welcome to again good shape coming up. cracking the secret of nuts why are they so good for us. tackling warts how to get rid of them quickly and effectively. end up pain in the gut help for irritable bowel syndrome. work to suffer from chronic diarrhea or constipation then you should get a proper diagnosis can get one here in berlin for instance at the hospital and this is why i will meet the head of the clinic for internal medicine professor manacles welcome to check. i.b.s. is not an imaginary or psychological disease but an organic problem. do

you suffer from pain from cram's or constipation or diarrhea you might have i.b.s. or irritable bowel syndrome many people think that i.b.s. is a hypochondriac disease but as a g.p. let me tell you the pain is real. a rumbling. persistent abdominal cramps if the symptoms don't go away and rest and a hot water bottle don't bring relief the diagnosis could be irritable bowel syndrome typical symptoms of i.b.s. our ongoing stomach pain bloating a feeling of incomplete ballad accusation and major discomfort they're typically accompanied by frequent diarrhea sometimes alternating with constipation. human intestinal tract is extremely complex. it's lined with one hundred million

nerve cells and packed with trillions of bacteria they digest food and neutralize pathogens many people with irritable bowel syndrome exhibit changes in their intestinal flora the natural mix of bacteria is disrupted the gut is often thrown out of balance after a stomach bug or a course of antibiotics i.b.s. sufferer's also have intestinal nerves that are very sensitive to change and let the brain know about it. all sufferers share one complaint a severe impairment in quality of life. causes of i.b.s. are often determined via what's called a diagnosis of exclusion that process typically begins with an internal examination a colonoscopy. like crones disease as well as ulcers or cancerous tumors can only two digestive disorders if the colonoscopy doesn't reveal the cause of the discomfort the next step is blood tests to check for inflammations of the liver or

gallbladder patients may also have a gastroscopy to see whether an ulcer in the stomach is responsible for an allergy might be to blame a new technique called common allergen provocation can now help pinpoint perpetrators. we used to only be able to in directly show food related reactions now for the first time we're able to see an immediate reaction in the intestine of a living organism to the food in question record it's. the procedure involves doctors guiding endoscopic probe all the way to do it and then injecting staple foods like soy egg or milk directly onto the intestinal membranes sometimes they lead to rapid inflammation in the area causing the cells in the membrane to burst. in patients where standard tests have failed to

provide answers to the examination offers a novel chance to finally get to the root of their suffering. so how should patients with i.b.s. lead their lives avoiding foods that irritate their intestines is crucial low carb cooking is also a good idea if you are carbohydrates means less sugar and cutting it can help reestablish a healthy balance in intestinal flora bread is not necessarily a no no even if dough does contain possible triggers what are known as five maps these are types of carbs. that aren't broken down properly in the gut resulting in abdominal bloating. allowing the dough to rise for at least four hours helps diminish map levels dramatically the resulting bread will help keep the intestine happy and the eater as well. i'm here with dr americus who is head of the apartment of internal medicine of the

martin luther hospital here in berlin thanks for having me today you not only intern is you're a psychologist as well a psychotherapist and so i think that the guestroom interest i'm tracked is very closely linked to our psyche in the true that's true because the brain get texas. it's the link between the central nervous system and the g.i. tract which is mediated by nerves and by homes and by the system effects of emotions on. a mediated so if we take a look at the irritable bowel syndrome is this is psychological disease you know it's not a psychological disease despite the fact that the psychological effect as strong emotions can induce symptoms to graduations of jeff functions which resemble. the problem of this is in the gut or in the brain that axis it's not a psychological disease ok and then what are the main thing terms the meant in

terms of editor bars and from pain and eye to asians of function this is constipation or diarrhea and sometimes also a distant so those are normal regulatory functions like cancer patients diarrhea but those are great in patients with irritable bowel disease is right the difference between normal subject where sometimes a little bit of discomfort or a trace and of the of the stool of the bone movements is that these patients have a significantly impairment of the quality of life due to the severity and frequency of this and i suspect that one of my patients has. entered my consent of over to you and you check for this yes what we do is we have to see if the so-called wrong criteria for phil that means the patient has more than three months of these kind of symptoms and we have to exclude other possible reasons for the symptoms of

the g.i. diseases or other of the g.i. function so what kind of other diseases can mask and irritable the effects us which can be used in your symptoms similar to be as effective inflammatory bowel disease chew moans infection. psychological diseases as well so if you diagnose and i.b.s. you can treat it so what kind of medications to use well you have to. decide which kind of type of i.b.s. the patient has which is in front of you is that a patient with i.b.s. constipation predominant subtype or is that patient with the diarrhea and depending on this you have to decide which kind of medication you use since the underlying mechanism between the subtypes the different what about diet can you cure or treat

i.b.s. with nutrition well first you have to find out if nutritional effect us are these patients so well how can you do this ideal of these patients. diarrhea for let's say four weeks to see if there's not the see asian between specific food ingredients and the and the symptoms if this is the case they should stay away from these so what about sports and exercise we usually in this programs test that it's very very important to say. yeah well it's it has been shown that sports and physical exercise is beneficial in i.b.s. patients. especially patients of. with and for them and constipation and or to other behavior affect us can be helpful as you said that if you want to diagnose i.b.s. you have to rule out other diseases of the colon like chronic inflammatory disease like crohn's t.c.'s which is

a disease where intestinal tissue can be destroyed. your gun has suffered from chronic disease her entire life. and that means she has to watch what she eats very carefully. any good. but having a good. i'll have a nice meal and have all the things that i shouldn't really eat when i'm having a bad day i'm out of luck during a serious flare up i often can't eat at all that can last for a week or two depending then i end up in the hospital where i get a feeding tube or i'm given nutrients intravenously. when things get bad stephanie suffers from severe stomach ache diarrhea and fatigue but now that she is receiving treatment here at the hospital flare ups occur less frequently scientists still aren't exactly sure what causes crohn's disease since

in effect there are four major factors at work first of all where you come from what country and what you eat then there are genetic factors. we also believe that the composition of bacteria viruses and parasites in your gut plays a major role. in eastern mass but not least there's your immune system it appears the immune system can overreact to the contents of the gut. and there may be some over activity as well particularly of t. lymphocytes and macrophages. thomas blocker is an immunologist who's interested in the complex processes at work in the gut. this kind of basic research could provide new insights into crohn's disease and lead to the development of more targeted therapies. his immune system and almost from the guts immune system is quite complex because it has so many jobs to do so the immune

system in the skin is much simpler placed on for. when the skin is injured bacteria into the wound a well functioning immune system immediately starts to mobilize against the invaders. but in that got the city. nation is far more complex the food we eat is a foreign body so normally you'd expect the immune system to mobilize against it moreover the gut contains some one hundred trillion bacteria and other microorganisms that need it for digestion but normally you'd expect them to trigger an immune response too so how do the guts immune cells know how to respond to invaders whether to attack or tolerate them a certain immune cells called dendritic cells play a key role in this decision making process inside the intestines they have a very important job to do. to dendritic cells in the gut normally suppress the

immune response and generate the opposite response meaning tolerance it's. blocker wanted to find out how dendritic cells behave in a healthy gut and in a diseased one. to do so his team flash rose a piece of intestine in the lab. afterwards very thin slices of the tissue were made. they then examined samples under the microscope to determine where the dendritic cells are located in the intestine. this is the result of the historical analysis you can see the dendritic cells which appear red in this healthy section there near the intestinal lumens and near the contents of the gut in contrast here we have a section of diseased gut which also has undergone histological analysis you can see how the structure has been damaged there's also

a massive infiltration of inflammatory cells which appear here in orange still you can't see any more dendritic cells they're gone into take the diseased got no longer has the cells that suppress the immune response so that leads to inflammation brocker is investigating several different hypotheses as to why the dendritic cells might be vanishing. but many open questions remain stephanie chicken takes medication that suppresses the unwanted immune response they have side effects they can cause joint pain for example but for her the trade off is worth it she hopes that one day researchers will discover drugs that can treat crohn's disease in a more targeted fashion with fewer side effects. dominant payment day we hear our frequent symptoms in patients who are not actually sick so as hakan is saying that it's cruel to see well in patients with crohn's did these diarrhea it's very often associated with blood in the stool or do these patients have seen very

intense. pain and sometimes also other and to dismiss symptoms like fever or weight loss the patient in the report was so sick that she needed to be fed artificially over time so is this very frequent situation where luckily nowadays this is not they were frequent in the crohn's disease so what happens to the patient if the disease is not treated well if that is not treated it progresses the inflammation continues and on the long run this can cause structural damage to the intestines to the colon especially and this will result in for exams to notice or physically so these are severe out of the of the intestines to be honest you cannot cure trolls disease but how can you help whether the. medication that

we can. control the information. especially in the last decades is tremendous progress has been made in the understanding of the mechanism but also in the treatment of the disease and new compounds have been found which are low to really slow down the inflammation and by acting on the immune system or other targets and the problem with crohn's disease that it's relaxing disease is it to avoid all three tips and this is extremely important so after you are successfully treated the acute phase of the disease you have to continue a medication to prevent these kind of really upsets and these medications also have the same target the target is. and information there's a lot of research going on across disease so what about the role of the gut bacteria well they got bacteria of the so-called microbiome play a role in the infantry processes as we know now.

but we are not at the point that we have a medication where we can say if we. change the microbial that. improve the disease so we got to view question from sydney in australia kylie smith's wants to know what she can do personally to influence positively because of the disease in respect of behavioral changes the most important factor is. not to smoke so if you're a smoker you should stop smoking you know this has beneficial effects on the course of the disease thanks so much for answer all the questions today and if you have any questions you like me to ask our experts special to me in email. on an upcoming show we'll be looking at blood twit supplies your body with nutrients and can flag up many diseases will also examine therapies that make use of the patient's own blood are they medically sound send your questions to in good shape that d.w.

dot com just write blood in the subject line we look forward to hearing from you. they are in knowing they are contagious and they're seen by many as a blemish i'm talking about watts and if your immune system is not able to fight towards some patients for the treatment. hypnosis by moonlight applying a banana skin poultice the slimy trail left by a snail even the ancient practice of charming folk medicine has no end of cures for the warts that occasionally pop up on your skin and sometimes they might even work . in the placebo effect is well known in medicine one way or another the immune system is positively stimulated by the patient developing a positive attitude. and if i'm in a good mood now after having been charmed then i've also got my positive placebo

effect. and that's enough in ten to twenty percent of cases. warts are caused by viruses common vectors of infection or public showers or changing rooms they affect people whose skin is compromised in some way and they should be treated quickly because they can spread rapidly. first of all an infected person becomes a vector and in addition warts can cause discomfort many patients say they can't run anymore or that it's painful the skin just isn't functioning properly anymore. there are plenty of remedies out there many from traditional medicine. things like castor oil. aloe vera. tree oil or marigold cream. but just how effective are they. generally speaking what's healed

by themselves around half the time that means of the six to eight weeks fifty percent of all wars will have disappeared because the immune system takes care of them. so if you apply a home remedy such as tea tree oil during this period and the water goes away. you might think it was because of the treatment but in fact that water would probably have gone away anyway. so. that makes it hard to estimate the efficacy of home remedies for wards but pharmacies also offer other over the counter solutions why it's myth turned to them to get rid of warts on his foot they've been plaguing him for five months and causing problems when walking to begin with he tried an acid tincture it's meant to soften up the warts crusty upper layer. of the tincture regularly but didn't get the desired results at all took

such a long time and the word didn't go away. special ward plasters are another recommended option they certainly appear to be effective against the growth at least in the initial stages of treatment. if you have the salicylic acid which is used in many plasters is very helpful for reducing warts. because the compound destroys cells destroying the virus along with. it. warts can also be frozen with liquid nitrogen although icing sprays are available in some pharmacies german to logical centers use far colder substances to freeze the warts some of them down to minus two hundred degrees celsius freezing them didn't help white smith nor did chemical burning in cases like these doctors used to cut the word out now they use lasers to burn it out. there are two methods

with warts one is the c o two laser essentially a pretty crude method the laser cuts the water out and you stick a plaster on the wound it takes a bit of time till it's properly healed and in the meantime you can't go barefoot outside because it can get in but it doesn't mean it's all gone at once. the other possibility. is to use a dial laser which cuts off the water nutrition source. it closes and quarter rises the blood vessels leading to it. both treatments work when dealing with very persistent and deep rooted works like those that sometimes appear on the soles of the feet wired opted for the dyed laser. it has the advantage that performing the procedure doesn't require a local anaesthetic. but it can't be done in just one sitting like the c o two treatment can. today he's come for his fourth di laser session.

it doesn't really hurt that much getting a shot is actually worse that i've already seen an improvement the wart gets smaller from session to session. after one or two more of them white smith swart disappears forever. when you get hungry between you should stay away from chocolate bars and the like get a handful of nuts sense that they will fill you up and they are healthy. this is fifths like worlds he can tell by sniffing a nut shell whether the nut inside is still good he's really got it cracked. this man is also a nut specialist researchers like professor michel have discovered that this type of food can protect us from some serious diseases. not such a positive impact on blood sugar and fat metabolism that reduces the risk of

developing type two diabetes and cardiovascular disease such as high blood pressure we can assume that eating nuts regularly can prolong your life. but what is their secret researchers across the world are busy trying to find out at the university of munich they're conducting a study with walnuts. one of the participants is detail gashed that's for eight weeks he ate a good handful of nuts forty three grams every day. first eight weeks of eating nuts and then as a control eight weeks without nuts but with the same calorie intake. he was given a full medical checkup before and after the not diet he was amazed by the results. and never would have thought that eating walnuts regularly could produce this kind

of result. the apparent impact of the nuts on cholesterol levels was particularly noteworthy the level of bad l.d.l. cholesterol sank by seven percent. this is the truth and this might help explain why patients who eat nuts regularly suffer fewer heart attacks we know that l.d.l. cholesterol plays a very very important role in increasing the risk of heart attack from and on since fifty two on a schmidt. close gashed it's has now become a not found not just because of the cholesterol he's actually lost weight since going on the not diet that's surprising given that nuts are packed with calories. while nets for example are about sixty five percent fat while proteins only make up fifteen percent and it's another puzzle for researchers.

to mean police good ol food of there's growing evidence that eating nuts regularly can help us lose weight but that only applies if you don't eat not in addition to your normal meals but as a replacement for other foods. to anonymous made an inch by the plan on board. the apparent slimming properties of nuts might also have another explanation when we munch on the whole nuts without chewing them completely a lot masses through the gut undigested. that's it for today see you next week and i'm so then let's all try to stay in good shape.

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