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Coeliac disease is an autoimmune condition where the small intestine is chronically inflamed, and nutrients from food may not be absorbed properly. This is due to a permanent allergy to gluten in the diet (present in wheat, barley and rye), which activates an abnormal mucosal immune response. Coeliac disease is treated effectively in the majority of patients by sticking to a 100% gluten-free diet indefinitely. Although a gluten-free diet is an effective treatment in most patients, a significant minority develop persistent or recurrent symptoms. Difficulties sticking to such a diet have led to the development of non-dietary therapies, several of which are undergoing trials in human beings.

Coeliac disease is common: in the UK, 1 in 100 people have it, and numbers are rising. It is more common in individuals with a first-degree relative (ie a parent or sibling) with the condition and in people from or with close relatives from Ireland and Finland. Patients with conditions such as type 1 diabetes, microscopic colitis, autoimmune thyroid disease, Down’s syndrome and Turner syndrome are at a higher risk of having coeliac disease.

The diagnosis may be considered in people with iron deficiency anaemia, low folate or vitamin D, chronic fatigue, in pre-menopausal women with osteoporosis, or in those with recurrent abdominal bloating, loose stools, constipation or weight loss. 

In patients with symptoms suggestive of coeliac disease a blood sample may be taken to look for special proteins or antibodies (anti-transglutaminase) that develop in patients with untreated coeliac disease. These are accurate in most cases (about 90%) but the “gold standard” diagnosis requires taking small samples (biopsies) from the small intestine at upper gi endoscopy and looking at these under a microscope to look for the characteristic signs of villous atrophy and an excess of inflammatory cells (lymphocytes). This test may be needed in patients who do respond to a gluten-free diet.

Coeliac disease is not to be confused with non-coeliac gluten sensitivity, which may present with similar symptoms but in the presence of normal blood tests and small intestine, and may improve on a gluten-free diet. Interestingly, a recent study found a subset of individuals with chronic fatigue syndrome may have sensitivity to wheat and related cereals in the absence of coeliac disease and may respond to dietary restrictions. There is still research to be done.

Advice on gluten free diet and what alternative foods can be eaten to maintain a balanced diet is best obtained from a state-registered dietician with experience in coeliac disease. Your GP (or a consultant gastroenterologist) will be able to make a referral for this advice if required.

For more information, please contact Dr Adam Harris.



Following a month of indulgence, many decide to make lifestyle changes in January. Some try dietary restriction (eg ’Veganuary’) or reduce their total caloric intake, while others abstain from alcohol (eg ‘Dry January’) or jumpstart new exercise regimes. There are even some heroes among us making several changes at once. While it is advised that individuals take proper care of themselves year round, it is appreciated that this does not always happen.

Of topical interest therefore is that intermittent fasting proves beneficial for weight loss in both animal and human studies. As humans, we have not evolved to consume three large evenly-spaced meals throughout the day (plus snacks). This is a symptom of modern life and is due to an abundance of resources. Rather, we went for short stretches of time without food. We still needed to perform, to hunt prey and escape predators, but we did so in a fasted state.

Two methods of intermittent fasting in humans provide evidence-based weight loss, specifically the 5:2 regime (fasting 2 days per week), and daily time-restricted feeding (leaving, for example 18 hours between dinner and breakfast the next day, ie a 6-hour eating period). Comparatively, intermittent fasting seems to provide greater health benefits than a simple reduction in daily caloric intake, and might be considered the method of choice for effective weight control, metabolism of energy, and improved health across the lifespan.

Healthcare professionals may not understand how to prescribe intermittent fasting regimes. Patients may also be unwilling to start one. This may be due to several unpleasant short-term effects, such as increased levels of hunger and irritability, and decreased concentration. Ideally, a patient would ease into the plan over a number of months, in order to minimise any unpleasant effects. This allows time for the body to adjust. The following plans can be considered for 5:2 intermittent fasting and daily time-restricted feeding, respectively:

5:2 Intermittent Fasting

    • For month 1: 1000 calories 1 day per week
    • For month 2: 1000 calories 2 days per week
    • For month 3: 750 calories 2 days per week
    • For month 4: 500 calories 2 days per week

Daily Time-Restricted Feeding

    • For month 1: 10 hour feeding period 5 days per week
    • For month 2: 8 hour feeding period 5 days per week
    • For month 3: 6 hour feeding period 5 days per week
    • For month 4: 6 hour feeding period 7 days per week

A new year provides a convenient opportunity for a fresh start, and widespread participation and media coverage provides a sense of camaraderie between friends, family and colleagues. This may increase the odds of success, and if nothing else, at least everyone is miserable together. If you still find yourself feeling unsatisfied with any lifestyle changes you may have made in January, then what about trying ‘Fasting February’?

For more information, please contact Dr Adam Harris.



This is a very common bacterial infection of the stomach lining. It was first discovered by Drs Warren and Marshall (subsequently awarded Nobel prizes for their amazing finding). It is thought to be caught in childhood and is very common in developing countries. In about 10% of infected individuals the bacterium may lead to a significant increase in the amount of acid produced by the stomach and this may lead to a duodenal ulcer or in older people, a stomach ulcer. Curing the infection (called eradication) will heal the ulcer and prevent it recurring.

Most people with H. pylori infection will be unaware of the infection or may develop intermittent indigestion (dyspepsia); the benefit of eradication therapy in such cases is less clear cut.

There is an association between long standing infection with H. pylori and an increase in the risk of developing cancer of the stomach. The latter condition is however getting less and less common in the UK and this is probably related, at least in part, to the decrease in the number of people infected with H pylori.  Large studies in South East Asia and more recently from Sweden, have shown a decrease in stomach cancer after eradication of the infection.

The infection has evolved with humans and some believe that is may confer a health benefit in some people (ie in those where it doesn’t cause an ulcer or stomach cancer). Thus, recent data found a possible protective role against Barrett’s oesophagus, eosinophilic oesophagitis (a chronic inflammatory disease of the oesophagus) and inflammatory bowel disease (a chronic inflammatory disease of the colon).

Patients who see their GP with indigestion (dyspepsia) may be checked (by a blood, stool or breath test) to see if they are infected with H. pylori and if so, offered treatment to cure the infection to see if the dyspepsia improves. This improvement in symptoms is most likely if the dyspepsia was due to a duodenal or stomach ulcer caused by the bacterial infection. Success or failure may be determined either by improvement in symptoms or by performing a special breath test (can be prescribed by your GP and undertaken either at home or in the GP surgery).

Curing (or eradicating) infection with H. pylori is more difficult than treating other infections. It requires treatment with 2 antibiotics (eg metronidazole, amoxicillin or clarithromycin) and an acid-lowering drug (eg omeprazole or lansoprazole) all taken twice or three times daily for 7-10 days. This treatment will work in about 80-90% of cases. In an era of growing antibiotic resistance, there is no evidence-based treatment for H. pylori patients with penicillin allergy and prior exposure to clarithromycin.

For more information about H. pylori and potential treatment options, please do not hesitate to contact Dr. Adam Harris.



In the 19th edition of the Gut Reaction series, I suggested that patients with Laryngo-Pharyngeal Reflux (LPR) may consider an alkaline water & plant-based Mediterranean style diet. As discussed in that blog, a paper published in JAMA Otolaryngology (October 2017) suggested that diet and consumption of alkaline water might be as effective as treatment with a PPI. The main outcome of the study was a change in Reflux Symptom Index (RSI) – the 1st group were treated with PPI and standard anti-reflux precautions (PS) and the 2nd group with alkaline water, a plant-based Mediterranean-style diet and standard anti-reflux precautions (AMS). Results from the study showed that the percentage of patients achieving a clinically meaningful reduction in RSI was 54% in PS-treated patients and 63% in AMS-treated patients.

How alkaline water and dietary change help the symptoms of LPR is unclear but it may change the biodiversity of the gut bacteria (microbiome) in the oro-pharynx, gullet (oesophagus) and stomach.

In this blog, I will provide some further information regarding alkaline water and what the Mediterranean-style diet involves.

First of all, the “alkaline” in alkaline water refers to its pH level. The pH level is a number that measures how acidic or alkaline a substance is on a scale of 0 to 14. Alkaline water has a higher pH level than regular drinking water. Because of this, some advocates of alkaline water believe it can help maintain balance by neutralising the acid in your body. Drinking water generally has a neutral pH of 7 while alkaline water typically has a pH 8-9.

It is relatively straightforward to make your own alkaline water at home. Here is a suggested recipe:

  • Pour a half-gallon of the filtered water (preferable to tap water) into a gallon jug with a lid. If using tap water, a filtration system is recommended.
  • Add one teaspoon each of baking soda, sea salt and coral calcium powder to the container.
  • Wash a lemon and slice it in half. Squeeze the juice into a small bowl.
  • Pour the juice into the water/baking soda/coral calcium mix.
  • Secure the container lid and then shake it vigorously to thoroughly mix all the ingredients.
  • Add the rest of the distilled water to the container, being sure to leave an inch of space at the top of the container for air.
  • Close the container tightly and shake it to mix the water.
  • Use pH strips to test the water to see the level, ideally around level 8 or 9. If that is not the case, add another ¼ teaspoon of baking soda and mix again until the proper pH level is reached.

Equally, many supermarkets stock alkaline water along with other specialty waters in the bottle water aisle. It can also be ordered online from a number of retailers.

Here is some basic information about the plant-based Mediterranean style diet:

  • Eating primarily plant-based foods, such as fruits and vegetables, whole grains, legumes and nuts.
  • Replace butter and other dairy with healthy fats such as olive oil and canola oil.
  • Use herbs and spices instead of salt to flavour foods.
  • Limit red meat to consume no more than a few times a month.
  • Eat fish and poultry at least twice a week.

If you have any questions about alkaline water or a plant-based Mediterranean style diet, please do not hesitate to contact Dr. Harris.



Most people with IBS find that making certain changes in diet and/or lifestyle can help reduce their symptoms. However, there is no single dietary modification that works for everyone, owing to the range of different symptoms experienced by any given individual.

Traditional dietary advice has been to maintain regular meal patterns, avoid large meals, reduce fat intake, avoid excessive insoluble fiber intake & reduce caffeine. More recently a low FODMAP (Fermentable Oligosaccharides Disaccharides Monosaccharides And Polyols) diet has also been shown to help symptoms of IBS. These types of carbohydrates aren’t easily broken down by the gut bacteria and the gases released during this slow process may lead to bloating and discomfort. A low FODMAP diet involves restricting the intake of various foods that are high in FODMAPs, such as some fruits and vegetables, animal milk, wheat products and beans.

However, a recent article in Gastroenterology (2015;149:1295-97) highlighted a study which compared two popular diets (i.e. traditional vs low FODMAP) in people with IBS. The main finding was that both diets were equally effective in improving symptoms. Although there is still a lack of basic science to explain how either diet works, we recommend spending time with an experienced dietician, who can help create the diet and lifestyle plan that works most effectively for you.



Studies conducted in recent years have explored the relationship between the gut microbiota, consisting of around 800 different bacteria species, and metabolism. It has been suggested that specific intestinal microbial compositions can either protect from, or contribute to, obesity and other metabolic diseases.

First, I would like to discuss short-chain fatty acids (SCFA) and the vital role they play in influencing gut health. SCFA are produced by bacteria from fermentation of dietary products, mostly fibre, within the colon. Their primary role is to serve as a source of energy for cells within the colon and to stimulate repair and replacement. Of potential interest, butyrate may influence how energy (including glucose) is metabolised in the body and so hold a possible protective effect against metabolic disease and obesity.

The potential relationship between gut microbiota and obesity was analysed in this excellent 2017 study when faecal microbiota from both lean and obese subjects was transferred into mice, which then changed their feeding behaviour and subsequently their body mass to reflect the human source. The researchers suggested that butyrate positively influences energy balance and thus protects from diet-induced obesity.

Subsequent research has shown a broad variety of possible effects of butyrate on metabolism including an increase in mitochondrial activity, preventing metabolic endotoxemia, improving insulin sensitivity, increasing intestinal barrier function and protecting against diet-induced obesity.

These fascinating findings suggest a relationship between the gut microbiota and human metabolism. Further research is needed in humans to extend the experimental findings in mice and to establish if the gut microbiome may be changed (by prebiotics, probiotics, antibiotics or even faecal transplantation) to help reduce obesity and even, diabetes.

If you have any questions about gut microbiota and its relationship to obesity, please do not hesitate to contact Dr. Harris



Irritable Bowel Syndrome affects up to 20% of the UK population with women at least twice as likely to be affected as men. Common symptoms include bloating, constipation, diarrhoea and abdominal discomfort. While there is no clearly defined cause of IBS, many sufferers find that symptoms are exacerbated by high stress levels, an imbalance between good and bad bacteria in the gut and dietary factors such as wheat and dairy products, which are high in FODMAPS (Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols). To clarify, FODMAPS are a collection of poorly absorbed simple and complex sugars that are found in a variety of fruit and vegetables as well as in milk and wheat.

While many control their IBS with a strict diet, avoiding ingesting foods high in FODMAPS, this blog will examine the positive effects that probiotic supplements, and more specifically Symprove, appear to have on the illness, relieving symptoms by correcting the imbalance in gut bacteria. Probiotics are defined as “live microorganisms, which, when administered in adequate amounts, confer a health benefit on the host.” So, how may a probiotic supplement help to reduce IBS symptoms?

–    Probiotic bacteria may give a boost to the numbers of friendly bacteria in the gut, so less space is available along the gut lining for the colonisation of ‘bad’ microorganisms, which may cause both digestive discomfort and excess gas production.

–    The supplement’s ‘friendly bacteria’ may help to break down the FODMAPS foods that may exacerbate IBS.

–    The healthy bacteria may also play a role in modulating the gut’s nervous system, thus reducing the impact of stress on the gut.

Symprove, available without prescription from the internet and health food shops, is the first probiotic remedy proven in a clinical trial to work. A trial at London’s King’s College found that 57 per cent more patients with moderate-severe IBS achieved remission than those taking placebo (an identical looking and tasting supplement but one which didn’t contain any bacteria) while taking this supplement. Symprove is a water-based treatment that contains four live strains of the ‘friendly bacteria’ lactobacillus – the supplement’s makers claim that it helps to balance the gut and ‘reset’ the digestive system. There are two major advantages to Symprove compared to competitors, many of which contain bacteria that are freeze-dried or transported in food:

–    Symprove’s bacteria is live and ready to work immediately. The various strains work together to address the gut’s imbalance. This differs from freeze-dried products which are inactive when ingested and usually have very low survival rates when subjected to stomach acid. Those that do survive may also pass through the gut before having a chance to re-activate.

–    As it is water-based, Symprove doesn’t trigger digestion when ingested, meaning that it survives the stomach’s hostile environment. Food or dairy-based probiotics (such as yoghurts) usually trigger digestion, resulting in many of the bacteria being killed before it can have any effect.

Symprove is drunk at the start of the day at 1ml per kilogram per day. Symprove’s makers assert that it can take up to three months to notice positive effects – time is required for the friendly bacteria to build momentum to restore and maintain the gut’s balance, thus relieving the IBS sufferer of some of their worst symptoms.

For more information about this treatment option, please do not hesitate to contact Dr. Harris.



What is it?

  • Colonic diverticulosis is the condition whereby diverticula, or pockets, form from the lining of the colon. These protrusions of the colon lining occur at sites of weakness in the muscle wall possibly due to increased pressure from muscle contractions.
  • Diverticulitis is an inflammatory process that causes acute symptoms and may be associated with serious complications.

What may cause it?

  • Potential risk factors include increasing age; diets low in fibre, high in red meat and refined carbohydrates; obesity.
  • There is no evidence that seeds or nuts cause diverticulitis.
  • Changes in the biodiversity of the colonic bacteria

What are the symptoms?

  • Diverticulosis is often asymptomatic and found on investigation by colonoscopy or CT scanning. It may be associated with low abdominal cramping, bloating or constipation.
  • Diverticulitis, due to infection or inflammation of the diverticula, may cause localized lower left sided abdominal pain with either diarrhoea or constipation and fever. Bleeding may occur.

How common is it?

  • Classically, this is a disease process that predominantly affects people over the age of 70 years and is more common in developed countries. It is however getting more common in younger people possibly related to obesity.

What tests are needed to diagnose it?

  • A colonoscopy enables the gastroenterologist to examine the lining of the colon to confirm diverticulosis and to exclude colon cancer or inflammatory bowel disease.
  • An abdominal CT scan is a radiological test used to diagnose diverticulitis and to look for complications.
  • A blood test may be performed to look for any signs of infection or inflammation within the colon.

How do you treat it?

  • Individuals with diverticulosis are advised to eat a healthy and balanced diet, avoid too much red meat and to lose weight if obese. Use of a prebiotic and/or a probiotic may be of benefit but at present this is an evidence-free zone.
  • Mild diverticulitis is usually treated with oral antibiotics. A recent placebo-controlled trial however did not show, in the outpatient setting, that antibiotics were any better than placebo.
  • Patients with complications of acute severe diverticulitis such as an abscess (collection of pus) or perforation (a hole in the colon) require emergency admission to hospital for intravenous antibiotics and sometimes urgent surgery.
  • Long-standing severe diverticulosis or following recurrent attacks of diverticulitis the colon may get narrowed (stricture formation) and surgery may be required to avoid obstruction.

If you have any questions, please do not hesitate to contact Dr. Harris.



At Digestive Health City & Docklands, we work hard to provide our patients with top-class care. You will enjoy friendly, fast and modern treatment by a highly experienced gastroenterologist. We carefully review patient satisfaction and feedback, and at Digestive Health we are continuously making improvements to our services, ensuring the highest level of care possible.

Clinic Locations

City Practice
120 Old Broad Street, City, EC2N 1AR

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1 West Ferry Circus, Canary Wharf, E14 4HA

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0203 875 9989

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