Protect Your Skin from the Summer Sun

This is the time of year for outdoor activities.  I know that I have really been looking forward to the warm summer sun throughout the long New England winter.  Whether it's a backyard cook out, or a day at the lake or beach, the sun is a big part of summer activities.  As good as the sun might feel, it is definitely not kind to your skin.
  

What are the dangers of sun exposure?

• Sunburn - You can actually sustain third degree burns from excessive sun exposure!  This can cause not only severe pain, but other complications similar to any severe burn.  Sunburns actually cause damage to the DNA of your skin.  
• Early aging - Sun exposure makes your skin age faster than normal.  This causes wrinkles, dark spots, as well as changes that make your skin tight or leathery.
• Eye injuries - Ultraviolet rays from the sun can damage the tissue in your eyes.  You can get "sunburn" on the cornea of your eye.  Over time, this can lead to cataracts or macular degeneration, and even lead to blindness in some cases.  You can also develop cancer on the retina of your eye as a result of excessive sun exposure.
• Skin cancer - There are several types of skin cancer.  Melanoma is a severe form of skin cancer that most people think of when they think of skin cancer.  Having 5 or more sunburns during your youth increases your lifetime risk of melanoma by 80%.  There are other forms of skin cancer that are not as severe, but much more common.  Some skin cancers, including melanoma, can spread to other parts of your body, and can even be a cause of death.
• Lowered immune system - When you have sun damage to the skin, especially a sunburn, your immune system has to work to remove the damage and help create new cells.  This has been shown to cause decreased immune function in other parts of your body.

What can you do to protect yourself from the sun? 

• Seek shade - You may still get some UV ray exposure, but it will be significantly less than in direct sun.
• Cover up with clothing - There are now several brands of sun protective clothing for children and adults, which can sometimes block up to 98% of UV rays.  A wide-brimmed hat is particularly helpful to protect your face, ears, and neck.  
• Wear Sunscreen - The American Academy of Dermatology recommends that everyone use sunscreen that offers the following.
  • Broad-spectrum coverage (protects against UVA and UVB rays)
  •  SPF 30 or higher
  •  Water resistant
•  Use extra caution near water, snow, and sand - They can reflect the UV rays, which increase your risk of sunburn.
• Avoid tanning beds - If you want your skin to look tan, try a self-tanning product, and remember to continue to use sunscreen with it.

How much sunscreen should you use?

•  Apply enough sunscreen to cover all exposed skin.  Most people only use about 25-50% of what they should.
•  Don't forget to apply it to the tops of your feet, your neck, your ears, and the top of your head.
• Apply sunscreen to dry skin, 15 minutes before going outdoors.
• To protect your lips, apply a lip balm or lipstick that contains sunscreen (SPF 30 or higher).
• When outdoors, reapply sunscreen approximately every 2 hours, or after swimming or sweating.

For more information about protecting your skin from the sun, check out this link to sunscreen FAQs: https://www.aad.org/media/stats/prevention-and-care/sunscreen-faqs

If you have any questions about skin protection, please log into your account and send us your question. We are here to help.

Dr. Anita Bennett MD - Health Tip Content Editor

Irritable Bowel Syndrome and the Low FODMAP Diet

In the last few years, we have been learning more about certain carbohydrates that can cause gastrointestinal distress.  There have now been reputable studies to show that about 75% of patients with irritable bowel syndrome get significant relief from their symptoms almost immediately after starting a low FODMAP diet.  In case you are thinking “What in the world is a FODMAP?” just keep reading and I think it will all become clear.

What does FODMAP stand for?

• Fermentable
• Oligosaccharides (a few sugars)
• Disaccharides (two sugars)
• Monosaccharides (one sugar)
• And
• Polyols (sugar alcohols)

Now what does that mean?  What are FODMAPS?

FODMAPs are specific types of carbohydrates which are found in certain foods.  Foods that do not contain any carbohydrates, such as meat, poultry, fish, eggs, butter, oils, and hard cheeses, are not a concern at all.  FODMAPs are only found within foods that contain carbohydrates.  A low FODMAP diet is not just a low-carb diet.  These are very specific carbs which are fermentable.

FODMAPs include:

• Fructose – A naturally occurring monosaccharide sugar found in fruit, vegetables, and honey  
• Lactose – A naturally occurring disaccharide found in dairy products
• Fructo-oligosaccarides – Found in wheat, onions, garlic, and other vegetables
• Galacto-oligosaccharides – Found in legumes, including beans, lentils, and soybeans
• Polyols – Sorbitol, mannitol, xylitol, and maltitol –often used as artificial sweeteners, but are also found naturally in some fruits and vegetables

Who should avoid FODMAPs?

People who have irritable bowel syndrome (IBS), a slow moving gut, or some other bowel disorders may not tolerate FODMAPs.  They are not absorbed easily by the bowel.  They draw water into your digestive tract, which contributes to bloating.  They can be fermented by gut bacteria, which produces gas.  For some people the combination of these properties can cause significant GI distress.

Avoiding FODMAPs is not necessary for everyone.  Most people tolerate FODMAPs without a problem.  In fact, some FODMAPs encourage the growth of beneficial bacteria in the gut, and are even sold as “prebiotics”.   Even some people with IBS do not see improvement when avoiding FODMAPs.

How do you start a low FODMAP diet? 

This is not a traditional diet.  It is a learning process, with lots of trial and error along the way until you find out which foods make your symptoms worse, without avoiding the foods that don’t bother you.

Here’s how to start:

• Eliminate any products that list the ingredients fructose, crystalline fructose, honey, or sorbitol.
• Look over the list of foods that contain high amounts of FODMAPs (link below).  If there are any that stand out to you as foods you eat often or foods that you think may be associated with your symptoms, cut them out first.  If you feel a lot better, you may not need to do anything else.
• If not, try cutting out as many FODMAP foods as you can for about 8 weeks.
• After 8 weeks, you can start slowly adding FODMAPs back into your diet, one at a time, preferably with lower FODMAP foods first, although you may want to start with your favorite FODMAPs first.  If you start having symptoms after adding a food back, it needs to stay on the list of foods to avoid.

If you are interested in learning more or trying a low FODMAP diet, try this link for more information, which also contains lists of low FODMAP foods to enjoy and high FODMAP foods to avoid.  

https://livinghappywithibs.com/2013/04/20/about-the-low-fodmap-diet/

If you have any questions about the Low FODMAP diet, please log into your account and send us your question. We are here to help.

Dr. Anita Bennett MD - Health Tip Content Editor

Irritable Bowel Syndrome

Irritable bowel syndrome (IBS) is a common condition that affects the large intestine.  It causes a mix of abdominal symptoms, including pain.  It can sometimes cause significant symptoms, but is not associated with any evidence of underlying damage in the colon.  There are three types of IBS; constipation-predominant (IBS-C), diarrhea-predominant (IBS-D), and mixed type.  Most people with IBS are able to manage this condition with lifestyle changes.  There are also medication treatments available if symptoms cannot be controlled with these changes.

What are the symptoms of IBS?

The symptoms do vary quite a bit between patients, but here are some of the common symptoms:

• Abdominal pain, often crampy
• Bloating or excess gas
• Diarrhea, constipation, or alternating between bouts of each

What causes IBS?

Unfortunately, we really don't know the exact cause of IBS.  There are some things that appear to play a role in the condition.  These include:

• Changes in the bacteria in the gut, often referred to as the microbiome. 
• Changes in the nervous system may cause abnormal signals between the brain and the gut.
• Abnormal muscle contractions in the intestines.  Overactive muscle contractions can lead to diarrhea and cramping.  Underactive contractions can cause constipation.
• Infection.  Some people develop IBS after a severe gastrointestinal infection.

What triggers IBS symptoms?

• Food - There are many foods that can trigger IBS symptoms.  Next week we will talk more about the foods that are typical triggers.
• Stress -Symptoms of IBS are often aggravated or worsened by stress.
• Hormones - Women often find that IBS symptoms are worsened around their menstrual periods.  Women with IBS who take estrogen supplements have more symptoms as well.

How is IBS diagnosed?

There is no test that can definitively diagnose IBS.  If you have gastrointestinal symptoms, your doctor will want to rule out other possible causes of your symptoms, particularly any causes that might be more serious.  Your doctor will start with a good medical history, do a thorough physical exam, and do some tests to rule out other causes.  What tests are done will usually depend on your history and physical exam findings.

How is IBS treated?

• Avoiding foods that trigger symptoms
• Regular exercise
• Drinking plenty of fluids, especially water
• Maintaining a good sleep pattern
• Medications - There are many medications available to treat IBS.  Medication is chosen based on the type of IBS you have, the severity of symptoms, and many other factors.
• Future treatment might include a fecal transplant - Recent research indicates significant improvement in IBS symptoms after fecal microbiome transplants.  More study needs to be done, but this appears very promising.

If you have any questions about irritable bowel syndrome, please log into your account and send us your question. We are here to help.

Dr. Anita Bennett MD - Health Tip Content Editor