, so you can’t know for certain when leaky gut is really present, or what influence it may have elsewhere in the body,” says Dr. Fasano.
Can you treat leaky gut?

You can, but the approach is similar to diagnosing a broken car, says Dr. Fasano. “You don’t know the exact problem until the mechanic lifts the hood, looks around, and tries different things — there is not a simple, direct approach to fixing the problem,” he says. “It’s the same with leaky gut. We have to try different strategies to see what helps.”

Your first step is to share your symptoms with your doctor. If leaky gut is a possibility, he or she can try several strategies to help relieve symptoms and reduce inflammation. The most common is to review your diet and eliminate known dietary causes of inflammation, such as excessive consumption of alcohol and processed foods, and to explore whether you have any food sensitivities — for instance, to gluten or dairy. “In theory, reducing inflammation from your diet like this also may rebuild the gut lining and stop further leakage,” says Dr. Fasano.

The best way to protect yourself from leaky gut is to invest more in your overall digestive health, he adds. This means being more attentive about following a gut-healthy diet that limits processed foods and high-fat and high-sugar foods, and includes enough fiber. Sticking to a regular exercise program also can strengthen your digestive system. For example, studies have suggested that taking a 15-to 20-minute walk after a meal can aid in digestion. “Your gastrointestinal system is complex, but caring for it doesn’t have to be,” says Dr. Fasano. It’s understandable, given how precious and elusive a full night’s sleep can be for new parents. The quest for a full night of sleep becomes so important that many a book has been written on how to achieve it, and it’s a common topic of conversation among new parents. Those whose babies sleep through the night feel like they have accomplished something important — and those whose babies don’t sleep through the night are often wondering if there is something wrong with their baby or their parenting. This is especially true because among Western cultures, there is a perception that by around 6 months of age, if not sooner, babies should be sleeping through the night.

This perception, it turns out, is not exactly correct. And that’s where the good news/bad news thing comes in. According to a study published in the journal Pediatrics, if your baby doesn’t sleep through the night at 6 months, or even at 12 months, it’s perfectly normal.

It’s always good news to hear that your baby is normal — but for some parents, it may understandably feel like bad news that a full night of sleep is further out on the horizon than they had hoped.

Researchers from Canada studied 388 infants at 6 months, and 369 infants at 12 months. They defined sleeping through the night as six or eight hours of sleep without any waking. They found that at 6 months, 38% of the babies couldn’t make it six hours without waking — and a full 57% didn’t sleep eight hours at once. At 12 months, those numbers were better but still not great: 28% didn’t sleep six hours straight, and 43% didn’t sleep eight hours.
It’s not a baby problem and it’s not a parenting problem — it’s not actually a problem at all

As cranky as being woken up at night can make a parent feel, the researchers did not find a correlation between waking at night and the “postnatal mood” of the mothers. They also found that babies that woke up at night didn’t lag behind the sound sleepers when it came to their cognitive, language, or motor development. The babies did fine either way.

They also found that babies who woke up at night were more likely to be breastfeeding. This makes sense, given that breast milk is more easily and quickly digested than formula, causing breastfed babies to get hungrier sooner. Given that breastfeeding has known health benefits, a little extra waking could end up working out for baby (and for the mother, given that breastfeeding has benefits for mothers too).

Now, for some parents waking up at night is a problem, and that’s where sleep training comes in. There are certainly various techniques and methods that can help teach babies to sleep longer and more independently. Many of them, though, involve letting the baby cry for a while — and while studies have shown that this doesn’t harm babies, it can be hard and stressful for many parents.

What this study shows is that if your baby is waking during the night and you’re doing okay with it, you don’t need to do anything. With time, it will get better. While those first few months of life can feel like an eternity, they aren’t. Before you know it you will be up at night for an entirely different reason: waiting for them to get home from a night out with friends. And when that does happen, those days of waking up with them as babies won’t seem so bad at all. Frequent use of hand sanitizer, instead of soap and water, may lead to fewer respiratory infections, fewer sick days, and less antibiotic use — at least if you’re a toddler. A Spanish study enrolled 911 children who attended day care, from newborns up to three-year-olds, and randomly assigned them to one of three groups.

In the control group, parents and caregivers continued usual hand care for the toddlers. In the two intervention groups, children were assigned to either labor-intensive hand sanitizer use or soap and water handwashing. Parents and caregivers were instructed to either apply hand sanitizer or wash the toddlers’ hands when they arrived at the classroom in the morning; before and after lunch; after playing outside; after coughing, sneezing, or blowing their noses; after diapering; and before they left for home. In both groups, handwashing with soap and water was mandatory after using the toilet or when hands were grossly soiled.

Outcomes in the hand sanitizer group were significantly better than either the soap and water group or the control group. The hand sanitizer group had lower rates of respiratory infections and missed fewer days of school, compared to the other two groups. Kids in the hand sanitizer group were also less likely to be prescribed antibiotics for respiratory infections.

The families or day care providers in the hand sanitizer group went through 1,660 liters of hand sanitizer during the eight-month study. Based on this, the researchers estimated that each toddler used hand sanitizer six to eight times daily, on average.

There are reasons to take the results of this study with a grain of salt. A great deal of time and effort went into reinforcing the importance of hand hygiene. Researchers visited the day care centers every two weeks to tell stories and sing songs about germs and cleanliness. This probably led to levels of hand sanitizer use that would be difficult to duplicate in a real-world situation. As well, some, but not all previous studies of hand sanitizer use in preschoolers have shown lower rates of cold and flu infections.

The researchers did not assess how often the kids in the handwashing group actually washed their hands. It is possible that the better outcomes in the hand sanitizer group were related to the greater ease of use of hand sanitizer, compared to handwashing, which usually requires a little more time and effort.
Take-home points

    Hand sanitizer use in toddlers may be associated with lower rates of respiratory infections than handwashing with soap and water alone.
    Hand sanitizer use probably has to be fairly compulsive for users to see significant benefits.
    Hand sanitizer should contain 70% ethyl alcohol to reliably kill bacteria and viruses; some bacteria have shown tolerance to lower amounts of ethyl alcohol.
    Although there is little high-quality evidence on the benefits of hand sanitizer use in the community at large, the use of hand sanitizer, along with handwashing and flu vaccination, is a reasonable measure to reduce the risk of respiratory infections in adults at risk.

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